I I I I I: First Aid Kit

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First Aid Kit
First Aid Kit
The Basic Equipment that should be included in a First Aid Kit are:
• Plastic bandages
• Transpore tape
• Alcohol preps
• Adhesive bandages
• Micropore tape
• Gauze
• Extra large plastic bandages
• Iodine prep pads
• Fingertip bandages
• Sterile pads
• Antiseptic towelettes
• Knuckle bandages
• Antiseptic ointment
• Ammonia inhalant
• Sponge packs
• Instant ice packs
• Sterile eye wash
• Elastic bandages
• Eye pads
• Safety pins
• First aid cream
• Bandage scissors
• Tweezers
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• Bandage scissors
• Tweezers
• Butterfly bandages
• Water tight utility box
• Burn gel to treat burns
• Burn bandages
• Adhesive spots
• Extra large strips
• Surgical tape
• Sponges
• Pain relievers
The following media (First Aid Kit) explains First Aid Kit:

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DRESSINGS
Dressings are protective coverings applied to a wound to control bleeding, prevent infection, absorb blood and discharge and prevent further damage.
Dressings should be germ free (sterile), if possible, and able to act as a filter-restricting entry of germs but allowing air to reach the wound. It must
also be very porous in order to absorb blood and sweat. If sweat cannot evaporate through it, an infection can set in.
They should also be of a non-adherent material so that it will not damage the repairing wound.
Adhesive dressings: These are often called 'plasters'; e.g. band aids and consist of a pad of absorbent gauze or cellulose with an adhesive backing
which, if perforated, allows sweat to evaporate. The surrounding skin should be dry before application. When a dressing has no sticking power of its
own it must be held in place by a bandage. Prepared sterile dressings consist of layers of gauze covered by a pad of cotton wool and come with a roller
bandage to tie them in position. Plain gauze dressings come in a variety of sizes. They tend to stick to wounds but this can assist in clotting. Vaseline
gauze dressings are sold in squares in sealed packs. They are available in a number of different sizes and they do not stick to wounds.
Handling Dressings: Wash your hands before handling dressings and bandages, and avoid touching wounds with fingers. Dressings should be covered
with adequate padding, extending well beyond the wound and held in place with a bandage.
CREAM AND OINTMENTS

In general, minor wounds are best cleaned with soap and water-creams and ointments should be unnecessary. Infected wounds need an antibiotic
cream Seek medical advice if you are in doubt about the use of any application.
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Contents of lifeboat first aid kit
Recommended medical survival kit' for lifeboats aboard merchant vessels. These supplies are intended for 20-30 survivors for a period of one week.
No. of
Description of item Container Usage, class
units
Medicines
Minor aches or
Paracetamol tablets, 500 mg, 100s Bottle 1
pains, fever
Analgesic, sedative
Morphine sulfate injection, 10mg/ml,
Package 1 (controlled
1-ml disposable cartridge, 10s
substance)
Sodium chloride tablets, lg, 100s Bottle 1 Heat cramps
Protection against
Sunscreen preparation Package 40
sunburn
Amoxicillin(SOO mg)+Clavulanic Broad-spectrum

Bottle 2
Acid(125 mg) antibiotic
Surgical supplies
Bandage, elastic, 10-cm roll, 12s Box 1
Bandage, gauze, roll, sterile, 10cm x

Box 1
!Om, 12s
Bandage, absorbent, adhesive, 2cm

Box 1
x 8 cm, 100s
Pad, sterile, 10cm x 10cm, 100s Box 2
Lister bandaoe scissors Item 1
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Protection against
Sunscreen preparation Package 40
sunburn
Amoxicillin(SOO mg)+Clavulanic Broad-spectrum

Bottle 2
Acid(125 mg) antibiotic
Surgical supplies
Bandage, elastic, 10-cm roll, 12s Box 1
Bandage, gauze, roll, sterile, 10cm x

Box 1
10m, 12s
Bandage, absorbent, adhesive, 2cm

Box 1
x 8 cm, 100s
Pad, sterile, 10cm x 10cm, 100s Box 2
Lister bandage scissors Item 1
Soap Cake 20
Sunglasses Item 20
Syringe, hypodermic cartridge holder Item 2
Tape, adhesive, surgical, Scm x Sm

Box 1
roll, 6s
Low-reading clinical thermometer Item 2
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HUMAN ANATOMY
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Right Common carotid Artery---- +l:::;;:==�l:eft Common C.arotld Artery
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Right Ffbula --------:--..

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POSmONS:
• Anatomical Position: A person standing straight with eyes looking forwards, both arms by the side of body, palms facing forwards, both feet
together is said to be in anatomical position.
• Supine position: A person lying on her/his back, arms by the side, palms facing upwards and feet put together is said to be in supine position.
• Prone position: A person lying on his/her face, chest and abdomen is said to be in prone position.
PLANES:
A flat surface where a human body is divided or transected in order to show the internal structures is called as plane.
• SAGITTAL PLANE: A plane passing through the center of the body dividing it into two right/left halves is the median or midsagittal plane. The
plane parallel to median or midsagittal plane is the sagittal plane.
• CORONAL (frontal) PLANE: A plane at right angles to the sagittal or median plane, which divides the body into anterior and posterior halves
is called a coronal plane.
• TRANSVERSE (horizontal) PLANE: A plane at right angles to both the sagittal and coronal planes, which divides the body into upper and
lower parts, is called a transverse plane.
BASIC ANATOMICAL TERMINOLOGY: describes the relationship of parts of the body to each other
• ANTERIOR OR VENTRAL: In front of or front

• POSTERIOR OR DORSAL: In back of or back
• CRANIAL/SUPERIOR: Towards the head end or above
• CAUDAL/INFERIOR: Towards the feet or below
• MEDIAL: Towards the midline
• LATERAL: Towards the side or away from the midline
• PROXIMAL: Nearest the point of attachment to the trunk
• DISTAL: Away from the point of attachment to the trunk
• SUPERFICIAL: Close to the surface of the body
• DEEP: Away from the surface of the body
• Ipsilateral: refers to a structure or a condition on the same side of the body as the reference point.
• Contralateral: refers to a structure on the opposite side of the body when compared to the reference point.
TERMS RELATED TO BODY MOVEMENTS:

General movements of the synovial joints are divided into four n1ain categories:
• Gliding moven1ent: Relatively flat surfaces which move back-and-forth and from side-to-side with respect to one another. No significant
change can be seen in the angle between articulating bones.
• Angular n1ovements: Increases or decreases of the angle between articulating bones. Flexion is a decrease in an angle between articulating
bones. Extension is the increase of an angle, between articulating bones.
• The sideways movement of the trunk, either to the right or left at the waist is called Lateral flexion_

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• DISTAL: Away from the point of attachment to the trunk
• SUPERFICIAL: Close to the surface of the body
• DEEP: Away from the surface of the body
• Ipsilateral: refers to a structure or a condition on the same side of the body as the reference point.
• Contralateral: refers to a structure on the opposite side of the body when compared to the reference point.
TERMS RELATED TO BODY MOVEMENTS:

General movements of the synovial joints are divided into four main categories:
• Gliding moven1ent: Relatively flat surfaces which move bac k -and-forth and from side-to-side with respect to one another. No significant
change can be seen in the angle between articulating bones.
• Angular movements: Increases or decreases of the angle between articulating bones. Flexion is a decrease in an angle between articulating
bones. Extension is the increase of an angle, between articulating bones.
• The sideways movement of the trunk, either to the right or left at the waist is called Lateral flexion_
• Adduction is movement of bone toward midline.
• Abduction is movement of bone away from midline.
Rotation: Rotation refers to the bone's revolution around its longitudinal axis.
In medial rotation the anterior surface of a bone of a limb is turned towards the midline.
In lateral rotation, the anterior surface of bone of a limb is turned away from midline.
Special n1ovements: Occur only within certain joints .

Radioulnar joints: pronation and supination
Temporon1andibular joint: protraction and retraction
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Body structure and functions Functions of important parts and systems
Functions of important parts and systems
Introduction
A good health means a proper balance between the physical and mental conditions. Based on the influences of external and internal environment and
the individual tendencies, health differs from one person to another. A thorough medical check is required to be done for all the crew members who
join the vessel, to know their health conditions. The general health status should always be good because life at sea is an away from all, unique
work place. Proper knowledge on the direct and indirect impact of carrying LNG onboard on health of the crew members is very essential.
Anatomy and Physiology

Anatomy is the study of the bodily structures of humans and other living organisms. Physiology is the study of various functions of the body.
The Cell
The independent microscopic unit of the body is called a cell. It is the basic building block for human body and other living organisms. The chemical
reactions that occur in the cells are the cause for all the functional processes of the body. The cells present in various tissues and organs cooperate
in fulfilling their duties. The water content in the cell comprises of 70 °/o of the total content. Other contents like carbohydrates, proteins and
inorganic materials are also present in the cell. Another thing about the cell is that they have a basic structure and certain basic qualities. Every
part of a cell is aligned to do a particular function. All human beings use nutrients for getting energy. The most essential source of energy in the cell
is glucose. Thus it is necessary to take nutrient rich food to gain energy.
Tissue
The tissues are formed by the look-alike cells. Epithelial tissue is a kind of tissue which covers the body's surfaces, channels and cavity. The tissue
network is formed by the support tissue and connective tissue. Other different kinds of tissues are nerve tissue, osseous tissue, muscular tissue etc.
The chemical signals control the cooperation of the cells. The two types of chemical signals are hormone signals and nerve signals. These two
signals work together for appropriate reactions. The activities of internal organs are controlled by the hormone signals and the activity of glands and
muscles are controlled by the nerve signals. These two signals are important for our survival.
The composition of tissue fluid is kept at a constant level mainly by the cooperation of various organ systems. The tissue fluid is renewed by the
blood. The blood circulates throughout the body all the time. The surplus tissue fluid is drained by the lymph artery.
Respiratory Organs
The process of exchange of gases between the lungs and the blood arteries is called respiration. Oxygen in the air is absorbed by the respiratory
organs and the blood helps in sending the oxygen to the cells of the body. The carbon dioxide produced by the cells is taken out of the body. The
two main respiratory organs are lungs and bronchia.
The Skin
The skin is the largest breathing organ of the human body and it also protects all the internal organs.

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The Imn1une Systen1

The system which protects the body from diseases and infections from outside is called the immune system. This system is called a defense system
where it provides some harmless infective agents to fight against the infective organisms from outside. This system also helps in fighting against the
internal changes in cells.
Thoughts and Attitude

Good health not only includes physical body conditions but also positive thoughts and attitude. The crew members face various types of risks
onboard. These risks have either direct or indirect influence on their health. Apart from the internal influence, the external influence present in the
atmosphere may also affect health.
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Body structure and functions Functions of important parts and systems Skeletal System
Skeletal System
Learning Objectives
• Describe the functions of bone

• Contrast the structure of bones found in the axial and appendicular skeleton
• Identify the parts and locations of the major bones present in human body
• Compare mechanisms for bone ossification
• Describe the mechanism for fracture repair
• Describe disorders associated with the skeletal system
Introduction

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Introduction
The skeletal system provides and protection support in living organisms. In the human body, the skeletal system consists of 206 bones, which work
in coordination with muscles to enable movement. The skeletal system consists of two branches called the axial and appendicular skeletons, each of
which is further divided into subsections.

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(c) Veda
The skeletal system provides and protection support in living organisms. In the human body, the skeletal system consists of 206 bones, which work
in coordination with muscles to enable movement. The skeletal system consists of two branches called the axial and appendicular skeletons, each of
which is further divided into subsections.

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Axial skeletal
The axial skeleton consists of bones that form the axis of the body, providing support and protection to the organs of the head, neck, and trunk.
• The skull: the bony framework of the head, consisting of eight crania l bones.
• Cranial Bones: serve as a protective framework of bones around the brain.
1. Frontal Bones: form part of forehead, cranial cavity, brow ridges, and nasal cavity
2. Parietal Bones: the left and right parietal bones form the superior and inferior portions of the cranium.
3. Temporal Bones: the right and left temporal bones form the lateral walls of cranium. They also house the external ear.
4. Occipital Bones: form the posterior and inferior portions of the cranium, and are attached to the neck muscles to provide articulation to the
neck .
5. Sphenoid Bones: help form the floor of the cranium and the eyes orbit.
6. Ethmoid Bones: form the roof of the nasal cavity as well as the medial portions of the orbits.
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• The skull: the bony framework of the head, consisting of eight cranial bones.
• Cranial Bones: serve as a protective framework of bones around the brain:
1. Frontal Bones: form part of forehead, cranial cavity, brow ridges, and nasal cavity
2. Parietal Bones: the left and right parietal bones fom1 the superior and inferior portions of the cranium.
3. Temporal Bones: the right and left temporal bones form the lateral walls of cranium. They also house the external ear.
4. Occipital Bones: form the posterior and inferior portions of the cranium, and are attached to the neck muscles to provide articulation to the
neck.
5. Sphenoid Bones: help form the floor of the cranium and the eyes orbit.
6. Ethn1oid Bones: form the roof of the nasal cavity as well as the medial portions of the orbits.
• Sutures: the immovable joints between the bones of the skull.
1. Sagittal suture: connect the parietal bones.

2. Coronal suture: meeting point of parietal bones and the frontal bones. Lambdoidal suture: meeting point of the parietal and occipital bones.
3. Squamous suture: meeting point of the parietal and temporal bones.
• Facial Bones: help make up the upper and lower jaw as well other facial structures.
1. Mandible: the lower jawbone, which helps to form the free joint in the head which can rotate in any direction. The mandible enables chewing
action by articulating with the temporal bones at the temporomandibular joints
2. Maxilla: the upper jawbones, which form part of the nose, orbits, as well the roof of the mouth.
3. Palatine: the left and right palatines fom1 a portion of the nasal cavity and posterior portion of mouth roof.
4. Zygon1atic: the left and right zygomatic bones form the cheekbones and a portion of orbit.
5. Nasal: the left and right nasal bones fom1 the superior portion of the bridge of the nose.
6. Lacrimal: the left and right lacrimal bones form the orbits.
7. Vomer: form a part of nasal septum and also helps divide the nostrils.
• The sternum: a flat, dagger-shaped bone found in middle of the chest that connects the ribs to for the ribcage, which provides protection to
the heart, lungs, and major blood vessels. The sternum is composed of the manubrium, body, and xiphoid process. If the sternum were not
present, there would be a large hole though the middle of the chest. The sternum thus protects the major organs of the chest.
1. Manubrium: top portion of the sternum that is also called the handle. It is connected to the first two ribs.
2. Body: middle portion of that is also called the blade or the gladiolus. The body helps connect the third along with seventh ribs directly. It
indirectly connects eighth through tenth ribs.
3. Xiphoid process: Bottom of the sternum is formed with the help of xiphoid process. It is also called tip.
• The Ribs: flat, thin, curved bones that form a protective cage over the organs in the upper portion of the body. Twenty-four bones arranged
in 12 pairs form the ribs. These bones are divided into three categories.
1 . True Ribs: the first seven bones in the ribs. Spines are connected with true ribs at back. Costal cartilage helps to connect the true ribs
directly with breastbone or sternum.
2 . False Ribs: the next three bones followinq the true ribs. These ribs, compared to true ribs, are shorter and are connected in the back with the "
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directly with breastbone or sternum.

2. False Ribs: the next three bones following the true ribs. These ribs, compared to true ribs, are shorter and are connected in the back with the
help of spine. False ribs are attached to the lowest true rib instead of connecting to the sternum directly.
3. Floating Ribs: the remaining two sets of rib bones are called floating ribs. Floating ribs are considered the smallest ribs.
• Vertebral Column: comprised of 33 pairs of irregularly shaped bones called vertebrae. It is also called the backbone, spinal column, or spine.
Based on the location of the backbone, the 33 vertebras are divided into five categories.
1. Cervical vertebrae: the first seven vertebrae found on top of the spinal column. These bones provide a flexible framework for the neck as
well support to the head. The first cervical vertebrae are named "atlas," followed by the "axis", the second vertebrae. The shape of the atlas
helps the head to nod "yes" and the shape of the axis allows the head to shake "no."
2. Thoracic vertebrae: the next twelve vertebrae following the cervical vertebrae. Movement of these bones with the ribs forms the rear anchor
of the ribcage. Thoracic vertebrae increase in size from top to bottom and are comparatively larger than cervical vertebrae.
3. Lumbar vertebrae: comprised of five bones that come after the thoracic vertebrae. It is the largest vertebrae in the spinal column. The
lumbar vertebrae balance and support most of the body weight. It is also attached to many of the back muscles.
4. Sacrum: the triangular bone found just below the lumbar vertebrae. The back wall of the pelvic girdle is formed by sacrum.
5. Coccyx: coccyx bones occupy the bottom of the spinal column, which is also called the tailbone.
Appendicular Skeleton
Bones that comprise the appendicular skeleton anchor the appendages to the axial skeleton.
• The upper Extremities: the arm, the forearm, and the hand comprise the upper extremity.
(i) The Arn1 - also called brachium, the arm is the region found between the shoulder and the elbow. The humerus is the long bone of the arm
and is the longest bone of the upper extremity. The head, or top, of brachium is large, smooth, and rounded, fitting into the scapula in the
shoulder. Two depressions are found at the bottom of humerus. The humerus is connected to the ulna and radius of the forearm at the
depression. Radius and ulna together make up the elbow.
(ii) The Forearm: the region between the elbow and the wrist. The radius on the lateral side and ulna on the medial side form the forearm
when viewed in the anatomical position. The radius, rather than the ulna, enables movement of the. The top of each bone connects to the
humerus of the arm and the bottom of each connects to the bones of the hand.
(iii) The Hand: comprised of 27 bones and three parts--wrist, palm, and five fingers.
1. Wrist: also called the carpus, the wrist is made up of 8 carpal bones. Carpal bones are bound together by ligaments. These bones in turn are
arranged into two rows of four each. The top row of bones (the row closest to the forearm) from the lateral (thumb) side to the medial side
holds the scaphoid, lunate, triquetral, and pisiform bones. Trapezium, trapezoid, capitates, and hamate form the second row from lateral to
medial sides.
2. Metacarpals: also known as the palm, comprised of five metacarpal bones, one aligned with each of the fingers. The metacarpals are
numbered from I to V starting with the thumb. Wrist bones are connected at the base of metacarpal bones and the bones of fingers are
connected to the heads. The heads of metacarpals form the knuckles of a clenched fist.
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rows. The first row is termed as proximal row, which is the closest row to the metacarpals. The second row is called the middle row, followed
by the distal row and is considered the farthest row. Similar to carpals, phalanges are numbered from I to V starting from the thumb. Each
finger is provided with prox mal phalanx, a middle phalanx and a distal phalanx, except the thumb, which does not contain a middle phalanx.
i
• The Lower Extremities: comprised of the bones of the thigh, leg, foot and patella.
1. The Thigh: the region between the hip and the knee. It is comprised of a single bone termed the femur or thighbone. It is the longest,
strongest, and largest bone in the human body.
2. The leg: the region between the knee and the ankle. The fibula and the tibia form the leg. The fibula is arranged facing away from the bone
and the tibia (shin bone) is arranged on the side nearest to the medial side of the body. Connecting tibia to the femur forms the knee joint.
The talus is a foot bone that rests on top of the calcaneus and is connected to tibia. Navicular bone is found in front of talus. Bones emerging
out from medial to lateral sides are the medial, intermediate, lateral cuneiform bones, and cuboid bone.
3 . Metatarsals and phalanges: bones of foot similar to bones of hand and are termed as metatarsals and phalanges. The metatarsals and
phalanges o f the foot are numbered I to V starting with the big toe. In order to support the body's weight, the first metatarsal bone is larger
than the others. The 14 phalanges of the foot, as with the hand, are formed in a proximal, middle and a distal row. It is also attached with the
big toe or hallux, which has only a proximal and distal phalanx.
4. The Patella: also called the kneecap, which is a large triangular sesamoid bone found between the femur and the tibia. It is formed in
response to the strain in the tendon forming the knee. The patella protects the knee joint. The bones of the lower extremities are considered
the heaviest, largest, and strongest bones in the body, as they are able to bear the entire weight of the body.
5. The shoulder and pelvic girdle: the shoulder girdle is also known as the pectoral girdle. It is an incomplete ring composed of four bones,
where two clavicles and two scapulae meet. The primary function of the shoulder girdle is to provide attachment points for numerous muscles
that allow the shoulder and elbow joints to move. It enhances the joint between the upper extremities (the arms) and the axial skeleton.
6. Clavicle: commonly known as the collarbone. It is a slender S-shaped bone connecting the upper arm to the trunk of the body. The clavicle
helps to hold the shoulder joint away from the body in order to allow freedom in movement. The sternum is connected to the clavicle at one
end and the scapula is connected to the other end.
7. Scapula: a large, triangular, flat bone on the backside of the rib cage. It is commonly known as the shoulder blade. The scapula serves as an
attachment for several muscles as the second rib is over layered through seventh rib. The glenoid cavity is a shallow depression found on the
scapula that serves as head of the humerus to fit in.
8. Pelvic Girdle: also termed as hip girdles. It serves several important functions in body. It is composed of two coxal (hip) bones, also known as
ossa coxae. The ilium, ischium and pubis are the three points forming the coxal bones during childhood. The three coxal bones are fused
together to form a single bone in adults. The two coxal bones meet on either side of the sacrum at the back. The weight of the body from
vertebral column is supported by pelvic girdle. It protects the lower organs are such as urinary bladder, reproductive organs, and the
developing fetus of pregnant woman. The 2 hipbones, the sacrum and the coccyx form the pelvis. Female pelvis is larger and wider than the
male pelvis that is taller and narrower.
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.Skull
Nasal bone
Zygomatic bone
Vomer bon
Maxilla
Mandible
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Nasal bone
The nasal bones are two small oblong bones.They occur in different size among individuals. They are
located in upper and middle parts of the face and provide bridge to the nose.
Zygomatic bone
Left and right zygomatic bones form cheek bones and portion of orbit.
Vomer bone
Vomer bones make part of nasal septum. This bone also divides between the nostrils.
Maxilla
The upper jaw bones are termed as maxilla. They also form part of nose, orbits as well as roof of
the mouth.
Mandible
The lower jawbone is termed as mandible. It forms free joint in head which can rotate at any
direction.
, . •·
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Rib�!
True ribs

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Anterior. vie
Ce.rvical vertebrae
The starting seven vertebrae are called cervical vertebrae found on the top of
the spinal column. These bones provide flexible framework for neck and
support to head.
Lumbar vertebrae
Five bones make up lumbar vertebrae which follows thoracic vertebrae. It is the
largest vertebrae in spinal column and balance the body weight.
I
Coccyx
Bottom of the spinal column 1s occupied by coccyx bones which is also termed
as tail bone..
Thoracic vertebrae
The next twelve joint bones following cervical vertebrae are called thoracic
vertebrae. The rear anchor of rib cage is formed by movement of these bones
with the ribs.
Sacrum
Triangular bone occurs below lumbar vertebrae. The back wall of the pelvic girdle is
formed by sacrum.
Frontal bone1------.!:-::=.��
1 Nasal bone }
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--------i Nasal bone
Temporal bone
Mandible
Frontal bone
This bone is simply human skuII and sin1ilar to cockle shell in structure and possess two portions.
Nasa[bones
The nasal bones are two small oblong bones and vary in size among indi viduals. They occur in
upper and midi!le part of the face and provides the bridge to the nose.
Temporal bone
It lies in the side portion of the skul! base. These bones support cerebrum part of the bone and
hence called temple.
Mandible
The mandible is simply the lower jaw or jaw bone. They form the skull with the cranium.
Coronal suture
It is basically connective tissue's joint that divides frontal and parietal skull bones. The skull bone
does not meet at birth.
Maxilla
The upperjaw fs called maxilla. Several bones make up maxllla by fusing together. It is placed in
front of and under the cranium.
•sternum
Jugular notch
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Manubrium

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Jugular notch
The juglar notch is also called suprasternal notch. It occurs in superior border of the manubrium
between clavicular notches. It is a large and visible dip.
Manubrium
The upper and broad part of the sternum is made by the manubrium sterni. Its shape is
quadrangular. It supports the clavicles and the first two ribs.
Xiphoid process
The xiphoid process is also called xiphisternum. The lower part of the sternum has small
cartilaginous extension. It modifies into strong bone in adult stage. ln new born babies the xiphoid
tip process is similar to lump and sternal notch.
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Clavicle_
It is commonly termed as collar bone. It is a slender S-shaped bone connecting
the upper arm lo the trunk of the body.
Acromion of scapula
Scapula is a large, triangular, flat bone on the back side of the rib cage.
It is commonly termed as shoulder blade.
Upper�
1.1,..;.��Humerus
Humerus
I
The reg ion found between the shoulder and elbow is termed as arm. Long arm bone is called
humerus. Radius and ulna together makes up the elbow,

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Bones making up the fingers are termed as phalanges. It is composed of 14 bones.
Metacarpal bones
It is also termed as palm. It is composed of five metacarpal bones, one aligned with each of the
fingers.
Carpal bones
Wrist is also called carpus made of8 bones called the carpal bones. Carpal bones are bound
together by ligaments.
Loweijl�
Tibia
Fibula
Metatarsals
Phalanges
Region between the hip and the knee is termed as thigh. It comprises a single bone termed as
femur or thlgh bone. The longest, strongest and the largest bone in the body is the femur.
Patella
It is afso called knee cap which is a large triangular sesamoid bone found between the femur and
I
the tibia.
Tibia and Fibula

The region form the knee to ankle is technically called the leg. Fibula and tibia forms the leg.
Metatarsals and Phalanges

Bones of foot similar tobones of hand are termed as metatarsals and phalanges.

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Pubic symphysis
They connect girdles in the front portion.
Coxalbone
It is nothing but the hip bone.
Notes
I Save Notes B I .S, U x, x' <& 1111 on <"' - = - Font Name Font S�e �-'/; i: :: :&

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Body structure and functions Functions of important parts and systems • Muscular System
Muscular System
Introduction

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The anatomical system, which enables movement, is termed the muscular system. Muscles are the contractile tissues of the body derived from
embryonic germ cells. The muscular system is controlled by the nervous system in vertebrates and few muscles work autonomously. The cells making
up the muscular system comprise muscle fibers. The functions of muscles include posture, balance, strength, movement and heart contraction.
Smooth muscles
Smooth muscle is involuntary under the control of the autonomic nervous system. The tissue ,s called smooth because the arrangement of the ,.,

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The anatomical system, which enables movement, is termed the muscular system. Muscles are the contractile tissues of the body derived from
embryonic germ cells. The muscular system is controlled by the nervous system in vertebrates and few muscles work autonomously. The cells making
up the muscular system comprise muscle fibers. The functions of muscles include posture, balance, strength, movement and heart contraction.
Sn1ooth muscles
Smooth muscle is involuntary under the control of the autonomic nervous system. The tissue is called smooth because the arrangement of the
myofibrils is homogenous and not striated. Smooth muscle tissue consists of long spindle-shaped cells with a single nucleus and is located on the
walls of hollow internal organs as they help contraction, especially in the digestive tract, bladder, uterus, blood vessel walls, and the respiratory
tract. Compared to other muscle types, smooth muscles contract slowly, do not fatigue easily and have sustained and prolonged contractions. Tonus
refers to a constant state of contraction as observed in blood vessels.
Cardiac n1uscle
Cardiac muscle is only found in the heart and is comprised of cells that mostly contain a single nucleus. It is involuntary under the control of the
autonomic nervous system. Cardiac muscle fibers appear striated, tubular, and branched, allowing fiber interlocking at intercalated disks.
Contractions spread quickly throughout the heart using the intercalated disks, which contain many gap junctions. These gap junctions allow ions to
flow freely and directly between cells, allowing coordinated muscle movement. Fatigue is prevented when the cardiac fibers relax between
contractions completely. Contraction of cardiac muscle is autonomous and rhythmical as it can occur without nervous stimulation from outside.
Skeletal muscle
Skeletal muscle contraction is voluntary, and is therefore under the control of the somatic nervous system. Striated muscle tissue composes the
skeletal muscle. It appears striated due repetitive arrangements of sarcomere units. Skeletal muscle fibers are tubular, striated, and are comprised
of long multinucleated cells. A whole muscle contains bundles of muscle fibers termed fascicles and a layer of connective tissue surrounds each
fascicle. Endomysium surrounds each muscle fiber and perimysium helps to bind muscle fibers into bundles termed as fascicles. These bundles then
group together to form muscle, enclosed in a sheath of epimysium. Skeletal muscles attach to bones through a dense connective tissue called
tendons.
Skeletal muscles fibers are composed of three types: fast twitch {II), slow twitch {I) and intermediate. Fast twitch fibers have a large diameter and
depend on anaerobic metabolism. Slow twitch fibers are smaller in diameter, contain high concentrations of myoglobin {gives red color), and contain
numerous mitochondria in order to perform aerobic respiration. Intermediate fibers resemble fast twitch because they contain little myoglobin but
resemble slow twitch because they contain more mitochondria than fast twitch. They are also called Type Ila fibers. The ratios of the three types of
fibers are determined genetically. Slow fibers are referred to as red muscle whereas fast fibers are often called white muscle.
Types of Muse le

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Types of Muse le
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Save Notes
Ire and functions Functions of important parts and systems Cardiovascular System
Cardiovascular System
Learning Objective:
• Understand the primary function of the circulatory system and its physiology.
• Trace the flow of blood through the heart
• Describe the structure of the heart.
• Describe the conducting system of the heart
• Compare/ contrast the structure and function of arteries, capillaries and veins.
Introduction
The cardiovascular system consists of the blood, heart and blood vessels and functions in the exchange of nutrients and chemicals between the
external environment and body cells. Humans have a closed circulatory system that means that the blood is confined to blood vessels. This
configuration allows for a higher blood pressure so blood can move by bulk flow through the arteries. Capillaries are the site of exchange (by
diffusion, filtration and osmosis) for materials between the blood and the interstitial fluid surrounding the cells.
The circulatory system is responsible for the transportation of water, nutrients, oxygen, hormones, and waste materials such as carbon dioxide and
urea throughout the body. The circulatory system plays a major role in cell metabolism by transporting nutrients from the intestine, oxygen from the
lungs to the entire body and by eliminating carbon dioxide from the body.
Physiology of circulation
The human heart is four-chambered and is considered a double pump. The cardiovascular system is comprised of the puln1onary, systen1ic and
coronary circulations. The pulmonary circuit consists deoxygenated blood traveling to the lungs from the right ventricle and returning to the left
atrium. The systemic circulation consists of the oxygenated blood traveling from the left ventricle to the rest of the body and returning to the right
atrium. Coronary circulation refers to the movement of blood in the blood vessels of the heart. Two types of valves, semilunar (SL) and
atrioventricular (AV), allow blood to flow only in one particular direction.
The following media (Heart) explains about the Heart:

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Passage of blood through the heart:
• Oxygen-depleted blood enters the right atrium through the superior and inferior vena cava. The superior vena cava returns blood from parts
of the body located above the heart, and the inferior vena cava returns blood from parts of the body located below the heart.
• Deoxygenated blood enters the right atrium, moves through the tricuspid valve, and enters the right ventricle.
• When contraction occurs, blood in the right ventricle passes through the pulmonary valve and enters the pulmonary arteries. The arteries
continue in smaller and smaller vessels until they reach the lungs.
• Blood reaches the capillaries lining the alveoli, participating in gas exchange by trading carbon dioxide for oxygen.
• The newly oxygenated blood then goes into pulmonary venules, then into pulmonary veins, which then transport the blood to the left side
of the heart. It then travels into the left atrium, through the mitral valve, and into the left ventricle.
• When contraction occurs, blood in the left ventricle passes through the aortic valve and into the aorta. Blood then travels to arteries,
arterioles, and then capillaries.
• The oxygenated blood participates in gas exchange at the capillaries.
• Deoxygenated blood enters the venules, and into the larger veins. Eventually, the deoxygenated blood enters the superior vena cava or the
inferior vena cava to enter the right side of the heart.
The following media (Cardiac Cycle) explains about the Cardiac Cycle:
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In humans, the heart contracts (systole) and relaxes (diastole) about 70 times a minute. Each heartbeat lasts about 0.85 seconds. A familiar lubb
dupp sounds occurs when the valves close. Vibrations occurring when ventricles contract leading to atrioventricular valve closure cause the lower
long-pitched "lubb". The shorter and sharper "dupp" occurs when semilunar valves close when the ventricles relaxes. A heart murmur or a slight
swishing sound after lubb occurs which is due to leaky valves, which allow blood to pass back into the atria after the atrioventricular valves have
closed.
Since the left ventricle requires greater pressure to pump, its walls are thicker than the right ventricle (which pumps blood across a shorter
distance). Thus, blood pressure is greatest in the aorta. It then decreases as the total cross-sectional area of arteries and then arterioles increases.
Intrinsic control of heartbeat

The intrinsic control of heartbeat leads to rhythmic contraction of the atria and the ventricles. The two types of nodes found in the human heart are
the sinoatrial node (SA node) and the atrioventricular node (AV node). The SA node is positioned in the upper dorsal wall of the right atrium and
the AV node is found at the base of the right atrium, near the septum. The SA node is termed as the pacemaker of the heart as it helps to
maintain regular heartbeat by generating an impulse.
The heartbeat is initiated by the excitation impulse passed on from the SA node every 0.85 seconds. This excitation impulse causes the atria to
contract. Slight delays are observed when the impulse reaches the AV node that allows the atria to finish their contraction before the ventricles
begin their contraction. Ventricles contract after receiving impulse from the AV node through two branches of atrioventricular bundle (AV bundle)
before reaching the numerous and smaller Purkinje fibers. The AV bundle, its branches, and the Purkinje fibers are comprised of specialized cardiac
muscle fibers that efficiently cause the ventricles to contract.
head and arms ----
jugular vein
(also subclavtan - Carotid artery
vein from arms)
(also subdavi&n artery to
arms)
Superior vena cava ---'io�:.;� ��,:rlli�-;---- Pulmonary vein

"'\;i'lt---Aorta
{nferior vena cava ---+
. ·--·"'-····-
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head and arms ----

jugufar vein
(also subdav1an -
�i>s--c..::irotid artery
vetn from arms}
( also sutx:1.::ivian artery to
arms)
r nferior vena cava -- -j.
Hepatic vein
Uver
Hepatic portal vein
Renal vein
Iliac vein
�""'<---Iliac artery
co, ,..----o,
Trunk and legs
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Extrinsic control of heartbeat

The body has an extrinsic way in regulating the heartbeat. Cardiac control center is present in the medulla oblongata, a portion of the brain that
helps control the internal organs. The heartbeat is controlled by the autonomic nervous system, which is divided into the sympathetic and
parasympathetic nervous systems. Signals from the sympathetic nervous system speed up the heart rate and increase contractility of cardiac
muscle. Parasympathetic signals slow down the heart via decreases in SA and AV nodal activity.
Blood Vessels
Learning objective:
• Identify the different types of blood vessels and their unique functions.
• Be able to understand the physiological similarities and differences among the different vessels
Arteries
The artery has three layers or tunics. The innermost layer of an artery (tunica interna) is made up of simple squamous epithelial cells called
endothelium. A thick layer of smooth muscle fibers and elastic connective tissue makes up the middle layer (tunica media) of an artery. The outer
layer (tunica externa) is relatively thin and is made up of connective tissue and elastic fibers.
Arteries transport blood away from the heart to the lungs and other organs in the body. The support to an artery under pressure is provided by the
strong architectural walls, which are muscular and elastic in nature. When pressure is created in the blood vessels the elastic tissue helps them to
expand in order to absorb the pressure.
Arteries branch into arterioles, which hold similar structural features as that of the artery. The middle layer is composed of smooth muscle and is
elastic in nature. The vessel constricts when these muscle fibers contract. On the contrary, when the vessel dilates, these muscles relax.
Constriction and dilation of arterioles have a direct effect on blood pressure. The greater the number of vessels dilated, the lower the blood
pressure.
Capillaries
Arterioles branch into capillaries, which are extremely narrow, microscopic structures. Capillaries are composed of one-cell thick walls made up of
endothelium along with a basement membrane. The thin walls of the capillary mean that gases, nutrients, hormones, and wastes can easily diffuse
through. Capillary beds are present in all regions of the body. In the tissues, only certain capillary networks are open at any given time. Since
capillaries are delicate, damages to them can cause blood to leak into the interstitial space, giving rise to bruises.
Veins
Veins are thin vessels that return blood from the body to the heart. They have larger lumens and thinner tunica media than arteries. Blood in the
capillaries is drained by the venules, which are smaller venous structures that rejoin to form veins. Walls of the veins are similar to the arteries in
that they contain three layers. However, veins contain less smooth muscle and less elastic tissue than arteries. The thinner walls of veins give them
far less elasticity than arteries.

