Hip Fracture

A hip fracture is a serious injury, with complications that can be life-threatening. The risk of hip fracture rises with age.

Risk increases because bones tend to weaken with age (osteoporosis). Multiple medications, poor vision and balance problems also make older people more likely to fall — one of the most common causes of hip fracture.

A hip fracture almost always requires surgical repair or replacement, followed by physical therapy. Taking steps to maintain bone density and avoid falls can help prevent a hip fracture.

Symptoms

Signs and symptoms of a hip fracture include:

  • Inability to get up from a fall or to walk
  • Severe pain in your hip or groin
  • Inability to put weight on your leg on the side of your injured hip
  • Bruising and swelling in and around your hip area
  • Shorter leg on the side of your injured hip
  • Outward turning of your leg on the side of your injured hip

Causes

A severe impact — in a car crash, for example — can cause hip fractures in people of all ages. In older adults, a hip fracture is most often a result of a fall from a standing height. In people with very weak bones, a hip fracture can occur simply by standing on the leg and twisting.

Risk factors

The rate of hip fractures increases substantially with:

  • Age. Bone density and muscle mass tend to decrease with age. Older people can also have problems with vision and balance, which can increase the risk of falling.
  • Your sex. Hip fractures occur in women about three times more often than they do in men. Women lose bone density faster than men do, in part because the drop in estrogen levels that occurs with menopause accelerates bone loss. However, men also can develop dangerously low levels of bone density.
  • Osteoporosis. If you have this condition, which causes bones to weaken, you’re at increased risk of fractures.
  • Other chronic medical conditions. Endocrine disorders, such as an overactive thyroid, can lead to fragile bones. Intestinal disorders, which can reduce your absorption of vitamin D and calcium, also can lead to weakened bones.

    Medical conditions that affect the brain and nervous system, including cognitive impairment, dementia, Parkinson’s disease, stroke and peripheral neuropathy, also increase the risk of falling.

    Having low blood sugar and low blood pressure also can contribute to the risk of falls.

  • Certain medications. Cortisone medications, such as prednisone, can weaken bone if you take them long-term. Certain drugs or certain combinations of medications can make you dizzy and more prone to falling. Drugs that act on your central nervous system — such as sleep medications, antipsychotics and sedatives — are most commonly associated with falls.
  • Nutritional problems. Lack of calcium and vitamin D in your diet when you’re young lowers your peak bone mass and increases your risk of fracture later in life. It’s also important to get enough calcium and vitamin D in older age to try to maintain the bone you have. As you age, try to maintain a healthy weight. Being underweight increases the risk of bone loss.
  • Physical inactivity. Lack of regular weight-bearing exercise, such as walking, can result in weakened bones and muscles, making falls and fractures more likely.
  • Tobacco and alcohol use. Both can interfere with the normal processes of bone building and maintenance, resulting in bone loss.

Complications

A hip fracture can reduce your independence and sometimes shorten your life. About half the people who have a hip fractures aren’t able to regain the ability to live independently.

If a hip fracture keeps you immobile for a long time, the complications can include:

  • Blood clots in your legs or lungs
  • Bedsores
  • Urinary tract infections
  • Pneumonia
  • Further loss of muscle mass, increasing your risk of falls and injuries
  • Death

Prevention

Healthy lifestyle choices in early adulthood build a higher peak bone mass and reduce your risk of osteoporosis in later years. The same measures adopted at any age might lower your risk of falls and improve your overall health.

