First aid; Effect of extreme cold

The body reacts to cold by shutting down blood vessles in the skin to stop "core heat" escaping. When deprived of warm blood, extremities such as finger or toes may freeze in severe conditions, causing frostbite. If the body's core temperature becomes dangerously low, bodily functions slow down (hypothermia) and may cease altogether.

Frosbite
This condition usually occurs in freezing and often dry and windy conditions. Those who cannot move are particularly vulnerable. The tissues of the extremities freeze-in severe cases this can lead to permanent loss of sensation and, eventually, gangrene.
Frostbite is often accompanied by hypothermia, which should be treated accordingly.
Recognition
There may be:
> At first, "pins and needles".
> A hardening and stiffening of the skin.
> A colour change to the skin of the affected area: first white; then mottled and blue; and eventually black;on recovery,red,hot,painful, and blistered.

Treatment
your aims are:
> To warm the affected area slowly, to prevent further tissue damage.
> To obtain medical aid if necessary.

1. Very gently remove gloves, rings, and any other constructions, such as boots. Warm the affected part with your hands, in your lap, or in the casualty's armpit. Avoid rubbing because it can damage skin and tissues.

2. Move the casualty into warmth before you thaw the affected part; carry her if possible when the feet are affected.
3. Place the affected part in warm water. Dry carefully, and apply a light dressing of fluffed-up, dry gauze bandage.
4. Raise and support the limb to reduce swelling. An adult casualty may take two paracetamol tablets for intense pain. Take or send her to hospital, if necesarry.

Leptin: The Weight-Loss Hormone

Despite day-to-day variations in food intake and physical activity, a healthy individual maintains a constant body weight and energy reserves of fat over long periods. Clearly, long-term negative feedback mechanisms are at work, but until recently scientists did not understand them. With the discovery of the hormone Leptin ( from the Greek word leptos, meaning thin), researchers have been able to piece together one long adypocytes, the cells in adipose tissue. Fat storage that occurs when food intake exceeds the body's demands stimulates adipocytes to release more leptin into the bloodstream. Centers in the hypotalamus respond to the increased leptin by decreasing food intake and increasing food intake and increasing energy expenditure, which result in weight loss. If this feedback mechanism is disrupted, obesity wil result. For example, mice with a genetic mutation that prevents them from making leptin are obese. Injecting the mice with leptin causes them to lose weight.
After discovering leptin and demonstrating that it could reverse obesity in genetically obese mice, researchers hoped that leptin cold be used to treat obesity in humans. It is now known that unlike genetically obese mice, the vast majority of obese humans are able to make leptib. Human obesity appears to be caused by an inability of the hypotalamus to respond to leptin, rather than our inability to make the hormone.

WHAT IS FIRST AID?

First aid is the immediate assistance or treatment given to someone injured or suddenly taken ill before the arrival of an ambulance, doctor or other appropriately qualified person. The person offering this help to a casualty must act calmly and with confidence, and above all must be willing to offer assistance whenever the need arises.

Being a First Aider

Most people can, by following the guidance given, give useful and effective first aid. However, first aid is a skill based on knowledge, training, and experience. The term “first Aider” is usually applied to someone who has completed a theoretical and practical instruction course, and passed a professionally supervised examination.

AIMS OF FIRST AID
 >To preserve life
 >To limit worsening of the condition
 >To promote recovery

THE FIRST AIDER IS:
 >Highly trained
 >Examined and regularly re-examined
 >Up-to-date in knowledge and skill

BEING A FIRST AIDER

The first aider learned from a manual or course is not quite like reality. Most of us feel apprehensive when dealing with “the real thing”. By facing up to cope with the unexpected.

Doing your part
First aid is not an exact science, and is thus open to human error. Even with appropriate treatment, and however hard you try, a casualty may not respond as hoped. Some conditions inevitably lead to death, even with the best medical care. If you do your best, your conscience can be clear.

Assessing risks
The golden rule is, “ First do no harm”, while applying the principle of “calculated risk”. You should use the treatment that is most likely to be of benefit to a casualty, but do not use a doubtful treatment just for the sake of doing something.