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Blood pressure
Learning Objectives:
• Understand the importance of maintaining blood pressure at a proper level.

• Learn the mechanisms through which the body maintains a sufficiently high blood pressure.
Blood pressure is the pressure exerted by blood against the wall of a blood vessel. A sphygmomanometer is used to measure blood pressure. Blood
surges to the arteries causing the elastic walls to stretch but then immediately recoil. This rhythmic expansion and recoil of an arterial wall can be
felt as pulse in artery running close to the body's surface. Normally the pulse rate indicates the rate of heartbeat because the arterial walls pulse
when the left ventricle contracts. The pulse rate is usually 70 beats and can vary from 60 to 80 per minute among individuals. Normal resting blood
pressure, expressed as a ratio of the systolic and diastolic pressures, for a young adult is 120 mm Hg over 80 mm Hg, and can be represented as
120/80. Blood pressures vary throughout the body and are highest in the aorta and lowest in the vena cava.
Blood pressure must be adequately high so that blood may be pumped forward, so information regarding blood pressure is important to assess the
effectiveness and function of the circulatory system.
Baroreceptors, which are neurons that sense pressure changes, regulate blood pressure in the walls of the vasculature by responding to changes
in arterial wall tension. When blood pressure is low, baroreceptors trigger vasoconstriction by stimulating the sympathetic nervous system.
i
Chemoreceptors are also involved in the regulation of blood pressure. During t mes of dehydration when the osmolarity of blood is high, ADH
(antidiuretic hormone) is released, causing the reabsorption of water. This causes an increase in blood volume, and therefore, blood pressure.
Cardiac Cycle and the ECG

• understand the purpose and function of an ECG.

• Identify the PQRS waves and what they represent.
Regulation and Detection of Cardiac Activity

Definition
The Electrocardiogram (ECG) machine is a medical device that records the electrical activity of the heart. It is externally recorded using the skin
electrodes. Excitation spreading through the myocardium produces local electrical potential. It causes small currents to flow through the body. A
suitable electrode can collect these currents in the form of electrocardiogram.
Clinical use
ECG is useful in determining and diagnosing the following:
• Abnormal rhythms of the heart.

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• Heart rate, arrhythmias, abnormal electrical conduction
• Poor blood flow to heart muscle and damage to the conductive tissues
• Heart attack, coronary artery disease.
• Hypertrophy of the heart chambers.
Disorders and Treatments

Learning objectives:
• Understand how blood lipids are implicated in cardiovascular diseases.

• Learn about common cardiovascular disorders and treatment options.
Important terminology:
a- Blood Lipids
Blood lipids are found either free or bound to other molecules. Blood lipids are composed of: cholesterol, high density lipoprotein, low density
lipoprotein, very low density lipoprotein, free fatty acid, chylomicrons, and triglycerides.
b- Cholesterol
The word cholesterol comes from a Greek word (chole - bile; stereos - solid). It is a waxy steroid metabolite present in the cell membranes and
lipoproteins of humans, as well as animals. It is transported in blood plasma.
The following media (Cholesterol) explains about the Cholesterol:

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C. Lipoprotein
The molecular complexes that consist of lipids and proteins are called lipoproteins. It is a typical example for conjugated proteins. They serve as
transport vehicles for lipids such as cholesterol, triacylglycerol etc. in blood plasma and deliver them to various tissues for utilization.
d. Triacylglycerol
An ester compound composed of a glycerol bound to three fatty acids. Vegetable oil and animal oil are the major source of triacylglycerol.
Lipids Levels:
Cholesterol chart for adults
Total cholesterol HDL cholesterol
Good Less than 200 (but Ideal is 60 or higher; 40 or higher

the lower the better) for men and 50 or higher for
women is acceptable
Borderline to Moderatelv elevated 200-239
150-199 Hi.ah 240 or hiaher
200 or higher; 500 Low n/a

considered verv hiah
POINTS TO REMEMBER SUMMARY
Nates
... ·- ·- ........
II P
• m
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Save Notes
Ire and functions Functions of important parts and systems Respiratory System
Respiratory System
Introduction
The respiratory system is primarily involved in the exchange of gases (carbon dioxide and oxygen) between the atmosphere and the blood that
provides oxygen to the cells and removes carbon dioxide produced by aerobic respiration. It is also involved in other important life functions such as
pH regulation, thermoregulation, and defense against pathogens. A series of structures allow for air to be conducted to the lungs by bulk flow. In the
lungs, gas exchange occurs by diffusion. The conducting zone includes the structures that carry air from the outside to the lungs and the
respiratory zone is the site of gas exchange in the lungs.
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Humans need a continuous supply of Oxygen for cellular respiration & they must get rid of excess carbon dioxide, the poisonous waste product of
this process.
Gas exchange supports this cellular respiration by constantly supplying oxygen & removing carbon dioxide
Oxygen required for respiration is obtained from Earth's atmospheric air, which is 21 °/o oxygen.
This oxygen in the air is exchanged in the body by respiratory surface provided by the Alveoli in the lungs.
The organs of the respiratory system can be divided into two groups. The upper respiratory tract consists of the nose, nasal cavity and pharynx.
The lower respiratory tract includes the larynx, trachea, bronchial tree, and lungs.
Air enters the respiratory tract through the nose and travels through the nasal cavity where it is filtered and warmed by mucous membranes and
nasal hairs (also called vibrissae). Olfactory receptors are also present on the walls of the nasal cavity. The humidified air then reaches the pharynx,
which is located behind the nasal cavity and at the back of the mouth. The pharynx is common to both the digestive and respiratory systems and
functions as a pathway for air traveling to the lungs and food entering the esophagus. The epiglottis is an elastic cartilaginous flap that closes to
keep food out of the respiratory tract. During swallowing, the larynx rises and the epiglottis covers the opening into the larynx. Two vocal cords are
present in the larynx that vibrates when air passes between them.
The trachea or windpipe is a flexible tube that extends from the larynx into the thoracic cavity where it divides into the right and left primary
bronchi. Cartilaginous rings are open posteriorly and function to maintain the rigidity of the trachea.
Within the lungs, the bronchi branch further into smaller structures called bronchioles. Bronchioles divide further until they end in small grape-like
structures called alveoli, where gas exchange occurs. Alveoli are therefore considered the functional unit of the lungs. Surfactant is a detergent-like
substance that prevents the alveolus from collapsing by lowering the surface tension. A web of blood capillaries surrounds each alveolus to carry
oxygen and carbon dioxide. The extensive branching and small size of the alveoli mean that there is a large surface area for gas exchange. The right
lung is divided into three lobes whereas the left lung has two lobes.
There are two types of cells that form the epithelial tissues of alveoli: Type I and Type II. Alveolar cells are also known as pneumocytes. Type I
alveolar cells are the thin squamous epithelial cells that line the alveolus and form the site of gaseous exchange between the alveolus and blood.
Type II alveolar cells are interspersed among the type I cells and they release the alveolar fluid and surfactant. Alveolar macrophages are found in
alveoli and function to engulf foreign particles including bacteria.
A layer of membrane called the visceral pleura is attached to each lung and folds over to form the parietal pleura that attaches to the inner wall of
the thoracic cavity. The space between these membranes is called the pleural cavity and it contains pleural fluid. This fluid functions to reduce
friction and to assist lung expansion.
The Upper and Lower Respiratory Tract
Structure Description
Nares

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The Upper and Lower Respiratory Tract
Structure Description
Nares
Structure Description Function

Pharynx

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< Prev Next > Progress : 100% HIGHLIGHT REMOVE HIGHLIGHT CALCULATOR CONVERTER
Body structure and functions Funct ions of important parts and systems Respiratory System
Respiratory System
Introduction
The respiratory system is primarily involved in the exchange of gases (carbon dioxide and oxygen) between the atmosphere and the blood that
provides oxygen to the cells and removes carbon dioxide produced by aerobic respiration. It is also involved in other important life functions such as
pH regulation, thermoregulation, and defense aga inst pathogens. A series of structures allow for air to be conducted to the lungs by bulk flow. In the
lungs, gas exchange occurs by diffusion. The conducting zone includes the structures that carry air from the outside to the lungs and the
respiratory zone is the site of gas exchange in the lungs.
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Structure
Pharynx

Larynx
Thyroid ...
bone

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The following media explains about the respiratory tract:

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; .....: . ·) "�
•
: . ·�·
(
Primary bronchi
Secondary bronchi
Cardiac not
718082

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--------------------------------------------------------------------
HIGHLIGHT REMOVE HIGHLIGHT CALCULATOR I
CONVERTER
CIRCULATION OF BLOOD
IN DIFFERENT ORGANS
..,.........
Veins of the head and trunk
Superior sagittal sinus
't---- Facial
Veins of the upper limb
Subdavian vein
Axillary vein
Cephaltc vein
Basilic vein Splcnic
Right pulmonary
Median cubltal vein - ---'
lnfeflor mesente,lc
lnfcr'ior vcnacavc
Superior mesenteric
Hepatic
Hepatic portal
Femoral vein
Great saphenous vein Left common iliac
Poplitcal vein Internal 11iac
Antertor tlblal
Posterior tlblal -------+:-;II.
Small saphenous
Fibular -------iH
718082
MAJOR VEINS
Ax111ary vein
Cephalic vein
Srachial vein Brachia! artery
Basilic vein <---,e\l'i-\1r-----Abdomlnal aorta
Real vein -- F==;lf:J�+-:= �-+-ll�',-----Renatartery

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MAJOR VEINS /'"
I Lt....... >,.
��11>.
Vfl)A
11--------Jntemal & EX'temal carotlcf''ti't'ery
Axillary vein
Cephalic vein
8raehial vein Srachial artery
Basilic vein .,_--,e\Pi-\1,-- ---- Abdom!nat aorta
Real vein --,==I 11>--f-!l!\;l,',-----Renalartery
Ulnar art
ery
Median cubital vein--' �--Radial artery
:
EE Common iltac artery
l�
:\�!
� l,-1-l
Internal iliac artery
;:::
-��,;:>,,---Extemal ll!ac artery
IIl !H--,fft\\----oeep femoral artery
;
Femoral vein ------*'-'� "',-Hf-------Femoral a1tery
Popllteal veln ------4,f\

1<+1-------Popliteal artery
Peroneal vein -------1-'!il �+-------Peroneal artery

I f,,11f--------Poster1or tlblal arte,y
Great saphenous vein --------t.\'.ll
I'
·-Artery •-Vein
718082
SUMMARY
Notes
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Body structure and functions Functions of important parts and systems Nervous System
Nervous System
Learning Objectives
• Describe the organisation o f the central nervous system.

• Describe the function and structure of the spinal cord.
• Compare the central and peripheral nervous systems.
• Compare the functions of the somatic and autonomic nervous systems, and the subdivisions of sympathetic and parasympathetic nervous
systems.

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Central Nervous System

The central nervous system is composed of the brain and the spinal cord.
The Spinal Cord

The spinal cord runs through the vertebral canal of the vertebral column, from the foramen magnum superiorly to the level of Ll or L2 inferiorly. The
spinal cord is involved in the sensory and motor innervation of the entire body inferior to the head via spinal nerves. It provides a two-way
conduction pathway for signals between the body and the brain, and additionally acts as a major reflex center. At its inferior end, the spinal cord
tapers into a long filament of connective tissue covered with pia mater, the filum terminale ("terminal filament"), which attaches to the coccyx. This
attachment anchors the spinal cord in place.
Thirty-one pairs of spinal nerves (PNS structures) arise from the spinal cord as nerve roots. They exit through the intervertebral foramina and travel
through the body. The spinal cord exhibits cervical and lumbar enlargements where the nerves serving the upper and lower limbs arise. Because the
cord does not reach the inferior end of the vertebral column, the lumbar and sacral nerve roots must descend for some distance before reaching
their intervertebral foramina. This collection of nerve roots at the inferior end of the vertebral canal is the cauda equine ("horse's tail").
The spinal cord proceeds down from the brainstem and is divided into four divisions: cervical, thoracic, lumbar, and sacral. It consists of white and
grey matter; the former is on the outside of the cord, while the latter lies deeper within. Within the spinal cord are the axons of the motor and
sensory neurons. The sensory neurons enter on the backside (dorsal) of the spinal cord bringing information from the periphery. The dorsal root
ganglia house the cell bodies of the sensory neurons. On the other hand, the motor neurons exit the spinal cord via ventral side.
Spinal nerves
Spinal nerves are grouped according to the level from which they arise and are numbered in sequence, beginning with those in the cervical region.
Each spinal nerve arises from two roots: a dorsal (sensory) root and a ventral (motor) root.
The main branches or some spinal nerves form plexuses.

Cervical Plexuses: The cervical plexuses lie on either side of the neck and supply muscles and skin of the neck.
Brachia! Plexuses: the brachia! plexuses arise from the lower cervical and upper thoracic nerves and lead to the upper limbs.
Lumbrosacral Plexuses: The lumbrosacral plexuses arise from the lower spinal cord lead to the lower abdomen, external genitalia, buttocks, and
legs.
Internal structure of the Spinal cord

A cross-section of the spinal cord reveals that the cord is wider laterally than anteroposteriorly. The anterior median fissure and the posterior median
sulcus run the length of the spinal cord. They partly divide it into right and left halves. The spinal cord consists of an outer region of white matter
and an inner region of gray matter. The gray matter consists of a mixture of neuron cell bodies, short unmyelineated axons, dendrites and neuroglia.
The gray matter is organized into horns. Each half of the central gray matter consists of a relatively thin posterior horn and a larger anterior horn.
Small lateral horns exist in the thoracic region (the region associated with the autonomic nervous system). The two halves of the spinal cord are
connected by gray and white commissures. These commissures contain axons that cross from one side of the spinal cord to the other.
The white matter of the soinal cord is composed of mvelinated axons. These fibers allow communication between different oarts of the soinal cord "

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I ne wnice maccer or cne sp1na1 cora 1s composea or mye11nacea axons. 1 nese noers a11ow communicauon oecween 01rrerenc pares or cne sp1na1 cora
and between the cord and the brain. The white matter in each half of the spinal cord is organized into three columns, the ventral, dorsal and lateral
columns. Each column is subdivided into nerve tracts or fasciculi, also referred to as pathways.
Nuclei of the Spinal Cord

The grey matter of spinal cord is arranged in three horns. Anterior is motor, lateral being visceral efferent and afferent in function, and posterior is
sensory in function.
Nuclei of Anterior Grey Column or Horn

The anterior horn is divided into ventral part, the head and a dorsal part, the base. The nuclei in anterior horn innervate the skeletal muscles. The
cells in the anterior horns are arranged in the following three main groups
1. Medial group- innervate axial muscles of the body

2 . Lateral group- supplies muscles of limbs
3. Central group - only in upper cervical segments as phrenic nerve nucleus and nucleus of spinal root of accessory nerve.
Nuclei of Lateral horn

Anteromedial nucleus:
1. From Tl -L2 segments, giving rise to preganglionic sympathetic fibers

2. From 52- 54 segments giving rise to preganglionic parasympathetic fibers chiefly for the pelvic viscera.
Nuclei in Posterior grey column
1. Posteromarginal nucleus - receives some of incoming dorsal root fibers

2. Substantia Gelatinosa - acts as a relay station for pain and temperature fibers and is concerned with sensory associate mechanism
3. Nucleus Proprius - concerned with sensory associate mechanism
4. Nucleus Dorsalis - relays nuclear column for reflex or unconscious proprioceptive impulses to cerebellum.
Tracts of the spinal cord

A collection of nerve fibers that connects two masses of grey matter within the central nervous 1s called the tract. Tracts may be ascending or
descending.
s_no Name Function Crossed uncrossed Spinal Beginning 1st

seoment termination
THE Lateral cortico Main motor crossed Cl- SS Motor area Anterior
ASCENDING spinal tract tract of cortex grey column
TRACTS (upper cells alpha
neurons) motor

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,-
S.no Name Function Crossed uncrossed Spinal Beginning 1st
seqment termination
THE Lateral cortico Main motor crossed Cl- SS Motor area Anterior
ASCENDING spinal tract tract of cortex grey column
TRACTS (upper cells alpha
neurons) motor
Al. neurons
A2. Anterior Main motor uncrossed Cl- SS Motor area Anterior

corticospinal tract of cortex grey column
tract (upper cells alpha
neurons) motor
neurons
81. Rubrospinal tract Efferent crossed CI- CS Red Anterior

pathway for nucleus of grey column
cerebellum midbrain cells
and corpus
stratum
82. Medial reticule Extra Uncrossed Cl- SS Reticular Anterior

spinal tract pyramidal formation grey column
tract mainly of grey cells (inter
matter of neurons)
oons
83. Lateral Extra crossed Cl- SS Reticular Anterior

reticulospinaltract pyramidal formation grey column
tract of grey cells (inter
matter of neurons)
medulla
oblonoata
84. Olivospinal tract Extra uncrossed CI- CS Inferior Anterior

pyramidal olivary grey column
tract nucleus cells
BS. Vestibulospinal Efferent uncrossed Cl- SS Lateral Anterior

tract pathway for vestibular grey column
equilibratory nucleus cells
control
86. Tectospinal tract Efferent crossed CI- CS Superior Anterior

pathway for colliculus grey column
visual cells
reflexes
S.no Name Function Crossed uncrossed Spinal Beginning 1st termination

seoment
. . . . . . - -
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s_no Name Function Crossed uncrossed Spinal Beginning 1st termination

S""'ment
1 Lateral Pain and crossed Cl- SS Substantia Posterolateral

spinothalamic temperature gelatinosa of
from opposite posterior ventral nucleus of
half of body qrev column thalamus
2 Anterior Touch (crude) crossed Cl- SS Posterior Posterolateral

spinothalamic and pressure grey column
from opposite of opposite ventral nucleus of
half of bodv side thalamus
3 Fasciculus Conscious Uncrossed SS-T7 Dorsal root Nucleus gracillis

gracillus proprioception, ganglion
discriminatory cells
touch
4 Fasciculus Vibratory Uncrossed Tl-TS Dorsal root Nucleus cuneatus

sense ganglion
cuneatus Stereoqnosis cells
s Posterior Unconscious Uncrossed Cl- L2 Thoracic Vermis of

spino proprioception nucleus of cerebellum (via
cerebellar to cerebellum posterior inferior cerebellar
qrev column peduncle)
6 Anterior Cerebellum crossed CI- L2 Posterior Vermis of

sp1no adjustments of grey column cerebellum (via
cerebellar muscle tone same side inferior cerebellar
peduncle) via re-
crossina
7 Spino- Proprioceptive uncrossed Cl- SS Posterior Dorsal and medial

olivary sense grey column accessory olivary
nuclei
8 Spinotectal Afferent limb crossed CI- C6 Posterior Tectum or superior

of reflex grey column colliculus of mid
movements of of opposite -brain
eyes and head side
towards
source of
stimulation
Peripheral Nervous System

The peripheral nervous system consists of nerve tissue and fibers outside the brain and the spinal cord. It is divided into the somatic and autonomic
nervous systems and connects the central nervous system to the rest of the body.
Somatic Nervous System

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L�l��
. . l ====""-'----'-��.,__�----'��
stimulation .l.__��--'I.
Peripheral Nervous System

The peripheral nervous system consists of nerve tissue and fibers outside the brain and the spinal cord. It is divided into the somatic and autonomic
nervous systems and connects the central nervous system to the rest of the body.
Somatic Nervous System

The somatic nervous system is comprised of sensory and motor neurons and is associated with voluntary muscle movement and involuntary reflex
arc. Sensory neurons transmit information through afferent fibers whereas motor impulses travel along efferent fibers.
The Autonon1ic Nervous System

The autonomic nervous system is in control of involuntary activities such as heartbeat, digestion, glandular secretions, and respiration. Additionally,
the ANS activates sweating to regulate body temperature and piloerection (goosebumps). Such functions are automatic, or outside of conscious
control.
It is important to note the difference between the somatic and autonomic nervous systems. There are two neurons in the peripheral portion of the
autonomic nervous system, whereas the motor neuron in the somatic nervous system travels directly from the spinal cord to the muscle without
synapsing. In the autonomic nervous system, two neurons exist to send messages from the spinal cord. The first is known as the preganglionic
neuron, whose soma is in the CNS and axon extends to a ganglion in the PNS. There it synapses on the cell body of the second neuron, which is
known as the postganglionic neuron. The postganglionic neuron affects the target tissue.
The autonomic nervous system is divided into the parasympathetic and sympathetic nervous systems:
The parasympathetic nervous system acts primarily to conserve energy by reducing heart rate, constricting the bronchi, and increasing peristalsis
and exocrine secretions. Both the preganglionic and postganglionic neurons release acetylcholine, the primary neurotransmitter associated with
i
parasympathet c responses. The parasympathetic portions of the thoracic and abdominal cavities are innervated by the vagus nerve. The functions
of the parasympathetic nervous system include:
• Constricts pupils
• Stimulates flow of saliva
• Constricts bronchioles
• Slows heartbeat
• Stimulates peristalsis and secretion
• Stimulates bile release
• Contracts bladder
The sympathetic nervous system, on the other hand, is associated with "fight-or-flight" reactions. Preganglionic neurons release acetylcholine. The
postganglionic neurons release norepinephrine. The functions of the sympathetic nervous system include:
• Tnrro::ioeoe ho:iort- r:iot-o

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The sympathetic nervous system, on the other hand, is associated with "fight-or-flight" reactions. Preganglionic neurons release acetylcholine. The
postganglionic neurons release norepinephrine. The functions of the sympathetic nervous system include:
• Increases heart rate

• Redistributing blood to muscles of locomotion
• Increasing blood glucose concentration
• Dilates bronchioles
• Inhibits digestion and peristalsis
• Dilates the eyes to maximize light intake
• Releases epinephrine into the bloodstream
Olfactory
Optic II
� Oculomotor
Trochlear
Trigeminal
Abducens v
Facial VII
Vestibulocochlear III
Glossopharyngeal IX
Vagus x
Accessory

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T= Inhibition
Stimulates
flow of saliva Inhibits flow Constrict pupil Dilates pupil
of saliva

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Dilates bronchi
00 •
Glycogen > Glucose
Stimulates Conversion of
release of bile glycogen to glucose
Inhibits bladder
Contracts bladder contraction

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Inhibits bladder
Contracts bladder contraction
Nervous systen1 diseases
• Alzheimer's disease. Alzheimer's disease affects the brain functions, memory and behaviour
• Bell's palsy. Bell's palsy is a sudden weakness or paralysis of facial muscles on one side of the face
• Cerebral palsy
• Epilepsy
• Motor neurone disease (MND)
• Multiple sclerosis (MS)
• Neurofibromatosis
• Parkinson's disease
Notes
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Body structure and functions Functions of important parts and systems Digestive system and abdomen
Digestive System
• Identify the major organs and accessory organs of the digestive system
• Describe the functions of the enzymes involved in digestion of food
Introduction
The digestive system consists of the major organs and accessory organs that convert complex organic molecules into a simpler form that can be
absorbed. It includes a series of organs forming a hollow tube called the gastrointestinal tract. It extends from the mouth to the anus. The path of
the gastrointestinal tract starts with mouth followed by pharynx, esophagus, stomach, small intestine, large intestine, rectum, and the anus. The
space formed in the gastrointestinal tube is called the lumen and helps to pass food and liquid. The whole of the gastrointestinal tract has certain
structural characteristics in common.
Generally, the alimentary canal starts with mouth, which contains different types of teeth. The following animation will discuss the structure, types,
and function of teeth.
Crown
Dentine
Gum
Pulp cavity
Cement
Root
Bone

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- Main section of the tooth and is a strong bony tissue
- Protects the jaw bone and roots of teeth
Pulp cavity - Serves as nerve endings connect to brain
Cement - Rough covering which has periodontal fibers and hold the tooth in place
Bone - Acts as sockets for teeth I

Crown - Exposed part of tooth I
Root - Part embedded in jaw I
(c) Ed Media, LLC., 2014
Pre,nolar Molar

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Ptemolar Molar I
Mllkteeth •• • ••
Permanent teeth •• ••
Function
Proper digestion of food depends on the enzymatic functions of the various secretions found throughout the digestive system. These secretions help
digest the macromolecules of food by breaking them into smaller molecules and facilitating their absorption. Various organs located in digestive tract
secrete digestive enzymes including the mouth, stomach, pancreatic, and intestinal cells. The accessory organs consist of the salivary glands,
gallbladder, liver, and pancreas.
The digestive enzymes target different substrates. Digestive enzymes are classified based on their target substrates:
• Proteases and peptidases split proteins into their monomers, amino acids.
• Upases split fat into three fatty acids and a glycerol molecule.
• Amylases split carbohydrates such as starch into simple sugars.
• Nucleases split nucleic acids into nucleotides.

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------ Salivary Glands

I
Oral cavity-----..:,
k,�-.,---------Pharynx
<E------"r-- Oesophagus
Liver -+----+.�
�---- Stomach
Ga11 bladder- - ---'
- ,-�
�---- Spleen
Pancreas-----+-
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C=,t'§'ij----- Large intestine
·�H�,----- Small intestine
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The following media explains about the Digestion in humans:
Digestion
in Humans
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Oral Cavity
Major Salivary Glands
Three pairs of major salivary glands and some minor salivary glands secrete saliva in the human body. They occur in pharyngeal mucous membrane.
Some important salivary glands are the parotid, submaxillary (or submandibular), and sublingual glands.
• Parotid Glands: the largest salivary glands present. These glands are located in the face just below and in front of the ear. Each gland weighs
between 20 to 30 grams. The oral cavity receives saliva secretions from these glands. A duct named Stensen's duct passes saliva to the oral
cavity. This duct opens at the side of the upper second molar tooth.
• Submaxillary Glands: also known as the submandibular glands. These glands occur in the submaxillary triangle medial to the mandible. The
weight of the gland varies from 8 to 10 grams. Saliva from these glands empties into the oral cavity through Wharton's duct. This duct opens
at the side of frenulum of tongue by a small opening on the summit of papilla called caruncula sublingualis.
• Sublingual Glands: the smallest of the major salivary glands. These glands are located in the floor of the mouth. Each gland weighs between
2 and 3 grams. There are small ducts called the ducts of Rivinus that obtain salivary secretions from the sublingual glands and provide saliva to
the underside of the tongue.
Minor Salivary Glands
• Lingual mucous glands: present on the posterior side of the tongue behind the circum vallate papillae.
• Lingual serous glands: present in the submandibular gland, and to a lesser extent, on the sublingual gland. These glands secrete enzymes
such as alpha-amylase.
• Buccal glands: situated between the mucous membrane and the buccinatory muscle. Four of five of these glands are also present outside of
the buccinators around the parotid ducts.
Saliva
Composition: Saliva is composed of 95.5°/o water and 0.5°/o solids, which include enzymes and other organic substances. These components include
amylase, lingual lipase, lysozyme, lactoferrin, secreted Ig A, phosphatases, carbonic anhydrase, and kallikrein. Organic substances present in saliva
include proteins, blood group antigens, free amino acids, nonprotein nitrogenous substances such as urea, uric acid, creatinine, xanthine, and
hypoxanthine. Inorganic substances present include sodium, calcium, potassium, bicarbonate, bromine, chloride, fluoride, and phosphate.
Functions: Saliva performs several vital functions in the digestive system:

1- Preparation of food for swallowing-
Saliva moistens food and enables easier chewing and swallowing. The moistened and masticated food is rolled into a bolus, which is lubricated by the
mucin of saliva.
2- Appreciation of taste

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mucin of saliva.
2. Appreciation of taste
As the solid food is broken down by salivary action, the dissolved substances stimulate the taste buds, enabling the sensation of taste.
3. Digestive function
Saliva aids digestion via three digestive enzymes, which are salivary amylase, maltase, and lingual lipase. Salivary amylase and maltase digest
carbohydrates while the lipase digests fat.
4. Cleaning and protective function

Constant secretion of saliva ensures that the mouth and teeth are rinsed and kept free of food debris. Epithelial cells and foreign particles are
removed due to salivary secretions. Saliva prevents bacterial growth ,n the mouth: an enzyme called lysozyme kills bacteria of the genera
Staphylococcus, Streptococcus, and Brucella present in the mouth.
5. Role in speech
The lubrication provided by saliva moistens the mouth and aids speech by enabling better pronunciation.
6. Excretory function
Substances such as mercury, potassium, iodide, lead, and thiocyanate are removed by saliva in the body. Salivary secretions also remove viruses
that cause rabies and mumps. During nephritis, excessive urea gets excreted in saliva. When hyperparathyroidism occurs excess calcium also is
removed through the saliva.
7. Regulation of water balance

During periods of dehydration, the body minimizes salivary secretions, which induces the feeling of thirst.
The following media explains about the Functions of saliva:
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Function of salivary glands

Salivary glands in the mouth secrete an array of substances.
• Potassium bicarbonate (KHC03): Neutralizes acid and enhances preservation of dentin and tooth enamel. It also balances bacterial
toxins. Bicarbonate prevents acid damage this is caused in esophageal lining before food enters the stomach.
• Lingual lipase: With the help of this enzyme lipid digestion begins in the mouth .
• Amylase: Enzyme produced by the salivary glands that breaks down complex carbohydrates to smaller links or even simple sugars. The other
name of the amylase is ptyalin.
I
• Mucin: Functions mainly to make food more pliable by lubricating the content.
• Lysozyme: the bacteria and viruses in food are killed by lysozyme. Lysozyme therefore serves beneficial anti-septic function in digestion.
• IgA: A sort of dimeric form of antibodies produced by the body. Gastrointestinal tract makes IgA mainly to battle bacterial toxins and virus.
• Haptocorrin: also known as R -factor. Haptocorrin has an important function: protecting vitamin 812.
The following media explains about the Mouth and buccal cavity:

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Pharynx
The pharynx extends from the mouth and back of the nasal cavity to the esophagus. This cavity is also connected to the larynx. Composed of the
nasopharynx, oropharynx, and the laryngopharynx, the pharynx serves an important role in the ingestion of food by connecting the oral cavity with
the larynx and esophagus. The epiglottis is a flaplike structure in the larynx that closes off the trachea so that that food does not enter the
respiratory tract.
Esophagus
The esophagus, which connects the pharynx and the stomach, is a muscular tube that is made of both skeletal and smooth muscle, and is therefore
under both somatic and autonomic nervous control. Peristalsis refers to the rhythmic contraction occurring in the muscle that allows food to travel
toward the stomach.

