Alcoholism

Alcoholism: The Basics

Alcoholism, a disease that makes one’s body dependent on alcohol, is a serious health concern in today’s society.  It is classified by the following four symptoms:

• Craving: the urge or need to drink
• Loss of control: inability to stop drinking once one has started
• Physical dependence: withdrawal symptoms
• Tolerance: a greater amount of alcohol must be consumed to get to the same state of “high” as before

Alcoholics may be unable to control their drinking habits even though these habits can have serious negative impacts on that person’s work, relationships, and health.  Alcoholism is a disease that gets worse with time and can be developed after a month or years of drinking.  It can not be cured, but there are many treatment options available for alcoholics.  These are just some general facts about alcoholism.

 Alcoholism: Genetics

Alcoholism may have strong links to a person’s genetics.  For instance, research has shown that the body’s enzyme that metabolize alcohol may be influenced by genetic factors.  Other research has shown that there are two type of genetic predisposition to alcoholism.  Type I is found mostly in males, that have a tendency to get in trouble, and fights.  Type II can be found in male or females and is triggered by stressful events.  All of these genetic factors do not guarantee that someone will become an alcoholic, they simple increase their risk factors.  Additionally, genetics can affect risk factors for alcoholism as shown by the CSF Family Alcoholism Study which states, “20-25% of sons and brothers of alcoholics become alcoholics” and “5% of daughters and sisters of alcoholics become alcoholics”.  Alcoholics are also six times more likely than nonalcoholics to report a positive family history of alcoholism.  These are the current arguments supporting the idea that genetic factors can influence the risk factors for developing alcoholism.

Alcoholism: Symptoms

The symptoms of alcoholism can vary from person to person.  A few or all of the symptoms of alcoholism listed below may be present in an alcoholic.
Early Stages:

• Activities are planned around drinking
• Sneaking drinks or hiding alcohol usage
• Drinking occurs to relieve stress
• Blackouts, the inability to recall or remember events or parts of time that happened while drinking
• More and more thoughts about alcohol
• More and more alcohol is required to feel drunk

Middle Stages:

• Lack of ability to keep promises
• Refusal to admit a drinking problem
• Drinking more than planned
• Drinking immediately after awakening from sleep
• Personality changes or mood swings
• Attempting to control drinking with mind games (ex. Telling one’s self not to drink prior to noon)

Late Stages:

• Severe withdrawal symptoms, such as delirium tremens

 Alcoholism: Risk Factors

There are many risk factors that can increase the likelihood that someone will become an alcoholic.  Steady drinking over time can increase the chance of physical dependence on alcohol.  Men that drink in excess of 15 drinks a week and women that drink 12 or more drinks a week are at risk for developing dependence.  Drinking is itself is only one of the many risk factors of alcoholism; some of the other risk factors are:
Age – Those who start drinking at an early age (16 or earlier) are at a higher risk of developing alcohol dependence or abuse.
Genetics / Family History – Your genetics / family history may increase or decrease the chance that you become an alcoholic.
Gender – Men are more likely to become alcohol dependent than women are.
Emotional State – Having severe depression or aniexty increases the chance of abusing alcohol; adults that are diagnoised with attention-deficit / hyperactivity disorder (ADHD) also have a greater risk of developing alcoholism.
Alcoholism: Complications
Alcohol depresses the central nervous system; for some people this means that the initial reaction may be stimulation.  As you continue to drink, the effect becomes sedated.  Alcohol lowers a person’s inhibitions and affects emotions, thoughts, and judgment.  Additionally, a heavy drinking binge can even cause a life threatening coma.  Over time, continuous alcohol use can cause fatigue and short term memory loss, as well as, weakness and paralysis of the eye muscle.  Other server effects of alcohol include:

• Liver disorders: Heavy drinking can cause alcoholic hepatitis and inflamation of the liver.  Signs and symptoms can cinlude a loss of appatite, nausea, vomitting, fever, yellowing of the skin (jaundice), abdominal pain, and confusion.  If a person continues to drink for years, hepatitis may lead to cirrhosis, an irreversible and progressive disease that destroys and scars the liver tissue.
• Cardiovascular issues:  Drinking excessively may lead to high blood pressure and damage to the hear (cardiomypathy).  These conditions increase the risk of heart stroke of failure.
• Birth defects: Alcohol use during pregnancy can cause fetal alcohol syndrome.  This condition causes birth defects, such as small head, heart defects, shortening of the eyelids, and an array of other abnormalities.
• Gastrointestinal problems: Alcohol can result in the inflammation of the stomach lining (gastritis) and an interference with the absorption of the B vitamins, especially with folic acid and thiamin.  Furthermore, drinking heavily can damage the pancreas, which is responsible for producing the hormones that regulate metabolism and the enzymes that digest proteins, carbohydrates, and fats.
• Diabetes complications: Alcohol prevents the release of glucose from the liver; this can increase the risk of low blood sugar (hypoglycemia).  If a person already has diabetes, this can be quite dangerous as that person is already taking insulin to lower their blood suagr level.
• Bone loss: Alcohol can interfere with the production of new bone; this can result in the thinning of bones and an increased risk of bone fracture.
• Increased risk of cancer: Continued alcohol abuse has been connected to a higher risk of various cancers, such as cancer of the pharynx, esophagus, larynx, mouth, rectum, colon, breast, and liver.
• Sexual function and menstruation: Alcohol abuse can result in erectile disfunction in men, and it can interrupt menstruation in women.
• Neurological issues: Heavy drinking affects the central nervous system; this can cause the numbing of the hands and / or feet, disorders thinking, and dementia.

Heroin: The Basics

Heroin is a highly addictive drug that is from the opium poppy.  It is a depressant (also known as a “downer”) that influences the pleasure system of the brain and stops the perception of pain.  Heroin is a powder or tarish substance that can range in color from white to dark brown.  Heroin can be used in an array of ways that include injected intravenously or intramuscular, smoked, or snorted.  The short term effects of heroin occur soon after it is abused and then disappear after a few hours.  These effects include a rush of euphoria that comes with a warm flushing of the skin, heavy extremities, and dryness of the mouth.  After this initial burst of euphoria, the abuser goes through a series of alternating states of wakefulness and drowsiness.  Since the central nervous system is depressed, mental functioning is reduced.  Additionally, speech may become slowed or slurred, pupil dilation, droopy eyelids, vomiting, and constipation are common short term effects.  Heroin’s long term effects appear after repeated use; chronic abusers can develop infection of the heart lining and valves, collapsed veins, abscesses, and liver disease.  Pulmonary effects can result in poor health of the abuser due to heroins depressing effects on the respiratory system.  Due to additives in the drug, blogging of blood vessels can also occur.  This causes reduce blood flow and can cause infection or death of small areas of cells in vital organs.  These are the basic facts about heroin, and the effects that are commonly seen in abusers of this drug.

Health Risks: Fisting and other Homosexual Practices

Health Risks: Fisting and other Homosexual Practices

Michelle A. Cretella, MD
American College of Pediatricians

Philip M. Sutton, PhD, LMFT, LP
Editor, Journal of Human Sexuality

In recent weeks, concern has been expressed nationally about workshops (Staver, 2010), often offered in schools, which have taught "fisting" along with a variety of other methods of homosexual sexual gratification to teens and young adults (including those not necessarily identifying as homosexual) between the ages of 14 and 25. Fisting is the sexual practice of inserting a large object or one's fist into the anus of one's sexual partner, in some cases up to one's forearm. Are such workshops a benefit or a threat to teen health? This question is best answered by examination of the practice of fisting itself, and likewise the broader health risks of teaching methods of homosexual gratification to adolescents and young adults.

From a medical standpoint anal intercourse, in contrast to vaginal intercourse, poses serious risk to its participants. The rectum differs from the vagina with respect to suitability for penetration by a penis, limb or inanimate object (Agnew, 1985; Diggs, 2002; Koop, 1990). The vagina is designed to expand, is supported by a network of muscles and produces natural lubricants. It is composed of a mucus membrane with a multi-stratified squamous epithelium that allows it to endure friction without damage. The anus, in contrast, is designed to allow passage of fecal material out of the body. It is composed of small muscles and significantly more delicate tissues. Consequently, anal intercourse often results in anorectal trauma, hemorrhoids and anal fissures. With repeated trauma, friction and stretching, the anal sphincter loses its tone. Chronic leakage of fecal material has been known to develop from penile/anal intercourse alone; for those engaging in fisting this is a more common problem (Agnew, 1985; Diggs, 2002; Wolfe, 2000). In addition, fisting places the recipient at risk for a variety of anorectal traumas.

Since fisting may result in anorectal trauma and exposure to blood, there is risk of acquiring HIV, Hepatitis B and Hepatitis C particularly if the insertive partner has cuts or abrasions on his hands (Sowadsky, 1996). The insertive partner is also exposed to fecal matter. Consequently, fisting has been associated with increased incidence of shigellosis (Aragon, 2007) and Hepatitis A (Sowadsky, 1996), two illnesses transmitted by the fecal-oral route. The greatest medical danger of anal fisting, however, involves the susceptibility to injury of the inner walls of the lower colon. This tissue is very easily torn, but may not be recognized by the individuals involved. Such an injury can lead to an overwhelming infection of the abdominal cavity called peritonitis which may result in death (Diggs, 2002; Wolfe, 2000).