To avoid falls and to maintain healthy bone:

  • Get enough calcium and vitamin D. As a general rule, men and women age 50 and older should consume 1,200 milligrams of calcium a day, and 600 international units of vitamin D a day.
  • Exercise to strengthen bones and improve balance. Weight-bearing exercises, such as walking, help you maintain peak bone density. Exercise also increases your overall strength, making you less likely to fall. Balance training also is important to reduce your risk of falls, since balance tends to deteriorate with age.
  • Avoid smoking or excessive drinking. Tobacco and alcohol use can reduce bone density. Drinking too much alcohol can also impair your balance and make you more likely to fall.
  • Assess your home for hazards. Remove throw rugs, keep electrical cords against the wall, and clear excess furniture and anything else that could trip you. Make sure every room and passageway is well lit.
  • Check your eyes. Have an eye exam every other year, or more often if you have diabetes or an eye disease.
  • Watch your medications. Feeling weak and dizzy, which are possible side effects of many medications, can increase your risk of falling. Talk to your doctor about side effects caused by your medications.
  • Stand up slowly. Getting up too quickly can cause your blood pressure to drop and make you feel wobbly.
  • Use a cane, walking stick or walker. If you don’t feel steady when you walk, ask your doctor or occupational therapist whether these aids might help.

What is a head injury

Head Injury

What is a head injury?

Head injuries are one of the most common causes of disability and death in adults. The injury can be as mild as a bump, bruise (contusion), or cut on the head, or can be moderate to severe in nature due to a concussion, deep cut or open wound, fractured skull bone(s), or from internal bleeding and damage to the brain.

A head injury is a broad term that describes a vast array of injuries that occur to the scalp, skull, brain, and underlying tissue and blood vessels in the head. Head injuries are also commonly referred to as brain injury, or traumatic brain injury (TBI), depending on the extent of the head trauma.

Head injuries are rising dramatically–about 1.7 million people have a TBI each year. Millions of Americans are alive today who have had a head injury and now need help with the activities of daily living, costing the country more than $56 billion per year.

What are the different types of head injury?

The following are some of the different types of head injuries:

  • Concussion. A concussion is an injury to the head area that may cause instant loss of awareness or alertness for a few minutes up to a few hours after the traumatic event.
  • Skull fracture. A skull fracture is a break in the skull bone. There are four major types of skull fractures, including the following:
    • Linear skull fractures. This is the most common type of skull fracture. In a linear fracture, there is a break in the bone, but it does not move the bone. These patients may be observed in the hospital for a brief amount of time, and can usually resume normal activities in a few days. Usually, no interventions are necessary.
    • Depressed skull fractures. This type of fracture may be seen with or without a cut in the scalp. In this fracture, part of the skull is actually sunken in from the trauma. This type of skull fracture may require surgical intervention, depending on the severity, to help correct the deformity.
    • Diastatic skull fractures. These are fractures that occur along the suture lines in the skull. The sutures are the areas between the bones in the head that fuse when we are children. In this type of fracture, the normal suture lines are widened. These fractures are more often seen in newborns and older infants.
    • Basilar skull fracture. This is the most serious type of skull fracture, and involves a break in the bone at the base of the skull. Patients with this type of fracture frequently have bruises around their eyes and a bruise behind their ear. They may also have clear fluid draining from their nose or ears due to a tear in part of the covering of the brain. These patients usually require close observation in the hospital.
  • Intracranial hematoma (ICH). There are several types of ICH, or blood clots, in or around the brain. The different types are classified by their location in the brain. These can range from mild head injuries to quite serious and potentially life-threatening injuries. The different types of ICH include the following:
    • Epidural hematoma. Epidural hematomas occur when a blood clot forms underneath the skull, but on top of the dura, the tough covering that surrounds the brain. They usually come from a tear in an artery that runs just under the skull called the middle meningeal artery. Epidural hematomas are usually associated with a skull fracture.
    • Subdural hematoma. Subdural hematomas occur when a blood clot forms underneath the skull and underneath the dura, but outside of the brain. These can form from a tear in the veins that go from the brain to the dura, or from a cut on the brain itself. They are sometimes, but not always, associated with a skull fracture.
    • Contusion or intracerebral hematoma. A contusion is a bruise to the brain itself. A contusion causes bleeding and swelling inside of the brain around the area where the head was struck. Contusions may occur with skull fractures or other blood clots such as a subdural or epidural hematoma. Bleeding that occurs inside the brain itself (also called intraparenchymal hemorrhage) can sometimes occur spontaneously. When trauma is not the cause, the most common causes are long-standing, high blood pressure in older adults, bleeding disorders in either children or adults, or the use of medications that cause blood thinning or certain illicit drugs.
    • Diffuse axonal injury (DAI). These injuries are fairly common and are usually caused by shaking of the brain back and forth, which can happen in car accidents, from falls or shaken baby syndrome. Diffuse injuries can be mild, such as with a concussion, or may be very severe, as in diffuse axonal injury (DAI). In DAI, the patient is usually in a coma for a prolonged period of time, with injury to many different parts of the brain.