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The upper esophageal sphincter allows food that is swallowed to travel to the top of the esophagus. The lower esophageal sphincter (cardiac
sphincter) is found near the bottom of the esophagus and relaxes to allow food to enter the stomach.
+ Normal passage of food
+ Food inhaled down

windpipe
718082

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It is a 25 centimeter (10 inch) muscular tube connecting the

throat and stomach. It helps in the movement of the food in
rhythmic contractions of the muscles known as peristaltic
movement. It takes about 10 seconds to move the food
through the entire esophagus to stomach. The three main
parts of esophagus are cervical thoracic abdominal segments,
upper esophageal sphincter and lower esophageal sphincter.
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The following media explains about the Food Pipe:

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stomach
The stomach plays a major role in both mechanical and enzymatic digestion. It is a muscular organ that is characterized by its highly acidic
environment that facilitates the breakdown of food particles. It receives food from the esophagus, mixes it with various secretions, and moves the
food to the small intestine. The stomach is divided into the cardiac, fundic, body and pyloric regions. The pyloric sphincter controls gastric emptying
into the small intestine. The following secretions in the stomach play key roles in digestion:
• Pepsinogen: the main gastric enzyme produced by stomach cells. Chief cells secrete peps1nogen, which is the inactive zymogen form of
pepsin. Pepsinogen is cleaved to pepsin in the presence of HCI. Pepsindigests proteins found in food into smaller particles, such as peptide
fragments and amino acids. Protein digestion therefore begins in the stomach.
• Hydrochloric acid (HCI): HCI functions to denature the proteins ingested, to destroy any bacteria or viruses that remain in the food, and to
activate pepsinogen into pepsin.
• Intrinsic factor (IF): Intrinsic factor is a glycoprotein produced by the parietal cells of the stomach. Its main function is to enable the proper
absorption of vitamin 812.
• Mucin: The stomach must be able to destroy bacteria and viruses using its highly acidic environment while also protecting its own lining from
the acid. Mucin and bicarbonate serve to protect the stomach cells from the effects of an acidic environment.
• Gastrin: This is an important peptide hormone produced by the "G cells" found in the pyloric glands of the stomach. G cells produce gastrin in
response to stomach stretching occurring after food enters it, and also after stomach exposure to protein. Gastrin is an endocrine hormone
and therefore enters the circulation of blood and eventually returns to the stomach where it stimulates parietal cells to produce their
hydrochloric acid (HCI) and Intrinsic factor (IF). Gastrin stimulates the stomach to contract in order to mix its contents into an acidic mixture
called chyme.
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Duodenum
The duodenum is one of three segments found in the small intestine. While the other two segments, the ileum and the jejunum, are responsible for
absorption, the duodenum is responsible for chemical digestion.
When chyme leaves the stomach via the pyloric sphincter, it enters the duodenum for further chemical digestion. The key secretions that take part
in the digestive process in the duodenum are:
• Brush border enzymes: release of chyme into the duodenum stimulates the release of brush border enzymes, which are found ,n the cells
lining the duodenum. These enzymes include maltase, isomaltase, lactase, and sucrase, which break down disaccharides, maltose, isomaltose,
lactose, and sucrose, respectively.
• Peptidases: break down proteins or peptides.
• Enteropeptidase: an enzyme that activates trypsinogen to trypsin and procarboxypeptidases A and B to their respective active forms.
• Secretin: This is an endocrine hormone produced by the duodenal 'S cells" in response to the acidity of the gastric chyme. It acts to regulate
pH in the digestive tract by increasing bicarbonate secretion from the pancreas in order to counteract HCI secretion from parietal cells.
• Cholecystokinin (CCK}: CCK is a peptide hormone that functions to stimulate the release of pancreatic juices and bile. Bile is a fluid
comprised of cholesterol, bile salts, and pigments. Bile salts, which are derived from cholesterol, serve to emulsify fats and cholesterol into
micelles.
• Somatostatin 1s a hormone produced by the mucosal cells of the duodenum and also the "delta cells" of the pancreas. Somatostatin has a
major inhibitory effect on pancreatic juice production.
• Gastric inhibitory peptide (GIP}: This peptide decreases gastric motility and is produced by duodenal mucosal cells.
• Motilin: this substance increases gastro-intestinal motility via specialized receptors called "motilin receptors."

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718082

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Pancreas
The pancreas is both an endocrine and an exocrine gland. As an endocrine gland, it releases hormones such as insulin and glucagon, which are
necessary to maintain blood glucose levels and regulate glucose metabolism, in the body, into the bloodstream. As an exocrine gland, the pancreas
produces digestive pancreatic juice via acinar cells. Pancreatic juice is secreted eventually via the pancreatic duct into duodenum. This digestive
juice functions to break down all three classes of biomolecules (proteins, carbohydrates, and fats). It is made up of the following enzymes:
• Pancreatic amylase: breaks down larger polysaccharides into smaller subunits, and is mainly responsible for the digestion of carbohydrates.
• Pancreatic peptidases: include trypsinogen, chymotrypsinogen, and carboxypeptidases A and B. These are released initially in their zymogen
forms and are activated by enteropeptidase that is produced by the duodenum. Once activated, these peptidases are responsible for digesting
proteins.
• Pancreatic lipase: functions to breakdown fats into glycerol and fatty acids.
Liver
The liver produces bile that is important to digestion. Bile functions to break down fat globules into smaller droplets called emulsification. Enzymes
can digest the fat droplets more efficiently due to the larger surface area. Bile is produced in the liver, stored in the gall bladder and transported to
the small intestine through bile ducts.
Bile is comprised of cholesterol, bile salts, and pigments. Bilirubin is the ma,n pigment found in bile and is a byproduct of the breakdown of
hemoglobin. The daily amount of bilirubin resulting from the destruction of red blood cells is around 250�300 mg. Bilirubin splits to heme and globin at
first, then is further split to iron and biliverdin, before biliverdin is finally converted to bilirubin. Bilirubin combines with albumin in the blood stream and
is separated into liver cells. Bilirubin in the hepatocytes conjugates with glucuronic acid to become conjugated bilirubin, which is excreted from
hepatocytes to the biliary tract and intestines and finally excreted out of the body. The original bilirubin from hemoglobin is free unconjugated
bilirubin in the blood stream, and is not soluble in water. After being taken into hepatocytes, it is converted to soluble conjugated form, which can
then be excreted into bile ducts.
The liver serves many such biochemical functions, including the following:
• Produces bile, which helps lipid digestion.

• Converts glucose to glycogen and helps control blood sugar levels.
• Acts as a storehouse for biomolecules such as carbohydrates, proteins, lipids, iron, copper, and vitamins A, D, E, and K.
• Helps regulate fluid balance in the blood.
• Is involved in red blood cell formation in the embryo and in some abnormal states, forms blood in adults.
• Removes foreign bodies by phagocytosis using Kupffer cells.
• Forms an anticoagulant called heparin.
Right lobe of
liver -----,
I B-- Oesophagus )' LY
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Common � �
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bile duct
Left lobe of liver
Common hepatic duct

Gall Bladder --'
Cystic duct Pylorus
Pancreas
---t v'--"""--<JI ��---- Small intestine

718082
Kidneys are located below the peritonium
Diaphragm ---.
at the level of lower ribs
....
-·-
Inferior ------ Left adrenal gland
vena cava ---,--- Left kidney
--..--- Renal vein
---+---Renal artery
Ureter---.---
Aorta- ---;----- -
-------Medulla
------Nephrons
-----Cortex

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The following media explains about the Functions of liver:

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The following media explains about the Bilirubin Metabolisn1: I

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The following media explains about the Bilirubin Metabolism:

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;; 1 e as no enzymes an ire y pours 1n o uo en urn.
;; Bilirubin and biliverdin are the two types of bile and they are produced as
a result of RBC breakdown.
panceatic duct
a
Crypts of
A
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Liberkhun

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Bru nner's glands
Mucosa
Lamina
Propria
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Umbilical
Hernia
Ventral
Spigelian
(Incisional)
(Lateral Ventral)
Hernia
Hernia
Inguinal
Hernia Femoral
HPrni;:::i ,.,

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Umbilical
Hernia
Ventral
Spigelian
(Incisional)
(Lateral Ventral)
Hernia
Hernia
Inguinal
Hernia Femoral
Hernia
718082
Hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Hernias come in a
number of types. Most commonly they involve the abdomen, specifically the groin. Groin hernias are most common of the inguinal type but may also
be femoral.
Usual onset: 50 years old (groin hernias)
Synlptoms: Pain especially with coughing, bulge can be painful, especially when you cough, bend over or lift a heavy object. An inguinal hernia isn't
necessarily dangerous.
GASTROINSTESTINAL SYSTEM:
Diarrhea Overview
• Diarrhea is the frequent passage of loose, watery, soft stools plus bloating, pressure, and cramps commonly referred to as gas.
• Diarrhoea is one of the most common illnesses in all age groups and is second only to the common cold as a cause of lost days of work or
school.
• Diarrhea can be further defined in these ways:
• Chronic diarrhea is seen in people who have had loose or liquid stool for over 2 weeks.

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ShowTOC I
Hernia
718082
Hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Hernias come in a
number of types. Most commonly they involve the abdomen, specifically the groin. Groin hernias are most common of the inguinal type but may also
be femoral.
Usual onset: 50 years old ( groin hernias)
Syn1ptoms: Pain especially with coughing, bulge can be painful, especially when you cough, bend over or lift a heavy object. An inguinal hernia isn't
necessarily dangerous.
GASTROINSTESTINAL SYSTEM:
Diarrhea Overview
• Diarrhea is the frequent passage of loose, watery, soft stools plus bloating, pressure, and cramps commonly referred to as gas.
• Diarrhoea is one of the most common illnesses in all age groups and is second only to the common cold as a cause of lost days of work or
school.
• Diarrhea can be further defined in these ways:
• Chronic diarrhea is seen in people who have had loose or liquid stool for over 2 weeks.
• Acute enteritis means inflammation of the intestine.
• Gastroenteritis is diarrhea associated with nausea and vomiting.
• Dysentery is diarrhea that contains blood, pus, or mucus.
Notes
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Toxicological hazards aboard ship
Toxicological hazards aboard ship

TOXIC HAZARDS OF CHEMICALS INCLUDING POISONING
Treatn1ent
Try to discover exactly what was taken (ask the patient, look for empty packets/bottles etc.) but do not waste time doing so in an emergency.
If the casualty is conscious, give one sachet (SOg) of oral activated charcoal in 250 mis of fluid, if available. Encourage fluids in conscious cases of
aspirin overdose.
If the patient is unconscious, then put him in the recovery (unconscious) position and give artificial respiration if breathing has stopped. Perform
chest compressions if the heart has stopped. DO NOT give anything by mouth.
Eye Contact
Many substances, in particular many chemical liquids or fumes of chemicals, will produce redness and irritation if the eyes are accidentally splashed
or exposed to the fumes. Treatment should be immediate. Wash the substance out of the eye with copious amounts of cold fresh water as quickly as
possible, keeping the eyelids wide open. This must be done thoroughly for ten minutes. If there is any doubt whether the chemical has been
completely removed, repeat the eye wash for a further 10 minutes. If severe pain is experienced, physical restraint to the patient may be necessary
in order to be certain of effective treatment. Read about identifying and treating damage to the eye. For pain, give two paracetamol tablets by
mouth every four hours until the pain subsides. If there is very severe pain use Morphine.
SKIN EXPOSURE TO CHEMICALS

Skin exposure to chemicals may cause local damage of either chemical burn or frost-bite. Chemical burns resemble thermal burns, with redness,
irritation, swelling, pain, blistering and ulceration.
The chemical may be absorbed through the skin, causing general symptoms of poisoning; these symptoms may be delayed for several hours.
Limited exposure to leaking refrigerator gases, compressed gases or solid carbon dioxide (dry ice) may cause local frost-bite that, in principle, will
cause the same damage as chemical or thermal burns and is treated accordingly. No special treatment instructions are needed - refer to chemical
burns.
In extended burns, fluid loss may be serious.
DECONTAMINATION in all cases of skin exposure, regardless of chemical or symptoms
• Chemical protective gloves and clothing should be used while washing the casualty's skin. After decontamination, it is not necessary to use
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• Chemical protective gloves and clothing should be used while washing the casualty's skin. After decontamination, it is not necessary to use
protective clothing.
• Carefully remove and double-bag contaminated clothing and personal belongings. Cut off the clothes, if necessary.
• If the chemical has affected eyes and skin, the eyes should have PRIOR attention.
• IMMEDIATE washing with copious amounts of water for at least 10 minutes while removing contaminated clothing, rings, wristwatches, etc.
Don't delay.
• Do not use neutralizin g substances.
• Remove the casualty to the ship's hospital.
• Continue washing the skin for additional 10 minutes with soap or shampoo and water.
Exposure to PHOSPHORUS (WHITE OR YELLOW) which ignites in air

Keep the injured part of the body under water or covered with wet dressings.
Using chemical protective gloves, remove the phosphorus with a clean spoon or forceps.
Exposure to HYDROFLUORIC ACID

Using latex gloves, massage exposed area with calcium gluconate gel for at least 15 minutes or until pain is relieved.
Leave the gel on the skin. The gel should be re-applied 4 to 6 times daily for 3 to 4 days if a chemical burn is present.
Signs & symptoms Treatment
Burning pain with redness • After washing with water, wash exposed areas thoroughly
and/or swelling of
(including skin folds, nail beds and hair) with soap or shampoo
contaminated skin, irritating
rash and water. Clean away from the burn in every direction. DO NOT
use cotton wool for cleaning as it is likely to leave bits in the
burn.
• Dab gently any remaining dirt using a swab soaked in warm
water. BE GENTLE as this may cause pain.
Chemical burns • Cover burns with a sterile dressing (e.g. perforated silicone
dressing or vaseline gauze), overlapping the burn or scald by 5
to 10 cm (2 to 4 inches). Then apply a covering of absorbent
material (e.g. a layer of sterile cotton wool) and a suitable
bandage.
Blisters • Leave blisters intact.

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Blisters • Leave blisters intact.

• If blisters have burst, clip off the dead skin by using a sterilized
pair of scissors. Flood area with clean, lukewarm (previously
boiled) water from a clean receptacle to remove debris.
• Cover bli'sters with a sterile dressing (e.g. perforated silicone
dressing or vaseline gauze), overlapping the burn or scald by 5
to 10 cm {2 to 4 inches). Then apply a covering of absorbent
material (e.g. a layer of sterile- cotton wool) and a suitable
bandage.
Pain • Give two tablets of paracetamol every six hours until the pain is
relieved.
• If there is very severe pain, give ro mg morphine sulphate and
10 mg metoclopramide intramuscularly, ifadvised medically.
• SEEK MEDICAL ADVICE
• If breakthrough pain persists after 15 minutes or more, give a
second injection of 10 mg morphine sulphate intramuscularly.
Blisters and ulcers Dressings should be left undis' turbed for 3 to 4 days unless the
dressing becomes smelly or very dirty, or tha temperature- is raised.
Redress such areas as described above).
Provide adequate relief for continuinq pain (see above).
Blisters, ulcers covering an • rn addition to normal food and fluid intake give:
area exceeding 9°/a of body
surface (corresponding to 9 The first 24 hours: For every lOo/o of the body surface area
times the size of the palm
of the hand) with burns, give 3 litres of salted water {l'h tea spoonfuls of
table salt in 1 litre) intermittently to help replace fluid loss.
24 to 48 hours: for every 10°/o of the body surface area with
burns, give 1'h litres of fluids (preferably oral rehydration salt
solution - ORS) intermittently.
• RADIO FOR MEDICAL ADVICE
After 48 hours the fluid intake should in principle be normal.
• Check for urine output that should be approximately 30 to 50 ml

per hour (approximately 1 litre per 24 hours).

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FOLLOW-UP
A patient who has had significant exposure or any symptoms related to exposure should be kept warm in bed and closely observed for 48 hours and
RADIO MEDICAL ADVICE OBTAINED.
Emergency transport for on-shore hospital evaluation will usually be required.
IN HALATION OF CHEMICALS
Inhalation of chemicals may cause suffocation (asphyxia) due to:
• Obstruction to breathing in the throat or the air passage through spasm of the air tubes or by swelling of the linings of the voice box due to
irritant fumes;
• Fluid in the lung air spaces caused by irritant fumes;
• Poisoning of the blood which prevents the carriage or use of oxygen in the body caused by, for example, carbon monoxide and cyanide;
• Poisoning of the mechanism of breathing in the chest (e.g. by organophosphate pesticides) or the brain (e.g. by chlorinated hydrocarbons);
• Gases whic h do not support life because they replace oxygen in the atmosphere (e.g. carbon dioxide, nitrogen).
• Vapours of volatile liquids often have a pleasant or disagreeable odour. They may cause lightheadedness, dizziness, headache or nausea.
A few gases have delayed corrosive effects on the lungs.
WARNING: Any casualty who has been gassed and has impaired consciousness must NOT be treated with morphine.
Signs & syn1pton1s Treatment
Soreness of throat, Remove the casualty from the polluted atmosphere, have him rinse his mouth
hoarseness or cou h and ive one lass of water to drink.
Dry cough, mild The casualty should be put to bed and placed in the high sitting-up position.
breathlessness and
wheezing

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Severe breathlessness If breathlessness or wheezing are present, give oxygen at a flow rate of 8
and wheezing litres per minute until symptoms resolve.
Additionally, administer by spacer device:
200 µg salbutamol or 500 µg terbutaline and
250 µg beclomethasone or 400 µg budenoside every 15 minutes for the first

hour.
At the same time: RADIO FOR MEDICAL ADVICE.
lf breathlessness and wheezing persist after the first hour, continue with
oxygen and repeat administration of salbutamol /terbutaline and
beclomethasone /budenoside every two hours for the next ten hours, and
then four times a day until symptoms resolve.
Severe breathlessness Casualties must be handled extremely carefully. All strain must be avoided.
and frothy sputum, blue
discoloration of the skin, RADIO FOR MEDICAL ADVICE.
anxiety and sweating
(pulmonary oedema) • Arrange for evacuatfon. The casualty will need to be transferred to a
shore hospital as soon as possible.
• Give oxygen, salbutamol /terbutaline and beclomethasone I budenoside
as above.
• Use a sucker, if available, to get rid of the frothy secretions.
• If the casualty is very breathless, give 50 mg furosemide (frusemide) by
intramuscular injection to increase the urine output.
• If symptoms persist, continue with oxygen and repeat administration of
salbutamol /terbutaline and beclomethasone /budenoside every two
hours for the next ten hours, and then four times a day until symptoms
resolve.
Fever, breathlessness, productive cough, increased pulse rate (over 110 per minute)
RADIO FOR MEDICAL ADVICE

The casualty should be put to bed and placed in the high sitting-up position.
Give 500 mg amoxicillin every eight hours.

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Fever, breathlessness, productive cough, increased pulse rate (over 110 per minute)
RADIO FOR MEDICAL ADVICE

The casualty should be put to bed and placed in the high sitting-up position.
Give 500 mg amoxicillin every eight hours.
Note: Some are allergic to penicillins, including amoxicillin. In such cases, give 500 mg erythromycin four times daily.
If the patient is breathless, wheezing or blue, oxygen should be given continuously together with 200,ug salbutamol or 500/ig terbutaline four times
daily by spacer device, until the symptoms and signs improve.
FOLLOW-UP
A patient who has had significant exposure or any symptoms related to exposure should be kept warn, in bed and closely observed for 48 hours and
RADIO MEDICAL ADVICE OBTAINED.
INGESTION OF CHEMICALS
Ingestion of hazardous materials at sea 1s rare but can occur through attempted suicide, contaminated food or water, or through poor personal
hygiene.
Ingestion of a toxic material can cause retching, vomiting (sometimes the vomit 1s blood-stained), abdominal pain, colic and later diarrhoea.
Particularly severe symptoms are caused by corrosives, strong acids, alkalis or disinfectants which burn the lips and mouth cause intense pain, and
rarely perforation of the gut.
Ingested poisons can also produce general toxic effects (e.g. impaired consciousness, convulsions, or heart, liver and acute kidney failure) with or
without irritation of the gastrointestinal tract, and such effects can be delayed.
In all cases of ingestion, if the casualty is completely alert and able to swallow, treat as follows:
• Have the casualty rinse mouth with water. Give one glass of water to drink.
• Observe in a place of safety for at least eight hours,
• If a significant amount of material has been ingested and the casualty complains of pain 1n the mouth or the stomach, give two tablets of
paracetamol every six hours until the pain is relieved. RADIO FOR MEDICAL ADVICE.
• Vomiting should not be induced

• Do not give salt water to induce vomiting, as it may be dangerous to do so.
• Inducing vomiting by stimulating the back of the throat is usually ineffective and may cause aspiration of the chemical into the lungs, and
therefore should not be attempted.
• nil, ,t-i"n \Mith 1 -:a .-no ::u·Y1n1 ,nt e l"'lf v.1-:ator ,.,.,. nth or lin, ,irl ie n n t .- o...-nmm o nrl orl :.e it- m -:a\l inrro -:aeo th o he ,,..-nti nl"'I nf th o rh omir-:al
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paracetamol every six hours until the pain is relieved. RADIO FOR MEDICAL ADVICE.
• Vomiting should not be induced

• Do not give salt water to induce vomiting, as it may be dangerous to do so.
i
• Inducing vomit ng by stimulating the back of the throat is usually ineffective and may cause aspiration of the chemical into the lungs, and
therefore should not be attempted.
• Dilution with large amounts of water or other liquid is not recommended as it may increase the absorption of the chemical.
• Syrup of Ipecac is not recommended, as it may cause aspiration of the chemical into the lungs and there is no evidence of clinical benefit from
its use.
• Activated charcoal is usually not recommended at sea because if unconsciousness occurs it may be inhaled into the lungs. Its use in a given
case should always be discussed with the Radio Medical Advice.
Sions & ..vn1ntoms Treatment
Frequent vomiting Frequent and prolonged vomiting is a bad sign. Give lOmg
metoclopramide intramuscularly; repeat two hours later if
vomiting persists.
Do not qive solid food.
Bleeding (bright red blood, dark If severe bleeding occurs, there may be circulatory collapse
brown "coffee ground" vomit or
black, tarry, foul-smelling faces) RADIO FOR MEDICAL ADVICE
Perforation of the gut (severe RADIO FOR MEDICAL ADVICE

pain all over the abdomen, board
- like rigidity of the abdominal Arrange for evacuation. The casualty will need to be
wall, shock) transferred to a shore hospital as soon as possible.
Note: no bowel sounds are heard Give 10 mg morphine sulphate and lOmg metoclopramide
on listening to the abdomen with intramuscularly, if advised medically.
a stethoscope.
If advised medically, give cefuroxime 750mg intramuscularly
every eight hours and a metronidazole lg suppository every
eight hours.
Institute a rectal infusion with rehydration salts while awaiting

the transfer of the casualty to shore hospital.
The intravenous administration of fluids mav be reauired.
Notes
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Toxicological hazards aboard ship Hazards of Transport of dangerous cargo
Hazards of Transport of dangerous cargo
Dangerous goods must be correctly handled and documented from the time of booking until the time of final delivery.
The precautions when handling DG cargo are as below:
• Inspect all packages for signs of damage before loading

• Do not drop or throw DG cargo, the use hooks, bars, etc. to be kept to a minimum
• Control mechanical loading of DG cargo (loading with fork lifts etc.)
• Do not take short cuts when loading DG cargo, personnel handling DG must be made aware of dangers involved
• DG packages if wet or with frost or snow adhering should be dried before loading
• Do not load goods unless it is certain that the space where DG is being loaded is intact and dry
• Packages provided with ventilation should be kept upright when handling
• Fibre board kegs (a small barrel) and plastic lined paper bags with DG cargo must not be damaged during loading, as they are frequently used
for chemicals and these chemicals could taint other cargo if they leak out from them
• Do not load damaged packages containing DG cargo (damage is sometimes indicated by odorless fumes that irritate your eyes)
IMDG cargoes can be carried safely if they are, segregated, stowed, secured, carried and discharged as per the guidelines given by the Code.
The following precautions may be taken, while working with the IMDG cargo
• Do not allow unauthorized persons onboard

• Display 'NO SMOKING' and enforce
• Display Bravo flag
i
• Ensure shipper has provided dangerous cargo declarat on prior loading. Loading without such document is an offence
• Leaking or damaged packages to be rejected
• Check Marking, Labeling, placarding of the packges
• Combustible materials to be stowed away from heat.
• Non compatible cargoes must be segregated as per IMDG code guidelines
i
• Electrical connect ons must be intrinsically safe
• Ensure ventilation in the stowage area
• Monitor securing and ensure stevedore follow the correct securing procedure.
Shipper including
manufacturer
Forwarding agent
Stevedore

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• Ensure ventilation in the stowage area

• Monitor securing and ensure stevedore follow the correct securing procedure.
Shipper including
manufacturer
Forwarding agenf
Stevedore
Ships manager
Shlpstaff
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Inspections
Inspections to be carried out prior to handling DG cargo
These are as below:
• Ensure the Bill of lading is sighted and free of endorsements

• On the DG package check the UN No, the commodity details, the labelling, and package condition
• Note any special stowage requirements that may be required, will be written on the DG package
• The DG stowage compartment must be clean and dry
• The DG document must carry the correct technical name of the DG
• The shipper must declare by signing that the DG is correctly packed and labelled, check this in the shippers declaration, if the good is a marine
pollutant the document must state that it is in proper condition for sea carriage
Notes
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Toxicological hazards aboard ship Use of Medical First Aid Guide
Use of Medical First Aid Guide
Use of Medical First Aid Guide when carrying dangerous cargo

The Medical First Aid Guide (MFAG) is published by the World Health Organization (WHO). The aim of MFAG is to give guidelines to give first aid to
persons onboard in case of any accident involving International Maritime Dangerous Goods (IMDG). Its guidelines on First Aid are for the cargoes
listed in the IMDG Code and the International Maritime Solid Bulk Cargoes (IMSBC) code.
The guidelines are devised for giving immediate First Aid, keeping in mind the available facilities onboard. It gives information on the dangerous nature
of the chemicals and the effect on human beings on contact.
Chemicals are grouped according to their properties in the MFAG.
It is a user friendly document. It has questions designed to diagnose the effect on the casualty, then it guides you to a table where methods of First
Aids are given for various types of injuries due to inhalation, contact in the eyes, contact on the skin, swallowing and fire burn.
The following are covered in MFAG:
• How to diagnose poison

• How to provide first aid
• The complications of poisoning
• General toxic and dangerous hazards
• Emergency treatment
• Chemical tables including indices and
• A list of medicines to be taken.
Details about treatment of general illnesses not connected with chemical poisoning may be in the IMGS of the WHO.
If there is any small chemical accident without any severe effects, the proper first aid measures described in the MFAG must be taken. Even though
the total number of serious accidents reported so far is small, accidents involving poisonous chemicals may be hazardous and must be treated as a
serious issue till the injured person has fully recovered or a medical suggestion that the issue is not serious has been obtained. If a person is injured
due to chemical poisoning, he or she must be treated by the doctor at the earliest at the next port of call. Sometimes radios are used to ask for
medical help from the doctor available ashore.
Depending on their properties, chemical substances are grouped into tables in the MFAG. Some chemical substances could not be grouped into a
proper table according to its properties. In such cases, the chemical substances are assigned to a table related with the similar toxic medical
effects. The tables themselves provide all the details regarding the specific group of chemicals and hence one can easily identify the toxic effects of
a particular chemical. In MFAG, the treatment that needs to be given is specified either in the related section or in the related table.

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Immediate care in case of accidents involving dangerous Goods

The IMO/WHO/ILO Medical First Aid Guide for Use in Accidents involving Dangerous Goods (MFAG) refers to the substance, material and articles
covered by the International Maritime Dangerous Goods Code (IMDG Code), and the materials covered by Appendix B of the Code of Safe Practice for
Solid Bulk Cargoes (BC Code). It is intended to provide advice necessary for initial management of chemical poisoning and diagnosis within the limits
of the facilities available at sea.
This Guide should be used in conjunction with the information provided in the IMDG Code, the BC Code, the Emergency Procedures for Ships Carrying
Dangerous Goods (EmS), the International Code for the Construction and Equipment of Ships Carrying Dangerous Chemicals in Bulk (!BC Code), and
the International Code for the Construction and Equipment of Ships Carrying Liquefied Gases in Bulk (JGC Code).
The MFAG itself gives general information about the particular toxic effects likely to be encountered. The treatment recommended in this Guide is
specified in the appropriate tables and more comprehensive in the appropriate sections of the Appendices.
However, differences exist between countries on certain types of treatment and where these differences occur they are indicated in the relevant
national medical guide.
Treatments in this guide cater for the accidental human consequences of the carnage of dangerous goods at sea. Accidental ingestion of toxic
substances during voyage is rare. The guide does not cover ingestion by intention.
Minor accidents involving chemicals do not usually cause severe effects provided that the appropriate first aid measures are taken.
Although the number of reported serious accidents is small, accidents involving those chemicals which are toxic or corrosive may be dangerous, and
must be regarded as being potentially serious until either the affected person has completely recovered, or medical advice to the contrary has been
obtained.
Information on the treatment of illnesses which are of a general nature and not predominantly concerned with chemical poisoning may be found in
the !LO/IMO/WHO International Medical Guide for Ships (IMGS).
Notes
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Toxicological hazards aboard ship TWA/TLV levels
TWA/TLV levels
TOXICITY
Toxicity is a measure of poisonous nature and potential health risks associated with oil cargoes.
Threshold Limit Value -Time Weighted Average (TLV-TWA)

The term threshold limit value-time weighted average (TLV-TWA) is used in the oil industry to express the toxicity of vapors from a substance. The
TLV-TWA of a substance is usually expressed as the number of parts per million (ppm) by volume of vapor in air. Threshold Limit Values refer to
airborne concentrations of substances and represent conditions under which it is believed that nearly all workers may be repeatedly exposed day
after day without adverse health effects. When expressed as a time weighted average, the concentration is considered over a normal eight-hour
workday and a forty-hour workweek.
Permissible Exposure Limit - Time Weighted Average (PEL-TWA)

The permissible exposure limit (PEL) of a substance is a regulatory value that must not be exceeded in the workplace.
Threshold Limit Value-Short-Tern1 Exposure Limit (TLV-STEL)

The threshold limit value-short-term exposure limit (TLV-STEL) defines the concentration of a substance to which workers can be exposed
continuously for a short period of time, provided that the daily TLV is not also exceeded.
The STEL is a fifteen-minute time weighted average exposure that should not be exceeded at any time during the workday, even if the eight-hour
time weighted average is within the TLV.
Exposures at the STEL may not be longer than fifteen minutes and cannot be repeated more than four times per workday. There must also be at
least sixty minutes between successive exposures at the STEL.
Threshold Limit Value-Ceiling (TLV-C)

The threshold limit value-ceiling (TLV-C) is the maximum concentration of vapor in air, expressed as either a TLV or PEL, that must not be exceeded
even for an instant . Where there is no estabilished limit, the TLV STEL is used.
Toxic Hazards of Hydrocarbon Vapors

Petroleum gas is noxious and harmful to the body.
Hydrocarbon Gas concentration

{Volumetric Proportion in Air) Effects on the Human body
0 .02 °/o 300ppm Industry Permissible concentration (TLV-TWA for 8 Hrs) or 2 °/o LEL
0 .1°/o 1,000ppm Irritation in the eyes within an hour.