Fisting is unfortunately only one of a number of practices of homosexual gratification taught at workshops such as those sponsored by GLSEN (MassResistance, n.d.; Staver, 2010; Whiteman, 2000). It is important also to review the general health risks of teaching adolescents and young adults that such behaviors are "natural and normal." Clinical experience and scientific research show that regardless of age, homosexual forms of sexual gratification place individuals at significantly greater risk for experiencing a number of physical and psychological health problems - some of which are life-threatening - as compared with individuals who engage in typical heterosexual behaviors.

Medically, men who have sex with men (MSM) are disproportionately at risk for sexually transmitted infections (STI) and HIV (Diggs, 2002). The U.S. Centers for Disease Control and Prevention's Division of HIV/AIDS Prevention estimates that gay and bisexual men (men who have sex with men or MSM) in the United States are 50 times more likely to contract HIV than are heterosexual men (Lansky, 2009). This is largely due to having multiple sexual partners and engaging in risky sexual practices, including a high incidence of anal intercourse within this population (Diggs, 2002).  For example, the estimated HIV risk with a single sexual exposure through receptive anal intercourse (2%) is 20 times greater than for receptive vaginal intercourse (0.1%), (Pinkerton, Martin, Roland, Katz, Coates, & Kahn, 2004).
Semen has immune-suppressant activity that increases the chance of sperm fertilizing a woman's egg during vaginal intercourse.  If released in the rectum, however, semen makes this already vulnerable tissue more prone to both infection and the development of cancer - rectal carcinoma in MSM results from infection with a highly carcinogenic strain of HPV (Diggs, 2002). Of greater concern is that despite knowing the high risk of contracting HIV, many MSM repeatedly indulge in unsafe sex practices such as "bare-backing," i.e, deliberate, "unprotected" anal intercourse (Parsons & Bimbi, 2007; Parsons, Kelly, Bimbi, Muench, & Morgenstern, 2007; van Kesteren, Hospers, & Kok, 2007.) Homosexual women are also at higher risk for STI and other health problems than are heterosexual women (Evans, Scally, Wellard, & Wilson, 2007.)
The negative consequences of homosexual behaviors are not limited to the physical harms noted above. Compared to their heterosexual peers, homosexual high school students and young adults (fourteen to twenty-one years old) in New Zealand, which has a culture highly tolerant of homosexuality, had significantly higher rates of major depression, generalized anxiety disorder, conduct disorder, nicotine dependence, other substance abuse and/or dependence, multiple disorders, suicidal ideation, and suicide attempts (Fergusson, Horwood, & Beautrais, 1999).
In general, compared to heterosexually behaving adolescents and adults, having same-sex sexual partners is associated with substantially greater risk for mood disorders, anxiety disorders, psychological distress, substance use disorders, for suicidal thoughts and suicidal plans, suicide attempts, unstable relationships and lower levels of quality of life (Andersson, Noack, Seierstad, & Weedon-Fekjaer, 2006; Balsam, Beauchaine, Rothblum, & Solomon, 2008; Cochran, Keenan, Schober, & Mays, 2000; Cochran, Sullivan, & Mays, 2003; Cochran, Ackerman, Mays, & Ross, 2004; de Graaf, Sandfort, & ten Have, 2006; Drabble & Trocki, 2005; Gilman, Cochran, Mays, Hughes, Ostrow, & Kessler, 2001; Herrell, Goldberg, True, Ramakrishnan, Lyons, Eisen, & Tsuang, 1999; Jorm, Korten, Rodgers, Jacomb, & Christensen, 2002; King, Semlyen, Tai, Killaspy, Osborn, Popelyuk, & Nazareth, 2008; Mathy, Cochran, Olsen, & Mays, 2009; Russell & Joyner, 2001; Sandfort, de Graff, Bijl, & Schnabel, 2001; Sandfort, de Graaf, & Bijl, 2003; Sandfort, T. G. M., Bakker, Schelievis, & Vanwesenbeeck, 2006.) The findings are consistent both for countries like Denmark, the Netherlands, New Zealand, Norway and Sweden where homosexuality is more socially accepted, and for the U.S. where it is less accepted.
While the seriousness of such health risks may not be minimized, neither may the vulnerability of teenagers and young adults to being taught ways of behaving that put them at significant risk. NIMH scientist Dr. Jay Giedd, M.D. has reported that as humans develop, their brains' "frontal cortex area — which governs judgment, decision-making and impulse control — doesn't fully mature until around age 25" (Voit, 2005). In other words, "the frontal lobes, the very area that helps make teenagers do the right thing, are one of the last areas of the brain to reach a stable grown-up state" (Strauch, 2003, p.16.) As a result, while physically, "the teen years and early 20s represent an incredibly healthy time of life, ....the top 10 bad things that happen to teens involve emotion and behavior." Because "the brain is pretty adept at learning by example," something "that parents" can and do do to influence "their children's brain development" is "modeling." The teenage "brain is pretty adept at learning by example," so parents- and the other adults involved in the lives of teenagers- teach healthy ways of behaving by showing and giving good examples of how to live (Voit, 2005), and unhealthy behaviors by showing or giving poor examples.
Conclusion: An adolescent's desire to prevent or cease experiencing serious medical, psychological, and relational health risks is sufficient reason for him or her to seek and receive competent psychological care to minimize or resolve the desires, behaviors and lifestyles associated with such increased risks. The concerns of parents, family members and friends of persons whose sexual behaviors and/or attractions leave them at risk for such harms are understandable and scientifically and clinically justified. Regardless of venue, the health and well-being of young persons is best served by sex education that is consistent with established clinical experience and scientific research.
Note: NARTH has released a more extensive review of the health risks associated with the behaviors of homosexual gratification in Volume I of the Journal of Human Sexuality (NARTH, 2009; cf. http://www.narth.com/docs/journalsummary.html for a summary or to obtain a complete copy of this document.) The U.S. Department of Health and Human Services Centers for Disease Control and Prevention (CDC) provides updated information on specific health risks related to homosexual behaviors, cf. http://www.cdc.gov/std/hiv/default.htm.

CDC Analysis Provides New Look at Disproportionate Impact of HIV and Syphilis Among U.S. Gay and Bisexual Men

CDC Analysis Provides New Look at Disproportionate Impact of HIV and Syphilis Among U.S. Gay and Bisexual Men

Summary by Philip M. Sutton, Ph.D.

In a March 10, 2010 report from the U.S. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (NCHHSTP, CDC), data presented at the CDC's 2010 National STD Prevention Conference found the following:

• The rate of new HIV diagnoses among men who have sex with men (MSM) is more than 44 times that of other men and more than 40 times that of women.
• The rate of primary and secondary syphilis among MSM is more than 46 times that of other men and more than 71 times that of women.

Factors reportedly contributing to these the higher rates of HIV and syphilis among gay and bisexual men include:

The high prevalence of HIV and other STDs among MSM. Greater risk of HIV transmission through receptive anal sex than via other sexual activities. MSM having limited access to prevention services, or relying on prevention strategies that may be less effective than consistent condom use. Complacency about HIV risk, particularly among young MSM. Difficulty consistently maintaining safe behaviors with every sexual encounter over the course of a lifetime. Lack of awareness of syphilis symptoms and how it can be transmitted (e.g., oral sex). It also was noted that factors such as "homophobia and stigma can prevent MSM from seeking prevention, testing, and treatment services." Kevin Fenton, M.D., director of NCHHSTP, CDC, is quoted: "There is no single or simple solution for reducing HIV and syphilis rates among gay and bisexual men....Solutions for young gay and bisexual men are especially critical, so that HIV does not inadvertently become a rite of passage for each new generation of gay men." It is ironic that none of the factors considered as significant for causing these increased health risks included psychological or other factors which may drive men to have sex with men- either initially or persistently. Also, none of the remedies that were considered as important for reducing the frequency of these health risks included therapies which might help to decrease the "demand" for - i.e., the motivation or felt need to engage in- such dangerous behaviors. To read the entire text of this CDC report, follow this link: http://www.cdc.gov/nchhstp/Newsroom/msmpressrelease.html

Foreign object in the skin

If a foreign object is projecting from your skin:

• Wash your hands and clean the area well with soap and water.
• Use tweezers to remove splinters of wood or fiberglass, small pieces of glass or other foreign objects.

If the object is completely embedded in your skin:

• Wash your hands and clean the area well with soap and water.
• Sterilize a clean, sharp needle by wiping it with rubbing alcohol. If rubbing alcohol isn't available, clean the needle with soap and water.
• Use the needle to break the skin over the object and gently lift the tip of the object out.
• Use tweezers to remove the object. A magnifying glass may help you see the object better.
• Wash and pat dry the area. Follow by applying antibiotic ointment.
• Seek medical help if the particle doesn't come out easily or is close to your eye.