The “Good Samaritan”
This principle supports those acting in an emergency (but not those who go beyond accepted boundaries). If you keep calm, and you follow the guidelines ,you need not fear any legal consequences.
PROTECTING THE CASUALTY
To avoid cross-infection when giving first aid, if possible you should:
 >Avoid direct contact with body fluids where possible
 >Wash your hands
 >Wear protective gloves.
If gloves are unavailable, life-saving treatment must still be given.

YOUR RESPONSIBILITIES AS A FIRST AIDER
 >To assess a situation quickly and safely, and summon appropriate help.
 >To protect casualties and others at the scene from possible danger.
 >To identify, as far as possible, the injury or nature of the illness affecting a casualty.
 >To give each e early and appropriate treatment, treating the most serious condition first.
 >To arrange for the casualty’s removal to hospital, into the care of a doctor, or to his or her home.
 >To remain with a casualty until appropriate care us available.
 >To report your observations to those taking over care of the casualty, and to give further assistance if required.
 >To prevent cross-infection between yourself and the casualty as much as possible.

GIVING CARE WITH CONFIDENCE

Every casualty needs to feel secure and in safe hands. You can create an air of confidence and assurance by:
 being in control, both of yourself and the problem;
 acting calmly and logically;
 being gentle, but firm, with your hands, and speaking to the casualty kindly, but purposefully.

Building up trust
Talk to the casualty throughout your examination and treatment.
 >Explain what you are going to do.
 >Try to answer questions honestly to allay fears as best you can. If you do not know the answer, say so.
 >Continue to reassure the casualty even when your treatment is complete-find out about the next-of-kin, or anyone else who should be contacted about the incident. Ask if you can help to make arrangements so that any responsibilities the casualty may have, such as collecting a child from school, can be taken care of.
 >Do not leave someone whom you believe to be dying. Continue to talk to the casualty, and hold his or her hand, never let the person feel alone.

Talking to relatives
The task of informing relatives of a death is usually the job of the police or the doctor on duty. However, it may well be that you have to tell relatives or friends that someone has been taken ill, or has been involved in an accident.
Always check that you are speaking to the right person first. Then explain, as simply and honestly as you can, what has happened, and, if appropriate, where the casualty has been taken. Do not be vague or exaggerate; you may cause undue alarm, it is better to admit ignorance than to give misleading information.

Coping with children
Young children are extremely perceptive and will quickly detect any uncertainly on your part. Gain an injured or sick child’s confidence by talking first to someone he or she trust-a parent accepts you and believes you will help, this confidence will be conveyed to the child.
Always explain simply to a child what is happening and what you intend to do;
Do not talk over his or her head. You should not separate a child from his or her mother, father or other trusted person.

LOOING AFTER YOURSELF
It is important not to jeopardize your personal safety. Do not attempt heroic rescues in hazardous circumstances.

Coping with unpleasantness
The practice of first aid can be messy, smelly, and distasteful, and you may feel that you will not be able to cope with this. Such fears are common but usually groundless. First-aid training will bolster your self-reliance and confidence and will help you to control your emotions in a difficult situation.

Taking stock after an emergency
Assisting at an emergency is a stressful event, and you may suffer a delayed reaction some time afterwards. You may feel satisfaction r even elation, but it is common to be upset, particularly if the casualty was a stranger and you might not know the outcome of your efforts.

PROTECTING YOUR SELF AGAINST INFECTION

You may worry about picking up infections from casualties. Often, simply measures such as washing your hands and wearing gloves will protect both you and the casualty from cross-infection.
However, there is a risk that blood-borne viruses, such as hepatitis B or C and HIV (which can lead to AIDS-Acquired Immune Deficiency Syndrome), may be spread by blood-to-blood contact.
These viruses can be transmitted only if an infected person’s blood makes contact with a break in the skin, such as a cut or abrasion containing blood or blood products, of another person. No evidence exists of hepatitis or HIV being passed on during mouth-to-mouth resuscitation.
To prevent cross-infection, you should:
 always carry protective gloves;
 cover your own sores or skin wounds with a waterproof plaster;
 wear a plastic apron when dealing with large quantities of a casualty’s body fluids and wear plastic glasses to protect your eyes against splashes;
 take care not to prick yourself with any needle found on or near the casualty, or to cut yourself on glass;
 if your eyes, nose or mouth or any wound on your skin is splashed by the casualty’s blood, wash thoroughly with soap and water as soon as possible, and consult a doctor;
 use a mask or face shield for mouth to mouth ventilation if the casualty’s mouth or nose is bleeding;
 dispose of blood and waste safely after treating the casualty

Seeking immunization
First Aiders should seek medical advice on hepatitis B immunization from their own doctors. If, after giving first aid, you are concerned that you have been in contact with infection of any sort, seek further medical advice.