What causes a head injury?

There are many causes of head injury in children and adults. The most common traumatic injuries are from motor vehicle accidents (automobiles, motorcycles, or struck as a pedestrian), from violence, from falls, or as a result of child abuse. Subdural hematomas and brain hemorrhages (called intraparenchymal hemorrhages) can sometimes happen spontaneously.

What causes bruising and internal damage to the brain?

When there is a direct blow to the head, shaking of the child (as seen in many cases of child abuse), or a whiplash-type injury (as seen in motor vehicle accidents), the bruising of the brain and the damage to the internal tissue and blood vessels is due to a mechanism called coup-countrecoup. A bruise directly related to trauma, at the site of impact, is called a coup (pronounced COO) lesion. As the brain jolts backwards, it can hit the skull on the opposite side and cause a bruise called a countrecoup lesion. The jarring of the brain against the sides of the skull can cause shearing (tearing) of the internal lining, tissues, and blood vessels that may cause internal bleeding, bruising, or swelling of the brain.

What are the symptoms of a head injury?

The person may have varying degrees of symptoms associated with the severity of the head injury. The following are the most common symptoms of a head injury. However, each individual may experience symptoms differently. Symptoms may include:

  • Mild head injury:
    • Raised, swollen area from a bump or a bruise
    • Small, superficial (shallow) cut in the scalp
    • Headache
    • Sensitivity to noise and light
    • Irritability
    • Confusion
    • Lightheadedness and/or dizziness
    • Problems with balance
    • Nausea
    • Problems with memory and/or concentration
    • Change in sleep patterns
    • Blurred vision
    • “Tired” eyes
    • Ringing in the ears (tinnitus)
    • Alteration in taste
    • Fatigue or lethargy
  • Moderate to severe head injury (requires immediate medical attention)–symptoms may include any of the above plus:
    • Loss of consciousness
    • Severe headache that does not go away
    • Repeated nausea and vomiting
    • Loss of short-term memory, such as difficulty remembering the events that led right up to and through the traumatic event
    • Slurred speech
    • Difficulty with walking
    • Weakness in one side or area of the body
    • Sweating
    • Pale skin color
    • Seizures or convulsions
    • Behavior changes including irritability
    • Blood or clear fluid draining from the ears or nose
    • One pupil (dark area in the center of the eye) is dilated, or looks larger, than the other eye and doesn’t constrict, or get smaller, when exposed to light
    • Deep cut or laceration in the scalp
    • Open wound in the head
    • Foreign object penetrating the head
    • Coma (a state of unconsciousness from which a person cannot be awakened; responds only minimally, if at all, to stimuli; and exhibits no voluntary activities)
    • Vegetative state (a condition of brain damage in which a person has lost his thinking abilities and awareness of his surroundings, but retains some basic functions such as breathing and blood circulation)
    • Locked-in syndrome (a neurological condition in which a person is conscious and can think and reason, but cannot speak or move)

The symptoms of a head injury may resemble other problems or medical conditions. Always consult your doctor for a diagnosis.

How are head injuries diagnosed?

The full extent of the problem may not be completely understood immediately after the injury, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a head injury is made with a physical examination and diagnostic tests. During the examination, the doctor obtains a complete medical history of the patient and family and asks how the injury occurred. Trauma to the head can cause neurological problems and may require further medical follow up.