Foreign object in the nose

If a foreign object becomes lodged in your nose:

• Don't probe at the object with a cotton swab or other tool.
• Don't try to inhale the object by forcefully breathing in. Instead, breathe through your mouth until the object is removed.
• Blow out your nose gently to try to free the object, but don't blow hard or repeatedly. If only one nostril is affected, close the opposite nostril by applying gentle pressure and then blow out gently through the affected nostril.
• Gently remove the object if it's visible and you can easily grasp it with tweezers. Don't try to remove an object that isn't visible or easily grasped.
• Call for emergency medical assistance or go to your local emergency room if these methods fail.

Foreign object in the eye

If you get a foreign object in your eye:

• Wash your hands.
• Try to flush the object out of your eye with clean water or saline solution. Use an eyecup or a small, clean drinking glass positioned with its rim resting on the bone at the base of your eye socket.

To help someone else:

1. Wash your hands.
2. Seat the person in a well-lighted area.
3. Gently examine the eye to find the object. Pull the lower lid down and ask the person to look up. Then hold the upper lid while the person looks down.
4. If the object is floating in the tear film on the surface of the eye, try flushing it out with saline solution or clean, lukewarm water.

Caution

• Don't try to remove an object that's embedded in the eyeball.
• Don't rub the eye.
• Don't try to remove a large object that makes closing the eye difficult.

When to call for help
Call 911 or your local emergency number when:

• You can't remove the object.
• The object is embedded in the eyeball.
• The person with the object in the eye is experiencing abnormal vision.
• Pain, redness or the sensation of an object in the eye persists after the object is removed.

Foreign object in the ear

A foreign object in the ear can cause pain and hearing loss. Usually you know if an object is stuck in your ear, but small children may not be aware of it.
If an object becomes lodged in the ear, follow these steps:

• Don't probe the ear with a tool. Don't attempt to remove the foreign object by probing with a cotton swab, matchstick or any other tool. To do so is to risk pushing the object farther into the ear and damaging the fragile structures of the middle ear.
• Remove the object if possible. If the object is clearly visible, pliable and can be grasped easily with tweezers, gently remove it.
• Try using gravity. Tilt the head to the affected side to try to dislodge the object.
• Try using oil for an insect. If the foreign object is an insect, tilt the person's head so that the ear with the offending insect is upward. Try to float the insect out by pouring mineral oil, olive oil or baby oil into the ear. The oil should be warm but not hot. As you pour the oil, you can ease the entry of the oil by straightening the ear canal. Pull the earlobe gently backward and upward for an adult, backward and downward for a child. The insect should suffocate and may float out in the oil bath. Don't use oil to remove any object other than an insect. Do not use this method if there is any suspicion of a perforation in the eardrum — pain, bleeding or discharge from the ear.

If these methods fail or the person continues to experience pain in the ear, reduced hearing or a sensation of something lodged in the ear, seek medical assistance.

Food-borne illness

All foods naturally contain small amounts of bacteria. But poor handling of food, improper cooking or inadequate storage can result in bacteria multiplying in large enough numbers to cause illness. Parasites, viruses, toxins and chemicals also can contaminate food and cause illness.
Signs and symptoms of food poisoning vary with the source of contamination, and whether you're dehydrated or have low blood pressure. Generally they include:

• Diarrhea
• Nausea
• Abdominal pain
• Vomiting (sometimes)
• Dehydration (sometimes)

With significant dehydration, you might feel:

• Lightheaded or faint, especially on standing
• Rapid heartbeat

Whether you become ill after eating contaminated food depends on the organism, the amount of exposure, your age and your health. High-risk groups include:

• Older adults. As you get older, your immune system may not respond as quickly and as effectively to infectious organisms as when you were younger.
• Infants and young children. Their immune systems haven't fully developed.
• People with chronic diseases. Having a chronic condition, such as diabetes or AIDS, or receiving chemotherapy or radiation therapy for cancer reduces your immune response.

If you develop food poisoning:

• Rest and drink plenty of liquids.
• Don't use anti-diarrheal medications because they may slow elimination of bacteria from your system.

Food-borne illness often improves on its own within 48 hours. Call your doctor if you feel ill for longer than two or three days or if blood appears in your stools.
Call 911 or call for emergency medical assistance if:

• You have severe symptoms, such as watery diarrhea that turns very bloody within 24 hours.
• You belong to a high-risk group.
• You suspect botulism poisoning. Botulism is a potentially fatal food poisoning that results from the ingestion of a toxin formed by certain spores in food. Botulism toxin is most often found in home-canned foods, especially green beans and tomatoes. Signs and symptoms of botulism usually begin 12 to 36 hours after eating the contaminated food and may include headache, blurred vision, muscle weakness and eventual paralysis. Some people also have nausea and vomiting, constipation, urinary retention, difficulty breathing, and dry mouth. These signs and symptoms require immediate medical attention.

first aid kits

A well-stocked first-aid kit can help you respond effectively to common injuries and emergencies. Keep at least one first-aid kit in your home and one in your car. Store your kits in easy-to-retrieve locations that are out of the reach of young children. Children old enough to understand the purpose of the kits should know where they are stored.
You can purchase first-aid kits at many drugstores or assemble your own. Contents of a first-aid kit should include:
Basic supplies

• Adhesive tape
• Antibiotic ointment
• Antiseptic solution or towelettes
• Bandages, including a roll of elastic wrap (Ace, Coban, others) and bandage strips (Band-Aid, Curad, others) in assorted sizes
• Instant cold packs
• Cotton balls and cotton-tipped swabs
• Disposable latex or synthetic gloves, at least two pairs
• Duct tape
• Gauze pads and roller gauze in assorted sizes
• Eye goggles
• First-aid manual
• Petroleum jelly or other lubricant
• Plastic bags for the disposal of contaminated materials
• Safety pins in assorted sizes
• Save-A-Tooth storage device containing salt solution and a travel case
• Scissors, tweezers and a needle
• Soap or instant hand sanitizer
• Sterile eyewash, such as a saline solution
• Thermometer
• Triangular bandage
• Turkey baster or other bulb suction device for flushing out wounds

Medications

• Activated charcoal (use only if instructed by your poison control center)
• Aloe vera gel
• Anti-diarrhea medication
• Over-the-counter oral antihistamine (Benadryl, others)
• Aspirin and nonaspirin pain relievers (never give aspirin to children)
• Calamine lotion
• Over-the-counter hydrocortisone cream
• Personal medications that don't need refrigeration
• If prescribed by your doctor, drugs to treat an allergic attack, such as an auto-injector of epinephrine (EpiPen)
• Syringe, medicine cup or spoon

Emergency items

• Cell phone and recharger that uses the accessory plug in your car dash
• Emergency phone numbers, including contact information for your family doctor and pediatrician, local emergency services, emergency road service providers and the regional poison control center
• Medical consent forms for each family member
• Medical history forms for each family member
• Small, waterproof flashlight and extra batteries
• Candles and matches for cold climates
• Sunscreen
• Mylar emergency blanket
• First-aid instruction manual

Give your kit a checkup
Check your first-aid kits regularly, at least every three months, to be sure the flashlight batteries work and to replace supplies that have expired.
In addition, take a first-aid course to prepare for a possible medical emergency. Be sure the course covers cardiopulmonary resuscitation (CPR) and how to use an automatic external defibrillator (AED). Renew your CPR certification at least every two years.
Prepare children for medical emergencies in age-appropriate ways. The American Red Cross offers a number of helpful resources, including classes designed to help children understand and use first-aid techniques.

fever

Fever is a sign of a variety of medical conditions, including infection. Your normal temperature may differ slightly from the average body temperature of 98.6 F (37 C).
For young children and infants, even slightly elevated temperatures may indicate a serious infection. In newborns, either a subnormal temperature or a fever may be a sign of serious illness. For adults, a fever usually isn't dangerous until it reaches 103 F (39.4 C) or higher.
Don't treat fevers below 102 F (38.9 C) with any medications unless your doctor tells you to. If you have a fever of 102 F (38.9 C) or higher, your doctor may suggest taking an over-the-counter medication, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others).
Adults also may use aspirin, but don't give aspirin to children. It may trigger a rare, but potentially fatal, disorder known as Reye's syndrome. Also, don't give ibuprofen to infants younger than 6 months of age.

How to take a temperature
Today most thermometers have digital readouts. Some take the temperature quickly from the ear canal and can be especially useful for young children and older adults. Other thermometers can be used rectally, orally or under the arm.
If you use a digital thermometer, be sure to read the instructions so that you know what the beeps mean and when to read the thermometer. Under normal circumstances, temperatures tend to be highest around 4 p.m. and lowest around 4 a.m.
Because of the potential for mercury exposure or ingestion, glass mercury thermometers have been phased out and are no longer recommended.
Rectally (for infants)
To take your child's temperature rectally:

• Place a dab of petroleum jelly or other lubricant on the bulb.
• Lay your child on his or her stomach.
• Carefully insert the bulb one-half inch to one inch into the rectum.
• Hold the bulb and child still for three minutes. To avoid injury, don't let go of the thermometer while it's inside your child.
• Remove the thermometer and read the temperature as recommended by the manufacturer.