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Hydrocarbon Gas concentration

(Volumetric Proportion in Air) Effects on the Human body
0.02°/o 300ppm Industry Permissible concentration (TLV-TWA for 8 Hrs) or 2°/o LEL
0.1 °/o 1,000ppm Irritation in the eyes within an hour.
0.2°/o 2,000ppm Irritation in the eyes, nose or throat within 30 minutes, dizziness and unsteadiness.
0.7 °/o 7,000ppm Signs of giddiness within 15 minutes.
1.0°/o 10,000ppm Sudden giddiness occurs and if the body is exposed to the same conditions continuously, unconsciousness results, and can
sometimes lead to death.
2.0 °/o 20,000ppm Sudden giddiness, unconsciousness, resulting in death.
HYDROGEN SULFIDE (H2S)

Characteristic of Hydrogen Sulfide (H2S)
H2S is a Highly toxic, corrosive and flammable gas that in low levels will smell like rotten eggs. It is Colorless and Heavier than Air, having relative
vapor density of 1.189. Exposure to high levels of H2S can be fatal after a very short period of time.
H2S Gas Concentration

(ppm by Vol. in air) Physiological Effects on the Human body
0.1 - 0.5 ppm First Detected by smell

10 ppm May cause some nausea, minimal eye irritation
25 ppm Eye and respiratory tract irritation. Strong odour
50 - 100 ppm Human sense of smell starts to break down. Prolonged exposure to concentrations at 100 ppm induces a gradual increase 1n the
severity of these symptoms and death may occur after 4 - 48 hours of exposure
150 ppm Loss of sense of smell in 2 - 5 minutes
350 ppm Could be fatal after 30 minutes of inhalation 700 ppm RAPIDLY induces consciousness (few minutes) and death. Causes seizures, loss of
control of bowel and bladder. Breathing will stop and death will result, if not rescued promptly.
> 700 ppm IMMEDIATELY FATAL
Precautions for Hydrogen Sulfide (H2S)

In cases where H2S concentrations are known to be greater than 100 ppm in the vapor space and likely to be present in the atmosphere, Emergency
escape Breathing Apparatus shall be made available to personnel working in the hazardous area, who, should already have a Personal (pocket-able)
H2S gas monitoring alarm/instrument.
Notes
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J hazards aboard ship Poisoning
Poisoning
POISONING
INHALED POISONS
Intake of Poisonous Materials
The inhalation of the poisonous gases or materials may affect the various parts of the human body such as the brain, lungs, nose and throat.
Consumption of poisonous gas can result in unconsciousness and sometimes may lead to death.
The following media provides an overview about the intake of poisonous materials.
Consequences of Cons Poisonous Materials
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Toxicological hazards aboard ship Poisoning
Poisoning
POISONING
INHALED POISONS
Intake of Poisonous Materials
The inhalation of the poisonous gases or materials may affect the various parts of the human body such as the brain, lungs, nose and throat.
Consumption of poisonous gas can result in unconsciousness and sometimes may lead to death.
The following media provides an overview about the intake of poisonous materials.
Consequences of Cons Poisonous Materials
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In such cases, remove victim to fresh air quickly. Restore or support breathing as needed. Use mouth-to-mouth resuscitation or CPR as needed if
asphyxiation has occurred. If available, have a trained person administer oxygen. Seek medical help immediately.
If gas is injected under skin, treat patient for shock and seek immediate medical treatment. If LNG has splashed on the skin, remove victim from
contact, flush affected area with lukewarm water. Apply a loose, sterile, bulky dressing. Get immediate medical help.
If leak is from a gas line, notify appropriate safety personnel. Evacuate the area. Provide explosion-proof ventilation. Use non-sparking tools to shut
off the gas flow ahead of the leak.
If leak is from an LNG container, put on proper protective clothing and dike the liquid with dirt or other non-flammable absorbent. Use water fog to
disperse the vapor cloud. Keep LNG or its vapors out of other enclosed spaces.
Additional Safety Precautions to be Taken
• Flame-retardant clothing, including leather or cotton gauntlet gloves, must be worn in any situation where pressurized LNG vapors may ignite
accidentally.
• Wear goggles or a face shield when working with any pressurized gases or LNG.
• Use an explosion-proof oxygen [Qi] tester, NOT a combustible-gas detector, to check the atmosphere of any area that may be deficient in
oxygen. If the oxygen reading is below 19°/o, use a self-contained breathing apparatus (SCBA) with a properly fitting face mask.
• Ensure all equipment and pipelines used for LNG, whether it is in liquid or gaseous state, are grounded to earth to prevent the buildup of static
possible sparks. Where feasible, use non-sparking tools to work on and around LNG lines and equipment.
Many chemicals produce fumes which can irritate the lungs and cause difficulty in breathing e.g. chlorine. This will alert you to their presence.
Other gases have no odour. This group includes carbon monoxide, carbon dioxide, hydrogen and some refrigerant gases. Gases such as carbon
dioxide and carbon monoxide may also be poisonous, particularly in a confined space, because they replace oxygen in the air and therefore in the
blood. The main symptoms of exposure are difficulty in breathing; nausea, headache, dizziness confusion or even unconsciousness in severe cases.
Remember that precautions against fire and explosion may be necessary for some gases.
Treatn1ent
Remove the casualty at once into the fresh air. Loosen tight clothing and ensure a clear airway. Give oxygen if available. Start artificial respiration by
the mouth to nose or mouth method if breathing is absent. The use of a Laerdal Pocket Mask (mouth to mask) is recommended for resuscitation in
the case of poisoning by solvents, hydrogen cyanide (prussic acid) or petroleum products to avoid poisoning the rescuer. Use oxygen if available.
Start chest compressions if the heart has stopped. In cases of hydrogen cyanide poisoning where breathing and pulse are present, break an ampoule
of amyl nitrite into a clean handkerchief or cloth and hold under the patient's nose so that he inhales the vapour.
swallowed Poisons
Astringents

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Start chest compressions if the heart has stopped. In cases of hydrogen cyanide poisoning where breathing and pulse are present, break an ampoule
of amyl nitrite into a clean handkerchief or cloth and hold under the patient's nose so that he inhales the vapour.
Swallowed Poisons
Astringents
Many substances will cause chemical burns to the mouth, gullet and stomach if swallowed. These include bleaches and other cleaners and
disinfectants, acids and alkalis and corrosives as well as petrochemicals. The main symptoms are blistering of the mouth, lips and tongue and pain in
the chest and stomach. The patients breath often smells of the astringent.
DO NOT MAKE THE CASUALTY VOMIT. If the patient is conscious and in pa,n then he may respond to a glass of milk. Do not give painkillers by
mouth . Use suppositories or a painkilling injection if you have any. Other substances can cause acute abdominal pain and vomiting. These include
arsenic, lead, fungi, berries and partly decomposed food. Treat the patient by making them as comfortable as possible, but do not make them vomit.
A Treatn1ent of Patient
1. Exposure of Gas
Medical treatment for exposure to gas first involves the removal of the casualty to a safe area from the dangerous atmosphere. Shift the patient as
soon as possible out into the fresh air. To check that the patient is breathing tilt the head firmly backwards as far as it will go to relieve obstructions
and listen for breathing with the rescuer's ear over the patient's nose and mouth. Oxygen should be administered in case of weak breathing. It is an
IMO Code requirement to have oxygen resuscitation equipment on board.
i. Patient Not Breathing:
• Give artificial respiration at once

• Give cardiac compression if the pulse is absent
ii. After an Acute Case of Poisoning, Patient Breathing But Unconscious:
• An unconscious person should be laid on his side, face down, with one arm and one leg bent to prevent him from rolling over. Loosen the
clothes around the neck and waist and remove false teeth.
• Check there are no obstructions in the mouth. First, keep the breathing passages free (prevent the tongue from falling back).
• Remove any dentures
• Insert an Airway; leave in place until the patient regains consciousness
• Administer oxygen
• Keep the patient warm
• Give nothing by mouth
• Give no alcohol, morphine or stimulant
Note: Mouth to mouth artificial breathing may be necessary (avoid mouth to mouth contact with severely poisoned or contaminated patients as the
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rescuer may then be at risk). Heart massage may be necessary.
iii- Patient Conscious But Having Breathing Difficulty:
• The patient to be brought into fresh air with as little effort and strain to himself as possible. Undue strain on the patient may affect him
adversely later Keep the patient in a comfortable inclined sitting position and administer oxygen
• Even if the patient is free of all symptoms he should be kept quiet and rest as some gases have delayed effects (nitrogen oxides in combustion
inert gas, nitrous gases).
• If breathing does not improve despite these measures, then asphyxia or other lung problems may have occurred
• In such circumstances, or if the patient's condition deteriorates rapidly, obtain medical advise.
2- Physical Contact
;_ After Splash in the Eyes:
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Immediately wash the eyes in gently flowing water, ,n a w, tic eye bath with a bottle of water. The eyelids may
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have to be forced open and the patient told to move the ey roughly rinsed out. Washing out the eyes may be very
painful and pain-relief eye drops can be used. Continue to ) Send Page to Device > n case of acids or alkalies (caustic) the washing must
be repeated for a couple of minutes every 15-30 min for thE View Background Image NaCl (table) salt solution (0, 7 - O, 9 °/o). A sterilising
eye ointment should be applied several times during the day. Select All in medical advice.
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PASSWORD HOME EXIT
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rescuer may then be at risk). Heart massage may be necessary.
iii- Patient Conscious But Having Breathing Difficulty:
• The patient to be brought into fresh air with as little effort and strain to himself as possible. Undue strain on the patient may affect him
adversely later Keep the patient in a comfortable inclined sitting position and administer oxygen
• Even if the patient is free of all symptoms he should be kept quiet and rest as some gases have delayed effects (nitrogen oxides in combustion
inert gas, nitrous gases).
• If breathing does not improve despite these measures, then asphyxia or other lung problems may have occurred
• In such circumstances, or if the patient's condition deteriorates rapidly, obtain medical advise.
2- Physical Contact
;_ After Splash in the Eyes:
Immediately wash the eyes in gently flowing water, in a washbasin, in a jug or a special plastic eye bath with a bottle of water. The eyelids may
have to be forced open and the patient told to move the eyes in order that all parts will be thoroughly rinsed out. Washing out the eyes may be very
painful and pain-relief eye drops can be used. Continue to wash for another 10-15 minutes. In case of acids or alkalies (caustic) the washing must
be repeated for a couple of minutes every 15-30 min for the next 4-5 hours, preferably with a NaCl (table) salt solution (0, 7 - O, 9 °/o). A sterilising
eye ointment should be applied several times during the day. In case of acids and alkalies: obtain medical advice.
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ii- After Skin Contact:

Regardless of product the area should be rinsed liberally with water, clean sea water can be used. Soiled clothes, rings, watches, shoes etc must be
taken off. Wash the area thoroughly with soap and water. Also products which do not dissolve in water will be partly removed by washing in soap
water. (Poison dissolved in the skin fat will then be washed off).
iii- After Swallowing:

If the patient is unaffected give him a couple of glasses of liquid to drink for dilution of the poison, preferably water (never any alcoholic drink). After
intake of alkalies (caustic) a drink of lemon juice can be given, or a 1 '76 solution of acetic acid. If available give medicine coal which absorbs a
number of poisons and which in itself is harmless (30-60 crushed coal tablets or coal granulate in some water). Make the patient vomit, NOT,
however, in the case of corroding (acids or caustic) products or oil products like kerosenes, gasoline, jet fuels, when vomiting may be life
threatening. Dilution of the stomach contents, however, is important. In case of doubt: do not cause the patient to vomit. Vomiting can be caused
by giving warm salt water (one table spoon of salt to one glass of water). Then by putting two fingers down the throat and moving them about
gently vomiting usually follows.
After certain products antidotes should be given. The most likely cargo for which an antidote may have to be used is acrylonitrile ("AN") and acetone
cyanohydrine. The remedy then is to douse some clean rag with an ampoule of amyl nitrite from the medicine kit and hold it under the patient's nose
5 times with 15 s interval.
3_ Prevention of Exposure
Prevention of exposure is achieved through a combination of cargo containment, which prevents toxic fumes or liquid from contaminating the
workplace, and the use of personal protective equipment (PPE). It is a clear responsibility of the Owner, the master and the officers to inform their
staff about the cargoes to be carried, safety procedures etc and to arrange for the proper training. Information should be given partly in the form of
written notices combined with informal meetings with the entire crew present when new cargoes are to be loaded or when inexperienced staff is
signed on. Among other things the following information should be given:
• Cargoes to be loaded; their characteristics as regards handling, pumping, toxicity, corrosiveness, first aid etc.
• The cargo loading plan to be posted in places where it will be clearly seen by everyone on board and at the accommodation ladder, when in
port.
• Post cargo information cards for products to be loaded or are contained on board. For "new" products ask the shipper for safety brochures and
leaflets
• The personal safety equipment to be used by those involved in cargo handling, pumping, sampling etc.
• Have available on board literature on chemical cargoes, medical advice etc,
• Inform in particular if the cargo to be loaded has an odour threshold which is higher than the TLV-value and about cargo danger which cannot
always be sensed in advance (e.g., allyl alcohol, carbon tetra chloride, ethylene dichloride).
• Give information that most vapours are heavier than air and have a tendency to accumulate in low spaces. Therefore work below gratings in
pump rooms, cofferdams, pipe tunnels etc is extra dangerous.
• Never take work clothes into vour cabin. Soiled clothes must be washed before beinq used aqain or in the case of toxic oroducts, destroved. "

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MEDICAL FIRST AID (MFA) ARVIND RATHORE I I I I I
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Progress : 1 00% HIGHLIGHT REMOVE HIGHLIGHT CALCULATOR I CONVERTER
Prevention of exposure is achieved through a combination of cargo containment, which prevents toxic fumes or liquid from contaminating the
workplace, and the use of personal protective equipment (PPE). It is a clear responsibility of the Owner, the master and the officers to inform their
staff about the cargoes to be carried, safety procedures etc and to arrange for the proper training. Information should be given partly in the form of
written notices combined with informal meetings with the entire crew present when new cargoes are to be loaded or when inexperienced staff is
signed on. Among other things the following information should be given:
• Cargoes to be loaded; their characteristics as regards handling, pumping, toxicity, corrosiveness, first aid etc.
• The cargo loading plan to be posted in places where it will be clearly seen by everyone on board and at the accommodation ladder, when in
port.
• Post cargo information cards for products to be loaded or are contained on board. For "new" products ask the shipper for safety brochures and
leaflets
• The personal safety equipment to be used by those involved in cargo handling, pumping, sampling etc.
• Have available on board literature on chemical cargoes, medical advice etc,
• Inform in particular if the cargo to be loaded has an odour threshold which is higher than the TLV-value and about cargo danger which cannot
always be sensed in advance (e.g., allyl alcohol, carbon tetra chloride, ethylene dichloride).
• Give information that most vapours are heavier than air and have a tendency to accumulate in low spaces. Therefore work below gratings in
pump rooms, cofferdams, pipe tunnels etc is extra dangerous.
• Never take work clothes into your cabin. Soiled clothes must be washed before being used again or in the case of toxic products, destroyed.
• Wash your hands before meals.
• Give information about fire fighting methods for each type of cargo on board.
• Give information if the cargo is water-reactive or reactive to other cargoes on board. Give information on segregation required.
• For some very toxic cargoes mouth to mouth artificial breathing might be dangerous to the rescuer (e.g. acrylonitrile, acetone cyanohydrine).
• Information must be given particularly if the cargo danger lies primarily in vapour inhalation (e.g. acrylonitrile, trichlorethylene) or skin contact
(e.g. phenol, caustic soda, sulphuric acid).
• State where eye washing bottles are located (deck office, at cargo manifolds on deck, in pump rooms, on fore deck etc).
• Insist on that nobody should work with cargo gear without anyone standing by. Have people report when going to and returning from pump
rooms!
• Give information if any cargo is so toxic that an escape breathing mask must be used in an emergency.
Notes
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Examination of patient I Fo rming diagnosis !cas ualty
Observations of a casualty
State of consciousness:
This is the level of the individual awareness and the responsiveness of his mind to himself, the environment and the impressions made by his senses.
State of unconsciousness:
stage 1
Drowsiness - Prolonged sleep from which the patient can be aroused.
stage 2
Stupor - This is a state of partial loss of response to the environment. The patient is difficult to arouse and though he can be aroused, it is slow and
inadequate. The patient is not aware of the environment and falls back into stupor us state.
stage 3
Coma - There is a complete loss of consciousness from which the patient cannot be aroused by painful stimuli, all reflexes including light reflex
(constriction of pupil when the rays of light are focused on the eye by means of torch) are lost.
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Examination of patient Forming diagnosis
Forming diagnosis
First Aid for Accidents and Injuries

Some injuries can be treated with basic first aid techniques such as wound cleansing, wound dressings, rest, application of ice, compression, and
elevation. More severe injuries may require cardiopulmonary resuscitation (CPR) and other resuscitation procedures or surgery.
These guidelines can help you care for minor cuts and scrapes:
• Wash your hands. This helps avoid infection

• Stop the bleeding
• Clean the wound
• Apply an antibiotic or petroleum jelly
• Cover the wound
• Change the dressing
• Get a tetanus shot
• Watch for signs of infection
You can treat some injuries at home or at your work place. But sometimes they are severe enough to require a visit to your doctor, or even a trip to
the hospital. The table below lists some of the remedies:
THE INJURY Your colleague A cup of hot Your colleague Your colleague Your colleague is
cuts his arm coffee spills sticks a coat swallows aspirin choking on a piece of
while using a onto your hanger into an meat and can't
sharp object colleague's leg electrical socket breathe
IMMEDIATE If the cut is Rinse the All injuries Check his mouth, Perform the Heimlich
FIRST AID superficial, wash burned area in involving and remove any maneuver: Stand
TREATMENT it and apply an cool water for electricity should remaining pills or behind your colleague
antibiotic and a only a few be reported to a fragments with a with your arms
bandage. For a minutes just doctor. If your washcloth. Do not around his waist.
deeper wound, enough to colleague looks give him anything to Make a fist, and hold
apply direct take the heat pale or feels sick, eat or drink. it with out pressing
pressure for out, but not have him lie the other hand
several minutes, cause down. Be sure to against the abdomen,
using a clean hypothermia. monitor his just below the rib
cloth, until Apply a cold condition closely cage. Pressing firmly
bleeding has compress to until you can get but gently, give
stopped. Then the spot, and proper medical upward thrusts until

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THE INJURY Your colleague A cup of hot Your colleague Your colleague Your colleague is
cuts his arm coffee spills sticks a coat swallows aspirin choking on a piece of
while using a onto your hanger into an meat and can't
sharp object colleague's leg electrical socket breathe
IMMEDIATE If the cut is Rinse the All injuries Check his mouth, Perform the Heimlich
FIRST AID superficial, wash burned area in involving and remove any maneuver: Stand
TREATMENT it and apply an cool water for electricity should remaining pills or behind your colleague
antibiotic and a only a few be reported to a fragments with a with your arms
bandage. For a minutes just doctor. If your washcloth. Do not around his waist.
deeper wound, enough to colleague looks give him anything to Make a fist, and hold
apply direct take the heat pale or feels sick, eat or drink. it with out pressing
pressure for out, but not have him lie the other hand
several minutes, cause down . Be sure to against the abdomen,
using a clean hypothermia. monitor his just below the rib
cloth, until Apply a cold condition closely cage. Pressing firmly
bleeding has compress to until you can get but gently, give
stopped. Then the spot, and proper medical upward thrusts until
clean and give your attention. the object is
bandage as colleague expelled.
above. acetaminophen
for the pain.
SHOULD If the bleeding If the skin In more severe Call your If your colleague
YOU SEEK doesn't stop blisters or if cases - if he's doctor/hospital loses consciousness1
MEDICAL after five the burn unconscious or if immediately and If patient becomes
HELP? YES minutes of surrounds a the shock follow the unconscious perform
pressure or if the joint, your involved water - directions. Have the CPR, looking in the
wound is very colleague call your doctor aspirin bottle on mouth to retrieve the
deep or gaping, should see a immediately. hand so you can foreign object only if
go to the doctor. If he's Check your describe it. If your you see it, before
hospital. You scalded over a colleague's colleague is not each breath perform
should go to the large part of breathing and breathing or is rescue breathing
hospital his leg, call pulse. If he has a convulsing, call your while someone else
immediately if your doctor I pulse but isn't doctor/hospital. calls a doctor. Even if
the wound is on hospital right breathing, your colleague seems
your colleague's away and perform rescue fine after a choking
face, neck, or cover him with breathing. If he incident, he should
head. a clean sheet doesn't have a see the doctor to
to prevent pulse, perform make sure that the
hypothermia. CPR until help obstruction has been
arrives. completely removed.
Notes
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Spinal injuries
Spinal injuries
The spinal cord is divided into four distinct regions. Knowing the region in which the injury is located is often the key to understanding diagnosis and
treatment. The four spinal cord regions are:
• The cervical spinal cord: This is the topmost portion of the spinal cord, where the brain connects to the spinal cord, and the neck connects
to the back. This region consists of eight vertebrae, commonly referred to as Cl-CS. All spinal cord numbers are descending, so Cl is the
highest vertebra, while CS is the lowest in this region.
• The thoracic spinal cord: This section forms the middle of the spinal cord, containing twelve vertebrae numbered Tl-Tl2.
• The lumbar spinal cord: This is a lower region of the spinal cord, where your spinal cord begins to bend. If you put your hand in your lower
back, where your back bends inward, you're feeling your lumbar region. There are five lumbar vertebrae, numbered Ll-LS.
• The sacral spine: This is the lower, triangle-shaped region of the spine, also with five vertebrae. While the lumbar cord bends inward, the
vertebrae of the sacral region bend slightly outward. There is no actual spinal cord in this section, it is made up of nerve roots which exit the
spine at their respective vertebral levels.
• The coccygeal region, sometimes known as the coccyx or tail bone, consists of a single vertebra at the very base of the spinal cord.
Types of Spinal Cord Injuries

All spinal cord injuries are divided into two broad categories: incomplete and complete.
• Incomplete spinal cord injuries: With incomplete injuries, the cord is only partially severed, allowing the injured person to retain some
function. In these cases, the degree of function depends on the extent of the injuries.
• Complete spinal cord injuries: By contrast, complete injuries occur when the spinal cord is fully severed, eliminating function. Though, with
treatment and physical therapy, it may be possible to regain some function.
Incomplete spinal cord injuries are increasingly common, thanks in part to better treatment and increased knowledge about how to respond and how
not to respond to a suspected spinal cord injury. These injuries now account for more than 60 °/o of spinal cord injuries, which means we're making
real progress toward better treatment and better outcomes.
Some of the most common types of incomplete or partial spinal cord injuries include:
• Anterior cord syndrome: This type of injury, to the front of the spinal cord, damages the motor and sensory pathways in the spinal cord.
You may retain some sensation, but struggle with movement.
• Central cord syndron1e: This injury is an injury to the center of the cord, and damages nerves that carry signals from the brain to the spinal
cord. Loss of fine motor skills, paralysis of the arms, and partial impairment usually less pronounced in the legs are common. Some survivors
also suffer a loss of bowel or bladder control, or lose the ability to sexually function.
• Brown-Sequard syndrome: This variety of injury is the product of damage to one side of the spinal cord. The injury may be more
pronounced on one side of the body; for instance, movement may be impossible on the right side, but may be fully retained on the left. The
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Some of the most co_m _1-;:=R=ec=og'- -ni- s- -s - m- to
e y p m s rlete or partial spinal cord injuries include:
• Anterior cord syndrome: This type of injury, to the front of the spinal cord, damages the motor and sensory pathways in the spinal cord.
You may retain some sensation, but struggle with movement.
• Central cord syndron1e: This injury is an injury to the center of the cord, and damages nerves that carry signals from the brain to the spinal
cord. Loss of fine motor skills, paralysis of the arms, and partial impairment usually less pronounced in the legs are common. Some survivors
also suffer a loss of bowel or bladder control, or lose the ability to sexually function.
• Brown-Sequard syndrome: This variety of injury is the product of damage to one side of the spinal cord. The injury may be more
pronounced on one side of the body; for instance, movement may be impossible on the right side, but may be fully retained on the left. The
degree to which Brown-Sequard patients are injured greatly varies from patient to patient.
Knowing the location of your injury and whether or not the injury is complete can help you begin researching your prognosis and asking your doctor
intelligent questions. Doctors assign different labels to spinal cord injuries depending upon the nature of those injuries. The most common types of
spinal cord injuries include:
• Tetraplegia: These injuries, which are the result of damage to the cervical spinal cord, are typically the most severe, producing varying
degrees of paralysis of all limbs. Sometimes known as quadriplegia, tetraplegia eliminates your ability to move below the site of the injury, and
may produce difficulties with bladder and bowel control, respiration, and other routine functions. The higher up on the cervical spinal cord the
injury is, the more severe symptoms will likely be.
• Paraplegia: This occurs when sensation and movement are removed from the lower half of the body, including the legs. These injuries are the
product of damage to the thoracic spinal cord. As with cervical spinal cord injuries, injuries are typically more severe when they are closer to
the top vertebra.
• Triplegia: Triplegia causes loss of sensation and movement in one arm and both legs, and is typically the product of an incomplete spinal cord
1nJury.
Injuries below the lumbar spinal cord do not typically produce symptoms of paralysis or loss of sensation. They can, however, produce nerve pain,
reduce function in some areas of the body, and necessitate several surgeries to regain function. Injuries to the sacral spinal cord, for instance, can
interfere with bowel and bladder function, cause sexual problems, and produce weakness in the hips or legs. In vary rare cases, sacral spinal cord
injury survivors suffer temporary or partial paralysis.
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Spinal injuries Recognise symptoms
Recognise symptoms
Symptoms of a Spinal Cord Injury

A spinal cord injury is not the sort of thing you have to wonder about having. If you've suffered a spinal cord injury, your life is in danger, and you'll
know you're injured. You can't use symptoms to diagnose the sort of spinal cord injury you have, and every patient's prognosis is different. Some
make a miraculous recovery within months; others need years of physical therapy and still make little to no progress.
The outcome depends on the nature of the injury, the quality of medical care you receive, the degree to which you work at your own recovery by
adopting a healthy lifestyle, your psychological health, luck, and innumerable other factors.
A partial list of common spinal cord injury symptoms includes:
• Varying degrees of paralysis, including tetraplegia/quadriplegia, and paraplegia

• Difficulty breathing; the need to be on a respirator
• Problems with bladder and bowel function
• Frequent infections; the likelihood of this increases if you are on a feeding or breathing tube
• Bedsores
• Chronic pain
• Headaches
• Changes in mood or personality
• Loss of libido or sexual function
• Loss of fertility
• Nerve pain
• Chronic muscle pain
• Pneumonia (more than half of cervical spinal cord injury survivors struggle with bouts of pneumonia)
How Spinal Cord Injuries Are Di agnosed

Doctors usually decide to assess patients for spinal cord injuries based on two factors: the location and type of injury a patient has sustained, and
his or her symptoms. Anyone who has fallen, suffered a blow, or lost consciousness may have suffered a spinal cord injury. If you also experience
headaches, loss of movement, tingling, difficulty moving, or difficulty breathing, your doctor may decide to assess you for a spinal cord injury.
No single test can assess all spinal cord injuries. Instead, doctors rely on a variety of protocols, including:
• Clinical evaluation: Your doctor will make a detailed list of all of your symptoms, and may conduct blood tests, ask you to move your limbs,
follow movement in your eyes, and conduct other tests to narrow down your symptoms.
• In1aging tests: Your doctor may order MRI imaging or other forms of radiological imaging to view your spinal column, spinal cord, and brain.

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Spinal injuries Recognise sy mptoms Bladder control in spinal injuries
Bladder control in spinal injuries
A sp inal cord injury may interrupt communication between the nerves in the spinal cord that control bladder and bowel function and the brain, causing
incontinence. This results in bladder or bowel dysfunction that is termed "neurogenic bladder" or "neurogenic bowel."
If you have a spinal cord injury, look for these signs of a neurogenic bladder:
• Loss of bladder control (urinary incontinence)

• Inability to empty the bladder
• Urinary frequency
• Urinary tract infections.
Signs of neurogenic bowel include:
• Loss of bowel control (bowel incontinence)

• Constipation
• Bowel frequency
• Lack of bowel movements.
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Spinal injuries Complicat ions when unconscious
Complications when unconscious
If you suspect a back or neck (spinal) injury, do not move the affected person. Permanent paralysis and other serious complications can result. Assume
a person has a spinal injury if:
• There's evidence of a head injury with an ongoing change in the person's level of consciousness
• The person complains of severe pain in his or her neck or back
• The person won't move his or her neck
• An injury has exerted substantial force on the back or head
• The person complains of weakness, numbness or paralysis or lacks control of his or her limbs, bladder or bowels
• The neck or back is twisted or positioned oddly
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Spinal injuries Apply first aid measures
Apply first aid measures
How Spinal Cord Injuries Are Treated

Unlike with many other injuries, the most important component of spinal cord injury treatment begins before you even get to the doctor. Remaining
still , avoiding moving your spinal column, and prompt emergency care, can all increase the odds that you survive, while minimizing the long-term
effects of your injury.
From there, doctors will focus on stabilizing you, since the first hours after a spinal cord injury are critical to a patient's survival. Assistance with
breathing, a collar to keep your neck still, blood transfusions, and other procedures to address your immediate symptoms may be necessary.
Thereafter, your doctor will work with you and your family to construct a detailed plan for addressing your injuries. Every family and every injury are
different, but treatment for a spinal cord injury may involve:
• Care to address, but not treat, your immediate symptoms. For instance, a ventilator can help you breathe and a feeding tube can help you eat
if you are unable to do so.
• Palliative care to help you be more comfortable. If you struggle with insomnia or chronic pain, your doctor might prescribe medication to help.
• Lifestyle changes, such as a healthier diet or giving up smoking.
• Physical therapy to help retrain your brain and body; many spinal cord injury survivors are able to regain significant mobility with physical
therapy.
• Family and individual counseling to help you cope with the pain and stress of life with a spinal cord injury.
• Surgery as needed to correct injury-related health problems.
• If the mechanism of injury makes a neck injury possible or likely, immobilize the neck with a rigid collar and board before attempting to move or
examine the patient.
• Use the Glasgow Coma Scale to determine the patient's level of consciousness: if the score is 15:
• Ask the patient to move all four limbs in turn;
• Ask if the patient feels tingling or pins-and-needles in the arms or legs.
• If the Glasgow Coma Scale score is less than 15, reassess in 30 minutes: if the score is 15, assess the neck injury then.
• You cannot assess a neck injury in a patient with impaired consciousness: leave the neck immobilized with rigid collar and board until the
patient's consciousness returns to normal.
• To check for sensation, prick points along the full length of the body with a pin or other sharp object:
• Each time you prick a point, ask: "Do you feel that?":
• If the answer is "Yes" ask: "Does it feel sharp or blunt?":
• Use the nipple and the belly-button (navel) as landmarks along the trunk.
• Seek medical advice with a view to evacuation if there is:

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• Each time you prick a point, ask: "Do you feel that?":
• If the answer is "Yes" ask: "Does it feel sharp or blunt?":
• Use the nipple and the belly-button (navel) as landmarks along the trunk.
• Seek medical advice with a view to evacuation if there is:
• Weakness of the arms or legs;
• Numbness or tingling or any areas the patient cannot feel when you test for sensation.
• Note down carefully any deficits in sensation and have this information available when you call for medical advice.
• If sensation and movement are normal, move the patient to the sick bay or ship's hospital for a more complete examination.
The Glasgow Coma Scale

Eye opening
• Spontaneously = 4 points
• In response to a verbal command = 3 points
• In response to pain = 2 points
• No eye opening = 1 point
Best Verbal response
• Oriented = 5 points
• Confused = 4 points
• Inappropriate words = 3 points
• Incomprehensible words = 2 points
• No speech = 1 point
Best motor response
• Obeys commands = 6 points

• Moves a hand to side of painful stimulus = 5 points
• Pulls away from painful stimulus = 4 points
• Flexes limbs when painful stimulus applied = 3 points
• Straightens limbs when painful stimulus applied = 2 points
• No motor response = 1 point
The score can range from 3 (the worst) to 15 (the best)
Notes
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Spinal injuries Apply first aid measures Treatment of suspected fracture of spine
Treatment of suspected fracture of spine
Designate four crew members to assist you:
• Have one assistant hold the patient's head in line with the neck, making sure the head does not move on the neck;
• At the same time, have the three remaining assistants roll the patient onto one side.
Remove the rigid collar carefully, but do not remove the collar if:
• The patient expresses anxiety about your doing so: this often indicates a fracture;
• You cannot assemble four reliable assistants.
Gently examine the neck for tenderness and muscle spasm.
Gently feel down the line of the vertebrae looking for tender points and irregularity.
If you find local tenderness on the back of the neck, seek medical advice with a view to evacuation.
While awaiting evacuation, replace the patient's collar and leave it in place.
If there is no tenderness at all, or even slight tenderness or muscle spasm in the neck, ask the patient to rotate the neck to the right and to the
left: if the patient is reluctant to do this, do not insist it could be a sign of a fracture.
You can be almost sure there is no serious injury if all three of the following conditions are met:
• Movement and sensation normal;

• No tenderness, or even slight tenderness, on the back of the neck;
• The patient can rotate the neck 45 ° to both right and left.
If the first two conditions are met but the third is not, leave the patient's collar on and give ibuprofen 400 mg orally, every six hours.
If there is no improvement 24 hours later, seek medical advice.
Collar bone (clavicle) injury

The clavicle is commonly fractured 1n falls onto an outstretched hand. Because the bone 1s close to the skin, the diagnosis 1s usually obvious.
Complications are rare.
• Apply a sling and swathe or Velpeau bandage.

• Give ibuprofen, 400 mg orally, every six hours.

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Spinal injuries Head injuries
Head Injuries
A head injury is any sort of injury to your brain, skull, or scalp. This can range from a mild bump or bruise to a traumatic brain injury. Common head
injuries include concussions, skull fractures, and scalp wounds. The consequences and treatments vary greatly, depending on what caused your
head injury and how severe it is.
Head injuries may be either closed or open . A closed head injury is any injury that doesn't break your skull. An open, or penetrating, head injury is
one in which something breaks your skull and enters your brain.
It can be hard to assess how serious a head injury is just by looking. Some minor head injuries bleed a lot, while some major injuries don't bleed at
all. It's important to treat all head injuries seriously and get them assessed by a doctor.
Causes of head injury

In general, head injuries can be divided into two categories based on what causes them. They can either be head injuries due to blows to the head
or head injuries due to shaking.
Head injuries caused by shaking are most common in infants and small children, but they can occur any time you experience violent shaking.
Head injuries caused by a blow to the head are usually associated with:
• Motor vehicle accidents

• Falls
• Physical assaults
• Sports-related accidents
In most cases, your skull will protect your brain from serious harm. However, injuries severe enough to cause head injury can also be associated with
injuries to the spine.
Types of head injuries

Hen1atoma
A hematoma is a collection, or clotting, of blood outside the blood vessels. It can be very serious if a hematoma occurs in the brain. The clotting can
cause pressure to build inside your skull, which can cause you to lose consciousness or result in permanent brain damage.
Hemorrhage
A hemorrhage is uncontrolled bleeding. There can be bleeding in the space around your brain, which is a subarachnoid hemorrhage, or bleeding within
your brain tissue, which is an intracerebral hemorrhage.
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Hen1orrhage
A hemorrhage is uncontrolled bleeding. There can be bleeding in the space around your brain, which is a subarachnoid hemorrhage, or bleeding within
your brain tissue, which is an intracerebral hemorrhage.
Subarachnoid bleeds often cause headaches and vomiting. The severity of intracerebral hemorrhages depends on how much bleeding there is, but
over time any amount of blood can cause pressure to build.
Concussion
A concussion 1s a brain injury that occurs when your brain bounces against the hard walls of your skull. Generally speaking, the loss of function
associated with concussions is temporary. However, repeated concussions can eventually lead to permanent damage.
Edema
Any brain injury can lead to edema, or swelling. Many injuries cause swelling of the surrounding tissues, but it's more serious when it occurs in your
brain. Your skull can't stretch to accommodate the swelling, which leads to a buildup of pressure in your brain. This can cause your brain to press
against your skull.
Skull fracture
Unlike most bones in your body, your skull doesn't have bone marrow. This makes the skull very strong and difficult to break. A broken skull is unable
to absorb the impact of a blow, making it more likely that there will also be damage to your brain. Learn more about skull fractures.
Diffuse axonal injury

f
A dif use axonal injury, or sheer injury, is an injury to the brain that doesn't cause bleeding but does damage your brain cells. The damage to the
brain cells results in them not being able to function and can also result in swelling, causing more damage. Though it isn't as outwardly visible as
other forms of brain injury, diffuse axonal injury is one of the most dangerous types of head injuries and can lead to permanent brain damage and
even death.
Syn1ptoms of a head injury

Your head has more blood vessels than any other part of your body, so bleeding on the surface of your brain or within your brain is a serious concern
in head injuries. However, not all head injuries cause bleeding.
It's important to be aware of other symptoms to watch out for. Many symptoms of serious brain injury won't appear right away. You should always
continue to monitor your symptoms for several days after you injure your head.
Common symptoms of a minor head injury include:
• A headache
• Lightheadedness
• A spinning sensation
• Mild confusion

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• A loss of consciousness
• Seizures
• Vomiting
• Balance or coordination problems
• Serious disorientation
• An inability to focus the eyes
• Abnormal eye movements
• A loss of muscle control
• A persistent or worsening headache
• Memory loss
• Changes in mood
• Leaking of clear fluid from the ear or the nose
Treatn1ent for Head injury

The treatment for head injuries depends on both the type and the severity of the injury.
With minor head injuries, there are often no symptoms other than pain at the site of the injury. In these cases, you may be told to take
acetaminophen (Tylenol) for the pain. You shouldn't take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) or aspirin
(Bufferin), because they can make any bleeding worse. If you have an open cut, your doctor may use sutures or staples to close it. They'll then
cover it with a bandage.
Even if your injury seems minor, you should still watch your condition to make sure it doesn't get worse. It isn't true that you shouldn't go to sleep
after you have injured your head, but you should be woken up every two hours or so to check for any new symptoms. You should go back to the
doctor if you develop any new or worsening symptoms.
You may need to be hospitalized if you have a serious head injury. The treatment you receive at the hospital will depend on your diagnosis.
The treatment for severe head injuries can include:
• Medication - If you've had a severe brain injury, you may be given antiseizure medication. You're at risk for seizures in the week following your
accident.
You may be given diuretics if your injury has caused a buildup of pressure in your brain. Diuretics cause you to excrete more fluids. This can
help to relieve some of the pressure.
If your injury is very serious, you may be given medication to put you in an induced coma. This may be an appropriate treatment if your blood
vessels are damaged. When you're in a coma, your brain doesn't need as much oxygen and nutrients as it normally does.
• Surgery - It may be necessary to do emergency surgery to prevent further damage to your brain. For example, your doctors may need to
operate to remove a hematoma, repair your skull, or release some of the pressure in your skull.