Diagnostic tests may include:

  • Blood tests
  • X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
  • Electroencephalogram (EEG). A procedure that records the brain’s continuous, electrical activity by means of electrodes attached to the scalp.
  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

Treatment of a head injury

Specific treatment of a head injury will be determined by your doctor based on:

  • Your age, overall health, and medical history
  • Extent of the head injury
  • Type of head injury
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the head injury
  • Your opinion or preference

Depending on the severity of the injury, treatment may include:

  • Ice
  • Rest
  • Topical antibiotic ointment and adhesive bandage
  • Observation
  • Immediate medical attention
  • Stitches
  • Hospitalization for observation
  • Moderate sedation or assistance with breathing that would require being placed on a breathing machine, or mechanical ventilator or respirator
  • Surgery

Treatment is individualized, depending on the extent of the condition and the presence of other injuries. If the patient has a severe head injury, he or she may require monitoring for increased intracranial pressure (pressure inside the skull). Head injury may cause the brain to swell. Since the brain is covered by the skull, there is only a small amount of room for it to swell. This causes pressure inside the skull to increase, which can lead to brain damage.

How is ICP monitored?

Intracranial pressure is measured in two ways. One way is to place a small hollow tube (catheter) into the fluid-filled space in the brain (ventricle). Other times, a small, hollow device (bolt) is placed through the skull into the space just between the skull and the brain. Both devices are inserted by the doctor either in the intensive care unit (ICU) or in the operating room. The ICP device is then attached to a monitor that gives a constant reading of the pressure inside the skull. If the pressure goes up, it can be treated right away. While the ICP device is in place the patient will be given medication to stay comfortable. When the swelling has gone down and there is little chance of more swelling, the device will be removed.

Lifelong considerations for a person with a head injury

The key is to promote a safe environment for children and adults and to prevent head injuries from occurring in the first place. The use of seat belts when riding in the car and helmets (when worn properly) for activities, such as bicycle riding, in-line skating, and skateboarding may protect the head from sustaining severe injuries.

Persons who suffer a severe brain injury may lose muscle strength, fine motor skills, speech, vision, hearing, or taste function, depending on the brain region involved and the severity of brain damage. Long- or short-term changes in personality or behavior may also occur. These persons require long-term medical and rehabilitative (physical, occupational, or speech therapy) management.

The extent of the person’s recovery depends on the type of brain injury and other medical problems that may be present. It is important to focus on maximizing the person’s capabilities at home and in the community. Positive reinforcement will encourage the patient to strengthen his/her self-esteem and promote independence.

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Why people are scared of carrying out cardiac arrest

For people who suffer cardiac arrest outside of a  hospital, the biggest difference between those who survive and those who don’t is that a bystander performed CPR on the survivors.

The difference is that stark. CPR can double or even triple the chance of survival. And for those who suffer cardiac arrest outside of a hospital, surviving often means getting CPR from a passing layperson who may not be a medical professional.

That’s why it’s so essential for everyone to get trained in CPR, and be willing to deliver it if need be. But the tragic thing is that cardiac arrest victims don’t get CPR from bystanders as often as they could. Bystanders are often reluctant to perform CPR—even if they’ve gone through training, and even though they could save a life.

Here are some common misconceptions and fears that keep people from providing lifesaving care when the chips are down.

Fear of hurting the victim.

Many people hesitate to perform CPR because they worry that they may do more harm than good. They may even break a rib.

The thing is, if you’re doing CPR right, it’s likely to break ribs. Compressions should be at a depth of about two inches on a full-grown adult in order to get the blood moving in the body. That takes about 60 pounds of force.

According to a 2015 study, as many as 86% of men and 91% of women experienced a bone injury in the chest after receiving CPR—including sternum fractures, rib fractures, and sternocostal separations.

However, these injuries are survivable. Cardiac arrest isn’t, unless the victim gets immediate lifesaving care. Most people would agree that a few broken ribs are preferable to death.

Fear of being sued.