Taking a rectal temperature is also an option for older adults when taking an oral temperature is not possible.
A rectal temperature reading is generally 1 degree Fahrenheit (about 0.5 degree Celsius) higher than an oral reading.
Orally
To take your temperature orally:

• Place the bulb under your tongue
• Close your mouth for the recommended amount of time, usually three minutes

Under the arm (axillary)
Although it's not the most accurate way to take a temperature, you can also use an oral thermometer for an armpit reading:

• Place the thermometer under your arm with your arm down.
• Hold your arms across your chest.
• Wait five minutes or as recommended by your thermometer's manufacturer.
• Remove the thermometer and read the temperature.

To take your child's axillary temperature, have the child sit in your lap, facing to the side. Place the thermometer under your child's near arm, which should be against your chest.
An axillary reading is generally 1 degree Fahrenheit (about 0.5 degree Celsius) lower than an oral reading.
Get medical help for a fever if:

• A baby younger than 3 months has a rectal temperature of 100.4 F (38 C) or higher, even if your baby doesn't have other signs or symptoms
• A baby older than 3 months has a temperature of 102 F (38.9 C) or higher
• A newborn has a lower than normal temperature — less than 97 F (36.1 C) rectally
• A child younger than age 2 has a fever longer than one day, or a child age 2 or older has a fever longer than three days
• An adult has a temperature of more than 103 F (39.4 C) or has had a fever for more than three days

Call your doctor immediately if your child has a fever after being left in a hot car or if a child or adult has any of these signs or symptoms with a fever:

• A severe headache
• Severe swelling of the throat
• Unusual skin rash
• Unusual eye sensitivity to bright light
• A stiff neck and pain when the head is bent forward
• Mental confusion
• Persistent vomiting
• Difficulty breathing or chest pain
• Extreme listlessness or irritability
• Abdominal pain or pain when urinating
• Other unexplained symptoms

Fainting

Fainting occurs when the blood supply to your brain is momentarily inadequate, causing you to lose consciousness. This loss of consciousness is usually brief.
Fainting can have no medical significance, or the cause can be a serious disorder. Therefore, treat loss of consciousness as a medical emergency until the signs and symptoms are relieved and the cause is known. Discuss recurrent fainting spells with your doctor.
If you feel faint:

• Lie down or sit down. To reduce the chance of fainting again, don't get up too quickly.
• Place your head between your knees if you sit down.

If someone else faints:

• Position the person on his or her back. If the person is breathing, restore blood flow to the brain by raising the person's legs above heart level — about 12 inches (30 centimeters) — if possible. Loosen belts, collars or other constrictive clothing. To reduce the chance of fainting again, don't get the person up too quickly. If the person doesn't regain consciousness within one minute, call 911 or your local emergency number.
• Check the person's airway to be sure it's clear. Watch for vomiting.
• Check for signs of circulation (breathing, coughing or movement). If absent, begin CPR. Call 911 or your local emergency number. Continue CPR until help arrives or the person responds and begins to breathe.

If the person was injured in a fall associated with a faint, treat any bumps, bruises or cuts appropriately. Control bleeding with direct pressure.

electrical burn

An electrical burn may appear minor or not show on the skin at all, but the damage can extend deep into the tissues beneath your skin. If a strong electrical current passes through your body, internal damage, such as a heart rhythm disturbance or cardiac arrest, can occur. Sometimes the jolt associated with the electrical burn can cause you to be thrown or to fall, resulting in fractures or other associated injuries.
Call 911 or your local emergency number for assistance if the person who has been burned is in pain, is confused, or is experiencing changes in his or her breathing, heartbeat or consciousness.
While helping someone with an electrical burn and waiting for medical help, follow these steps:

1. Look first. Don't touch. The person may still be in contact with the electrical source. Touching the person may pass the current through you.
2. Turn off the source of electricity if possible. If not, move the source away from both you and the injured person using a dry, nonconducting object made of cardboard, plastic or wood.
3. Check for signs of circulation (breathing, coughing or movement). If absent, begin cardiopulmonary resuscitation (CPR) immediately.
4. Prevent shock. Lay the person down with the head slightly lower than the trunk, if possible, and the legs elevated.
5. Cover the affected areas. If the person is breathing, cover any burned areas with a sterile gauze bandage, if available, or a clean cloth. Don't use a blanket or towel, because loose fibers can stick to the burns.

dislocation

A dislocation is an injury in which the ends of your bones are forced from their normal positions. The cause is usually trauma, such as a blow or fall, but dislocation can be caused by an underlying disease, such as rheumatoid arthritis.
Dislocations are common injuries in contact sports, such as football and hockey, and in sports that may involve falls, such as downhill skiing and volleyball. Dislocations may occur in major joints, such as your shoulder, hip, knee, elbow or ankle or in smaller joints, such as your finger, thumb or toe.
The injury will temporarily deform and immobilize your joint and may result in sudden and severe pain and swelling. A dislocation requires prompt medical attention to return your bones to their proper positions.

If you believe you have dislocated a joint:

1. Don't delay medical care. Get medical help immediately.
2. Don't move the joint. Until you receive help, splint the affected joint into its fixed position. Don't try to move a dislocated joint or force it back into place. This can damage the joint and its surrounding muscles, ligaments, nerves or blood vessels.
3. Put ice on the injured joint. This can help reduce swelling by controlling internal bleeding and the buildup of fluids in and around the injured joint.

Cuts and scrapes

Minor cuts and scrapes usually don't require a trip to the emergency room. Yet proper care is essential to avoid infection or other complications. These guidelines can help you care for simple wounds:

1. Stop the bleeding. Minor cuts and scrapes usually stop bleeding on their own. If they don't, apply gentle pressure with a clean cloth or bandage. Hold the pressure continuously for 20 to 30 minutes and if possible elevate the wound. Don't keep checking to see if the bleeding has stopped because this may damage or dislodge the clot that's forming and cause bleeding to resume. If blood spurts or continues flowing after continuous pressure, seek medical assistance.
2. Clean the wound. Rinse out the wound with clear water. Soap can irritate the wound, so try to keep it out of the actual wound. If dirt or debris remains in the wound after washing, use tweezers cleaned with alcohol to remove the particles. If debris still remains, see your doctor. Thorough cleaning reduces the risk of infection and tetanus. To clean the area around the wound, use soap and a washcloth. There's no need to use hydrogen peroxide, iodine or an iodine-containing cleanser.
3. Apply an antibiotic. After you clean the wound, apply a thin layer of an antibiotic cream or ointment such as Neosporin or Polysporin to help keep the surface moist. The products don't make the wound heal faster, but they can discourage infection and help your body's natural healing process. Certain ingredients in some ointments can cause a mild rash in some people. If a rash appears, stop using the ointment.
4. Cover the wound. Bandages can help keep the wound clean and keep harmful bacteria out. After the wound has healed enough to make infection unlikely, exposure to the air will speed wound healing.
5. Change the dressing. Change the dressing at least daily or whenever it becomes wet or dirty. If you're allergic to the adhesive used in most bandages, switch to adhesive-free dressings or sterile gauze held in place with paper tape, gauze roll or a loosely applied elastic bandage. These supplies generally are available at pharmacies.
6. Get stitches for deep wounds. A wound that is more than 1/4-inch (6 millimeters) deep or is gaping or jagged edged and has fat or muscle protruding usually requires stitches. Adhesive strips or butterfly tape may hold a minor cut together, but if you can't easily close the wound, see your doctor as soon as possible. Proper closure within a few hours reduces the risk of infection.
7. Watch for signs of infection. See your doctor if the wound isn't healing or you notice any redness, increasing pain, drainage, warmth or swelling.
8. Get a tetanus shot. Doctors recommend you get a tetanus shot every 10 years. If your wound is deep or dirty and your last shot was more than five years ago, your doctor may recommend a tetanus shot booster. Get the booster as soon as possible after the injury.Kindle Wireless Reading Device (6" Display, Global Wireless, Latest Generation)

Corneal abrasion (scratch)

The most common types of eye injury involve the cornea — the clear, protective "window" at the front of your eye. Contact with dust, dirt, sand, wood shavings, metal particles or even an edge of a piece of paper can scratch or cut the cornea. Usually the scratch is superficial, and this is called a corneal abrasion. Some corneal abrasions become infected and result in a corneal ulcer, which is a serious problem. Corneal abrasions caused by plant matter (such as a pine needle) can cause a delayed inflammation inside the eye (iritis).
Corneal abrasions can be painful. If your cornea is scratched, you might feel like you have sand in your eye. Tears, blurred vision, increased sensitivity or redness around the eye can suggest a corneal abrasion. You may get a headache.
In case of corneal abrasion, seek prompt medical attention. Other immediate steps you can take for a corneal abrasion are to:

• Rinse your eye with clean water (use a saline solution, if available). You can use an eyecup or small, clean drinking glass positioned with its rim resting on the bone at the base of your eye socket. If your work site has an eye-rinse station, use it. Rinsing the eye may wash out a foreign object.
• Blink several times. This movement may remove small particles of dust or sand.
• Pull the upper eyelid over the lower eyelid. The lashes of your lower eyelid can brush a foreign object from the undersurface of your upper eyelid.