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If your injury is very serious, you may be given medication to put you in an induced coma. This may be an appropriate treatment if your blood
vessels are damaged. When you're in a coma, your brain doesn't need as much oxygen and nutrients as it normally does.
• Surgery - It may be necessary to do emergency surgery to prevent further damage to your brain. For example, your doctors may need to
operate to remove a hematoma, repair your skull, or release some of the pressure in your skull.
• Rehabilitation - If you've had a serious brain injury, you'll most likely need rehabilitation to regain full brain function. The type of rehabilitation
you get will depend on what functionality you've lost as a result of your injury. People who've had a brain injury will often need help regaining
mobility and speech.
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Spinal injuries Head injuries Levels of consciousness/unconsciousness
Levels of consciousness/unconsciousness
Traumatic Brain Injury Levels of Consciousness

Loss of consciousness is a common but alam1ing consequence of traumatic brain injury. Traumatic brain injury victims may lose consciousness for
minutes, for weeks, or forever. To help determine the extent of traumatic brain injury and the chance for regaining consciousness, doctors classify a
traumatic brain injury victim into one of six abnormal conscious states: stupor, coma, vegetative state, persistent vegetative state, locked-in
syndrome, and brain dead.
Stupor
Stupor is an excessively long sleeplike state from which a person can be awakened only by loud noises or by i ntense pain. Traumatic brain injury can
damage areas of the brain stem that control consciousness. Any bleeding or accumulation of blood puts pressure on these areas, causing further
damage. Brain tumor or abscess also puts pressure on these areas. Cardiac arrest, aneurysms, cerebral infarction (stroke), seizures, hyperthyroidism,
hypothermia, or hyperthermia can also cause stupor.
Coma
Coma is a profound state of unconsciousness in which a person cannot be awakened by pain or by vigorous stimulation. Interestingly, a person in a
coma does not always lie still or quiet. Sometimes a person can talk or perform other functions that appear to be conscious acts but are not.
Doctors use the Glasgow Coma Scale or the Rancho Los Amigos Scale to measure a coma's severity. The Glasgow Coma Scale uses a 15 point scale
to assess damage to the brain and to help establish a prognosis. The Rancho Los Amigos Scale is a complex scale that describes eight levels of coma
and is used within the first weeks or months of coma.
As a coma deepens or progresses, brain responsiveness and chances for recovery decrease. For individuals who emerge from coma, recovery is slow
and gradual. Many people emerge from a coma with physical, intellectual, and psychological impairments that require special treatments. Some
people may never progress beyond very basic responses, while others recover with full awareness. Other people who do not recover slip from coma
into vegetative or persistent vegetative states.
Vegetative State
Traumatic brain injury victims in a vegetative state are unconscious and unaware of their surroundings. They may continue to have short periods of
alertness and may move, groan, or show reflex responses. Vegetative state can be caused by damage to the parts of the brain that control thinking,
memory, consciousness, and speech (cerebral hemispheres). A person with damage to these areas may not have damage to the part of the brain
that coordinates movement and balance (cerebellum) or the part of the brain that controls breathing and heart rate (brain stem).
Many people can emerge from a vegetative state within a few weeks. However, if a person does not recover from a vegetative state, the person is
deemed to be in a persistent vegetative state.
Persistent Vegetative State

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Persistent Vegetative State

Vegetative state that lasts for more than 30 days is referred to as persistent vegetative state. Persistent vegetative state recovery depends on the
extent of brain injury and the person's age. Typically, younger people have a better chance of recovery than do older people. Adults have about a
50 percent chance of recovery, whereas children have about a 60 percent chance of recovery.
After a year, the chances of recovery from a persistent vegetative state are very low, and most patients who do recover consciousness will be
severely disabled. The longer a patient is in a persistent vegetative state, the worse the disabilities are.
Locked-In Syndron1e
Locked-in syndrome is an exceptionally frustrating state of consciousness for a victim. Due to paralysis of the whole body, a person cannot
communicate or move but is aware and awake. Unlike persistent vegetative state, in which only upper portions of the brain are damaged, locked-in
syndrome is caused by damage to lower portions of the brain that control movement and mobility. Thinking, emotions, and memory are intact.
Most locked-in syndrome patients can communicate by blinking their eyes. Some people have the ability to move certain facial muscles as well. Most
locked-in syndrome patients do not regain motor control.
Brain Dead
A brain dead state reflects the absence of brain function. Before life support equipment was invented, the body would die as soon as the brain died.
Brain death is irreversible. A brain dead person has no electrical activity and no clinical evidence of brain function on physical examination, with no
response to pain, absent cranial nerve reflexes, and no spontaneous breathing. It is important to distinguish between brain death and states that
mimic brain death like coma, hypothermia, and intoxication or drug overdose.
To pronounce a person brain dead, legal criteria usually require neurological exams by two independent doctors. Doctors rigorously test to detem1ine
if a person is brain dead or only appears to be brain dead. These tests must show complete absence of brain function, including a completely flat
electroencephalogram (EEG), which measures electrical activity in the brain. Cranial blood flow scans and tests such as positron emission
tomography (PET) or functional magnetic resonance imaging (fMRI) that show complete absence of brain blood flow can be used to confirm the
diagnosis without performing an EEG. In 1980 the Uniform Determination of Death Act was proposed in the United States in an attempt to
standardize the legal criteria across all the states.
Notes
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HELP I I I
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Burns, scalds and effects of heat and cold
Burns, scalds and effects of heat and cold
Burns and Scalds Do's and Don'ts

Oo's
Remember 3 B's and 3 C's:
Stop the !l,urn Cool the part
Check !l,reathing Cover the area
Examine !l,ody Carry to the hospital
Don'ts
Give liquid to unconscious casualty
Rupture blisters
Remove stuck clothes
Apply oil or cream
Leave casualty alone
Heat Injury
Thermal burns are caused by dry heat {e.g. fire & hot metal) Scalds result from moist heat e.g. hot liquids or steam Chemical burns are caused by
acids & alkalis
Electrical burns are clinically evident at the point of entry and exit, the latter being more severe.
1. For clinical purpose the surface area of the burn is estimated by the Rule of Nine.
2. Depth of the burns -
• First Degree burns - Only the epidermis, superficial layer of the skin in involved. There is redness with burning sensation.
• Second Degree burns superficial second degree burns: The epidermis & the superficial layer of the dermis is involved.
This presents as a blister formation, considerable swelling & weeping of fluid.
• Deep Second Degree: The epidermis & dermis {full thickness) are involved, may not be easy to distinguish from third degree burns immediately
after the injury. Pain may be severe because of damage to the nerve endings.
• Third Degree Burns: Involve the whole thickness of the skin and may extend to underlying fat & muscle. The skin may be charred, black or
dark brown, leather or white according to the cause of the burn. Pain may be absent due to destruction of the nerve endings.
ALWAYS EXAMINE CAREFULLY

Whether the patient has
1. Soot on his teeth

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ALWAYS EXAMINE CAREFULLY
Whether the patient has
1. Soot on his teeth

2. Singed hair in the nostrils
3. Cherry red oral mucosa
4. Circumferential burns (of the neck)
5. The burns involving face and genitalia, and large burns around joints.
6. Third degree burns with any other con-comitant injury or disease.
7. Burns over 18 °/o of the body surface (in an adult) and 10 °/o in children and persons above 40 years of age.
FIRST AID
• Remove the burnt clothing. Do not pull those tags of cloth stuck to the burnt surface.
• Remove all the jewellery.
• Immerse the burnt part of the body in water or pour water over the burnt area.
If the burn is of FIRST DEGREE

Treatment includes pouring water over the wound, dabbing it dry with a swab and apply.
Oinment Siver Sulphadiazine (Silvere x) or Petroleum Jelly or Zinc Oxide
If the burn is of SECOND DEGREE,

WOUND DRESSING IS IMPORTANT
• Wear sterilized gloves

• Keep the dressing trolley ready with an assistant to help you do the dressing. The assistant should also wear on gloves.
• Treat the wound with saline/ warm water to remove all the dirt or mud.
• Clean the area around the wound first with SAVLON or 1°/o CETRIMIDE SOLUTION. Then clean the wound with the same solution. Cleansing
should be done with a piece of bandage (gauze piece) by holding it in a needle-holder and not with a cotton swab and should be carried out
from centre (wound) to the periphery.
For the final dressing use a Betadine soak or Ointment Betadine or Ointment Soframycine or Soft tulle
Cover the entire wound and the surrounding region with the dressing and then tie a bandage (not very tight).
Immunize with !NJ TETA NUS TOXOID (!M).
If the burn is of THIRD DEGREE,

Procedure is as follows:
IMMEDIATE THERAPY
Emergency Respiratory Care:

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• Keep the dressing trolley ready with an assistant to help you do the dressing. The assistant should also wear on gloves.
• Treat the wound with saline/warm water to remove all the dirt or mud.
• Clean the area around the wound first with SAVLON or 1 °/o CETRIMIDE SOLUTION. Then clean the wound with the same solution. Cleansing
should be done with a piece of bandage (gauze piece) by holding it in a needle-holder and not with a cotton swab and should be carried out
from centre (wound) to the periphery.
For the final dressing use a Betadine soak or Ointment Betadine or Ointment Soframycine or Soft tulle
Cover the entire wound and the surrounding region with the dressing and then tie a bandage (not very tight).
Immunize with !NJ TETANUS TOXOID (IM).
If the burn is of THIRD DEGREE,

Procedure is as follows:
IMMEDIATE THERAPY
Emergency Respiratory Care:
• Exposure to heavy smoke may lead to carbon-monoxide poisoning.

• Treatment consists in administration of 100 °/o oxygen by nasal catheter or through endotracheal tube.
Relief of Pain
• The burnt area is kept covered with sheets to prevent irritation.

• Exposure to cold is avoided as this induces pain
• Sedat ves/ pain killers are administered intravenously every 4-6 hours. For adults PETHIDINE OR MORPHINE and for children
i
• BARBITURATES are advised.
Intra-venous Fluid Resuscitation

All adults with burns exceeding 18°/o and children with burns above 10 °/o require fluid resuscitation.
RINGER'S LACTATE is the IV fluid of choice. AVOID SUGAR CONTAINING FLUIDS.
• The rate of IV fluid flow in an adult is 2 to 4 ml of fluid x0/o of burnt surface x kg body weight
• The urinary output in an average adult must be 35 to 50 ml/hour.
TETANUS PROPHYLAXIS
Antibiotics
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They can be classified into three types
!st degree • When the burns are superficial affecting only the skin
!Ind degree - When the burns involve the underlying tissue
I!Ird degree - When the burns involve deep tissue up to the bone
First aid for burns
• Run cold water over burned area for 15 minutes, if possible

• Do NOT put any creams or greases on the burned area
• Do not pop any blisters. Cover the burn with a light gauze dressing
• If blisters pop, apply a light antibiotic ointment and dress as above.
• NEVER put petroleum on burns: it holds the heat.
• NEVER loosen tourniquet once it has been applied. Only to be done by physician.
First degree, second degree and third degree burns

How to determine the severity of a burn
010 Total Body Surface Area Burn
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First-degree burn:
Skin level:
• Outer skin layer (epidermis)
Signs and symptoms:
• Redness which turns pale on pressure

• Mild swelling, tenderness, pain
Outcome:
• Heals in three to seven days without scarring.
Second-degree, or partial-thickness, burn:

Skin level:
• Deep skin layer (dermis).
Superficial second-degree burn:

Signs and symptoms:
• Pain
• Tenderness to pressure and to air blown on the skin
• Redness
• "Weeping" burn area burn area turns pale when pressed ) blisters
Outcome: heals in 7-2 I days, usually without scarring.
Deep second-degree burn:

At first hard to distinguish from third-degree burn (see below)
Signs and symptoms:
• Pain, possibly severe, from damage to nerve endings

• Tender only to pressure and not to air blown on the skin
• Extensive blisters, which burst readily
• Burn areas weeping or waxy
• Burn areas dry, red or pale
• Red areas do not turn pale when pressed

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Signs and symptoms:
• Pain, possibly severe, from damage to nerve endings

• Tender only to pressure and not to air blown on the skin
• Extensive blisters, which burst readily
• Burn areas weeping or waxy
• Burn areas dry, red or pale
• Red areas do not turn pale when pressed
Outcome:
• Heals in weeks to months

• Scarring often severe.
Third-degree, or full-thickness, burn:

Skin layer:
• Entire thickness of skin

• May extend to underlying fat, muscle, and bone
Signs and symptoms:
• Skin possibly charred black or dark brown

• Skin leathery or white
• Usually no pain (nerve endings destroyed)
Outcome:
• Untreated, will never heal

• Treated, usually with skin grafting, will heal within weeks to months
• Scarring always severe.
The following media explains about the Fire injuries:

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HELP I I I
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Apply appropriate first aid measures

Treatment
Seek medical advice in all cases expect for small superficial burns.
You may be able to treat on board:
• A partial-thickness burn in:
1. An adult patient under SO years of age:

2. Whose burn covers less than 15°/o of the total body surface area
• A partial-thickness burn in:
1. An adult patient over SO years of age

2. Whose burn covers less than 10 °/o of the total body surface area;
3. A full-thickness burn covering less than 2°/o of the total body surface area.
Cool the heat burns as quickly as possible with cold running water (sea or fresh) for at least 10 minutes; OR
• Immerse the burned area in basins of cold water.
If you cannot cool a burn on the spot, take the victim to a place where cooling is possible.
Try to remove clothing gently but do not tear off any clothing that adheres to skin.
Cover the burned areas with a dry, non-fluffy dressing larger than the burns, and bandage in place.
After cooling the burn, remove the patient to a warm cabin with a supply of clean water and dressing material.
For pain relief in a patient with a small burn give paracetamol or ibuprofen.
For pain relief in a patient with a large or deep burn give morphine, starting with 15-20 mg intramuscularly, every three to four hours:
• Do not wait for the pain to return before giving the next dose of morphine
• Increase the dose of morphine by 5 0°/o if the patient still has pain one hour after the second dose.
Encourage the patient to drink oral rehydration solution or hot sweet tea; OR
• Insert an intravenous cannula and give 0.9°/o sodium chloride solution (i.e. normal saline) at a rate of 125 ml/hr.
If the patient is awaitinq evacuation, do nothinq further except keep the patient warm: take care to prevent blankets from stickinq to the burns. "'

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Encourage the patient to drink oral rehydration solution or hot sweet tea; OR
• Insert an intravenous cannula and give 0.9°/o sodium chloride solution (i.e . normal saline) at a rate of 125 ml/hr.
If the patient is awaiting evacuation, do nothing further except keep the patient warm: take care to prevent blankets from sticking to the burns.
If the patient is to remain on board, wash the burn gently with soap and potable water:
• Do not use disinfectants such as chlorhexidine because they may delay healing
• Do not expose several large burn areas at a time
• Keep the patient warm: loss of skin makes the patient prone to hypothermia
• Use sterile scissors to cut away loose, dead skin, including broken blisters
• Leave intact blisters alone, unless:
1. The fluid in the blisters is bloody or cloudy; OR

2. The blisters are over a joint; OR
3. The patient cannot avoid lying on a blister;
• For such blisters, use sterile scissors to remove the entire blister roof:
1. Do not use a needle to prick blisters;
• Smear the burn with honey and cover it, first with petroleum gauze, then with a sterile non-adherent dressing; note:
1. Honey helps prevent infection, and has been shown in scientific studies to be as effective as, but safer than, an antibiotic
• Cover the dressing with padding to absorb fluid leaking from the burn and hold the dressing in place with a suitable bandage, such as a tubular
dressing or crepe bandage for limbs, an elastic net dressing for other body areas
• For hand or foot burns, dress fingers or toes separately to prevent them from sticking together;
• Leave superficial hand and face burns uncovered or cover only with a non-adherent gauze pad;
• Change dressings daily or, over the first day or so, whenever the padding is damp with leaking tissue fluid;
• Wash the old honey off with water, put on a new layer, and dress again as before;
• As soon as the burn wound is covered by new pink skin (usually in one to three weeks), stop applying honey and cover the burn with a dry
dressing;
• To relieve itching, which often occurs as the burn heals, give cetirizine, 5-10 mg orally, twice daily.
For a full-thickness burn greater than 2 cm across, or a large partial-thickness burn, have the patient see a doctor with specialist training in burns at
the next port with good medical facilities: a skin graft may be required, but this is best done eight to 10 days after the burn.
Actions to Avoid
Do not treat a patient with a burn if you have any doubts about whether you can or should:

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HELP I I I
PASSWORD HOME EXIT
Actions to Avoid
Do not treat a patient with a burn if you have any doubts about whether you can or should:
• Less than perfect care can worsen the outcome

• Seek medical advice immediately.
Do not treat a burn patient on board who:
• Has any other injury; OR

• Is a baby or a child or older than SO; OR
• Has a burn on the face, hand, foot, groin, genitals, or anus; OR
• Has a burn lying across a large joint; OR
• Has a burn going all the way around a limb.
Infection of a burn
Because a burn alone causes pain, redness, and swelling, it is difficult to know whether the burn area is infected. Fever or lymph node enlargement
or an increase in pain within the first two days of the burn injury suggests infection. Infection in a burn wound is dangerous: it can cause
bloodstream infection and can worsen tissue damage in the wound.
Treatn1ent
If you suspect that the burn area has become infected:
• Seek medical advice with a view to early evacuation;

• Give amoxycillin/clavulanate, 875 mg orally, twice daily.
Respiratory tract burns

A respiratory tract burn should be suspected in any patient with burns around the nose and mouth. The patient must be evacuated urgently. Burns
caused by the inhalation of dry gas and smoke do not usually go beyond the throat. Inhalation of superheated steam can cause burns to the lungs
as well as to the throat.
Treatn1ent
For a patient with a throat burn and difficulty breathing due to swelling or to blisters in the throat that appeared very soon after the burn injury,
arrange for urgent evacuation.
CLOTHING ON FIRE
Treatn1ent
i
Tell the vict m to close the eyes immediately and use a dry-powder fire extinguisher (colour-coded red in many countries) to put out the fire
• After the fire is extinguished, have the victim wash out any powder that has entered the eyes.

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!:!J l HIGHLIGHT REMOVE HIGHLIGHT CALCULATOR CONVERTER
caused by the inhalatiG ually go beyond the throat. Inhalation of superheated steam can cause burns to the lungs
as well as to the throat Save !'.age As...
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Treatment
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For a patient with a t� due to swelling or to blisters in the throat that appeared very soon after the burn injury,
arrange for urgent evai Viel,l! Background Image
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CLOTHING ON FIRE Tb.is Frame >
Treatment
Y:iew Page Source
Tell the vict m to close -powder fire extinguisher (colour-coded red in many countries) to put out the fire
i
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• After the fire is e Inspect Accessibility Properties out any powder that has entered the eyes.
Inspect Element (Q)
If a dry-powder extinguisher is not available, lay the victim down and smother the flames by wrapping the victim in any available material; OR
• Throw bucketfuls of water over the victim; OR

• Use a hose, if available, to douse the victim.
Make sure all smouldering clothing is extinguished.
Actions to Avoid
Do not use a carbon dioxide extinguisher (colour-coded black in many countries), unless nothing else is available: the gas can suffocate the patient:
• If you must use a carbon dioxide extinguisher, get the victim away from the gas cloud as soon as the fire is out.
Notes
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caused by the inhalation of dry gas and smoke do not usually go beyond the throat. Inhalation of superheated steam can cause burns to the lungs
as well as to the throat.
Treatment
For a patient with a throat burn and difficulty breathing due to swelling or to blisters in the throat that appeared very soon after the burn injury,
arrange for urgent evacuation.
CLOTHING ON FIRE
Treatment
Tell the vict m to close the eyes immediately and use a dry-powder fire extinguisher (colour-coded red in many countries) to put out the fire
i
• After the fire is extinguished, have the victim wash out any powder that has entered the eyes.
If a dry-powder extinguisher is not available, lay the victim down and smother the flames by wrapping the victim in any available material; OR
• Throw bucketfuls of water over the victim; OR

• Use a hose, if available, to douse the victim.
Make sure all smouldering clothing is extinguished.
Actions to Avoid
Do not use a carbon dioxide extinguisher (colour-coded black in many countries), unless nothing else is available: the gas can suffocate the patient:
• If you must use a carbon dioxide extinguisher, get the victim away from the gas cloud as soon as the fire is out.
Notes
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Burns, scalds and effects of heat and cold Scalds
Scalds
Distinguishes between burns and scalds
HEAT BURNS AND SCALDS

The treatment of burns and scalds is generally the same, whether the cause is dry or wet heat, electricity, or chemicals. With electrical burns, there
may be only a small burn on the skin surface but extensive damage to underlying tissue.
Note
Skin has an outer layer (epidermis) and a deep layer (dermis). The dermis contains sweat glands, hair follicles, and nerves relaying sensation and
pain to the skin.
The most important questions to consider in a burn injury are:
• How deeply does the burn go into the skin?

• How extensive is the area of skin affected by the burn ?
Burns generally cause loss of fluid from the body:
• The fluid lost is plasma (the pale-yellow liquid part of blood)

• Generally, the more extensive the burn (as distinct from its depth), the greater the fluid loss and the more severe the de_gree of shock.
A standard method of estimating the surface area affected by a burn is the "rule of nines". For children (not babies), the percentage for the head
should be doubled and 1°/o take off each of the other areas.
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 isn't always related to how serious the burn is. Even a very serious burn may be relatively painless.
Treating burns and scalds

To treat a burn, administrate first aid as indicated below:

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• How deeply does the burn go into the skin?

• How extensive is the area of skin affected by the burn ?
Burns generally cause loss of fluid from the body:
• The fluid lost is plasma (the pale-yellow liquid part of blood)

• Generally, the more extensive the burn (as distinct from its depth), the greater the fluid loss and the more severe the de_gree of shock.
A standard method of estimating the surface area affected by a burn is the "rule of nines". For children (not babies), the percentage for the head
should be doubled and 1 °/o take off each of the other areas.
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 isn't always related to how serious the burn is. Even a very serious burn may be relatively painless.
Treating burns and scalds

To treat a burn, administrate first aid as indicated below:
• 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 don't use ice, iced water, or any creams or greasy substances such as butter
• Remove any clothing or jewellery that's near the burnt area of skin, including babies' nappies but don't move anything that's stuck to the skin
• Make sure the person 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
Notes
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Burns, scalds and effects of heat and cold Heatstroke
Heatstroke
Heat stroke is the most severe form of what is called "hyperthermia". Unlike fever, which is due to retention of heat by the body, hyperthermia is due
to a failure of the body's temperature regulating systems. Heat stroke results from an overloading of the body's ability to keep a balance between
the heat entering the body and the heat leaving the body. Strenuous work in hot conditions or in heavy clothing is a common precipitating factor,
but air temperatures do not need to be high. On board ship, seafarers most at risk are those working in the engine room or on deck in the sun or
participating in fire-fighting exercises in protective clothing.
A "thermostat" in the brain keeps the body temperature at a setting between 36 °C and 38 °C: it does so by keeping a balance between the amount
of heat the body gains and the amount it loses.
The body preserves or gains heat through:
• Mechanisms, such as:
1. Muscle shivering
2. Muscle contraction during strenuous physical work
3. The chemical processes of the body's cells (metabolism)
4. Narrowing (constriction) of blood vessels in the skin, which reduces loss of blood heat from the body surface
• Radiation, for example, from the sun's rays

• Conduction, when the body is in contact with a hot surface, such as a hot deck
• Convection, when air carries heat from a heat source, such as a ship's engine
• Insulation from thick clothing.
Signs and symptoms
• Core (internal) body temperature over 40.5 °C as a result of heat load from the environment; note:
1. Heat stroke can develop quickly: take action (see below, What to do) if there is any rise in body temperature
2. Oral and axillary (armpit) temperatures are slightly lower than the core temperature: if they are elevated, the rectal temperature should be
taken in order to determine core temperature.
• Altered mental function, possibly with:
1. Aggression
2. Confusion
3. Delirium

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2. Confusion
3. Delirium
4. Fits (convulsions)
• Skin warm and pink, and typically dry, although if heat stroke has developed rapidly the skin may be moist from sweat.
• Rapid pulse rate.
• Rapid respiratory rate .
• Dry cough in some cases.
Treatment
• Move the pat ient into a cool environment.

• Remove all the patient's clothing.
• Spray or splash the patient's whole body with cold water and fan him vigorously, or immerse him in a bath of cold water.
• Seek medical advice with a view to evacuation: even if body temperature is brought under control, heat stroke can cause life-threatening
damage to internal organs.
• If body temperature does not fall below 39°C within 30 minutes, place the patient in an ice-water bath. Take the patient out of the bath as
soon as rectal temperature has fallen to 39°C.
Actions to Avoid
• Do not give anti-pyretic (anti-fever) medicines, such as aspirin or paracetamol: they will not help and may worsen the damage heat stroke can
cause to internal organs.
• Do not leave the patient unattended in a bath.
To prevent heat stroke
• Drink plenty of water containing salt before, during, and after exposure to heat - at least 400-500 ml every 20 minutes during exposure.
• Stay as little as possible in a hot, high-risk environment - take a IS-minute break for every hour of exposure.
• Be especially wary when crew are working in warm or hot conditions wearing heavy clothing.
Acclimatization to heat
• A seafarer can become acclimatized to working in hot conditions by gradual exposure to such work.
• Initial acclimatization can take one to two weeks.
• Full acclimatization requires exposure to working in hot conditions three to four times a week for at least four weeks.

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stoker's cramps
Stoker's, or heat, cramps are painful muscular spasms of the large muscles of the arms, legs, and back. They occur following fluid loss caused by
heavy sweating during long periods of physical activity.
Signs and symptoms
• Abrupt onset of severe pain in muscles of the limbs and/or back.
Treatment
• Give the patient fluid containing salts, ideally oral rehydration solution, or water together with salty food.
• Have the patient sit quietly in a cool, shaded area.
• Allow resumption of physical activity only when the patient has rested for an hour after the cramps have stopped.
Heat exhaustion
Heat exhaustion is a very common heat disorder. It can occur when there is an excessive loss of fluids and salts from the body, from sweating, for
example. The result is a reduction in the amount of blood circulating in the body. The symptoms and signs are generally more severe than those of
heat cramps.
Signs and symptoms
• Weakness and fatigue

• Dizziness
• Clammy, ashen skin
• Thirst
• Heavy sweating
• Nausea and vomiting
• Normal temperature and mental function: note:
• Any rise of temperature or abnormal mental function suggests early heat stroke.
Treatn1ent
• Have the patient lie down in a cool environment with the feet raised.
• Loosen or remove the patient's clothing.
• Administer fluid, ideally oral rehydration solution, but have the patient drink slowly to avoid nausea and vomiting.
• Check vital signs (temperature, breathing, and heart rate), and mental function.
• Have the patient taken off duty for 24 hours .

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Burns, scalds and effects of heat and cold Effects of heat
Effects of heat
The body loses heat through:
• Sweating when sweat evaporates, it takes energy (in the form of heat) from the body:
• Sweating is the main mechanism of heat loss in a hot environment, but is not effective in very humid conditions or when there is so much sweat
that it drips off the skin without evaporating;
• Loss of warm faeces, urine and air exhaled from the lung
• Radiation from the body surface
• Convection, when air next to the body is heated and then carried away by a breeze:
• Convection is an important mechanism of heat loss, but only if the air is moving and is cooler than skin temperature
• Conduction, for example, from contact with a cold steel deck.
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Burns, scalds and effects of heat and cold Hypothermia
Hypothermia
Overview
Hypothermia occurs when a person's normal body temperature of around 37°C (98.6 ° F) drops below 35 ° C (95 ° F). It is usually caused by being in a
cold environment. It can be triggered by a combination of things, including prolonged exposure to cold, rain, wind, sweat, inactivity or being in cold
water.
In this unit will give brief knowledge about hypothermia and it's symptoms, preventions, first aid and treatments. And also to get knowledge about
immersion and life saving craft s .
Hypothermia is defined as abnormally low body temperature. The prefix hypo means abnormally low and thermia, in this case, refers to body heat or
temperature. Therefore hypothermia is a decrease in core body temperature to a level at which normal muscular and brain functions are impaired.
The condition needs to be treated as an emergency when the body temperature falls to about 35 deg C (95 deg F) or below. Hypothermia becomes
life threatening below body temperatures of 32.2 deg C (90 deg F).
Causes of Hypothermia
Hypothermia occurs due to the following reasons:
• Exposed to cold temperatures for long periods or when the skin comes in contact with extreme damp and chillness.
• Exposure to cold-outdoors, winter weather and may even occur indoors when it is unusually chill.
• Inadequate protecti ve clothing in cold temperatures, accompanied by wind and rain may aggravate the condition.
• Slim and weak persons who have inadequate body fat and where insulation to cold is poor.
• Submerged in cold water for long duration of time.
Hypothermic Effects
If you don't eat, dress, and think warmly, then the following signs and symptoms might occur at the temperature ranges:
• 98° - 95° F: Feel chilly, skin numbness, minor muscular impairment especially in hands, shivering begins.
• 95 ° - 93 ° F: Early stage muscular in-coordination is obvious, weakness, stumbling, mild confusion, and apathy.
• 93 ° - 90 ° F:Gross muscular in-coordination, frequent stumbling, inability to use hands, mental sluggishness, slow speech and delayed thought
with mild amnesia.
• 90° - 86° F: Shivering stops, severe muscular in-coordination and stiffness, inability to stand, incoherence, confusion, irrationality.
• 86 ° - 82 ° F: Severe muscular rigidity, semi-conscious (barely arousable patient in spite of stimulus), pupil dilation, pulse virtually unapparent .
• 82 ° - 78° F: Unconsciousness followed by death.
SVmotoms of Hvoothermia

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Synlptoms of Hypothermia
There are several symptoms observed by Hypothermia patients. The symptoms are classified as:
Signs & Symptoms observed in Emergency Situations
• Fatigue, drowsiness, exhaustion, unwillingness to go on

• Feeling of deep cold or numbness
• Poor coordination
• Stumbling
The victim needs en1ergency care if the following symptoms are present:
• Poor articulation of words

• Disorientation
• Decrease in shivering followed by rigidity of muscles
• Cyanosis (blueness of skin)
Signs & Synlptoms observed by others
• Slowing of pace, drowsiness, fatigue

• Stumbling
• Thickness of speech
• Amnesia
i
• Irrat onality, poor judgement
• Hallucinations
• Loss of perceptual contact with environment
• Blueness of skin (cyanosis)
i
• Dilat on ( enlargement) of pupils
• Decreased heart and respiration rate
• Stupor
Prevention of Hypothermia
Simple precautions when observed could help you to avoid Hypothermia. Son1e of these include:
• Consume high energy snacks to maintain body heat during outdoor stays.
• Dress adequately as per situations and your indoor home temperature should be in 70 degrees range.
• Get out of wet clothing immediately as it aggravates loss of body heat.
• Stock up with emergency provisions during extreme winter conditions.

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Treatment of Hypothermia
Following are the procedures for treatment of Hypothern1ia:
• Shift the affected person to a warm place.

• Remove all wet clothes and change into warm dry clothing.
• Wrap the person in blankets or woolen sheets, to prevent further loss of body heat.
• The affected person has to be given warm fluids like tea, coffee or soup.
• Keep the hypothermic person awake by talking or jostling.
First Aid
The following steps should be taken for administering First Aid to Hypothermic persons at sea:
• Make sure the victim has an open airway and is able to breathe. Then, check for the respiration and pulse. Respiration may be slow and
shallow and the pulse may be very weak. So check vital signs very carefully. If there is no pulse or respiration, CPR must be started
immediately.
• Prevention of heat loss:
• a. Gently move the victim to shelter and warmth as rapidly as possible
• b. Gently remove all wet clothing; cut it away if necessary. The small amount of heat energy the victim has left must not be expended on
warming and drying wet clothing.
• c. Wrap the victim in blankets or a sleeping bag. If available, place warm water bottles or other gentle sources of heat under the blanket on
the victim's neck, groin, and on the sides of the chest.
• Transport the victim to a hospital as soon as possible. Only a physician should determine when the patient should be released. Incorrect
treatment of hypothermia victims may induce a condition known as 'After-Drop'. After drop is a drop in the core body temperature that occurs
after rewarming has been started. It occurs as cold blood in the extremities flows back into the trunk (core body).When this cold blood returns
to the core of the body it may drop the core temperature below a level that will sustain life. For the same reason, hypothermia victims must be
handled gently and should not be allowed to walk.
Ways to avoid after drop:
• Do not let the person walk around after being rescued. The person should lie still for at least 30 minutes after recovery.
• Do not massage the limbs to "restore circulation."
• Warm the head, neck and trunk but not the extremities during the resuscitation.
Do not:
• Place an unconscious victim in a bath tub.

• Give a victim anything to drink, including hot liquids and especially alcohol.
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the victim's neck, groin, and on the sides of the chest.
• Transport the victim to a hospital as soon as possible. Only a physician should determine when the patient should be released. Incorrect
treatment of hypothermia victims may induce a condition known as 'After-Drop'. After drop is a drop in the core body temperature that occurs
after rewarming has been started. It occurs as cold blood in the extremities flows back into the trunk (core body).When this cold blood returns
to the core of the body it may drop the core temperature below a level that will sustain life. For the same reason, hypothermia victims must be
handled gently and should not be allowed to walk.
Ways to avoid after drop:
• Do not let the person walk around after being rescued. The person should lie still for at least 30 minutes after recovery.
• Do not massage the limbs to "restore circulation."
• Warm the head, neck and trunk but not the extremities during the resuscitation.
Do not:
• Place an unconscious victim in a bath tub.