Thick and Thin Skin: Getting a Grip on Their Differences

The skin is the largest organ in the body, weighing about 4 kg. Though it appears uniform in structure and function. Its thickness in fact varies, from less than 1 mm covering the eyelids to more than 5 mm on the upper back. Many of the functional differences between skin regions reflect the thickness of the epidermis and not the skin's overall thickness. Based on epidermal thickness, skin can be categoraized as thick (about 1 mm deep) or thin (about 0.1 mm deep).
Areas of the body exposed to significant wear and tear (the palms, fingertios, and bottoms of the feet and toes) are covered with thick skin. It is composed of a thick stratum corneum and an extra layer not found in thin skin, the stratum lucidum, both of which make thick skin resistant to abration. Thick skin is also characterized by epidermal ridges (e.g, fingerprints) and numerous sweat glands, but lacks hair and sebaceous (oil) glands. These adaptations make the thick skin covering the hand and feet effective for grasping or gripping. Thick skin's dermis also contains many sencory receptors, giving the hands and feet a superior sense of touch.
Thin skin covers area of the body not exposed to much wear adn tear. It has a very thin stratum lucidium. Though thin skin lacks epidermal ridges and has fewer sensory receptors than thick skin, it has several specializations that thick skin does not. Thin skin is covered with hair, which may help prevent hear loss from the body. In fact, hair is most densely distributed in skin that covers regions of great heat loss--the head, axille (armpits), and groin. Thin skin also contains numerous sebaceous glands, making it supple and free of cracks that may let infectious organisms enter.

Surgical Management of Stones

Normally, urine contains chemicals that prevent crystals from forming. But what happens when you start to have pain in your back or side or you are having problems with urination? Could you be one of the thousands of people with kidney stones? The information below should give you a head start about this potentially serious health hazard.



What happens under normal conditions?

The kidney performs many functions, the most important of which is the filtering of blood to remove toxins. Blood flows into the filtering component of the kidney called the glomerulus. The filtered portion of the blood then progresses through channels within the kidney, called tubules, which perform "fine tuning" of the filtering process. The final product of the filtered blood is urine, which gathers briefly in the renal pelvis and then is transported down the ureter, the muscular tube that carries urine to the bladder.

What are kidney stones?

Normally, urine contains many dissolved substances. At times, some materials may become concentrated in the urine and form solid crystals. These crystals can lead to the development of stones when materials continue to build up around them, much as a pearl is formed in an oyster.

The incidence of urolithiasis, or stone disease, is about 12 percent by age 70 for males and 5 percent for females in the United States. The debilitating effects of urolithiasis are quite substantial, with patients incurring billions of dollars in treatment costs each year. Stones occur more commonly in men than women, at a ratio of 3-to-1. In general, the peak incidence of stones occurs when a person is in their 30s.

The majority of stones contain calcium, with most being comprised of a material called calcium oxalate. Other types of stones include substances such as calcium phosphate, uric acid, cystine and struvite.

What are some risk factors for kidney stones?

A number of risk factors play major roles in stone formation. The first is loss of body fluids (dehydration). When one does not consume enough fluids during the day, the urine often becomes quite concentrated and darker. This increases the chance that crystals can form from materials within the urine, because there is less fluid available to dissolve them.

Diet can also affect the probability of stone formation. A high-protein diet can cause the acid content in the body to increase. This decreases the amount of urinary citrate, a "good" chemical that helps prevent stones. As a result, stones are more likely to form. A high-salt diet is another risk factor, as an increased amount of sodium passing into the urine can also pull calcium along with it. The net result is an increased calcium level in the urine, which increases the probability for stones. Intake of oxalate-rich foods such as leafy green vegetables, tea or chocolate may also worsen the situation.

Finally, a family history of stones, especially in a first-degree relative (parent or sibling), dramatically increases the probability of having stones.

What are the symptoms of kidney stones?

Once stones form in the urinary tract, they often grow with time and may change location within the kidney. Some stones may be washed out of the kidney by urine flow and end up trapped within the ureter. Stones usually begin causing symptoms when they block the outflow of the urine leading to the bladder.