Take caution to avoid certain actions that may aggravate the injury:

• Don't try to remove an object that's embedded in your eyeball. Also avoid trying to remove a large object that makes closing the eye difficult.
• Don't rub your eye after an injury. Touching or pressing on your eye can worsen a corneal abrasion.
• Don't touch your eyeball with cotton swabs, tweezers or other instruments. This can aggravate a corneal abrasion.

Choking

Choking occurs when a foreign object becomes lodged in the throat or windpipe, blocking the flow of air. In adults, a piece of food often is the culprit. Young children often swallow small objects. Because choking cuts off oxygen to the brain, administer first aid as quickly as possible.
The universal sign for choking is hands clutched to the throat. If the person doesn't give the signal, look for these indications:

• Inability to talk
• Difficulty breathing or noisy breathing
• Inability to cough forcefully
• Skin, lips and nails turning blue or dusky
• Loss of consciousness

If choking is occurring, the Red Cross recommends a "five-and-five" approach to delivering first aid:

• First, deliver five back blows between the person's shoulder blades with the heel of your hand.
• Next, perform five abdominal thrusts (also known as the Heimlich maneuver).
• Alternate between five back blows and five abdominal thrusts until the blockage is dislodged.

To perform abdominal thrusts (Heimlich maneuver) on someone else:

• Stand behind the person. Wrap your arms around the waist. Tip the person forward slightly.
• Make a fist with one hand. Position it slightly above the person's navel.
• Grasp the fist with the other hand. Press hard into the abdomen with a quick, upward thrust — as if trying to lift the person up.
• Perform a total of five abdominal thrusts, if needed. If the blockage still isn't dislodged, repeat the five-and-five cycle.

If you're the only rescuer, perform back blows and abdominal thrusts before calling 911 or your local emergency number for help. If another person is available, have that person call for help while you perform first aid.
If the person becomes unconscious, perform standard CPR with chest compressions.
If you're alone and choking, you'll be unable to effectively deliver back blows to yourself. However, you can still perform abdominal thrusts to dislodge the item.
To perform abdominal thrusts (Heimlich maneuver) on yourself:

• Place a fist slightly above your navel.
• Grasp your fist with the other hand and bend over a hard surface — a countertop or chair will do.
• Shove your fist inward and upward.

Clearing the airway of a pregnant woman or obese person:

• Position your hands a little bit higher than with a normal Heimlich maneuver, at the base of the breastbone, just above the joining of the lowest ribs.
• Proceed as with the Heimlich maneuver, pressing hard into the chest, with a quick thrust.
• Repeat until the food or other blockage is dislodged or the person becomes unconscious.

Clearing the airway of an unconscious person:

• Lower the person on his or her back onto the floor.
• Clear the airway. If there's a visible blockage at the back of the throat or high in the throat, reach a finger into the mouth and sweep out the cause of the blockage. Be careful not to push the food or object deeper into the airway, which can happen easily in young children.
• Begin cardiopulmonary resuscitation (CPR) if the object remains lodged and the person doesn't respond after you take the above measures. The chest compressions used in CPR may dislodge the object. Remember to recheck the mouth periodically.

Clearing the airway of a choking infant younger than age 1:

• Assume a seated position and hold the infant facedown on your forearm, which is resting on your thigh.
• Thump the infant gently but firmly five times on the middle of the back using the heel of your hand. The combination of gravity and the back blows should release the blocking object.
• Hold the infant faceup on your forearm with the head lower than the trunk if the above doesn't work. Using two fingers placed at the center of the infant's breastbone, give five quick chest compressions.
• Repeat the back blows and chest thrusts if breathing doesn't resume. Call for emergency medical help.
• Begin infant CPR if one of these techniques opens the airway but the infant doesn't resume breathing.

If the child is older than age 1, give abdominal thrusts only.
To prepare yourself for these situations, learn the Heimlich maneuver and CPR in a certified first-aid training course.

Chest pain

Causes of chest pain can vary from minor problems, such as indigestion or stress, to serious medical emergencies, such as a heart attack or pulmonary embolism. The specific cause of chest pain is often difficult to interpret.
Finding the cause of your chest pain can be challenging, especially if you've never had symptoms in the past. Even doctors may have a difficult time deciding if chest pain is a sign of a heart attack or something less serious, such as indigestion. If you have unexplained chest pain lasting more than a few minutes, you should seek emergency medical assistance rather than trying to diagnose the cause yourself.
As with other sudden, unexplained pains, chest pain may be a signal for you to get medical help. Use the following information to help you determine whether your chest pain is a medical emergency.

Heart attack

A heart attack occurs when an artery that supplies oxygen to your heart muscle becomes blocked. A heart attack may cause chest pain that lasts 15 minutes or longer. But a heart attack can also be silent and produce no signs or symptoms.
Many people who experience a heart attack have warning symptoms hours, days or weeks in advance. The earliest warning sign of an attack may be ongoing episodes of chest pain that start when you're physically active, but are relieved by rest.
Someone having a heart attack may experience any or all of the following:

• Uncomfortable pressure, fullness or squeezing pain in the center of the chest lasting more than a few minutes
• Pain spreading to the shoulders, neck or arms
• Lightheadedness, fainting, sweating, nausea or shortness of breath

If you or someone else may be having a heart attack:

• Call 911 or emergency medical assistance. Don't "tough out" the symptoms of a heart attack for more than five minutes. If you don't have access to emergency medical services, have someone, such as a neighbor or friend, drive you to the nearest hospital. Drive yourself only as a last resort, if there are absolutely no other options. Driving yourself puts you and others at risk if your condition suddenly worsens.
• Chew a regular-strength aspirin. Aspirin reduces blood clotting, which can help blood flow through a narrowed artery that's caused a heart attack. However, don't take aspirin if you are allergic to aspirin, have bleeding problems or take another blood-thinning medication, or if your doctor previously told you not to do so.
• Take nitroglycerin, if prescribed. If you think you're having a heart attack and your doctor has previously prescribed nitroglycerin for you, take it as directed. Don't take anyone else's nitroglycerin.
• Begin CPR on the person having a heart attack, if directed. If the person suspected of having a heart attack is unconscious, a 911 dispatcher or another emergency medical specialist may advise you to begin cardiopulmonary resuscitation (CPR). Even if you're not trained, a dispatcher can instruct you in CPR until help arrives. If help from a 911 dispatcher or emergency medical specialist is unavailable, begin CPR. If you don't know CPR, begin pushing hard and fast on the person's chest — 100 compressions per minute.

Angina

Angina is a type of chest pain or discomfort caused by reduced blood flow to your heart muscle. Angina may be stable or unstable:

• Stable angina — persistent, recurring chest pain that usually occurs with exertion
• Unstable angina — sudden, new chest pain, or a change in the pattern of previously stable angina, that may signal an impending heart attack

Angina is relatively common, but can be hard to distinguish from other types of chest pain, such as the pain or discomfort of indigestion.
Angina signs and symptoms include:

• Chest pain or discomfort
• Pain in your arms, neck, jaw, shoulder or back accompanying chest pain
• Nausea
• Fatigue
• Shortness of breath
• Anxiety
• Sweating
• Dizziness

The severity, duration and type of angina can vary. If you have new or changing chest pain, these new or different symptoms may signal a more dangerous form of angina (unstable angina) or a heart attack. If your angina gets worse or changes, becoming unstable, seek medical attention immediately.

Pulmonary embolism

Pulmonary embolism occurs when a clot — usually from the veins of your leg or pelvis — lodges in an artery of your lung. The lung tissue served by the artery doesn't get enough blood flow, causing tissue death. This makes it more difficult for your lungs to provide oxygen to the rest of your body.
Signs and symptoms of pulmonary embolism include:

• Sudden, sharp chest pain that begins or worsens with a deep breath or a cough, often accompanied by shortness of breath
• Sudden, unexplained shortness of breath, even without pain
• Cough that may produce blood-streaked sputum
• Rapid heartbeat
• Fainting
• Anxiety
• Sweating

Pulmonary embolism can be life-threatening. As with a suspected heart attack, call 911 or emergency medical assistance immediately.

Aortic dissection

An aortic dissection is a serious condition in which a tear develops in the inner layer of the aorta, the large blood vessel branching off the heart. Blood surges through this tear into the middle layer of the aorta, causing the inner and middle layers to separate (dissect). If the blood-filled channel ruptures through the outside aortic wall, aortic dissection is usually fatal.
If you think aortic dissection is the cause of your chest pain, seek emergency medical assistance immediately.