• Give a victim anything to drink, including hot liquids and especially alcohol.
• Rub the victim's skin; particularly not with ice/snow.
Hypothermia at Sea
• Humans are warm blooded animals. The chemical processes that allow us to move and think are designed to run at high temperatures. Under
normal circumstances, our body maintains its temperature at 98.6 degrees Fahrenheit. We expend most of the energy we consume maintaining
that temperature.
• When the body loses heat, it compensates by restricting blood to the extremities. This reduces the loss of heat and protects the most
important functions of the body, the internal organs and the brain.
• Water is many times denser than air. It has a tremendous heat capacity. It can pull heat from the immersed body twenty five times faster than
air. While one may be uncomfortable during 30 minutes of exposure to 40 degree air, one can easily die immersed in 40 degree water. Many
drowning victims are actually victims of hypothermia.
• Knowledge, preparation and help are the best safeguards against hypothermia and the first safety item in any boat kit.
• Knowing and respecting the dangers of hypothermia are important irrespective of your skill level.
Notes
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Burns, scalds and effects of heat and cold Hypothermia How Heat is lost from the Body
How Heat is Lost from the Body
There are four processes by which heat leaves the body:

Radiation
It is the direct transfer of heat to the environment. This is the most common method by which heat is lost from the body.
Convection
In this process the air next to the skin is warmed and the warm air rises from the body and is replaced with cool air. This is more prevalent in cooler
climates.
Evaporation
In this process Heat is mainly lost due to sweating. Evaporation occurs when the air breathed in is saturated due to humidity and when increased
muscular activity promotes heat loss. Both of these methods which vaporize water cause great heat and water losses. Both are also increased with
exercise. This cause of body heat loss is common in the tropics where the humidity is high.
Conduction
This occurs when Heat is directly removed from the body due to contact with colder materials such as sitting on a cold surface or in the snow,
jumping in water or excessive sweating. This happens due to sudden variations in the external environment.
HEAT LOST FROM THE BODY
Radiation
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Direct transfer of heat to the environment. This is the most common method by
which heat is lost from the body.
Air next to the skin is warmed; the warm air rises from the body and is replaced with
cool air. This is more prevalent in cooler climates.
Heat is mainly lost due to sweating. The air breathed in is saturated due to humidity
and increased muscular activity. These promote heat loss. Both of these methods which
vaporize water cause great heat and water losses. In both the cases, heat loss
increases with excercises. This method is common in the tropics where the humidity is
high. This is more prevalent in cold climates.
Heat is directly removed from the body due to contact with colder materials, sitting on a
rock or in the snow, jumping in water or excessive sweating. These happen due to
sudden variations in the external environment.
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Burns, scalds and effects of heat and cold Hypothermia How the Body defends itself against Cold
How the Body defends itself against Cold
The normal temperature of our body is about 98.6 degrees F. With different ways in which body heat is lost, how do we adapt to change? How does
our body stay warm? Even though we aren't prepared for the cold, our bodies are capable of keeping us warm for a while.
Increased heat production by the body
• Human bodies increase the metabolism rate to meet the demand for more heat. Muscular activity can also boost body heat, voluntary or not.
Shivering is an involuntary reaction to increase body heat, but it's not efficient enough to prevent hypothermia. Physical activity can greatly
increase heat production. So, if you feel cold you must dance, jump and wiggle or do push-ups. In other words, stoke the fire i.e the
body and eat plenty of food to keep the fire fueled up.
• Cold hands indicate that your body is trying to keep your heart warm. The human body could be considered to be of two parts a core and a
shell. The core includes the vital internal organs such as the brain, heart, and lungs which must be kept at a constant temperature. The shell
is comprised of the skin, muscles and legs which can tolerate relatively wide temperature variations. Since it is so important to maintain core
temperature, the body constricts the blood vessels to the surface of the body, thereby reducing the amount of blood flow to the body's outer
layer. This way heat is kept deep within the body otherwise it could be lost by convection, radiation and conduction.
• The skin also tries to help by closing the pores and raising the hairs on the surface of the skin for insulation. This phenomenon is commonly
known as goose bumps {Momentary roughness of the skin caused by erection of the papillae in response to cold or fear).
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• However, in general, we don't have the amount of fur that our ancestors used to have, so we must look at goose bumps as a signal that our
body is cold and do something about it.

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Burns, scalds and effects of heat and cold Hypothermia Survival in Cold Water
Survival in Cold Water
• Survival in cold water depends on many factors. The temperature of the water is one factor. Others include body size, fat, and activity in the
water. Large built persons cool slower than persons with smaller build. Fat people cool slower than thin people. Children cool faster than adults.
• By swimming or treading water, a person will cool about 35 percent ·faster than when remaining still. Down-proofing the technique of staying
afloat, facedown, with lungs full of air, and raising the head every 10 to 15 seconds for a breath, conserves energy. But it also results in rapid
heat loss through the head and neck. This technique reduces survival time by nearly one-half in cold water.
• An average person, wearing light clothing and a Lifejacket, may survive 2 1/2 to 3 hours in 50° F water by remaining still. This survival time can
be increased considerably by getting as far out of the water as possible and covering the head. Getting into or onto anything that floats can
save life.
Predicted Survival Time

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2 hours
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Holding still /,,, hours
H.E.L_P. position 4 hours
Huddle 4 hours
Wearing a PFD 7 hours

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• If you fall into cold water, remember that water conducts heat many times faster that air. Most boats will float even when capsized or
swamped, so get in or on the boat to get as far out of the water as possible. Wearing a Lifejacket is a must.
• It will keep you afloat even if you are unconscious. Remaining still and, if possible, assuming the fetal, or heat escape lessening posture
(HELP), will increase your survival time. About 50 percent of the heat is lost from the head. It is therefore important to keep the head out of
the water. Other areas of high heat loss are the neck, the sides, and the groin.
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It is impossible to assume the HELP position while wearing some Lifejackets. However, even a partial HELP position gives some protection to the high
heat loss areas, thus increasing survival time. If there are several people in the water, huddling close, side to side in a circle, also will help preserve
body heat. Placing children in the middle of the circle will lend them some of the adult body heat and extend their survival time.
Should you swim for the shore?
• This is a most difficult decision . It depends on many things. Some good swimmers have been able to swim to distances upto 0.8 mile in 50 ° F
water before being overcome by hypothermia.
• Others have not been able to swim even 100 yards. Furthermore, distances on the water are very deceptive. Staying with your boat is usually
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Should you swim for the shore?
• This is a most difficult decision. It depends on many things. Some good swimmers have been able to swim to distances upto 0.8 mile in 50 ° F
water before being overcome by hypothermia.
• Others have not been able to swim even 100 yards. Furthermore, distances on the water are very deceptive. Staying with your boat is usually
the best thing to do. This will make it easier for rescuers to spot you. Even a capsized boat is easier to see than a person in the water. Do not
swim unless there is absolutely no chance of rescue and you are absolutely certain you can make it to the nearest shore. If you do swim, use
a Lifejacket or some other floatation aid.
Stages in Immersion
Initial immersion (first 2 minutes)
• A large percentage of deaths that occur due to immersion occur within three meters of a safe refuge, and many are regarded as 'good
swimmers'. Such statistics suggest much quicker incapacitation than can occur with the protracted period of cooling necessary to produce
hypothermia. Rapid cooling of the skin on immersion in cold water initiates a set of undesirable respiratory and cardiac responses or 'cold
shock'. The ability to do perform useful work, to save oneself declines substantially after 10 minutes, as the body protectively cuts off blood
flow to "non-essential" muscles.
• Two possibilities that can occur are drowning and cardiac arrest and they are most likely the causes of death. Cold shock response is
characterized by an uncontrollable gasp for air, followed by a prolonged period of hyperventilation. This rapid breathing quickly translates to
rapid drowning if the victim is submerged under water. The cold shock response can also cause a heart attack as cold blood from the
extremities reaches the heart. The responses include a 'gasp' response, uncontrollable rapid breathing, and an increase in blood pressure with
work required of the heart.
• The inability to control respiration can result in drowning, and the cardiac responses can result in a stroke or heart attack in susceptible
individuals. The magnitude of the response can be reduced by entering the water slowly, or by keeping as much of the body surface as dry
and warm as possible. It also shows a high degree of habituation, being reduced by as much as 45°/o following just six, 3-minute immersions in
cold water. This habituation appears to occur in the central nervous system and lasts for at least 7 months.
The following media (stages and Effects of ln1n1ersion) explains about the stages and Effects of lmn1ersion:

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Short-Term Immersion (2-30 minutes)

Cooling in water results in a rapid loss of neuro-muscular function, which can produce significant loss in muscular strength, dexterity, proprioception,
and co-ordination. These can impair swimming performance and other actions essential to survival during the early minutes of immersion. Survival
may therefore depend on the immersion duration and taking essential survival actions as soon as possible following immersion or upon boarding a
liferaft.
Long-Term Immersion (30 minutes plus)

For the first time, the falling deep body temperature becomes the primary hazard. Progressive hypothermia can cause: confusion, disorientation,
introversion (at 35° C), amnesia (at 34° C), cardiac arrhythmias (at 33°C), clouding of consciousness (at 33-30 ° C), loss of consciousness (at 30 °C),
ventricular fibrillation (at 28 °C), and death (at 25° C). The deep body temperatures figures are only a very rough guide, as great variation exists
between individuals. For instance, persons can develop cardiac arrest even at higher core body temperatures. Depending on conditions,
consciousness' can be lost some time before death. This emphasizes the importance of wearing a good Lifejacket, which will support the airway clear
of the water and prevent death by drowning at an early stage. Protection against hypothermia is provided primarily by immersion suits and liferafts.
People cool 4-5 times faster in water than in air at the same temperature and, therefore, should get out of the water whenever as fast as possible.
Post-Immersion
Approximately 17°/o of immersion deaths occur during or immediately following rescue. Originally, it was thought that the continued fall in deep body
(rectal) temperature following the immersion, the after drop, was responsible for these deaths. More recent study has suggested that they are more
probably caused by the collapse of blood pressure when hypothermic casualties are removed from the water and re-exposed to the full effects of
gravity. One practical way of reducing this effect is to remove casualties from the water in a horizontal rather than vertical posture. This helps to
maintain venous return and cardiac output. These considerations apply equally to the rescue of survivors who have been adrift in lifesaving crafts
for some time.
Notes

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\ and effects of heat and cold Frostbite
Frostbite
What is Frostbite?
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Frostbite occurs when t ssues freeze. This condition happens when you are exposed to temperatures below the freezing point of skin. Hypothermia is
the condition of developing an abnormally low body temperature. Frostbite and hypothermia are both cold-related medical emergencies.
Frostbite Causes
Your body works to stay alive first, and to stay functioning second.
• In conditions of prolonged cold exposure, the body sends signals to the blood vessels in the arms and legs telling them to constrict (narrow).
By slowing blood flow to the skin, the body is able to send more blood to the vital organs, supplying them with critical nutrients, while also
preventing a further decrease in internal body temperature by exposing less blood to the outside cold.
• As this process continues and the extremities (the parts farthest from the heart) become colder and colder, a condition called the hunter's
response is initiated. The body's blood vessels are dilated (widened) for a period of time and then constricted again. Periods of dilatation are
cycled with times of constriction in order to preserve as much function in the extremities as possible. However, when the brain senses that the
person is in danger of hypothermia (when the body temperature drops significantly below 98.6 F [37 C]), it permanently constricts these blood
vessels in order to prevent them from returning cold blood to the internal organs. When this happens, frostbite has begun.
• Frostbite is caused by two different means: cell death at the time of exposure and further cell deterioration and death because of a lack of
oxygen.
1. In the first, ice crystals form in the space outside of the cells. Water is lost from the cell's interior, and dehydration promotes the destruction
of the cell.
2. In the second, the damaged lining of the blood vessels is the main culprit. As blood flow returns to the extremities upon rewarming, it finds
that the blood vessels themselves are injured, also by the cold. The vessel walls become permeable and blood leaks out into the tissues. Blood
flow is impeded and turbulent and small clots form in the smallest vessels of the extremities. Because of these blood flow problems,
complicated interactions occur, leading to inflammation that causes further tissue damage. This injury is the primary determinant of the amount
of tissue damage that occurs in the end.
3. It is rare for the inside of the cells themselves to be frozen. This phenomenon is only seen in very rapid freezing injuries, such as those
produced by frozen metals.
Frostbite Treatment
Remove all wet clothing from the affected area, and elevate the area higher than the heart if possible to avoid swelling. Keep the person dry and
warm. If they are immobile, and unable to walk try to keep the person busy with conversation. Keep the body warm and dry if possible.
The f ollowing media explains about the Frost Injuries:

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To Create an Arm Splint
Place the person's forearm against his chest. If this is too painful, place a pillow or sheet between his arm and chest. Using gauze, a sheet, or a
blanket, begin at the elbow and wrap the splint in a diagonal direction around the person's back, coming around his chest and wrapping the upper
and lover arm all the way up to the hand. Secure the splint snugly with an ACE bandage or safety pins. Apply ice to the area.
Applying a Splint
• Find a rigid straight object that is longer than the bone and the joint that you are going to support. You are going to use this as the splint.
• Cover any broken skin with a sterile cloth. Pad the splint with softer materials such as cloth.
• Tie the splint to the injured limb using tape or rope. Make sure the splint is tight but not so tight that it cuts of blood circulation of the victim.
Make sure the splint is applied in a way that prevents the limb from further movement or strain.
• If available, place an ice bag over the splinted break area. Do not place it directly on the skin or wound but cover it with cloth.
DISLOCATIONS
A dislocation is present when a bone has been displaced from its normal position at a joint. It may be diagnosed when an injury occurs at or near a
joint and the joint cannot be used normally. Movement is limited. There is pain, often quite severe. The pain is made worse by attempts to move the
joint. The affected area is misshapen both by the dislocation and by swelling (bleeding) which occurs around the dislocation. Except that there is no
grating of bone-ends, the evidence for a dislocation is very similar to that for a fracture. Always remember that fractures and dislocations can occur
together.
DISLOCATED SHOULDER
First Aid
Dislocations can be closed or open. If a wound is present at or near a dislocation.
1. The wound should be covered both to stop bleeding and to help prevent infection.
2. Do not attempt to reduce a dislocation.
3. A fracture may also be present, in which case attempted manipulation to reduce the dislocation can be matters worse.
4. Prevent movement in the affected area by suitable immobilization.
5. Look out for impaired circulation and loss of feeling.
6. If these are present, and if you cannot feel a pulse at the wrist or ankle, try to move the limb gently into a position in which circulation can
return, and keep the limb in this position. Look then for a change in colour of the fingers or toes, from white or blue to pink.
7. Transport the casualty in the most comfortable position. This is usually sitting up for upper limb injuries and lying down for lower-limb injuries.
The following media explains about the Bones Joints and Soft tissue Injuries:

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Fractures, dislocation and muscular injuries Apply practical first aid procedures
Apply practical first aid procedures
If its a Broken Bone
• A broken bone can cause severe pain, swelling, tenderness, and also bruising, making it difficult to use that part of his body.
• But even if the person is able to move an injured hand or foot, for example, he may still have a hidden fracture that needs medical attention.
• If you suspect that any bones may be broken, you should call for medical assistance especially if the person is unconscious, bleeding
uncontrollably, or cannot walk due to a possible break in a leg or ankle bone. NEVER try to move the person yourself in the unlikely event of an
open fracture (i.e., the bone has penetrated the skin). Call for the doctor immediately. Apply pressure to the wound with a clean cloth to stop
the bleeding until help arrives.
• Take the person to the hospital yourself if he is able to walk (i.e., if he breaks an arm or wrist). First immobilize the broken bone, since
movement can cause further bone injury or damage surrounding blood vessels, nerves and tissues.
The following media (Applying an arm sling) explains about the Applying an arm sling:

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< Prev Next > Progress : 100% HIGHLIGHT REMOVE HIGHLIGHT CALCULATOR I CONVERTER
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First Aid for Fractures

If the victim complains about extreme pain at a certain area you should check for a fracture:
• Ask if the victim heard or felt a bone snap

• Check if the victim is able to move the inflicted body part
• Check for deformities
• Check for swelling
• Check for discoloration of the skin
If bone is sticking out of the skin then it is a compound fracture. Compound fractures are very serious injuries that may cause serious bleeding.
• Do not apply too much pressure to stop the bleeding

• Cover the wound with a sterile pad or cloth if available
• Do not push the bone back or try to re-align the fracture. Instead apply a splint to prevent further injury
• Do not move the victim but wait for professional assistance. Keep the victim warm and comfort him/her
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Fractures, dislocation and muscular injuries Describes types of fracture
Describes types of fracture

A bone cracks, breaks, or shatters due to external pressure.
What to expect
Severe pain or deformity (if the bone is bent in an unnatural position), or in rare cases, an open wound.
Some Breaks are Less Obvious

If you're not sure, monitor the injured area for two days. If pain persists or increases, you may have a greenstick fracture (only one side of the bone
is broken) or a hairline fracture (the bone has just cracked).
TYPES OF FRACTURES
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Fractures, dislocation and musc ular injuries Describes types of fracture Open (or compound) Fractures
Open (or compound) Fractures
An open fracture, also called a compound fracture, is a fracture in which there is an open wound o r break in the skin near the site of the broken
bone. Most often, this wound is caused by a fragment of bone breaking through the skin at the moment of the injury.
An open fracture requires different treatment than a closed fracture, in which there is no open wound. This is because, once the skin is broken,
bacteria from dirt and other contaminants can enter the wound and cause infection. For this reason, early treatment for an open fracture focuses on
preventing infection at the site of the injury. The wound, tissues, and bone must be cleaned out in a surgical procedure as soon as possible. The
fractured bone must also be stabilized to allow the wound to heal.
Open fractures vary greatly in severity. In many high-energy injuries, there is obvious skin loss and the bone can be seen protruding through the
wound. In other cases, the wound may be no larger than a puncture.
In either situat on, the damage to the soft tissues around the bone including muscles, tendons, nerves, veins, and arteries can be extensive. For this
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reason, any acute fracture with an open wound in the area is considered to be an open fracture.
The severity of an open fracture depends upon several factors, including:
• The size and number of the fracture fragments

• The damage to surrounding soft tissues
• The location of the wound and whether the soft tissues in the area have good blood supply
To some extent, the setting in which an open fracture occurs will affect the degree of contamination. Objects such as dirt, broken glass, grass,
mud, and even the patient's own clothing can be driven into an open wound. Knowing the setting where your injury occurred can help your doctor
determine the best course of treatment.
Open fractures pose an immediate risk of infection. In general, the greater the damage is to bone and soft tissues, the greater the risk of infection.
A bone infection can be difficult to treat. The patient may require long-term antibiotics and multiple surgical procedures. In extreme cases where the
infection cannot be cured and the patient's life is threatened, amputation may even be necessary. For this reason, preventing infection is the focus
of early treatment.
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Fractures, dislocation and muscular injuries Describes types of fracture Closed (or simple) Fractures
Closed (or simple) Fractures
Closed (or simple) fracture means the skin is not broken through. An open fracture or compound the skin has been ruptured the may or may not be
visible. A simple fracture the bone has what appears to be a clean or smooth edge break to it and it contained to two separate and distinct pieces.
Simple fractures include:
• Greenstick fracture: an incomplete fracture in which the bone is bent. This type of fracture occurs most often in children.
• Transverse fracture: a fracture at a right angle to the bone's axis.
• Oblique fracture: a fracture in which the break is at an angle to the bone's axis.
• Comminuted fracture: a fracture in which the bone fragments into several pieces.
• An impacted fracture is one whose ends are driven into each other. This commonly occurs with arm fractures 1n children and 1s sometimes
known as a buckle fracture.
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Fractures, dislocation and muscular injuries Describes types of fracture Complicated
Complicated Fracture
A bone injury is considered a complicated fracture especially if aside from the fragmented bones there are also lesions found on other joints, nervous
trunk, and arteries. Complicated fractures are one of the most dangerous types of bone injuries because it can also cause severe damage on other
organs which can lead to other complications. One example is a broken ribcage. In cases like this, the fragmented rib can pierce through the lungs
causing detrimental effects on the individual. Most complex fractures also cause internal bleeding so most of the time they need surgery as
treatment.
Fracture Types
• Oblique fracture. This is a type of fracture wherein the crack is diagonal to the long axis of the bone .
• Compacted fracture. This bone injury is the result of two bones that comes from a single bone and the two fragments crushed into each
other.
• Transverse Fracture. This fracture has a crack that is positioned on a right angle to the long shaft of the bone.
• Spiral fracture. This is considered a complex fracture wherein one area of the bone is twisted and cracked.
Diagnosis
Complex fractures will definitely need some x-rays so that the physician can properly see the other regions that might have possibly affected by the
fragmented bone. There are some cases wherein the x-rays do not clearly show the fracture and in this case there need to be the amplification and
sharp imaging of the fracture and these can be provided by the use of MRI or CT scans. Moreover, most complex fractures are generally considered
serious cases of fractures that need immediate emergency treatment so a lengthy diagnosis is not needed. If the complex fracture has caused a
wound to the muscles and bone has pierced the skin, the injury should be immediately cleaned to ensure that no infection will develop. However, if
the injury hasn't affected any major internal organs or muscles, the physician may ask the patient to undergo a physical examination. Rehabilitation
is a must.
Notes
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Fractures, dislocatio n and muscular injuries Treatment for injured parts
Treatment for injured parts
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Fractures, dislocation and muscular injuries Immobilization of injured parts
Immobilization of injured parts
Temporary immobilization in case of fractures/dislocations

Immobilization refers to the process of holding a joint or bone in place with a splint, cast, or brace. This is done to prevent an injured area from
moving while it heals.
Splints, casts, and braces support and protect broken bones, dislocated joints, and injured soft tissues such as tendons and ligaments.
Immobilization restricts motion to allow the injured area to heal. It can help reduce p ain, swelling, and muscle spasms. In some cases, splints and
casts are applied after surgical procedures that repair bones, tendons, or ligaments. This allows for protection and proper alignment early in the
healing process.
When an arm, hand, leg, or foot requires immobilization, the cast, splint, or brace will generally extend from the joint above the injury to the joint
below the injury. For example, an injury to the mid-calf requires immobilization from the knee to the ankle and foot. Injuries of the hip and upper
thigh or shoulder and upper arm require a cast that encircles the body and extends down the injured leg or arm.
Casts and splints

Casts are generally used to immobilize a broken bone. Once the doctor makes sure the two broken ends of the bone are aligned, a cast is put on to
keep them in place until they are rejoined through natural healing. Casts are applied by a physician, a nurse, or an assistant. They are custom-made
to fit each person, and are usually made of plaster or fiberglass. Fiberglass weighs less than plaster, is more durable, and allows the skin more
adequate air flow than plaster. A layer of cotton or synthetic padding is first wrapped around the skin to cover the injured area and protect the skin.
The plaster or fiber-glass is then applied over this and is then allowed to dry. It can take up to 24 hours for a cast to dry completely.
Most casts should be kept dry. However, some types of fiberglass casts use Goretex padding that is waterproof, allowing the cast to be completely
immersed in water when taking a shower or bath. There are some circumstances when this type of cast material cannot be used.
A splint is often used to immobilize a dislocated joint while it heals. Splints are also often used for finger injuries, such as fractures or baseball finger.
Baseball finger is an injury in which the tendon at the end of the finger is separated from the bone as a result of trauma. Splinting is also used to
immobilize an injured arm or leg immediately after an injury . Before moving a child who has injured an arm or leg, some type of temporary splint should
be applied to prevent further injury to the area. Splints may be made of acrylic, polyethylene foam, plaster of paris, or aluminum. In an emergency, a
splint can be made from a piece of wood or rolled magazine.
Slings
Slings are often used to support the arm after a fracture or other injury. They are generally used along with a cast or splint, but are sometimes used
alone as a means of immobilization. They can be used in an emergency to immobilize the arm until a doctor can see the child. A triangular bandage is
placed under the injured arm and then tied around the neck.
Braces

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Braces
Braces are used to support, align, or hold a body part in the correct position. Braces are sometimes used after a surgical procedure is performed on
an arm or a leg. They may also be used when an injury has occurred. Since some braces can be easily taken off and put back on, they are often
used when the child needs physical therapy or must exercise the limb during the healing process. Many braces can also be adjusted to allow for a
certain amount of movement.
Either a custom-made or a ready-made brace can be used. The off-the-shelf braces are made in a variety of shapes and sizes. They generally have
Velcro straps that make the brace easy to adjust and to put on and take off. Both braces and splints offer less support and protection than a cast
and may not be a treatment option in all circumstances.
Collars
A collar is generally used for neck injuries. A soft collar can relieve pain by restricting movement of the head and neck. Collars also transfer some of
the weight of the head from the neck to the chest. Stiff collars are generally used to support the neck when there has been a fracture in one of the
neck bones. Cervical collars are widely used by emergency personnel at the scene of injuries when there is a potential neck or head injury. The collar
helps to ensure that the neck and head do not move, which could make the injury worse.
Traction
Immobilization may also be secured by traction. Traction involves using a method for applying tension to correct the alignment of two structures
{e.g., two bones) and hold them in the correct position. For example, if the bone in the thigh breaks, the broken ends may have a tendency to
overlap. Use of traction will hold them in the correct position for healing to occur. The strongest form of traction involves inserting a stainless steel
pin through a bony prominence attached by a horseshoe-shaped bow and rope to a pulley and weights suspended over the end of the patient's bed.
Traction must be balanced by counter traction. This may be obtained by tilting the bed and allowing the patient's body to act as a counterweight.
Another technique involves applying weights pulling in the opposite direction.
Traction for neck injuries may be in the form of a leather or cotton cloth halter placed around the chin and lower back of the head. For very severe
neck injuries that require maximum traction, tongs that resemble ice tongs are inserted into small holes drilled in the outer skull. All traction requires
careful observation and adjustment by doctors and nurses to maintain proper balance and alignment o f the traction with free suspension of the
weights.
Immobilization can also be secured by a form of traction called skin traction. This is a combination of a splint and traction that is applied to the arms
or legs by strips of adhesive tape placed over the skin of the arm or leg. Adhesive strips, moleskin, or foam rubber traction strips are applied on the
skin. This method is effective only if a moderate amount of traction is required.

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Fractures, dislocation and muscular injuries Pelvic and spinal injuries
Pelvic and spinal injuries
Pelvic Fractures
The pelvis is the sturdy ring of bones located at the base of the spine. Fractures of the pelvis are uncommon accounting for only about 3°/o of all adult
fractures.
Most pelvic fractures are caused by some type of traumatic, high-energy event, such as a car collision. Because the pelvis is in proximity to major
blood vessels and organs, pelvic fractures may cause extensive bleeding and other injuries that require urgent treatment.
In some cases, a lower-impact event such as a minor fall may be enough to cause a pelvic fracture in an older person who has weaker bones.
Treatment for a pelvic fracture varies depending on the severity of the injury. While lower-energy fractures can often be managed with conservative
care, treatment for high-energy pelvic fractures usually involves surgery to reconstruct the pelvis and restore stability so that patients can resume
their daily activities.
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Fractures, dislocation and muscular injuries Transporting a casualty
Transporting a casualty
THE FOUR HANDED SEAT

It can be used when a heavy person has to be carried. The casualty must be able to co-operate and to hold on with both arms around the shoulders
of the two men carrying him.
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THE THREE HANDED SEAT

One arm and hand of a helper is left free and can be used either to support an injured limb or as a back support for casualty.
THE FIREMAN'S UFT:
• Must never be used unless the helper is as well built as the casualty.
• It is easy for the helper to carry the casualty along the ladder since one hand is free to grasp the rail.
• Roll the patient so that he is lying face downwards, lift him so that, when you droop down, you can put your head under his left arm.
• Then put your left arm between his legs and grasp his left hand, letting his body fall over your left shoulder.
• Steady yourself and then stand upright simultaneously shifting his weight so that he lies well balanced across the back of your shoulder.
• Hold the casualty's arm above the wrist.

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Neil Robertson Rescue Stretcher (1-6m)

The Neil Robertson's unique spliced slat design is frequently the stretcher of choice in difficult rescue situations when a casualty needs to be
lowered or lifted to safety. It is widely used by the Merchant Navy and Emergency Rescue Services.
Made of shout canvas and bamboo this stretcher is designed for lifting casualties in the upright position through small hatches, such as manholes or
portholes entrances, r for lowering casualties from heights as in mountain rescue.
The casualty is placed on a stretcher. Rope at the base acts as "stirrups" to hold the casualty's feet. The strap at the top is passed around the
casualty's forehead to hold the head in position. The upper flaps are strapped around the lower limbs.
The ring at the head of stretcher is used for hoisting. Another length of rope is attached to the ring at the foot of the stretcher to guide the
stretcher.
The stretcher should be stored in a place where it is most likely to be needed together with a suitable length of rope, preferably made of rat-proof
fibre.
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Fractures, dislocation and muscular injuries Sprains, strains and dislocations
Sprains, strains and dislocations
DISLOCATED SHOULDER
Humerus or anterior
Humeral Head dislocation
.,.._ Humerus
Pre-accident condition Post-accident condition

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A dislocated joint is a joint that slips out of place. It occurs when the ends of bones are forced from their normal positions. When a joint is
dislocated, it no longer functions properly.
A severe dislocation can cause tearing of the muscles, ligaments and tendons that support the joint.
If you think someone has dislocated vertebrae due to a back or neck injury, don't move the person and call Emergency Personnel immediately.
Syn1ptoms of a Joint Dislocation
• Swelling
• Intense Pain
• Immobility of the affected joint
First Aid for Joint Dislocation

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A severe dislocation can cause tearing of the muscles, ligaments and tendons that support the joint.
If you think someone has dislocated vertebrae due to a back or neck injury, don't move the person and call Emergency Personnel immediately.
Symptoms of a Joint Dislocation
• Swelling
• Intense Pain
• Immobility of the affected joint
First Aid for Joint Dislocation
• Check the injured person's breathing. If necessary administer the CPR or rescue breathing. Also take steps to staunch bleeding before
beginning first aid for a joint dislocation.
• Don't attempt to move injured person unless absolutely necessary. If you must move him, grab his clothes, not his body
• Cover any open wounds to prevent infection. If sterile bandages aren't available, cut up a clean piece of clothing.
• Do not try to move the bone and/or joint. Splint it or immobilize it just as it is. If you try to move a dislocated joint, you risk further injury and
more pain to the injured person.
• Check that the wounded area is getting enough blood flow. Press near the injury. The skin should turn white, then immediately get its color
back
• Keep the victim calm unti l emergency help arrives. Cover him with a blanket to keep him warm. Be observant for the signs of shock that may
set in several minutes after the injury occurs. Apply an ice bag to the dislocated joint to provide some relief from the pain.
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Fractures, dislocation and muscular injuries Pneumatic splints
Pneumatic splints
A pneumatic (air) splint is normally used to immobilize a fracture of the forearm or lower leg. A pneumatic splint can be applied quickly and easily. Since
they are transparent, the injury can be observed through the splint. Pneumatic splints, however, also have disadvantages.
A pneumatic splint cannot be used with an open fracture since the pressure from the splint would force the bone back into the arm. The splint can also
be rendered useless if it is torn or punctured. The pressure may need to be adjusted periodically, especially if the casualty is evacuated by air.
Notes
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Medical care of rescued persons, including distress, hypothermia and cold exposure
Medical care of rescued persons, including distress, hypothermia and cold exposure
Care of rescued persons
SICK BAY
• Wherever possible a patient who is ill and requires nursing should be in the ship's sick bay or in a cabin away from others.
• Adequate ventilation of the sick bay is important.
• A receptacle with a cover/lid is provided to the patient if he has cough with sputum.
• A kidney tray to collect the vomit in; a urine pot and a bed pan is kept by the bedside.
• Temperature, BP chart and fluid input- output chart is kept ready.
• Dietary intake will depend on the patient's illness and can be recorded.
• Check and record if bowels have moved or not.
KEEP A WRITTEN RECORD OF THE TREATMENT GIVEN AND PATIENT'S RESPONSE TO IT.
RESPIRATORY RATE (R/ R)
Always count respirations for one full minute, noting any discomfort in breathing in or out. The pulse rate will usually rise about 4 beats per minute
for every rise of 1 respiration per minute. The 4: 1 ratio will be altered in chest diseases such as pneumonia which can cause a great rise in
respiration rate.
TAKING TEMPERATURE
The normal body temperature is 37 ° C (98.4° F), but it may vary by without indicating any abnormality. Those slight variations may occur, for
example, in the early morning (lower) or in very hot weather, after severe exertion or after hot meals (higher). Feeling the skin gives only a general
guide to body temperature.
UNDER THE ARM: Place the bulb of the thermometer high under the armpit and support it by pressing the patient's arm against its chest. Read after
about 2 minutes. This method usually shows a temperature lower than normal.
Abnormally low temperatures are frequently brought about by shock, severe bleeding or exposure (Hypothermia)
IN THE GROIN: Place the bulb of the thermometer in the skin fold o the groin and gently hold the legs of the child together. Read after 2 minutes.
This method usually shows a temperature lower than normal.
IN THE MOUTH: (Suitable in children over 5 years old.) Place the bulb of the thermometer under one side of the tongue on the floor of the mouth.
Support the thermometer between gently closed lip. Read after 2 minutes.
IN THE RECTUM: (At any age but especially in babies and infants). Gently slip the bulb of the thermometer through the anus into the rectum (about
25mm) and support it there for 1 minute. This will result in a temperature reading higher than normal.

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FEELING FOR THE PULSE

The heart beasts about 90 to 110 Times each minute in a young child about 80 to 100 times each minute in an older child. Each heart beat forces
blood around the arteries of the body and can be felt as a pressure wave over several points of the body.
RADIAL ARTERY
The WRIST is the commonest place to feel the pulse. Gently press the tips of your index and middle fingers over the under side of the wrist at the
base of the thumb.
CAROTID ARTERY
NECK: Place your thumb around the back of the patient's neck and place your index or middle finger on the side of the neck next to the windpipe
and gently press towards your thumb.