That’s all well and good—but what if, after saving someone’s life by delivering CPR, that person turns around and sues you for your actions?

It’s possible, but unlikely. Good Samaritan laws vary by state, but all have protections for bystanders delivering CPR. It’s in the interests of the country to encourage people to provide CPR, and the law reflects that.

As long as you’re responding the way a reasonable person would, providing care according to your level of training, and are not being compensated for your actions, these laws should protect you from a lawsuit.

Fear of catching a disease.

It’s not unusual to have an instinctive ick-factor reaction when it comes to mouth-to-mouth resuscitation. For many, the possibility of catching a contagious disease stops them from helping a cardiac arrest victim—even when they know CPR.

You can contract bacteria and viruses through mouth-to-mouth contact with an infected person. Chances are low that this will happen during rescue breathing, but it’s possible.

However, you don’t need to give rescue breaths in order to deliver effective CPR. Recently, the AHA released new guidelines for hands-only CPR that require lay rescuers only to “push hard and fast in the center of the chest,” to the tune of “Stayin’ Alive” by the Bee Gees. You can skip the mouth-to-mouth part altogether.

Hands-only CPR has been shown to be just as effective as traditional CPR in bystander rescue situations. In some studies, it’s even more effective—possibly because people are more willing to give this type of CPR in the first place.

Fear of doing it wrong.

Studies have shown that about 70% of Americans don’t have the confidence to perform CPR in an emergency situation—and would be reluctant to provide it for this reason.

Again, that’s where hands-only CPR comes in. It’s far less complicated than the traditional version—there’s no need to try to remember the ratio of compressions to rescue breaths, or slow down your compressions to provide breaths.

Hands-only CPR is very easy to learn and administer—even for people with no medical training. There’s really only one step—push hard and fast in the center of the chest.

Today, anyone can learn and administer CPR—and the learning process only takes minutes.

Fear of inappropriate touching.

According to a study conducted by researchers at UPenn, women are less likely to receive CPR than men—because some rescuers are afraid to touch a female victim’s chest.

This has real-world consequences. The study found that men were 23% more likely to survive cardiac arrest than women, because rescuers were more reluctant to deliver CPR to women. In examining over 20,000 cases nationwide, the study found that only 39% of women in cardiac arrest outside of a hospital got bystander CPR—as opposed to 45% of men.

Over 350,000 people suffer cardiac arrest in America each year outside of a hospital setting. Approximately 90% of them do not survive. Those numbers could be improved with CPR training—and the knowledge to overcome these misconceptions.

Stridor (respiratory concern)

Stridor is a high-pitched, wheezing sound caused by disrupted airflow. Stridor may also be called musical breathing or extrathoracic airway obstruction.

Airflow is usually disrupted by a blockage in the larynx (voice box) or trachea (windpipe). Stridor affects children more often than adults.

Types of stridor

There are three types of stridor. Each type can give your doctor a clue about what is causing it.

Inspiratory stridor

In this type, you can only hear the abnormal sound when you breathe in. This indicates an issue with the tissue above the vocal cords.

Expiratory stridor

People with this type of stridor only experience abnormal sounds when they breathe out. Blockage in the windpipe causes this type.

Biphasic stridor

This type causes the abnormal sound when a person breathes in and out. When the cartilage near the vocal cords narrows, it causes these sounds.

What causes stridor?

It is possible to develop stridor at any age. However, stridor is more common in children than adults because children’s airways are softer and narrower.

Stridor in adults

Stridor in adults is most commonly caused by the following conditions:

  • an object blocking the airway
  • swelling in your throat or upper airway
  • trauma to the airway, such as a fracture in the neck or an object stuck in the nose or throat
  • thyroid, chest, esophageal, or neck surgery
  • being intubated (having a breathing tube)
  • inhaling smoke
  • swallowing a harmful substance that causes damage to the airway
  • vocal cord paralysis
  • bronchitis, an inflammation of the airways leading to the lungs
  • tonsillitis, an inflammation of the lymph nodes at the back of the mouth and top of the throat by viruses or bacteria
  • epiglottitis, an inflammation of the tissue covering the windpipe caused by the H. influenza bacterium
  • tracheal stenosis, a narrowing of the windpipe
  • tumors
  • abscesses, a collection of pus or fluid

Stridor in infants and children

In infants, a condition called laryngomalacia is usually the cause of stridor. Soft structures and tissues that obstruct the airway cause laryngomalacia.