Pneumonia with pleurisy

Frequent signs and symptoms of pneumonia are chest pain accompanied by chills, fever and a cough that may produce bloody or foul-smelling sputum. When pneumonia occurs with an inflammation of the membranes that surround the lung (pleura), you may have considerable chest discomfort when inhaling or coughing. This condition is called pleurisy.
One sign of pleurisy is that the pain is usually relieved temporarily by holding your breath or putting pressure on the painful area of your chest. This isn't true of a heart attack. If you've recently been diagnosed with pneumonia and then start having symptoms of pleurisy, contact your doctor or seek immediate medical attention to determine the cause of your chest pain. Pleurisy alone isn't a medical emergency, but you shouldn't try to make the diagnosis yourself.
Chest wall pain One of the most common varieties of harmless chest pain is chest wall pain. One kind of chest wall pain is costochondritis. It causes pain and tenderness in and around the cartilage that connects your ribs to your breastbone (sternum).
In costochondritis, pressing on a few points along the edge of your sternum often results in considerable tenderness in those small areas. If the pressure of a finger causes similar chest pain, it's unlikely that a serious condition, such as a heart attack, is the cause of your chest pain.
Other causes of chest pain include:

• Strained chest muscles from overuse or excessive coughing
• Chest muscle bruising from minor injury
• Short-term, sudden anxiety with rapid breathing
• Peptic ulcer disease
• Pain from the digestive tract, such as esophageal reflux, peptic ulcer pain or gallbladder pain that may feel similar to heart attack symptoms

Back Pain

If you have back pain or neck pain, you have a lot of company. About 8 in 10 people experience back pain at some point in their lives. Back or neck pain often goes away in time—60% of back pain is gone within a week and 95% within 12 weeks. But if your pain persists for three months or more, it’s considered chronic pain, a tricky-to-treat condition that could be due to injury, overuse, arthritis, or spinal problems.

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chemical splashes into your eye

If a chemical splashes into your eye, take these steps immediately:
Flush your eye with water. Use clean, lukewarm tap water for at least 20 minutes, and use whichever of these approaches is quickest:

• Get into the shower and aim a gentle stream of lukewarm water on your forehead over your affected eye. Or direct the stream on the bridge of your nose if both eyes are affected. Hold your affected eye or eyes open.
• Put your head down and turn it to the side. Then hold your affected eye open under a gently running faucet.
• Young children may do best if they lie down in the bathtub or lean back over a sink while you pour a gentle stream of water on the forehead over the affected eye or on the bridge of the nose for both eyes.

Wash your hands with soap and water. Thoroughly rinse your hands to be sure no chemical or soap is left on them. Your first goal is to get the chemical off the surface of your eye, but then you must remove the chemical from your hands.
Remove contact lenses. If they don't come out during the flush, then take them out.
Caution:

• Don't rub the eye — this may cause further damage.
• Don't put anything except water or contact lens saline rinse in the eye, and don't use eyedrops unless emergency personnel tell you to do so.

Seek emergency medical assistance
After following the above steps, seek emergency care or, if necessary, call 911 or your local emergency number. Take the chemical container or the name of the chemical with you to the emergency department. If readily available, wear sunglasses because your eyes will be sensitive to light.

chemical burns

If a chemical burns the skin, follow these steps:

1. Remove the cause of the burn by first brushing any remaining dry chemical and then rinsing the chemical off the skin surface with cool, gently running water for 20 minutes or more.
2. Remove clothing or jewelry that has been contaminated by the chemical.
3. Wrap the burned area loosely with a dry, sterile dressing or a clean cloth.
4. Rewash the burned area for several more minutes if the person experiences increased burning after the initial washing.
5. Take an over-the-counter pain reliever. These include aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) or acetaminophen (Tylenol, others). Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns.

Get a tetanus shot. All burns are susceptible to tetanus. Doctors recommend you get a tetanus shot every 10 years. If your last shot was more than five years ago, your doctor may recommend a tetanus shot booster.
Minor chemical burns usually heal without further treatment.
Seek emergency medical assistance if:

• The person shows signs of shock, such as fainting, pale complexion or breathing in a notably shallow manner
• The chemical burn penetrated through the first layer of skin, and the resulting second-degree burn covers an area more than 3 inches (7.6 centimeters) in diameter
• The chemical burn occurred on the eye, hands, feet, face, groin or buttocks, or over a major joint
• The person has pain that cannot be controlled with over-the-counter pain relievers

If you're unsure whether a substance is toxic, call the poison control center at 800-222-1222. If you seek emergency assistance, take the chemical container or a complete description of the substance with you for identification.

Burns

To distinguish a minor burn from a serious burn, the first step is to determine the extent of damage to body tissues. The three burn classifications of first-degree burn, second-degree burn and third-degree burn will help you determine emergency care:

First-degree burn
The least serious burns are those in which only the outer layer of skin is burned, but not all the way through. The skin is usually red, with swelling, and pain sometimes is present. Treat a first-degree burn as a minor burn unless it involves substantial portions of the hands, feet, face, groin or buttocks, or a major joint, which requires emergency medical attention.

Second-degree burn
When the first layer of skin has been burned through and the second layer of skin (dermis) also is burned, the injury is called a second-degree burn. Blisters develop and the skin takes on an intensely reddened, splotchy appearance. Second-degree burns produce severe pain and swelling.

If the second-degree burn is no larger than 3 inches (7.6 centimeters) in diameter, treat it as a minor burn. If the burned area is larger or if the burn is on the hands, feet, face, groin or buttocks, or over a major joint, treat it as a major burn and get medical help immediately.

For minor burns, including first-degree burns and second-degree burns limited to an area no larger than 3 inches (7.6 centimeters) in diameter, take the following action:

* Cool the burn. Hold the burned area under cool (not cold) running water for 10 or 15 minutes or until the pain subsides. If this is impractical, immerse the burn in cool water or cool it with cold compresses. Cooling the burn reduces swelling by conducting heat away from the skin. Don't put ice on the burn.
* Cover the burn with a sterile gauze bandage. Don't use fluffy cotton, or other material that may get lint in the wound. Wrap the gauze loosely to avoid putting pressure on burned skin. Bandaging keeps air off the burn, reduces pain and protects blistered skin.
* Take an over-the-counter pain reliever. These include aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) or acetaminophen (Tylenol, others). Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns.

Minor burns usually heal without further treatment. They may heal with pigment changes, meaning the healed area may be a different color from the surrounding skin. Watch for signs of infection, such as increased pain, redness, fever, swelling or oozing. If infection develops, seek medical help. Avoid re-injuring or tanning if the burns are less than a year old — doing so may cause more extensive pigmentation changes. Use sunscreen on the area for at least a year.

Caution

* Don't use ice. Putting ice directly on a burn can cause a burn victim's body to become too cold and cause further damage to the wound.
* Don't apply butter or ointments to the burn. This could cause infection.
* Don't break blisters. Broken blisters are more vulnerable to infection.

Third-degree burn
The most serious burns involve all layers of the skin and cause permanent tissue damage. Fat, muscle and even bone may be affected. Areas may be charred black or appear dry and white. Difficulty inhaling and exhaling, carbon monoxide poisoning, or other toxic effects may occur if smoke inhalation accompanies the burn.

For major burns, call 911 or emergency medical help. Until an emergency unit arrives, follow these steps:

1. Don't remove burned clothing. However, do make sure the victim is no longer in contact with smoldering materials or exposed to smoke or heat.
2. Don't immerse large severe burns in cold water. Doing so could cause a drop in body temperature (hypothermia) and deterioration of blood pressure and circulation (shock).
3. Check for signs of circulation (breathing, coughing or movement). If there is no breathing or other sign of circulation, begin CPR.
4. Elevate the burned body part or parts. Raise above heart level, when possible.
5. Cover the area of the burn. Use a cool, moist, sterile bandage; clean, moist cloth; or moist towels.

Get a tetanus shot. Burns are susceptible to tetanus. Doctors recommend you get a tetanus shot every 10 years. If your last shot was more than five years ago, your doctor may recommend a tetanus shot booster.

Blisters

Common causes of blisters include friction and burns. If the blister isn't too painful, try to keep it intact. Unbroken skin over a blister provides a natural barrier to bacteria and decreases the risk of infection. Cover a small blister with an adhesive bandage, and cover a large one with a porous, plastic-coated gauze pad that absorbs moisture and allows the wound to breathe. If you're allergic to the adhesive used in some tape, use paper tape.

Don't puncture a blister unless it's painful or prevents you from walking or using one of your hands. If you have diabetes or poor circulation, call your doctor before considering the self-care measures below.

To relieve blister-related pain, drain the fluid while leaving the overlying skin intact. Here's how:

• Wash your hands and the blister with soap and warm water.
• Swab the blister with iodine or rubbing alcohol.
• Sterilize a clean, sharp needle by wiping it with rubbing alcohol.
• Use the needle to puncture the blister. Aim for several spots near the blister's edge. Let the fluid drain, but leave the overlying skin in place.
• Apply an antibiotic ointment to the blister and cover with a bandage or gauze pad.
• Cut away all the dead skin after several days, using tweezers and scissors sterilized with rubbing alcohol. Apply more ointment and a bandage.

Call your doctor if you see signs of infection around a blister — pus, redness, increasing pain or warm skin.

To prevent a blister, use gloves, socks, a bandage or similar protective covering over the area being rubbed. Special athletic socks are available that have extra padding in critical areas. You might also try attaching moleskin to the inside of your shoe where it might rub, such as at the heel.

Shoe-shopping tips
Remember the following when you shop for shoes:

• Shop during the middle of the day. Your feet swell throughout the day, so a late-day fitting will probably give you the best fit.
• Wear the same socks you'll wear when walking, or bring them with you to the store.
• Measure your feet. Shoe sizes change throughout adulthood.
• Measure both feet and try on both shoes. If your feet differ in size, buy the larger size.
• Go for flexible, but supportive, shoes with cushioned insoles.
• Leave toe room. Be sure that you can comfortably wiggle your toes.
• Avoid shoes with seams in the toe box, which may irritate bunions or hammertoes.