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1-ttUNG I-OK I Ht l'ULSt SUBCLAV1AN AKltKY
Above COLLARBONE: hook your Index finger over the top of the child's collarbone and gently press into the soft depression above.
AXILLARY ARTERY
ARM: Hold the upper arm as shown in the diagram and gently press your index and middle fingers against the arm bone.
FEMORAL ARTERY
GROIN: Gently press your index and middle fingers over the middle of the groin fold.
BLOOD PRESSURE
• Blood pressure is measured in millimeters of mercury, and represents the pressure of blood within the vessels.
• Because of the pumping action of the heart, the pressure levels have a wave form, falling in between heart beats. The peak pressure is called
systolic pressure, while the lowest point represents the diastolic pressure. Thus blood pressure is recorded as two numbers -e.g. 120/80- the
first(higher) pressure being the systolic, and the second being diastolic.
• The normal range of blood pressure is lOOto 140 for systolic, and 70 to 90 for diastolic pressures. Older people tend to have a slightly higher
diastolic pressure, usually between 90 and 95 millimeters of mercury. Their systolic pressure may extend up to 160 mm.
Hypertension
HYPERTENSION
Cuff
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Hypertension (HTN or HT), also known as high blood pressure (HBP), 1s a long-term medical condition in which the blood pressure in the arteries is
persistently elevated. High blood pressure typically does not cause symptoms.
Essential hypertension include obesity; diabetes; stress; insufficient intake of potassium, calcium, and magnesium; lack of physical activity; and
chronic alcohol consumption. There are four stages of high blood pressure or hypertension:
• STAGE 1 or Prehypertension is 120/80 to 139/89.

• STAGE 2 or Mild Hypertension is 140/90 to 159/99.
• STAGE 3 or Moderate Hypertension is 160/100 to 179/109.
• STAGE 4 or Severe Hypertension is 180/110 or higher.
HOW BLOOD PRESSURE IS MEASURED
• Blood pressure is measured with a sphygmomanometer and a stethoscope. An inflatable cuff is usually wrapped around the upper arm (but can
be wrapped around the thigh,) and then pumped up.
• The cuff is connected to a pressure measuring device, and once the pressure is higher than the systolic value, no blood flow occurs.
• When the pressure applied by the cuff is less than the diastolic pressure, blood flow is undisturbed. In both these situations no sounds will be
heard by a stethoscope placed over the artery just below the cuff.
• Between these two pressures, however, as the cuff is being deflated slowly there will be some narrowing of the blood vessel and the blood
flow will be turbulent. This turbulence produces a clearly audible sound. Thus the pressure at which these sounds being is the systolic pressure
and the pressure when they cease is the diastolic pressure.

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Medical care of rescued persons, including distress, hypothermia and cold expos... - Treatment for Hypothermia
Treatment for Hypothermia
HYPOTHERMIA
Hypothermia is the term given to the condition when deep body temperature is lowered to less than 35 ° C {95° F) when normal body function will be
impaired. Loss of life may occur when deep body temperature falls below 30° C {86° F).
Causes
The usual causes among seafarers are immersion in the sea, or exposure to cold air while in a survival craft, in colder water death from hypothermia
can occur in less than an hour.
Diagnosis
Hypothermia should always be suspected in every individual rescued at sea. If the casualty is unconscious, there are no reflexes and the pupils are
dilated. The respiratory rate is very slow with two or three movements a minute. The pulse is imperceptible and heart sounds cannot be heard even
with a stethoscope. Death by hypothermia is then defined as being the failure to revive the casualty by re-warming .
TREATMENT
• Removal of all wet clothes and replacement with dry clothes or blankets.
• Hot sweet drinks
• Rest in a warm environment not exceeding 22° C {72 °F) (normal room temperature) are also recommended.
• NEVER GIVE ALCOHOL
• If the survivor is not shivering but is semi-conscious, unconscious or apparently dead, slow rewarming ,s essential. Never attempt rapid
rewarming by immersion in a hot bath except on medical advice.
The following measures will be necessary to preserve life:
1. On rescue always check the survivor's breathing and listen for hear sounds. If the survivor is not breathing, ensure the airway is clear and
start artificial respiration immediately (mouth to mouth or mouth to nose). Attempt are resuscitation should be continued until medical advice
can be obtained, or for at least 30 minutes.
2. Prevent further heat loss due to evaporation or exposure to the wind.
3. Do not massage the limbs.
4. Avoid all unnecessary handling, even the removal of wet clothing.
5. Enclose the survivor in a plastic bag of blankets or preferably both. The blankets should not be warmed, and it is important that the head, but
not the face, is well covered. Place in a room that is not too warm {15 ° -20° C) {59° -70° F). Never attempt to give any fluids by mouth to an
unconscious casualty. When consciousness is regained never give alcohol if the survivor is breathing but unconscious, lay him in the
unconscious position. When consciousness has been fully regained give a warm sweet drink.
6. Conscious survivors suffering from hypothermia should be laid on their side and, whenever possible, in a slightly head-down attitude.

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Medical care of rescued persons, including distress, hypothermia and cold expos... - Treatment for Hypothermia
Treatment for Hypothermia
HYPOTHERMIA
Hypothermia is the term given to the condition when deep body temperature is lowered to less than 35 ° C {95° F) when normal body function will be
impaired. Loss of life may occur when deep body temperature falls below 30° C {86° F).
Causes
The usual causes among seafarers are immersion in the sea, or exposure to cold air while in a survival craft, in colder water death from hypothermia
can occur in less than an hour.
Diagnosis
Hypothermia should always be suspected in every individual rescued at sea. If the casualty is unconscious, there are no reflexes and the pupils are
dilated. The respiratory rate is very slow with two or three movements a minute. The pulse is imperceptible and heart sounds cannot be heard even
with a stethoscope. Death by hypothermia is then defined as being the failure to revive the casualty by re-warming .
TREATMENT
• Removal of all wet clothes and replacement with dry clothes or blankets.
• Hot sweet drinks
• Rest in a warm environment not exceeding 22° C {72 °F) (normal room temperature) are also recommended.
• NEVER GIVE ALCOHOL
• If the survivor is not shivering but is semi-conscious, unconscious or apparently dead, slow rewarming ,s essential. Never attempt rapid
rewarming by immersion in a hot bath except on medical advice.
The following measures will be necessary to preserve life:
1. On rescue always check the survivor's breathing and listen for hear sounds. If the survivor is not breathing, ensure the airway is clear and
start artificial respiration immediately (mouth to mouth or mouth to nose). Attempt are resuscitation should be continued until medical advice
can be obtained, or for at least 30 minutes.
2. Prevent further heat loss due to evaporation or exposure to the wind.
3. Do not massage the limbs.
4. Avoid all unnecessary handling, even the removal of wet clothing.
5. Enclose the survivor in a plastic bag of blankets or preferably both. The blankets should not be warmed, and it is important that the head, but
not the face, is well covered. Place in a room that is not too warm {15 ° -20° C) {59° -70° F). Never attempt to give any fluids by mouth to an
unconscious casualty. When consciousness is regained never give alcohol if the survivor is breathing but unconscious, lay him in the
unconscious position. When consciousness has been fully regained give a warm sweet drink.
6. Conscious survivors suffering from hypothermia should be laid on their side and, whenever possible, in a slightly head-down attitude.

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Medical care of rescued persons, including distress, hypothermia and cold expos... - Treatment for cold injury
Treatment for cold injury
FREEZING COLD INJURY-FROSTBITE

Frostbite is the tern, given to the condition when tissue fluids freeze ,n localized areas of the body; the hands face and feat are particularly
suspectible
CAUSE
Exposure, particularly of bare skin to sub-zero temperatures, especially when combined with air movement. Look-outs in life rafts or survivors in open
boats are particularly prone to this injury
Diagnosis
The signs are:
• Extreme waxy pallor of the skin;

• Initial local tingling and stiffness when it is difficult to wrinkle the face or wriggle affected toes or fingers;
• Complete absence of sensation in the area effect; and
• Local hardness due to freezing of the flesh.
PREVENTION
If bare skin has to be exposed to the elements, the periods of exposure should be kept to a minimum and freezing winds particularly avoided.
Moderate exercise and massage at an early stage will help to prevent the onset of cold injury. Do not smoke; smoking reduces the blood supply to
the hands and feet.
TREATMENT
On detection of the above signs, immediate steps shouk be taken to re-warm the frozen parts before pem1anent damage occurs.
1. Get out of the wind.

2. Re-warm the frozen area by applying it to a warmer part of the body, e.g. hands under armpits, cupped hand over cheek, nose, ear, etc.
3. Once freezing has occured do not rub or massage affected areas.
4. When treatment has been ineffective the skin dies and becomes black. If this occurs dry dressings should be applied to the affected part.
NON-FREEZING COLD INJURY-IMMERSION FOOT

This is a term given to the condition when the temperature of local tissues in the limbs (usually the feet) remains sub-normal but above freezing for
a prolonged period. It is commonly encountered by ship wreck survivors who have been adrift and cold for several days. Usually the feet have been
wet and immobile, but this injury can occur in conditions. Other contributory factors are tight footwear and sitting still with the feet down for
prolonged periods.

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DIAGNOSIS
Feet become white, numb, cold and frequently are slightly swollen. When returned to the warmth, the feet become hot, red, swollen, and usually
painful.
PREVENTION
1. Every effort should be made by survivors to keep their feet warm and dry
2. Shoe laces should be loosened;
3. The feet should be raised and toe and ankle exercises encouraged several times a day.
4. Shoes should be removed and feet kept warm by placing them under the armpits, but outside the clothing, of another occupant of the life-raft
or boat.
5. Unwanted spare clothing may be wrapped round the feet to keep them warm.
6. Smoking should be discouraged.
TREATMENT
After rescue every effort should be made
1. To avoid rapid re-warming of the affected limbs.

2. Care should be taken to avoid damaging the skin or breaking blisters.
3. Do not massage affected limbs.
Elicit a proper medical history from the patient about his present illness.
Rjo past h/o hypertension, lung disease and diabetes mellitus, and drug allergy.
• Jot down the general common features(skin e.g. any discoloration, hair, spine, nails and level of consciousness)
• The vital parameters (TPR & BP)
• Your findings o/e of respiratory system, cardio vascular system and abdomen (gastro-intestinal system)
Always report the Rx that you've started with and keep with you the list of medicines and equipments available on the ship.
Jot down the instructions given by the doctor and REPEAT THEM BACK TO THE DOCTOR.
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Medical care of rescued persons, including distress, hypothermia and cold expos... Seasickness
Seasickness
Seasickness is a form of terrestrial motion sickness characterized by a feeling of nausea and, in extreme cases, vertigo experienced after spending
time on a boat. It is essentially the same as carsickness, though the motion of a watercraft tends to be more regular.
Seasickness, is a common disturbance of the inner ear. This is the area of the body that affects your sense of balance and equilibrium. Seasickness
happens when your brain receives conflicting messages about motion and your body's position in space. The conflicting messages are delivered from
your inner ear, your eyes (what you see), your skin receptors (what you feel), and muscle and joint sensors . For example, you might become airsick
because your eyes cannot see the turbulence that is tossing the plane from side to side. Motion sickness can occur with any mode of travel: ship,
plane, train, bus, or car.
What are the symptoms of Seasickness?

Symptoms of Seasickness include dizziness, sweating, nausea, and vomiting. Symptoms can strike suddenly, progressing from simply not feeling well
to cold sweats, dizziness, and then vomiting.
Seasickness is more common in women and in children 2-12 years old. People who suffer from migraine headaches are also more prone to motion
sickness.
Here are some ways you can reduce the risk of becoming seasick:
1. Be well rested before setting sail

2. Take antiemetic drugs
3. Get fresh air
4. Request a cabin mid ship and near the water line
5. Have a bite
6. Wear an acupressure wristband
7. Avoid stimuli that can trigger nausea
8. Choose your itinerary carefully
Notes
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Medical care of rescued persons, incl uding distress, hypothermia and cold exposure Sunburn
Sunburn
Sunburn is a form of radiation burn that affects living tissue, such as skin, that results from an overexposure to ultraviolet {UV) radiation, commonly
from the sun. Common symptoms in humans include red or reddish skin that is hot to the touch, pain, general fatigue, and mild dizziness. An excess of
UV radiation can be life-threatening in extreme cases. Exposure of the skin to lesser amounts of UV radiation will often produce a suntan.
How to treat sunburn
1. Take frequent cool baths or showers to help relieve the pain

2. Use a moisturizer that contains aloe vera or soy to help soothe sunburned skin
3. Consider takin� aspirih or ibup��n to help reduce any swelling, redness and discomfort
4. Drink extra water
5. If your skin blisters, allow the blisters to heal
Notes

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Medical care of rescued persons, including distress, hypothermia and cold expos... Dehydration
Dehydration
Dehydration is a condition that can occur when the loss of body fluids, mostly water, exceeds the amount that is taken in. With dehydration, more
water is moving out of individual cells and then out of the body than the amount of water that is taken in through drinking. Medically, dehydration
usually means a person has lost enough fluid so that the body begins to lose its ability to function normally and then begins to produce symptoms
related to the fluid loss. Although infants and children are at highest risk for dehydration, many adults and especially the elderly have significant risk
factors.
People lose water every day in the form of water vapor in the breath we exhale, and as water in our sweat, urine, and stool. Along with the water,
small amounts of salts or electrolytes are also lost. Our bodies are constantly readjusting the balance between water (and salts or electrolytes)
losses with fluid intake. When we lose too much water, our bodies may become out of balance or dehydrated. Dehydration can be divided into three
stages: 1) mild, 2) moderate and 3) severe. Mild and often even moderate dehydration can be reversed or put back in balance by oral intake of fluids
that contain electrolytes (or salts) that are lost during activity. If unrecognized and untreated, some instances of moderate and severe dehydration
can lead to death.
Severe dehydration should be treated with intravenous fluids until the patient is stabilized (i.e., circulating blood volume ,s restored). Treatment
should include 20 ml per kg of isotonic crystalloid (normal saline or lactated Ringer solution} over 10 to 15 minutes
Treatment
Dehydration must be treated by replenishing the fluid level in the body. This can be done by consuming clear fluids such as water, clear broths,
frozen water or ice pops, or sports drinks (such as Gatorade). Some dehydration patients, however, will require intravenous fluids in order to re
hydrate.
Intravenous fluid administration (20-30 ml/kg of isotonic sodium chloride 0.9°/o solution over 1-2 h) may also be used until oral rehydration is
tolerated. According to a Cochrane systematic review, for every 25 children treated with ORT for dehydration, one fails and requires intravenous
therapy.
Notes
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Radio Medical Advice
Radio Medical Advice
• Apart from the first aid training of the ship's crew, professional medical advice is also available through Radio Medical Advice service across the
globe. Under international conventions, countries are required to provide radio medical advice to ships at sea. Radio medical advice is available
24 X 7 across the globe.
• All details of the accident/injury and the patient's condition, symptoms and the first aid administered along with the list of medicines available
on board, should be kept ready to be passed on to the Doctor while seeking radio medical advice.
The International Radio Medical Centre (Centro Internazionale Radio Medico, C.J.R.M.) was founded in 1935 with the purpose of giving radio medical
advice to ships on any nationality navigating on all seas of the world. The Centre has its headquarters in Rome, and its medical services are
completely free of charge. They also include arrangements for the transfer, if necessary, of a patient to a ship with a doctor on board or if the
distance allows it, to evacuate the patient for hospitalization. Requests for medical advice reaching C.J.R.M. are handled by doctors on continuous
duty at the C.J.R.M. headquarters. These doctors advice on the appropriate treatment and keep in contact with every ship that has asked for
assistance, following up the progress of the patient until his recovery or evacuation to the hospital on shore.
The treatment of any ill or injured person on board should be initially undertaken as per the guidelines mentioned in the 'WHO International Medical
Guide for Ships'.
If the Guide advises vessel to seek "Radio Medical Advice" or otherwise deemed necessary by the Master, the following procedure is to be followed
In International waters, the Master should contact:

INTERNATIONAL RADIO MEDICAL CENTRE (C.J.R.M.)
OR Alternatively,
Master may request Medical advice or Medical Evacuation (in case of serious medical emergency) by contacting nearest CES by Inmarsat phone
OR
The Master may also request Medical advice or Medical Evacuation (in case of serious medical emergency) by contacting nearest MRCC by Inmarsat
phone, the contact details being mentioned in ALRS Volume I (NP 281)
Serious Medical Emergency

Where the Radio Medical Advice suggests emergency evacuation of the patient to shore medical facility, the Master has to liaise with the nearest
Coastal State MRCC on whether; Helicopter evacuation is possible (If affirmative, seek guidance from WHO International Medical Guide for Ships and
the Guide to Helicopter/Ship Operations)

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Radio Medical Advice is available by radio telegraphy or by direct contact with the doctor by radio telephony from a number of ports in all parts of
the world. It may, on occasion, be obtained from other ships in the vicinity who have a doctor on board. Elicit a proper medical history from the
patient about his present illness.
1. Jot down the general common features (skin e.g. any discoloration, hair, spine, nails and level of consciousness)
2. The vital parameters {Temperature & BP)
3. Your findings o/e of respiratory system, cardio vascular system and abdomen (gastro-intestinal system)
Always report the treatment that you've started with and keep with you the list of medicines and equipments available on the ship.
Jot down the instructions given by the doctor and REPEAT THEM BACK TO THE DOCTOR.
INFORMATION TO BE READY WHEN REQUESTING Radio Medical Advice
Part A- In the case of Illness

1. Particulars of the ship:
Name, call sign of the ship with date and time {GMT), port of destination and/or nearest port is_ _ _ _ Hours/days away.
_ and is _ _ _
2. Particulars about the patient/casualty:
• Full name of the casualty beginning with surname

• Age, sex, job on board (occupation) & the rank.
3. Particulars about the illness:
• Mention the patient's chief complaint (illness)

• Since past how many days patient has been suffering form each of the complaints/illness
• Whether the onset of symptoms was sudden or gradual
• Mention significant past history & family history (if relevant)
• Any Rx taken by the patient, if yes (specify for what, since how many days and the doses/day)
• Whether the patient is a chronic alcoholic or smoker
• Are the sleep, appetite, urinary and bowel habits normal?
4. Results on Examination of the patient:
• Whether the patient is conscious, co-operative, well-oriented in time and space.

• Temperature & BP
• Skin, hair, nails, spine & joints
• Swellinsi in the feet, yellow discoloration of the sclera.

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• Whether the patient is conscious, co-operative, well-oriented in time and space.

• Skin, hair, nails, spine & joints
• Swelling in the feet, yellow discoloration of the sclera.
• Swollen & painful glands in the neck, armpit or groin
5. Provisional diagnosis made by you
6. Treatment
• Treatment given by you. MENTION THE NAME OF THE ANTIBIOTIC OR ANY DRUG GIVEN WITH DOSES/DAY
• How has the patient responded to the Rx given.
7. Complications
• What complicat ons you anticipate?

i
• What do you think you need to be advised on?
8. Comments by the Radio Doctor:

(Type or write them down, repeat them back to the doctor)
PART B - In case of INJURY

Give the particulars of ship & casualty
3. HISTORY OF INJURIES
• How did the injury (exactly) occur?

• How long ago was that and whether accidental?
• Ascertain whether it was caused by sharp or blunt object
• What are the patient's chief complaints?
• Significant past history of illness/injury.
• Mention the medicines if in case the patient has been taking them (dose/day)
• Did the patient lose consciousness (though momentary), was under the influence of alcohol/drug?
• Does the patient remember the incidence of injury entirely?
4. RESULTS OF EXAMINATION
• Whether the patient is conscious, co-operative, well-oriented in time and space

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• What are the patient's chief complaints?
• Significant past history of illness/injury.
• Mention the medicines if in case the patient has been taking them (dose/day)
• Did the patient lose consciousness (though momentary), was under the influence of alcohol/drug?
• Does the patient remember the incidence of injury entirely?
4. RESULTS OF EXAMINATION
• Whether the patient is conscious, co-operative, well-oriented in time and space

• Skin, hair, nails, spine & Joints
• Number of injuries, mention the SITE & NATURE (contused lacerated wound/bruise/stab/incision/ burns/gun-shot, etc.)
• Length, breadth & depth of the injury
• Bleeding (mild/heavy)
• SIGNS OF HYPOVOLAEMIC SHOCK
• Blood in urine or vomits(if occured)
5. TREATMENT
• Mention the first-aid carried out

• Name of the PAIN KILLERS/ ANTIBIOTICS USED
• Patient's response (whether positive)
6. COMPLICATIONS
• What complications you anticipate?

• What do you think you need to be advised on?
7. COMMENTS BY THE DOCTOR
Notes
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HELP I I I
PASSWORD HOME EXIT
Radio Medical Advi ce Using GMDSS
Using GMDSS
Urgency comn1unications procedure
In a terrestrial system, urgency communications consist of an announcement, transmitted using digital selective calling, followed by the urgency call
and message transmitted using radiotelephony, narrow-band direct-printing, or data.
The announcement o f the urgency message shall be made on one or more of the distress and safety calling frequencies specified, using either digital
selective calling and the urgency call format, or if not available, radio telephony procedures and the urgency signal.
A separate announcement need not be made if the urgency message is to be transmitted through the maritime mobile-satellite service.
Ship stations not equipped for digital selective-calling procedures may announce an urgency call and message by transmitting the urgency signal by
radiotelephony on the frequency 156.8 MHz (channel 16), while taking into account that other stations outside VHF range may not receive the
announcement.
In the maritime mobile service, urgency communications may be addressed either to all stations or to a particular station. When using digital
selective calling techniques, the urgency announcement shall indicate which frequency is to be used to send the subsequent message and, in the
case of a message to all stations, shall use the "All Ships" format setting.
Urgency announcements (urgency call) may be addressed to all ships, to selected group of vessels, to the specific ships, or to vessels in a defined
geographical area or to specific coast station. The frequency on which the urgency message will be transmitted after the announcement shall be
indicated in the DSC urgency call.
The urgency call and message shall be transmitted on one or more of the distress and safety traffic frequencies specified in the table distress and
safety frequencies.
However, in the maritime mobile service, the urgency message shall be transmitted on a working frequency:
• In the case of a long message or a medical call; or

• In areas of heavy traffic when the message is being repeated.
An indication to this effect shall be included in the urgency announcement or call.
In the maritime mobile-satellite service, a separate urgency announcement or call does not need to be made before sending the urgency message.
However, if available, the appropriate network priority access settings should be used for sending the message.
The urgency call format and the urgency signal indicate that the calling station has a very urgent message to transmit concerning the safety of a
mobile unit or a oerson.

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Radio Medical Advice Helicopter evacuation
Helicopter evacuation
Evacuating a patient by helicopter is sometimes the only option given the circumstances. Helicopters are a swift and efficient means of transporting
the patient towards more advanced medical help. A helicopter's range, however, is limited to an average of 150-200 nm outside the coast, this being
primarily a question of fuel supply.
SAR helicopters are normally manned with a doctor or medic who are well trained in medical emergency treatment and transportation. This implies
that in getting help from a helicopter to evacuate the patient, expert medical personnel are also called in. This can be vital to assess the situation,
come to a preliminary diagnosis, give advanced first aid treatment and stabilise the patient. Besides advanced medical know-how, the helicopter
crew will also bring in advanced medical equipment such as Propaq (monitoring equipment) and a defibrillator.
Gett ing expert medical help on board through a helicopter and transporting the patient need not be an inevitable sequence. For instance it may well
be that the doctor decides, once the patient is sufficiently stabilised, not to transport the patient by helicopter, but to have him transported by the
vessel itself to the nearest port. If the patient cannot be stabilised, it may be hazardous to have him undergo the extra physical and emotional
stress of a helicopter evacuation. It may also happen that a critically ill or injured patient cannot be saved, and that it is best for the body to remain
on board.
A helicopter evacuation ,s a costly operations and not without dangers in itself. When the weather conditions are adverse, the risks involved
increase markedly. The helicopter crew put their own safety at risk in these undertakings, so it is evident that their decision whether or not to fly
must be a well-balanced one. This firstly implies that the indication for the "Helivac" to be conducted must be medically sound, and that the benefits
for the patient outweigh the risks that will need to be taken.
In ideal cases, the vessel will have a helicopter platform on which the aircraft can land, offload the doctor and possibly a helper, wait until the
patient is stabilised and secured on a stretcher, and load everyone back on the craft. In most instances the conditions are not that ideal. If there is
no landing platform, the doctor and other crew will need to be lowered by a line for the helicopter, and the aircraft will need to wait in the air, with
evident consequences for its fuel reserves. Sometimes the helicopter may choose in the meantime to return to shore or possibly to an offshore oil-rig
to refuel and return to pick up crew members and the patient.
i
Lower ng and hoisting persons from a vessel can be hampered markedly by cranes, masts, antennas and objects on deck. The procedures for
lowering and hoisting persons from a helicopter may differ. It is essential that the ship's crew are fully aware and acquainted with the procedure.
One should also realise that, once aboard the helicopter, in spite of a doctor being nearby, the possibilities for further stabilisation and/or treatment
are minimal due to noise, lighting, movement and restrained space.
It is important to realise that transport of a patient from a vessel either by the vessel itself, via another vessel or by helicopter sometimes needs to
be followed by yet more transport by road ambulance to reach an on-shore medical facility.

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Pharmacology
Pharmacology
The over usage or abuse of alcohol or other drugs is known as substance abuse. It is very common and costly too. Substance abuse is a pattern of
repeated use of alcohol, drugs or both even though it cause distressing events in the users life. Alcohol, drugs, or both have been used repeatedly can
lead to dangerous situations such as accidents while driving and operating machinery, this include personal as well as social problems. It is very difficult
to stop drinking or using a drug without outside help, Medical treatment is very much needed for substance abuse.
There is not much point in eating a sensible, balanced diet, keeping your weight in check and taking regular exercise if you abuse your body. The most
common abuses are use of tobacco and excessive use of alcohol. Tobacco in the form of cigarettes kills. It causes lung cancer, bronchitis and coronary
artery diseases. In moderation alcohol is okay. But becomes a problem when too much of it is taken too regularly. Drugs like heroin, opium and cocaine
are taken for pleasure by some, but they are highly addictive and dangerous to health. It is essential to avoid indulging in these harmful abuses which
sometimes are related to life styles of individuals or families.
Notes

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E-SOOK ASSESSMENT I EMAIL QUESTION & ANSWER SESSION
Pharmacology Drugs on board
Drugs on board
Usage
Recommended quantities of medicines as given in International Medical Guide for Ships
Name Form strength Indication Quantities per 10 crew Notes

For Trip Duration of 3-4
weeks
A B
(Crew (Crew (Crew
30-40) 20) 20)
Acetylsalicylic acid tab 300mg Pain, fever, blood so so -

clots
Aciclovir tab 400mg Herpes 70+ 35+ -

simplex/zoster
Adrenaline amo lma/ml Anaohvlaxis 10+ 5+ 5+
Amoxicillin/ clavulanic tab 875mg/125mg Infections 20 10 -

acid
Artemether amp soma/ml Malaria treatment 12+ 12+ -

Artemether+ tab 20mg/120mg Malaria treatment 24+ 24+ - Double if crew
lumefantrine size >30
Atropine amp 1.2mg/ml MI/organophosphate 10+ 5+ - Double quantity if

poisoning carrying
ornanoohosohates
Azithromycin tab SOOmg Infections 10+ 5+ - Double if crew

size >30
Ceftriaxone amo 10 Infections 15 5+ -

Cetirizine tab lOmg Hayfever/hives 30+ 30+ -
/dermatitis
Charcoal, activated powder Poisoning 120q+ 120q+ -

Ciprofloxacin tab 250mg Infections 20+ 10+ - Double if crew
size >30

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Ciproftoxacin tab 250mg Infections 20+ 10+ - Double if crew

size >30
Cloves, oil of liq Toothache lOml lOml+ -

Dexamethasone amp 4mg/ml Severe 3 1 -
asthma/anaohvlaxis
Diazeoam tab Sma Alcohol withdrawal 50+ 20+ -

Docusate with tab SOmg/Smg Constipation 30+ - -
senna
Doxvcvcline tab lOOmq Infections 10 - -

Ethanol, hand gel 70°/o Hand cleaning SOOml SOOml+ lOOml+
cleanser
Ethanol liq 70°/o Disinfect instruments SOOml lOOml -

Fluorescein eye strips 1•;. Detect corneal 20+ 20+ -
damaqe
Frusemide amo 40ma/4ml Pulmonarv oedema 5+ 5+ -

Glucaaon amo lma Hvnoalvcaemia 1+ 1+ -
Haloperidol amp Smg/ml Psychosis/severe 5 5+ -
aqitation
Hydrocortisone crm 1°/o Allergy/inflammatory 2 x 30g l x - One tube per

skin 3Qn oatient
lbuorofen tab 400ma lnftammation/oain 100 50 so.+
lsosorbide dinitrate tab Smq Anqina/MI 10 10 5+
Lignocaine amp 1°/o, Sm! Suturing/minor 5 5 -

surgery
Looeramide tab 2ma Diarrhoea 30 30 10+
Mebendazole tab lOOmq Intestinal worms 6+ 6+ -

Metoprolol tab lOOmg HTN/AF/Angina 60+ - -
/Miaraine
Metronidazole tab SOOma Infections 30+ 20+ -

Miconazole crm 2•1o Fungal skin 2 x 30g l x - Double quantities
infections 30g if females on
board

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Oral Rehydration powder sachet Dehydration due to 151(75) 101(50) 21 Quantities in

Solution diarrhoea (10)+ brackets are
number of
sachets based on
sachets made up
to 200ml
Oxymetazoline nasal drop 0.50°/o Nasal 2 1 - One bottle per

obstruction/drain patient
sinuses
Morphine amp lOmq/ml Severe pain 10 10 -

Morphine liq lmg/ml Severe pain in lOOml+ lOOml+ -
patients able to eat
and drink
Naloxone amp 0.4mq/ml Opiate overdose 10+ 5+ -

Omeprazole Tab 20ma Reflux, peptic ulcers 30+ 30+ -
Ondanestron tab 4mg Vomiting, sea- 10 10 10+
sickness
Paracetamol tab 500ma Pain and fever 100 50 25
Permethrin lot 1 .,. Lice 200ml+ lOOml+ - Double if crew

size >30
Permethrin lot 5 °/o Scabies 300ml+ lOOml+ - lOOml oer oatient
Povidone iodine oint 10°/o Disinfect 1 x 25g 1 x25g -

skin/wounds
Povidone iodine liq 10°/o Disinfect lOOml lOOml lOOml+

skin/wounds
Prednisone tab 25mg Asthma/inflammatory 30+ 30+ -

conditions
Salbutamol inh lOOug/dose Asthma/bronchitis/ 1 1 - One inhaler per

emohvsema oatient
sodium chloride liq 0.9°/o, 1 litre Fluid replacement 5+ 1 -

Tetracaine eye drop 0.50°/o Eye examination 20+ 20+ -
[amethocaine]
Tetracycline eye oint 1°/o Minor eye infections 2 1 1+ One tube per
oatient
Vitamin K amp lOmg/ml Reverse warfarin or 2+ 2+ -

similar

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conditions
Salbutamol inh lOOug/dose Asthma/bronchitis/ 1 1 - One inhaler per

emohvsema oatient
sodium chloride liq 0.9°/o, 1 litre Fluid replacement 5+ 1 -

Tetracaine eye drop 0.50°/o Eye examination 20+ 20+ -
[amethocaine]
Tetracycline eye oint 1°/o Minor eye infections 2 1 1+ One tube per
oatient
Vitamin K amp lOmg/ml Reverse warfarin or 2+ 2+ -

similar
Water for injection amp 5ml Reconstitute 10 5+ - Only used to

injections reconstitute
ceftriaxone
Zidovudine + tab 300mg/150mg Needle-stick injury 56+ 56+ -

lamivudine oroohvlaxis
zinc oxide paste/oint 20°/o Irritated skin 2009+ lOOg+ 1009+ 4 x 25g or 3 x 30g
tubes oer lOOa
• amp = ampoule; crm = cream; inh = inhalation; liq = liquid; lot = lotion; oint = ointment; tab = tablet
• AF = atrial fibrillation; HTN = hypertension; Ml = myocardial infarct ion
Dosages for controlled drugs are as follows:

Morphine ampoules 10 mg/ml
2.5 mg-12.5 mg every two hours dependent on age
Morphine liquid 1 mg/ml

3. 75 mg/ 18. 75 mg every two hours dependent on age
Notes
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Pharmacology Drugs on board - Injections IM/IV/SC
Injections IM/IV/SC
Intravenous and Intra-muscular injections

Routes of adn1inistration
INTRAMUSCULAR
• The intramuscular route can be used when a medicine is likely to irritate the subcutaneous tissue Uust under the skin) or in some cases when
a prolonged action is desired, such as for treatment with procaine benzylpenicillin.
INTRAVENOUS
• To avoid serious risks, intravenous administration of a medicine should only be carried out by a person with appropriate training.
SUBCUTANEOUS
• The most usual sites for injecting medicines under the skin are:
• The lower abdomen;
• The lateral surfaces (outer sides) of the thighs;
• The outer surface of the upper arm.
Recommended Injections as given in International Medical Guide for Ships
Name Form Strength Method Indication
Adrenaline amp lmq/ml IM Anaphylaxis
Artemether amp SOmq/ml Malaria treatment
Atrooine amo 1.2ma/ml IM or IV MI/oraanoohosohate ooisonina
Ceftriaxone amp lq Infections
Dexamethasone amp 4mq/ml IM or IV Severe asthma/anaphylaxis
Frusemide amo 40ma/4ml IM or IV Pulmonarv oedema
Glucaaon amo lma IM or SC Hvnoalvcaemia

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100% MEDICAL FIRST AID (MFA) I ARVIND RATHORE HELP PASSWORD HOME EXIT
I Drugs on board axone

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amp lg Infections
Dexamethasone amp 4mq/ml IM or IV Severe asthma/anaphylaxis
Frusemide amo 40ma/4ml IM or IV Pulmonarv oedema
Glucaaon amo lma IM or SC Hvnoalvcaemia
Haloperidol amp Smq/ml IM Psychosis/severe aqitation
Lianocaine amo 1°/o, Sml Suturina/minor suraerv
Midazolam amo Sma/ml IM Eoileotic fits
Morphine amp lOmq/ml Severe pain
Naloxone amp 0.4ma/ml IM Opiate overdose
Vitamin K amo lOma/ml IM Reverse warfarin or similar
Water for iniection amp Sml Reconstitute iniections

IM - Intramuscularly; IV - Intravenously; SC - Subcutaneously
Forms and strengths, route of administration

80 mg in 1 ml ampoule (80 mg/ml), oily solution for IM injection.
When the dose required is less than lml, use a lml syringe graduated in 0.01 ml.
Dosage and duration- ( Child and adult)

3.2 mg/kg by IM injection on the first day followed by 1.6mg/kg once daily.
1. Ceftriaxone: Given IV -Applies to the following strengths: 250mg; SOOmg; lg; 2g; lOg; lg/SO ml-iso-osmotic dextrose; 2 g/50 ml-iso-osmotic
dextrose
2. Morphine Sulphate: Long Acting Tablet form, Morphine Sulphate Injection IV, IM given.
3. Lignocaine:
a)l0/o used Intradermal/Subacute for superficial upper
b) 2°/o Lidocaine, also known as lignocaine, is a medication used to numb tissue in a specific area (local anesthetic). It is also used to treat
ventricular tachycardia and to perform nerve blocks.
Notes
=
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Pharmacology Drugs on board Test dose for penicillin
Test dose for penicillin
Penicillin allergy is the most common medication allergy. However, up to 90 percent of patients who think they are allergic to penicillin may be able to
take penicillin-based antibiotics.
The most common reasons are:
• Patients lose their allergy to penicillin over time.