It often goes away as your child ages and their airways harden. It may be quieter when your child is lying on their stomach, and louder when lying on their back.

Laryngomalacia is most noticeable when your child is about 6 months oldTrusted Source. It may start as soon as a few days after birth. Stridor usually goes away by the time your child is 2 years old.

Other conditions that may cause stridor in infants and children include:

  • croup, which is a viral respiratory infection
  • subglottic stenosis, which occurs when the voice box is too narrow; many children outgrow this condition, though surgery may be necessary in severe cases
  • subglottic hemangioma, which occurs when a mass of blood vessels forms and obstructs the airway; this condition is rare and may require surgery
  • vascular rings, which occur when an outer artery or vein compresses the windpipe; surgery may release the compression.
Who is at risk for stridor?

Children have narrower, softer airways than adults do. They’re much more likely to develop stridor. To prevent further blockage, treat the condition immediately. If the airway is completely blocked, your child won’t be able to breathe.

How is stridor diagnosed?

Your doctor will try to find the cause of you or your child’s stridor. They’ll give you or your child a physical examination and ask questions about medical history.

Your doctor may ask questions about:

  • the sound of the abnormal breathing
  • when you first noticed the condition
  • other symptoms, such as a blue color in your face or your child’s face or skin
  • if you or your child has been ill recently
  • if your child could have put a foreign object in their mouth
  • if you or your child is struggling to breathe

Your doctor may also order tests, such as:

If your doctor suspects an infection, they’ll order a sputum culture. This test checks material you or your child cough up from the lungs for viruses and bacteria. It helps your doctor see if an infection, such as croup, is present.

How is stridor treated?

Don’t wait to see if stridor goes away without medical treatment. Visit your doctor and follow their advice. Treatment options depend on the age and health of you or your child, as well as the cause and severity of the stridor.

Your doctor may:

  • refer you to an ear, nose, and throat specialist
  • provide oral or injected medication to decrease swelling in the airway
  • recommend hospitalization or surgery in severe cases
  • require more monitoring
When is emergency care necessary?

Contact your doctor immediately if you see:

  • a blue color in you or your child’s lips, face, or body
  • signs of difficulty breathing, such as the chest collapsing inward
  • weight loss
  • trouble eating or feeding

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Management of Burns and Scalds

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Burns and scalds are damage to the skin usually caused by heat. Both are treated in the same way.

A burn is caused by dry heat – by an iron or fire, for example. A scald is caused by something wet, such as hot water or steam.

Burns can be very painful and may cause:

– red or peeling skin
– blisters
– swelling
– white or charred skin
The amount of pain you feel is not always related to how serious the burn is. Even a very serious burn may be relatively painless.

To treat a burn

immediately get the person away from the heat source to stop the burning

cool the burn with cool or lukewarm running water for 20 minutes – do not use ice, iced water, or any creams or greasy substances like butter
remove any clothing or jewellery that’s near the burnt area of skin, including babies’ nappies, but do not move anything that’s stuck to the skin.

make sure the patient keeps warm by using a blanket, for example, but take care not to rub it against the burnt area

cover the burn by placing a layer of cling film over it – a clean plastic bag could also be used for burns on your hand

use painkillers such as paracetamol or ibuprofen to treat any pain
if the face or eyes are burnt, sit up as much as possible, rather than lying down – this helps to reduce swelling (make sure no allergic)

if it’s an acid or chemical burn, dial 999, carefully try to remove the chemical and any contaminated clothing, and rinse the affected area using as much clean water as possible

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