Black eye

The so-called black eye is caused by bleeding beneath the skin around the eye. Sometimes a black eye indicates a more extensive injury, even a skull fracture, particularly if the area around both eyes is bruised (raccoon eyes) or if there has been a head injury.

Although most black eye injuries aren't serious, sometimes there is an accompanying injury to the eyeball itself sufficient to cause bleeding inside the eye. Bleeding in the front part of the eye, called a hyphema, is serious and can reduce vision and damage the cornea — the clear, protective "window" at the front of the eye. In some cases, abnormally high pressure inside the eyeball (glaucoma) also can result. For this reason, it's advisable to have an eye specialist examine your eyeball if there has been enough of an injury to cause a black eye.

To take care of a black eye:

• Using gentle pressure, apply a cold pack or a cloth filled with ice to the area around the eye. Take care not to press on the eye itself. Apply cold as soon as possible after the injury to reduce swelling, and continue using ice or cold packs for 24 to 48 hours.
• Be sure there's no blood within the white and colored parts of the eye.
• Seek medical care immediately if you experience vision problems (double vision, blurring), severe pain, or bleeding in the eye or from the nose.

Animal bites

If an animal bites you or your child, follow these guidelines:

• For minor wounds. If the bite barely breaks the skin and there is no danger of rabies, treat it as a minor wound. Wash the wound thoroughly with soap and water. Apply an antibiotic cream to prevent infection and cover the bite with a clean bandage.
• For deep wounds. If the animal bite creates a deep puncture of the skin or the skin is badly torn and bleeding, apply pressure with a clean, dry cloth to stop the bleeding and see your doctor.
• For infection. If you notice signs of infection, such as swelling, redness, increased pain or oozing, see your doctor immediately.
• For suspected rabies. If you suspect the bite was caused by an animal that might carry rabies — including any wild or domestic animal of unknown immunization status — see your doctor immediately.

Doctors recommend getting a tetanus shot every 10 years. If your last one was more than five years ago and your wound is deep or dirty, your doctor may recommend a booster. You should have the booster as soon as possible after the injury.

Domestic pets cause most animal bites. Dogs are more likely to bite than cats are. Cat bites, however, are more likely to cause infection. Bites from nonimmunized domestic animals and wild animals carry the risk of rabies. Rabies is more common in raccoons, skunks, bats and foxes than in cats and dogs. Rabbits, squirrels and other rodents rarely carry rabies.

anaphylaxis

A life-threatening allergic reaction (anaphylaxis) can cause shock, a sudden drop in blood pressure and trouble breathing. In people who have an allergy, anaphylaxis can occur minutes after exposure to a specific allergy-causing substance (allergen). In some cases, there may be a delayed reaction or anaphylaxis may occur without an apparent trigger.

If you're with someone having an allergic reaction with signs of anaphylaxis:

1. Immediately call 911 or your local medical emergency number.
2. Ask the person if he or she is carrying an epinephrine autoinjector to treat an allergic attack (for example, EpiPen, Twinject).
3. If the person says he or she needs to use an autoinjector, ask whether you should help inject the medication. This is usually done by pressing the autoinjector against the person's thigh.
4. Have the person lie still on his or her back.
5. Loosen tight clothing and cover the person with a blanket. Don't give the person anything to drink.
6. If there's vomiting or bleeding from the mouth, turn the person on his or her side to prevent choking.
7. If there are no signs of breathing, coughing or movement, begin CPR. Do uninterrupted chest presses of about two a second until paramedics arrive.
8. Get emergency treatment even if symptoms start to improve. After anaphylaxis, it's possible for symptoms to recur. Monitoring in a hospital setting for several hours is usually necessary.

If you're with someone having signs of anaphylaxis, don't wait to see whether symptoms get better. Seek emergency treatment right away. In severe cases, untreated anaphylaxis can lead to death within half an hour. An antihistamine pill, such as diphenhydramine (Benadryl, others), isn't sufficient to treat anaphylaxis. These medications can help relieve allergy symptoms, but work too slowly in a severe reaction to help.

Signs and symptoms of anaphylaxis include:

• Skin reactions including hives, itching, and flushed or pale skin
• Swelling of the face, eyes, lips or throat
• Constriction of the airways, leading to wheezing and trouble breathing
• A weak and rapid pulse
• Nausea, vomiting or diarrhea
• Dizziness, fainting or unconsciousness

Some common anaphylaxis triggers include:

• Medications (especially penicillin)
• Foods such as peanuts, tree nuts, fish and shellfish
• Insect stings from bees, yellow jackets, wasps, hornets and fire ants

If you've had any kind of severe allergic reaction in the past, ask your doctor if you should be prescribed an epinephrine autoinjector to carry with you.

Health risks associated with obesity

Health risks associated with obesity

• Bone and cartilage degeneration (Osteoarthritis)
  Obesity is an important risk factor for osteoarthritis in most joints, especially at the knee joint (the most important site for osteoarthritis). Obesity confers a nine times increased risk in knee joint osteoarthritis in women. Osteoarthritis risk is also linked to obesity for other joints. A recent study indicated that obesity is a strong determinant of thumb base osteoarthritis in both sexes. Data suggest that metabolic and mechanical factors mediate the effects of obesity on joints (University of Bristol).
• Coronary heart disease
  Obesity carries a penalty of an associated adverse cardiovascular risk profile. Largely as a consequence of this, it is associated with an excess occurrence of cardiovascular disease morbidity and mortality. (Department of Preventive Medicine, University of Tennessee)
• Gallbladder disease
  Being overweight is a significant risk factor for gallstones. In such cases, the liver over-produces cholesterol, which is then delivered into the bile causing it to become supersaturated. Some evidence suggests that specific dietary factors (saturated fats and refined sugars) are the primary culprit in these cases (University of Maryland Medical Center)
• High blood pressure (Hypertension)
  There are multiple reasons why obesity causes hypertension, but it seems that excess adipose (fat) tissue secretes substances that are acted on by the kidneys, resulting in hypertension. Moreover, with obesity there are generally higher amounts of insulin produced. Excess insulin elevates blood pressure. (Weight.com)
• High total cholesterol, high levels of triglycerides (Dyslipidemia)
  The primary dyslipidemia related to obesity is characterized by increased triglycerides, decreased HDL levels, and abnormal LDL composition. (Howard BV, Ruotolo G, Robbins DC.)
• Respiratory problems
  Obesity can also cause respiratory problems. Breathing is difficult as the lungs are decreased in size and the chest wall becomes very heavy and difficult to lift. (Medical College of Wisconsin)
• Several cancers
  In 2002, approximately 41,000 new cases of cancer in the USA were thought to be due to obesity. In other words, about 3.2% of all new cancers are linked to obesity (Polednak AP. Trends in incidence rates for obesity-associated cancers in the U.S. Cancer Detection and Prevention 2003; 27(6):415-421)
• Sleep apnea
  Obesity has been found to be linked to sleep apnea. Also, weight reduction has been associated with comparable reductions in the severity of sleep apnea. (NHLBI)
• Stroke
  Rising obesity rates have been linked to more strokes among women aged 35 to 54. (Medical News Today - "Stroke Increase And Obesity Linked Among Middle-Aged Women")
• Type 2 diabetes
  One of the strongest risk factors for type 2 diabetes is obesity, and this is also one of the most modifiable as it can be partially controlled through diet and exercise. (Medical News Today - "Researchers Verify Link Between Type 2 Diabetes And Diet" )

Treatments for obesity (source: The Mayo Clinic)

Obesity treatments have two objectives:

1. To achieve a healthy weight.
2. To maintain that healthy weight.

People who are obese are often discouraged because they think they have to lose a lot of weight before any benefits are experienced. This is not true. Any obese person who loses just five to ten per cent of their body weight will have significant improvement in health - this would mean between 12-25 pounds for an obese person who weighs 250 pounds.

It is important for patients to realize that a small drop in weight is a good start and a great achievement. Experts have found that obese people who lose weight slowly and constantly, say one or two pounds each week, are more successful in keeping their weight down when they have reached their target weight.

According to the Mayo Clinic, successful and permanent weight loss is best achieved as a result of increased physical activity, changing how and when you eat, and modifying your behavior. Some patients may be prescribed medication, while others might undergo weight-loss surgery.

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Dietary changes

The Mayo Clinic advises obese people to reduce their total daily calorie intake and to consume more fruits, vegetables and whole grains. It is important that your diet is varied - you still need to feed yourself, and should continue to enjoy the tastes of different foods. The consumption of sugar, certain refined carbohydrates and some fats should be reduced significantly.

Ideally, you should work with your doctor, a dietician, and/or a well-known weight-loss program.

Trying to lose weight quickly by crash-dieting carries the following risks:

• You may develop health problems
• You will probably experience vitamin deficiencies
• You chances of failure are significantly higher

People who are seriously obese may be prescribed a very low calorie liquid diet. These must be done with a health care professional.

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Physical activity

The more you move your body the more calories you burn. To lose a kilogram of fat you need to burn 8,000 calories (1 pound of fat = 3,500 calories). Walking briskly is a good way to start increasing your physical activity if you are obese. Combining increased physical activity with a good diet will significantly increase your chances of losing weight successfully and permanently!