Symptoms of an obstructing stone can vary. Most often, patients will complain of pain centered in their sides (flank), which may also radiate toward the front of the abdomen or to the groin area. At times, the pain may become so severe that the patient becomes unable to find a comfortable position. Blood in the urine (hematuria) may also appear when a stone is present. In some patients, especially those with diabetes, a fever may develop from infected urine that becomes trapped behind a stone. This is a medical emergency, as a bacterial infection that is not drained can cause a critical illness.

How are kidney stones diagnosed?

When a urinary stone is suspected, an immediate evaluation is required. Blood is obtained to check on overall kidney function as well as to exclude signs of infection throughout the body. Urine is sent for a urinalysis and culture. A simple X-ray of the abdomen is sometimes enough to pinpoint a calcification in the area of the kidneys or ureters, thus identifying a likely obstructing stone. If the X-ray film does not provide enough information to make a diagnosis, then an intravenous pyelogram (IVP) may be performed. A kidney blocked by a stone will not be able to excrete the dye from the IVP test as quickly and may appear enlarged. A final diagnostic exam that can be done is an abdominal/pelvic CT scan, which is very sensitive and can detect almost all types of urinary stones.

The abovementioned tests give your urologist information about the size, location and number of stones that are causing the symptoms. This allows the urologist to determine appropriate treatments.

How are kidney stones treated?

Stone size, the number of stones and their location are perhaps the most important factors in deciding the appropriate treatment for a patient with kidney stones. The composition of a stone, if known, can also affect the choice of treatments. Options for surgical treatment of stones include:

Shock Wave Lithotripsy (SWL): This is a completely non-invasive form of treatment in which an energy source generates a shock wave that is directed at a urinary stone within the kidney or ureter. Shock waves are transmitted to the patient either through a water bath, which the patient is placed in, or using a water-filled cushion that is placed against the skin. Ultrasound or fluoroscopy is used to locate the stone and focus the shock waves. The repeated force caused by the shock waves fragments the stone into small pieces.

SWL is most often performed under heavy sedation, although general anesthesia is sometimes used. Once the treatment is completed, the small stone particles then pass down the ureter and are eventually urinated away. In certain cases, a stent may need to be placed up the ureter just prior to SWL to assist in stone fragment passage.

Certain types of stone (cystine, calcium oxalate monohydrate) are resistant to SWL and usually require another treatment. In addition, larger stones (generally greater than 2.5 centimeters) may break into large pieces that can still block the kidney. Stones located in the lower portion of the kidney also have a decreased chance of passage.

Ureteroscopy (URS): This treatment involves the use of a very small, fiber-optic instrument called a ureteroscope, which allows access to stones in the ureter or kidney. The ureteroscope allows your urologist to directly visualize the stone by progressing up the ureter via the bladder. No incisions are necessary but general anesthesia is used.

Once the stone is seen through the ureteroscope, a small, basket-like device can be used to grasp smaller stones and remove them. If a stone is too large to remove, a laser, spark-generating probe or air-driven (pneumatic) probe can be passed through a channel built into the ureteroscope and the stone can be fragmented.

A straightforward case is complete once the stone has been shattered appropriately. However, if extensive manipulation was required to reach and/or treat the stone, your urologist may choose to place a stent within the ureter to allow the post-operative swelling to subside.

Percutaneous nephrolithotomy (PNL): PNL is the treatment of choice for large stones located within the kidney that will not be effectively treated with either SWL or URS. General anesthesia is required to perform a PNL. The main advantage of this approach compared to traditional open surgery is that only a small incision (about one centimeter) is required in the flank. The urologist then places a guide wire through the incision. The wire is inserted into the kidney under fluoroscopic guidance and directed down the ureter. A passage is then created around the wire using dilators to provide access into the kidney.

An instrument called a nephroscope is then passed into the kidney to visualize the stone. Fragmentation can then be done using an ultrasonic probe or a laser. Because the tract allows passage of larger instruments, your urologist can suction out or grasp the stone fragments as they are produced. This results in a higher clearance of stone fragments than with SWL or URS.

Once the procedure is complete, a tube is left in the flank to drain the kidney for several days.

Open surgery: A large incision is required in order to expose the kidney or portion of ureter that is involved with the stone. The portion of kidney overlying the stone or the ureteral wall is then surgically cut and the stone removed.