Try to find activities which you can fit into your daily routine. Anything that becomes part of your daily life, weaved into your existing lifestyle, is more likely to become a long-term habit. If you use an elevator, try getting off one or two floors before your destination and walking the rest. You could try the same when driving your car or taking any form of public transport - get off earlier and walk that bit more.

If any of your regular shops are within walking distance, try leaving your car at home. Several surveys indicated that the majority of urban car trips outside the rush hours are less than a mile long - we can all walk a mile, and should!

If you are very obese, are unfit, or have some health problems, make sure you check with a health care professional before increasing your physical activity.

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Prescription medications for losing weight

Prescription medications should really only be considered as a last resort. If the patient finds it extremely hard to shed the pounds, or if his obesity has reached such a point as to significantly undermine his health, then prescription drugs may become an option.

According to the Mayo Clinic prescription medications should only be considered if:

• Other strategies to lose weight have failed
• The patient's BMI is over 27 and he also has diabetes, hypertension, or sleep apnea.
• The patient's BMI is over 30

There are two approved drugs a physician may consider, Sibutramine (Meridia in USA/Canada, Reductil in Europe and much of the world) or Orlistat (Xenical). Bear in mind that as soon as you stop taking these drugs the overweight problem generally comes back - they have to be taken indefinitely. Some patients may not respond to these drugs, while others may find their beneficial effects may lessen somewhat after a few months.

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Weight loss surgery (bariatric surgery)

Weight loss surgery (WLS) is also known as Bariatric Surgery. It comes from the Greek work baros, which means weight.

WLS is a development of cancer/ulcer operations that consisted of removing part of a patient's stomach or small intestine. Those cancer/ulcer patients subsequently lost weight after surgery. Doctors decided the procedure might be beneficial for morbidly obese patients.

In 2008 about 220,000 bariatric operations were carried out in the USA (American Society for Bariatric Surgery). As obesity levels in America and many other parts of the world grow, so does the number of bariatric procedures. About 15 million people in the U.S. have morbid obesity; only 1% of the clinically eligible population is being treated for morbid obesity through bariatric surgery. According to the American Society for Bariatric Surgery, the average female surgery patient weighs about 300 pounds.

The American Society for Bariatric and Metabolic Surgery says that Bariatric surgery can improve or resolve more than 30 obesity-related conditions, including type 2 diabetes, heart disease, sleep apnea, hypertension and high cholesterol .

Basically, bariatric surgery alters your stomach or small intestine so that you are unable to consume much food in one sitting. This reduces the total number of calories you consume each day, thus helping to lose weight.

There are two types of bariatric surgeries:

• Restrictive procedures - These make your stomach smaller. The surgeon may use a gastric band, staples, or both. After the operation the patient cannot consume more than about one cup of food during each sitting, significantly reducing his food intake. Over time, some patients' stomachs may stretch and they are gradually able to consumer larger quantities.
• Malabsorptive procedures - Parts of the digestive system, especially the first part of the small intestine (duodenum) or the mid-section (jejunum), are bypassed. Doctors may also reduce the size of the stomach. This procedure is generally more effective than restrictive procedures. However, the patient has a higher risk of experiencing vitamin/mineral deficiencies because overall absorption is reduced.

Obesity

What is Obesity?

An obese person has accumulated so much body fat that it might have a negative effect on their health। If a person's bodyweight is at least 20% higher than it should be, he or she is considered obese। If your Body Mass Index (BMI) is between 25 and 29.9 you are considered overweight. If your BMI is 30 or over you are considered obese.

What is Body Mass Index (BMI)?

The BMI is a statistical measurement derived from your height and weight। Although it is considered to be a useful way to estimate healthy body weight, it does not measure the percentage of body fat. The BMI measurement can sometimes be misleading - a muscleman may have a high BMI but have much less fat than an unfit person whose BMI is lower. However, in general, the BMI measurement can be a useful indicator for the 'average person'.

Why do people become obese?

People become obese for several reasons, including:

1. Consuming too many calories.
   People are eating much more than they used to. This used to be the case just in developed nations - however, the trend has spread worldwide. Despite billions of dollars being spent on public awareness campaigns that attempt to encourage people to eat healthily, the majority of us continue to overeat. In 1980 14% of the adult population of the USA was obese; by 2000 the figure reached 31% (The Obesity Society).
   
   In the USA, the consumption of calories increased from 1,542 per day for women in 1971 to 1,877 per day in 2004. The figures for men were 2,450 in 1971 and 2,618 in 2004. Most people would expect this increase in calories to consist of fat - not so! Most of the increased food consumption has consisted of carbohydrates (sugars). Increased consumption of sweetened drinks has contributed significantly to the raised carbohydrate intake of most young American adults over the last three decades. The consumption of fast-foods has tripled over the same period.
   
   Various other factors also may have contributed to America's increased calorie and carbohydrate intake:
   
   
   • In 1984 the Reagan administration freed up advertising on sweets and fast foods for children - regulations had previously set limits.
   • Agricultural policies in most of the developed world have led to much cheaper foods.
   • The US Farm Bill meant that the source of processed foods came from subsidized wheat, corn and rice. Corn, wheat and rice became much cheaper than fruit and vegetables.


2. Leading a sedentary lifestyle.
   With the arrival of televisions, computers, video games, remote controls, washing machines, dish washers and other modern convenience devices, the majority of people are leading a much more sedentary lifestyle compared to their parents and grandparents. Some decades ago shopping consisted of walking down the road to the high street where one could find the grocers, bakers, banks, etc. As large out-of-town supermarkets and shopping malls started to appear, people moved from using their feet to driving their cars to get their provisions. In some countries, such as the USA, dependence on the car has become so strong that many people will drive even if their destination is only half-a-mile away.
   
   The less you move around the fewer calories you burn. However, this is not only a question of calories. Physical activity has an effect on how your hormones work, and hormones have an effect on how your body deals with food. Several studies have shown that physical activity has a beneficial effect on your insulin levels - keeping them stable. Unstable insulin levels are closely associated with weight gain.


3. Not sleeping enough.
   If you do not sleep enough your risk of becoming obese doubles, according to research carried out at Warwick Medical School at the University of Warwick. The risk applies to both adults and children. Professor Francesco Cappuccio and team reviewed evidence in over 28,000 children and 15,000 adults. Their evidence clearly showed that sleep deprivation significantly increased obesity risk in both groups.
   
   Professor Cappuccio said, "The 'epidemic' of obesity is paralleled by a 'silent epidemic' of reduced sleep duration with short sleep duration linked to increased risk of obesity both in adults and in children. These trends are detectable in adults as well as in children as young as 5 years."
   Professor Cappuccio explains that sleep deprivation may lead to obesity through increased appetite as a result of hormonal changes. If you do not sleep enough you produce Ghrelin, a hormone that stimulates appetite. Lack of sleep also results in your body producing less Leptin, a hormone that suppresses appetite.


4. Endocrine disruptors, such as some foods that interfere with lipid metabolism.
   A team from the University of Barcelona (UB) led by Dr Juan Carlos Laguna published a study in the journal Hepatology that provides clues to the molecular mechanism through which fructose (a type of sugar) in beverages may alter lipid energy metabolism and cause fatty liver and metabolic syndrome.
   
   Fructose is mainly metabolized in the liver, the target organ of the metabolic alterations caused by the consumption of this sugar. In this study, rats receiving fructose-containing beverages presented a pathology similar to metabolic syndrome, which in the short term causes lipid accumulation (hypertriglyceridemia) and fatty liver, and eventually leads to hypertension, resistance to insulin, diabetes and obesity.
   
   Poorly balanced diets and the lack of physical exercise are key factors in the increase of obesity and other metabolic diseases in modern societies. In epidemiological studies in humans, the effect of the intake of fructose-sweetened beverages also seems to be more intense in women. (From - "New Data On Fructose-Sweetened Beverages And Hepatic Metabolism").
   
   Although there appears to be a consensus on the negative effects of fructose-sweetened beverages there is still some debate over the effects of fructose versus high fructose corn syrup - two studies of note are:
   "AMA Finds High Fructose Syrup Unlikely To Be More Harmful To Health Than Other Caloric Sweeteners" and "Fructose Sweetened Drinks Increase Nonfasting Triglycerides In Obese Adults".


5. Lower rates of smoking (smoking suppresses appetite).
   According to the National Institutes of Health (NIH) "Not everyone gains weight when they stop smoking. Among people who do, the average weight gain is between 6 and 8 pounds. Roughly 10 percent of people who stop smoking gain a large amount of weight - 30 pounds or more."


6. Medications that make patients put on weight.
   According to an article in Annals of Pharmacotherapy, some medications cause weight gain. "Clinically significant weight gain is associated with some commonly prescribed medicines. There is wide interindividual variation in response and variation of the degree of weight gain within drug classes. Where possible, alternative therapy should be selected, especially for individuals predisposed to overweight and obesity." (The Annals of Pharmacotherapy: Vol. 39, No. 12, pp. 2046-2054. DOI 10.1345/aph.1G33)

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