At present, open surgery is used only for very complicated cases of stone disease.

What can be expected after treatment for kidney stones?

Recovery times vary depending upon treatment, with the less invasive procedures allowing shorter recovery periods and quicker return to activity.

Shock Wave Lithotripsy (SWL): Patients generally go home the same day as the procedure and are able to resume a normal activity level in two to three days. Fluid intake is encouraged, as larger quantities of urine can help stone fragments to pass. Because the fragments need to pass spontaneously down the ureter, some flank pain can be anticipated. It is possible that the stone may not have shattered well enough to pass all of the fragments. If so, a repeat SWL treatment or other option may be required. If a stent was placed prior to SWL, this will need to be removed in your urologist's office within a few weeks. Stents are usually well tolerated by patients but can occasionally cause some bladder irritation and frequent urination.

Ureteroscopy (URS): Patients normally go home the same day and can resume normal activity in two to three days. As with SWL, if your urologist places a stent, it will need to be removed in approximately one week.

Percutaneous nephrolithotomy (PNL): After PNL, patients usually spend two to three days in the hospital. Your urologist may choose to have additional X-rays done while you are still in the hospital to determine if any stone fragments are still present. If some remain, your urologist may want to look back into the kidney with a nephroscope to remove them. This secondary procedure usually can be done with sedation and through the existing tract into the kidney. Once the stones have been removed, the stent coming out of the flank is removed and the patient can be discharged. Normal activity can be resumed after approximately one to two weeks.

Open surgery: Because these procedures are the most invasive and painful, patients often spend up to five to seven days in the hospital. Full recovery may take up to six weeks.

Postoperatively, your urologist will encourage a high fluid intake, to keep the daily volume of urine produced greater than two liters a day. In addition, you may need to undergo additional blood and urine tests to determine specific risk factors for stone formation and help minimize the chance for future stones. Although stone recurrence rates differ with each individual, a good estimate to keep in mind is a 50 percent chance of redeveloping a stone within a five-year period.

Frequently Asked Questions:

What are the risks or potential complications of the various treatments?

Each treatment has its own inherent risks. Some risks that can be associated with all surgical procedures are the possibility of bleeding and infection. It is extremely rare for patients undergoing shock wave lithotripsy (SWL) or ureteroscopy (URS) to have any problems with blood loss or infection. The probability is higher with more invasive treatments such as percutaneous nephrolithotomy (PNL) or open surgery. In most cases, patients do not require transfusion unless the procedure is unusually difficult.

With SWL, except in emergencies, patients must avoid aspirin, non-steroidal anti-inflammatory drugs such as ibuprofen or other blood thinners, as these can cause significant bleeding around the kidney. It is important that these medications be stopped at least one week prior to treatment if possible. SWL is generally a very safe treatment. Long-term follow up of patients has shown a slight increase in blood pressure, but no lasting adverse effect on kidney function has been noted.

In URS, there is a small possibility that the ureteral wall could be damaged or torn during the procedure. If this occurs, placement of a stent for two to three weeks is usually sufficient to allow the damaged area to heal. A complete tear of the ureter is very rare and requires open surgery to repair.

When PNL is performed, there is a small chance of air or fluids forming around a lung if the access channel is made toward the upper portion of the kidney. These entities are treated with a chest tube, which allows drainage of the fluid from around the lung. Other rare complications include injury to the bowel and injury to blood vessels within the kidney.

Will I have significant pain after the procedure?

Some discomfort is inevitable after surgical intervention for stones. The degree of discomfort is directly related to the invasiveness of the procedure. If needed, your urologist will prescribe medication to help control the pain during the recovery period.

What are signs of a problem postoperatively?

It is not uncommon for a patient to have a low-grade fever for the first 48 hours after surgery. However, if the fever continues or rises above 101.5° F (38.5° C) it could be a sign of active infection and should be reported to your urologist. Flank discomfort is also common after surgical interventions. However, if the pain becomes increasingly worse or unbearable, despite medication, your urologist should be notified.

How many times will I need to be treated?

The answer to this question depends on the size of stone and the treatment used. The chances for re-treatment are highest after SWL if the stone is large, extremely hard or in the lower portion of the kidney. PNL and open surgery tend to produce the highest stone-free rates.