• The initial reaction was not caused by penicillin.
Penicillin skin testing is the best way to determine if you are still allergic to penicillin. A test can help if, in the past, penicillin has given you:
1. Rashes
2. Itching
3. Hives
4. Swelling in your face or throat
5. Low blood pressure
How do penicillin allergy skin tests work? There are two types of skin tests. In the first, a drop of penicillin is pricked or scratched on the surface of
your arm. If you are allergic, you will have a small spot of redness or itching where the penicillin was placed. If the test is negative, you will be given
a second test. For this test, you will be injected a small amount of penicillin into the skin of your upper arm. How long does it take to get skin test
results? For both types of skin tests, positive reactions such as redness and itching at the test spot usually appear within 15 minutes. If both tests
are negative, you will receive a test dose of penicillin. You will be monitored for an allergic reaction for 30 minutes. If your penicillin skin test is
negative and you have no reaction to your test dose, you are no longer allergic to penicillin. Your chance of an allergic reaction to penicillin-based
antibiotics is as low as it is for most people. What are the benefits of penicillin skin testing? Knowing if you are allergic to penicillin is important.
For many illnesses, penicillin antibiotics are the best treatment options available.
1. Penicillin antibiotics are often less expensive than other antibiotics.

2. Other kinds of antibiotics may cause side effects.
3. Antibiotics without penicillin may lead to drug resistance (commonly called "superbugs"), which may make antibiotics less effective 1n the
future.
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Pharmacology Drug Abuse
Drug Abuse
Drugs can be consumed for good reasons as well as for bad reasons. Drug abuse is a serious problem to the community and for the family too, leading
to problems such as child abuse, drugged driving, stress and violence. Drug abuse can lead to less concentration power, absenteeism in work,
homelessness, finally destroys the families pleasant environment. Some of the common abused drugs are Amphetamines, Anabolic steroids, Cocaine,
Heroin, Inhalants, Marijuana and Morphine.
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hY Drug Abuse - Amphetamine
Amphetamine
Amphetamine is a stimulant and an appetite suppressant. It stimulates the central nervous system, by increasing the amount of certain chemicals in
the body. This drug is used to treat narcolepsy and attention deficit disorder with hyperactivity. This habit forming medicine can cause more
withdrawal effects when stop taking suddenly after several weeks of continuous use.
An amphetamine drug may available as amphetamine salt, or amphetamine sulfate, in Smg and lOmg tablets.
The effects of the drug is increases heart rate and blood pressure and decreases appetite, and may cause dizziness, blurred vision, or restlessness.
The following media explains Amphetamine:
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Who will avoid amphetamine Drug

Do not take amphetamine if you;
• Have heart disease or high blood pressure;

• Have arteriosclerosis (hardening of the arteries);
• Have hyperthyroidism;
• Have glaucoma;
• Have a history of drug or alcohol abuse.
• Pregnancy and lactating women, because this drug passes into breast milk and may affect a nursing baby.
Synlptoms of an amphetamine overdose
• Symptoms of an amphetamine overdose include restlessness, tremor, rapid breathing, confusion, hallucinations, panic, aggressiveness, nausea,
vomiting, diarrhea, an irregular heartbeat, and seizures.
An1phetan1ine side effects

The side effects of amphetamine are:
• An allergic reaction like difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives.
• An irregular heartbeat or very high blood pressure; or
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• Halluc nations, abnormal behavior, or confusion.
Some of the less side effects are
• Restlessness or tremor;
• Insomnia;
• Headache or dizziness;
• Anxiety or nervousness;
• Dry mouth or an unpleasant taste in the mouth;
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• Diarrhea or constipat on; or
• Impotence or changes in sex drive.
Treatments
Addiction:
• Bromocriptine may help craving

• Psychotherapy
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Some of the less side effects are
• Restlessness or tremor;
• Insomnia;
• Headache or dizziness;
• Anxiety or nervousness;
• Dry mouth or an unpleasant taste in the mouth;
• Diarrhea or constipation; or
• Impotence or changes in sex drive.
Treatments
Addiction:
• Bromocriptine may help craving

• Psychotherapy
• Meditation
• Environmental support
Overdose:
• Maintain airway
• Mechanical ventilation if necessary
• Treat coma, heart attacks, or Seizures as they occur
• Diazepam or Midazolam for agitation or psychosis
• If overdose by mouth, gastric lavage and charcoal.
• Phentolamine, nifedipine, or labetalol for elevated blood pressure
• Esmolol for rapid heart race/rapid heart arrhythmias
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Pharmacology Drug Abuse - Anabolic steroids
Anabolic steroids
Anabolic steroids or more precisely, anabolic androgenic steroids[AAS] are synthetically produced variants o f the naturally occurring male sex
hormone testosterone. Both anabolic and androgenic have origins from the Greek: "Anabolic" refers to muscle-building, and "androgenic" refers to
increased male sexual characteristics. "Steroids" refers to the class of drugs. These drugs can be legally prescribed to treat conditions resulting from
steroid hormone deficiency, such as delayed puberty, as well as diseases that result in loss of lean muscle mass, such as cancer and AIDS
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steroid Abuse
Mainly sports persons are abuse AAS in an attempt to enhance performance and/or improve physical appearance. AAS are taken orally or injected,
typically in cycles rather than continuously.
How Do steroid Affect the Brain?

The immediate effects of AAS in the brain are mediated by their binding to androgen (male sex hormone) and estrogen (female sex hormone)
receptors on the surface of a cell. This AAS-receptor complex can then shuttle into the cell nucleus to influence patterns of gene expression.
Because of this, the acute effects of AAS in the brain are substantially different from those of other drugs of abuse. The most important difference
is that AAS are not euphorigenic, meaning they do not trigger rapid increases in the neurotransmitter dopamine, which is responsible for the "high"
that often drives substance abuse behaviors. However, long-term use of AAS can eventually have an impact on some of the same brain pathways
and chemicals such as dopamine, serotonin, and opioid systems that are affected by other drugs of abuse. Considering the combined effect of their
complex direct and indirect actions, it is not surprising that AAS can affect mood and behavior in significant ways.
Mental Health
Research shows that steroids can cause psychiatric dysfunction. Abuse of anabolic steroids may lead to aggression, extreme mood swings, paranoid
jealousy, extreme irritability, delusions, and impaired judgement stemming from feelings of invincibility.
Adverse Effects of AAS

Men - Although anabolic steroids are derived from a male sex hormone, men who take them may actually experience a "feminization" effect along
with a decrease in normal male sexual function. Some possible effects include:
• Reduced sperm count

• Impotence
• Development of breasts
• Shrinking of the testicles
• Difficulty or pain while urinating
Women - On the other hand, women often experience a "masculinization" effect from anabolic steroids, including the following:
• Facial hair growth

• Deepened voice
• Breast reduction
• Menstrual cycle changes
With continued use of anabolic steroids, both sexes can experience the following effects, which range from the merely unsightly to the life
endangering. They include:
• Acne
• Bloated appearance

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Women - On the other hand, women often experience a "masculinization" effect from anabolic steroids, including the following:
• Facial hair growth

• Deepened voice
• Breast reduction
• Menstrual cycle changes
With continued use of anabolic steroids, both sexes can experience the following effects, which range from the merely unsightly to the life
endangering. They include:
• Acne
• Bloated appearance
• Rapid weight gain
• Clotting disorders
• Liver damage
• Premature heart attacks and strokes
• Elevated cholesterol levels
• Weakened tendons
Adolescents
Anabolic steroids can halt growth prematurely in adolescents.
Behavioral side effects

Anabolic steroids can cause severe mood swings and aggression.
In addition, people who inject AAS run the added risk of contracting or transmitting HIV/AIDS or hepatitis, which causes serious damage to the liver.
Treatn1ent
There has been very little research on treatment for AAS abuse. Current knowledge derives largely from the experiences of a small number of
physicians who have worked with patients undergoing steroid withdrawal. They have learned that, in general, supportive therapy combined with
education about possible withdrawal symptoms is sufficient in some cases. Sometimes, medications can be used to restore the balance of the
hormonal system after its disruption by steroid abuse. If symptoms are severe or prolonged, symptomatic medications or hospitalization may be
needed .
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Pharmacology Drug Abu! Heroin pine
Cocaine
Cocaine is an addictive stimulant drug which can be smoked, inhaled, insuffalated and injected. Acute cocaine intoxication may present with
agitation, paranoia, tachycardia, tachypnea, hypertension, and diaphoresis. Complications of acute and chronic use can include myocardial ischemia
or infarction, stroke, pulmonary edema, and rhabdomyolysis. Crack is the street name given to cocaine that has been processed to make a rock
crystal, which, when heated, produces vapors that are smoked. The term "crack" refers to the crackling sound produced by the rock as it is heated.
The following media (Cocaine) explains about the Cocaine:
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What happens if you t� Heroin re once?

Because cocaine affects the CNS, there's a wide variety of side effects that can result.
Here are some commonly reported side effects after initial use of cocaine:
• Bloody nose
• Trouble breathing
• Abnorma l heart rhythms
• Chest pain
• Dilated pupils
• Inability to get or keep an erection
• Insomnia
• Restlessness or anxiety
• Paranoia
• Tremors
• Dizziness
• Muscle spasms
• Abdominal pain
• Stiffness in the back or spine
• Nausea
• Diarrhea
• Extremely low blood pressure
In rare cases, cocaine may lead to sudden death after its first use. This is often due to cardiac arrest or seizures.
Forms of cocaine
Salts
Cocaine or benzoylmethylecgonine 1s a crystalline tropane alkaloid which is obtained from coca leaves. Like many alkaloids, cocaine can also form
different salts such as hydrochloride ans sulphate. I t is soluble in water, different salts have different solvency in solvents.
Basic
Smoking cocaine has the additional effect of releasing methylecgonidine into the user's system due to the pyrolysis of the substance. Pure cocaine is
prepared by neutralizing its compounding salt with an alkaline solution which will precipitate to non-polar basic cocaine. It is further refined through
aqueous-solvent liquid to liquid extraction.
Crack cocaine
Crack is a lower purity form of free-base cocaine and contains sodium bicarbonate as impurity. Freebase and crack are often administered by
smoking. The term "crack" refers to the crackling sound produced by the rock as it is heated.

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smoK1ng. 1 ne term "cracK" reters to tne cracKllng souna proaucea oy cne rocK as 1t 1s neatea.
Coca leaf infusion

Coca is also referred to as coca tea and it is a herbal infusion. The effect of this coca tea are stimulation and mood lift. It does not produce any
significant numbing of the mouth nor does it give a rush like snorting cocaine. In order to prevent the demonization of this product, its promoters
publicize the unproven concept that much of the effect of the ingestion of coca leaf infusion would come from the secondary alkaloids, as being not
only quantitatively different from pure cocaine but also qualitatively different.
How is cocaine abused?

Three routes of administration of cocaine
• Snorting: Snorting is the process of inhaling cocaine powder through the nose, where it is absorbed into the bloodstream through the nasal
tissues
• Injecting: Injecting is the use of a needle to insert the drug directly into the bloodstream.
• Sn1oking: Smoking involves inhaling cocaine vapor or smoke into the lungs, where absorption into the bloodstream 1s as rapid as it 1s by
injection.
All the above mentioned methods cocaine abuse can lead to addiction which may lead to severe health problem, increasing the risk of HIV/AIDS and
other infectious diseases.
Effects of cocaine
Cocaine usually makes the user feel euphoric and energetic (increased energy), reduced fatigue, and mental alertness. Excess intake of cocaine may
also lead to adverse effect on the body such as increased body temperature, dilates pupils, constricts blood vessels, blood pressure, and increased
heart rate. Continuous usage of cocaine may lead to headaches and gastrointestinal complications such as abdominal pain and nausea.
If the cocaine is snorted it may lead to loss of the sense of smell; nosebleeds; problems with swallowing; hoarseness; and a chronically runny nose.
Inject ng cocaine may lead to severe allergic reactions and increased risk for contracting HIV/AIDS and other blood-borne diseases. If the cocaine is
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ingested it may lead to severe bowel gangrene as a result of reduced blood flow.
Treatment for cocaine

Cocaine abuse and addiction is a complex problem involving biological changes in the brain as well as a myriad of social, familial, and environmental
factors. Psychological counseling, Pharmacological approaches, behavioural interventions especially cognitive behavioural therapy which shows
effective reduction of cocaine usage and preventing relapse.
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hY Drug Abuse • Heroin
Heroin
Heroin is an opioid drug made from morphine, a natural substance taken from the seed pod of the various opium poppy plants grown in Southeast and
Southwest Asia, Mexico, and Colombia. Heroin can be a white or brown powder, or a black sticky substance known as black tar heroin. Other
common names for heroin include big H, horse, hell dust, and smack.
It is a "downer" or depressant that affects the brain's pleasure systems and interferes with the brain's ability to perceive pain.
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Route of drug administration

Heroin can be taken by variety of ways, depending on user preference and the purity of the drug. It can be injected into a vein, injected into a
muscle, smoked in a water pipe or standard pipe, mixed in a marijuana joint or regular cigarette, inhaled as smoke through a straw, known as
"chasing the dragon," snorted as powder via the nose.
Short-term effects
The short-term effects of heroin abuse appear soon after a single dose and disappear in a few hours, The effects are:
• Surge of euphoria
• Dry mouth,
• Depression
• Slowed and slurred speech,
• Slow gait,
• Constricted pupils,
• Droopy eyelids,
• Impaired night vision,
• Vomiting,
• Constipation.
Long-term effects
Long-term effects of heroin appear after repeated use for some period of time, the effects are:
• Collapsed veins,
• Infection of the heart lining and valves,
• Abscesses,
• Cellulites,
• Liver disease
• Pneumonia,
• Clogging the blood vessels.
Withdrawal effect
Major withdrawal symptoms are appear between 48 and 72 hours after the last does of drug, the symptoms are:
• Drug craving,
• Restlessness,
• Muscle and bone pain,
• Insomnia,
• Diarrhea and vomiting,
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Withdrawal effect
Major withdrawal symptoms are appear between 48 and 72 hours after the last does of drug, the symptoms are:
• Drug craving,
• Restlessness,
• Muscle and bone pain,
• Insomnia,
• Diarrhea and vomiting,
• Cold flashes with goose bumps,
• Kicking movements,
Treatn1ent
There are several type of treatment available for heroin addicts. Time period for the treatment of heroin is dependence upon the type of users.
Psychosocial treatments are effective parts of a total treatment plan of patients with opiate disorders. Cognitive behavioural therapy, behavioural
therapy, psychodynamic therapy, group therapy and family therapy can be effective with heroin dependence. The choice for a certain treatment
should be made after it is obvious what the patient wants, what problems should be solved, whether there are any other psychological problems and
what have been the results of earlier treatments.
A patient with mild or moderate withdrawal symptoms can sometimes deal with these problems at home. The treatment of a heroin withdrawal
syndrome is usually focused on relief of the critical symptoms and the motivation to take part in a long-term treatment of heroin addiction.
Methadone can be prescribed temporarily and also Clonidine can be used to suppress the withdrawal symptoms. The use of other narcotics can
interfere with or complicate the attempt to kick the habit.
The success of the treatment depends on various things:
• The quantity and the kind of substances used.

• The severity of the disorder and the consequences.
• Simultaneous physical and/or psychological disorders.
• The strong and weak characteristics of the patient.
• The patient's motivation
• The social surroundings of the patient (friends, acquaintances, colleagues, family, etc.)
Treatment Centers for Inhalant Addiction

Rehabs that have doctors and clinicians on staff are informed of the best treatment options for a broad range of addictions. To find a rehab that
specializes in treatment for inhalant addiction.
Detox from Inhalants:

Detox is the first phase in treating someone with an inhalant addiction. Detoxing from inhalant abuse may take longer than other substances; chronic
inhalant abusers may need several weeks to fully detox. Inhalants accumulate in the fatty tissue of the brain, heart, liver and muscles, which is why ,.,,

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specializes in treatment for inhalant addiction.
Detox from Inhalants:

Detox is the first phase in treating someone with an inhalant addiction. Detoxing from inhalant abuse may take longer than other substances; chronic
inhalant abusers may need several weeks to fully detox. Inhalants accumulate in the fatty tissue of the brain, heart, liver and muscles, which is why
chronic inhalant abusers take longer to fully rid their body of the substance. The detox period allows chemicals stored in the body to be flushed out.
During detox, people getting clean from inhalants may also experience physical and psychological symptoms of withdrawal.
These withdrawal symptoms may include:
• Anxiety
• Depression
• Irritability
• Extreme fatigue
• Insomnia
• Hand tremors
• Nausea
• Vomiting
• Brief hallucinations
Most people who stop taking inhalants do not experience withdrawal symptoms. If they do, these symptoms usually start showing up around 24 to
48 hours after quitting. There aren't any medications specifically designated to help alleviate the symptoms of inhalant withdrawal, but doctors may
recommend supplements to help with the nausea and sleeplessness.
Inpatient Rehabilitation for Inhalant Addiction

An inpatient rehabilitation center can be beneficial since inhalants are legal and easy to acquire. However, going through rehabilitation for an inhalant
addiction is generally not the same as the process for more common addictions. It is recommended for incoming patients to have a physical exam in
case they have an inhalant-related health problem, such as liver or kidney abnormalities. The patient should also be assessed for any co-occurring
mental conditions.
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Pharmacology Drug Abuse Inhalants
Inhalants
The term "inhalants" refers to all household and commercial products that can be abused by inhaling them. These products are composed of solvents
and substances commonly found in commercial adhesives, lighter fluids, cleaning solvents and paint products. Since inhalants are easily accessible
and affordable, they have become the drug of choice for many young people. Inhalants are typically inhaled directly from a container or placed in a
bag or another container of choice and "huffed," or inhaled, to achieve a "high."
Type of Inhalants abused

Inhalants generally fall into the following categories:
Volatile solvents: Liquids that vaporize at room temperature

Industrial or household products, including paint thinners or removers, degreasers, dry-cleaning fluids, gasoline, and lighter fluid
Art or office supply solvents, including correction fluids, felt-tip marker fluid, electronic contact cleaners, and glue
Aerosols: sprays that contain propellants and solvents

Household aerosol propellants in items such as spray paints, hair or deodorant sprays, fabric protector sprays, aerosol computer cleaning products,
and vegetable oil sprays
Gases: Found in household or commercial products and used as medical anesthetics

Household or commercial products, including butane lighters and propane tanks, whipped cream aerosols or dispensers, and refrigerant gases
Medical anesthetics, such as ether, chloroform, halothane, and nitrous oxide.
Nitrites: A special class of inhalants that are used primarily as sexual enhancers
Organic nitrites are volatiles that include cyclohexyl, butyl, and amyl nitrites, commonly known as "poppers." Amyl nitrite 1s still used 1n certain
diagnostic medical procedures.
These various products contain a wide range of chemicals such as
• Toluene (spray paints, rubber cement, gasoline)

• Chlorinated hydrocarbons (dry-cleaning chemicals, correction fluids)
• Hexane (glues, gasoline)
• Benzene (gasoline)
• Methylene chloride (varnish removers, paint thinners)
• Butane (cigarette lighter refills, air fresheners), and
• Nitrous oxide (whipped cream dispensers, gas cylinders).
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Adolescent tend to abuse different products at different ages, At the age of 12-15 people start to abuse inhalants. The commonly used inhalants
are glue, shoe polish, spray paints, gasoline, and lighter fluid. And 16-17 age group peoples abused drug are nitrous oxide or whippets.
Effects of Inhalant Abuse

The effects of inhalant abuse can resemble alcoholism. Upon inhalation, the body becomes starved of oxygen. This can often cause:
• Rapid heart beat

• Brain stimulation
• Distorted perception
• Sensory depression
• Lethargy
• Slurred speech
• Headaches
• Loss of coordination
• Wheezing
Users of inhalants can become intoxicated several times over a few hours because of the chemical's short-acting, rapid-onset effect.
Withdrawal Effects
Heavy or sustained inhalant abuse can result in a tolerance on the substance which can cause physical withdrawal symptoms that can last for
several hours to a few days after use. Withdrawal symptoms may include:
• Sweating
• Rapid pulse
• Insomnia
• Hand tremors
• Agitation
• Anxiety
• Hallucinations
• Seizures
Warning Signs of Inhalant Abuse
• Paint or stains on the body or clothing

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Warning Signs of Inhalant Abuse
• Paint or stains on the body or clothing

• Spots or sores around the mouth
• Red or runny eyes and nose
• Chemical odor on the breath
• A drunken or dazed appearance
• Loss of appetite
• Excitability and/or irritability
Medical Complications Associated with Inhalant Abuse

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Common Sources of Inhalant Abuse
• Adhesives: Model airolane qlue, rubber cement, household qlue

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Common Sources of Inhalant Abuse
• Adhesives: Model airplane glue, rubber cement, household glue

• Anesthetics: Nitrous oxide, ether, chloroform
• Cleaning: Dry cleaning fluid, spot remover.
• Food: Vegetable cooking spray, "whippets" (nitrous oxide)
• Gases: Nitrous oxide, butane, propane, helium
• Solvents: Nail polish remover, paint thinner, typing correction fluid and thinner, toxic markers, pure toluene, cigar lighter fluid, gasoline
• Aerosols: Spray paint, hair spray, air freshener, deodorant, fabric protector
Treatment for Inhalant Abuse

There are many type of inhalant abuse treatments are available. with the use of medications to avoid seizures or convulsions and to manage mood
swings and feelings such as anxiety, agitation, irritability or depression. In many cases, a psychiatric evaluation may be ordered to rule out or allow a
psychiatrist to treat a presenting disorder.
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Pharmacology Drug Abuse • Marijuana
Marijuana
Marijuana is the most commonly abused illicit drug by adolescents. This crude drug made from the plant Cannabis sativa. The main mind altering
components in marijuana is THC (delta-9-tetrahydrocannabinol), but more than 400 other chemicals also are in the plant. Marijuana is usually smoked
as a cigarette (joint) or in a pipe, blunts (replacement of marijuana in cigars) and also used as hash.
Marijuana cigarettes is made from the dried particle of the plant. The effect of the marijuana cigarettes is directly propositional to the THC amount
of the marijuana. It increases physical and mental effects and the possibility of health problems for the user. Hashish, or hash, is made by taking the
resin from the leaves and flowers of the marijuana plant and pressing it into cakes or slabs. Hash is usually stronger than crude marijuana and may
contain five to ten times as much THC.
The following media (Marijuana) explains about the Marijuana:

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Adverse effect of marijuana
• Increased heart rate,

• Emphysema,
• Lung cancer,
• Acute panic,
• Anxiety,
• Loss of fertility,
• Depression,
• Suicidal ideation, and
• Schizophrenia.
Long tern1 effect of marijuana

Long-te rm regular users of marijuana may become psychologically dependent. They may have a hard time limiting their use, they may need more of
the drug to get the same effect, and they may develop problems with their jobs and personal relationships. The drug can become the most important
aspect of their lives.
The time duration of n1arijuana stay in the body after the drug i s smoked
When marijuana is smoked, THC, its active ingredient, is absorbed by most tissues and organs in the body; however, it is primarily found in fat
tissues. The body, in its attempt to rid itself of the foreign chemical, chemically transforms the THC into metabolites. Urine tests can detect THC
metabolites for up to a week after people have smoked marijuana. Tests involving radioactively labeled THC have traced these metabolites in animals
for up to a month.
Immediate effects of smoking marijuana

Immediate physical effects of marijuana are include:
• A faster heartbeat and pulse rate,

• Bloodshot eyes,
• A dry mouth and throat.
• Some studies are shown that the drug can impair or reduce short-term memory,
• Reduce ability to do things which require concentration,
• And coordination, such as driving a car or operating machinery.
Dangers of marijuana for young people

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, � ' . I
tissues. T he body, in its attempt to rid itself of the foreign chemical, chemically transforms the THC into metabolites. Urine tests can detect THC
metabolites for up to a week after people have smoked marijuana. Tests involving radioactively labeled THC have traced these metabolites in animals
for up to a month.
Immediate effects of smoking marijuana

Immediate physical effects of marijuana are include:
• A faster heartbeat and pulse rate,

• Bloodshot eyes,
• A dry mouth and throat.
• Some studies are shown that the drug can impair or reduce short-term memory,
• Reduce ability to do things which require concentration,
• And coordination, such as driving a car or operating machinery.
Dangers of marijuana for young people
• Lose of interest to do schoolwork,

• lose of impairing thinking
• difficulty in reading comprehension
• lose of knowledge in verbal and mathematical skills.
Treatn1ent
Behavioural interventions, including cognitive behavioural therapy and motivational incentives have shown efficacy in treating marijuana dependence.
Although no medications are currently available, recent discoveries about the workings of the cannabinoid system offer promise for the development
of medications to ease withdrawal, block the intoxicating effects of marijuana, and prevent relapse.
Notes
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Pharmacology Drug Abuse • Morphine
Morphine
Morphine is a narcotic pain reliever drugs. It is obtained from opium, the juice secreted by the seeds of the poppy. It works o n several types of
receptors, widely found in nervous tissue. "Opioids" is a term used for all drugs that act on these receptors. The most important of these are relief of
pain and respiratory depression. In anesthesia morphine is used to relieve pain. This is an effect of its action on the spinal cord to decrease the
transmission of painful stimuli from body to brain, and its action within the brain itself.
The following media explains the Morphine:
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Side Effects
• Respiratory depression
• Nausea
• Vomiting
i
• Sedat on
• Constipation
• Urinary retention.
• Itching of the skin and nose
• Increase heart or blood pressure
• Emptying of the stomach
• Hypotension
• Hypovolaemia
Withdrawal effects
• Restlessness
• Lacrimation
• Rhinorrhea
• Yawning
• Perspiration
• Goose flesh
• Restless sleep
• Mydriasis
• Twitching and spasms of muscles
• Kicking movements
• Severe aches in the back, abdomen, and legs
• Abdominal and muscle cramps
• Hot and cold flashes
• Insomnia
• Nausea
• Vomiting
• Diarrhea
• Coryza
• Severe sneezing
• Increases in body temperature, blood pressure, respiratory rate, and heart rate

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Reason for avoiding 01orphine
FDA pregnancy category C. Morphine may be harmful to an unborn baby, and could cause addiction or withdrawal symptoms in a newborn. And do
not use morphine if you have ever had allergic with some other narcotic medicine or following diseases.
• Asthma, COPD, sleep apnea, or other breathing disorders

• Liver or kidney disease
• Under active thyroid
• Curvature of the spine
• A history of head injury or brain tumor
• Epilepsy or other seizure disorder
• Low blood pressure
• Gallbladder disease
• Addison's disease or other adrenal gland disorders
• Enlarged prostate, urination problems
• Mental illness
• A history of drug or alcohol addiction.
In1portant information about morphine
• Don't take morphine, if you are already taken any other opioid pain medicine
• MorP.hine is a habit formin_g drug so, avoid to take the drug if you are already addicted or abused of any other drugs.
• Dangerous side effects or death caA occur when aleohol is combined with morphiAe.
• Never take more than your prescribed dose of morphine.
• Do not stop taking morphine suddenly, or you could have unpleasant withdrawal symptoms.
Treatn1ent
Morphine abuse and addiction is a complex problem involving biological changes in the brain as well as a myriad of familial, social or environmental
factors. Psycho biological counseling, Pharmacological approaches, behavioural interventions especially cognitive behavioural therapy which shows
effective reduction of cocaine usage and preventing relapse.
Notes
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Sterilization
Sterilization
Different sterilization methods are used in the laboratory. Sterilization can be achieved by a combination of heat, chemicals, irradiation, high pressure
and filtration like steam under pressure, dry heat, ultraviolet radiation, gas vapor sterilants, chlorine dioxide gas etc. Classical sterilization techniques
using saturated steam under pressure or hot air are the most reliable and should be used whenever possible. Other sterilization methods include
filtration, ionizing radiation (gamma and electron-beam radiation), and gas (ethylene oxide, formaldehyde).
Importance of sterile dressings

sterile technique
Sterile is generally defined as meaning free from microorganisms. Sterile technique involves strategies used in patient care to reduce exposure to
microorganisms and maintain objects and areas as free from microorganisms as possible. Sterile technique involves meticulous hand washing, use of a
sterile field, use of sterile gloves for application of a sterile dressing, and use of sterile instruments. "Sterile to sterile" rules involve the use of only
sterile instruments and materials in dressing change procedures; and avoiding contact between sterile instruments or materials and any non-sterile
surface or products. Sterile technique is considered most appropriate in acute care hospital settings, for patients at high risk for infection, and for
certain procedures such as sharp instrumental wound debridement.
Major principles for wound dressing
1. Use Standard Precautions at all times.

2. When using a swab or gauze to cleanse a wound, work from the clean area out toward the dirtier area. (Example: When cleaning a surgical
incision, start over the incision line, and swab downward from top to bottom). Change the swab and proceed again on either side of the
incision, using a new swab each time.
3. When irrigating a wound, warm the solution to room temperature, preferably to body temperature, to prevent lowering of the tissue
temperature. Be sure to allow the irrigant to flow from the cleanest area to the contaminated area to avoid spreading pathogens.
Types of Dressing:
The types of dressing is as follows
• Transparent adhesive films

• Hydrocolloids
• Collagens
• Hydrogels
• Exudate absorbers
• Polyurethane foams
• Lubricating sprays of emollients
• Enzymatic debriders

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Sterilization Disinfection of surgical instruments
Disinfection of surgical instruments
Cleaning, disinfecting and sterilising are the three levels of instrument care.
Cleaning removes dirt, debris and biological material from surgical instruments. You can clean surgical instruments manually or mechanically using
water and detergents or an enzymatic cleaner. Thoroughly clean your instruments, because debris that remains on instruments can interfere with
further disinfection/ sterilisation or corrupt research data. Cleaning is the first step toward sterilisation and sometimes is all that is required.
Cleaning
The first step in properly cleaning your surgical instruments is to rinse off all blood, bodily fluids and tissue immediately after use. Dried soils may
damage the instrument surface and make cleaning more difficult. Rinse your instruments in cool water. Hot water can cause proteinous substances
to coagulate. If desired, soak your surgical instruments in cool water with an enzymatic detergent. The detergent helps to dissolve the proteins and
break down oils. Then, the instruments may be cleaned manually or mechanically in a washer or ultrasonic bath.
Manual Cleaning
If a mechanical cleaning method is unavailable, manual cleaning may be necessary. Likewise, if instruments are easily damaged, complex (requiring
disassembly) or have small lumens, they may need to be cleaned manually.
When cleaning your instruments manually, wear heavy-duty rubber gloves, a plastic apron, eye protection and a mask. Use only neutral pH
detergents. If your instruments are not rinsed properly, low pH detergents may break down the protective surface of stainless steel instruments and
cause black staining. Likewise, alkaline detergents may leave surface deposits that cause a brown stain and interfere with the smooth operation of
the instrument.
Use soft plastic cleaning brushes to scrub the instruments. Do not use steel wool, wire brushes or other abrasive materials that could scratch the
finish or dull your instruments. Hold the instruments below the surface of the water when you scrub them to avoid splattering contaminants. Be sure
to brush out all crevices, teeth and grooves. Rinse each instrument thoroughly under running water. Open and close hinged instruments like scissors,
hemostats and needle holders under running water to thoroughly rinse detergent from the hinges.
Mechanical Cleaning
Typically, a washing machine runs through several cycles. A cold water rinse removes debris. Then, a hot water bath and rinse cycle is followed by a
blow dry with hot air. Some washers are also disinfectors. These units use 100°c water in the hot water cycle. Follow the manufacturer's
instructions when using a mechanical washer. Be sure to lubricate hinged instruments after the last rinse cycle and prior to sterilisation.
Disinfection
Both thermal and chemical methods are available. As a general rule, surgical instruments are not susceptible to heat, making boiling the preferred
method for disinfecting. Boiling instruments in 100°c water for at least one minute kills all microorganisms, except for a few bacterial spores. Boiling
does NOT sterilise equipment.

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Disinfection
Both thermal and chemical methods are available. As a general rule, surgical instruments are not susceptible to heat, making boiling the preferred
method for disinfecting. Boiling instruments in 100°C water for at least one minute kills all microorganisms, except for a few bacterial spores. Boiling
does NOT sterilise equipment.
Bring the boiler to a rolling boil. Submerge open instruments in the boiling water. When the water returns to the boiling point, turn the heat down to a
gentle boil. A rolling boil could damage instruments as they bounce around in the boiler. After one minute, remove the instruments from the water
using a set of disinfected tongs. Allow the instruments to dry and lubricate the hinges. Do NOT leave boiled instruments in the water as it cools,
because they could be re-contaminated. Discard the water when you finish disinfecting your instruments.
Sterilisation
Sterilisation kills all microorganisms and spores. Autoclaving (saturated steam under high pressure) is the most common method for sterilising surgical
instruments, however, dry heat and chemical sterilants (ethylene gas, hydrogen peroxide gas plasma, etc.) can also be used.
Autoclave
Prior to autoclaving, clean the instruments and lubricate all hinged instruments with a surgical instrument lubricant. Do not use WD-40@ or other
industrial lubricants. Always autoclave instruments in an open position. Locking an instrument prevents the steam from reaching all the surfaces. The
heat also causes the metal to expand, which can crack the hinges of locked instruments. Never overload the autoclave chamber. Instruments can be
placed in sterilisation trays or wrapped in paper or muslin before autoclaving. This helps to prevent contamination of the instruments after
sterilisation.
Arrange the instruments, ·sterilisation trays or packs in the autoclave without stacking them. The steam must circulate freely inside the autoclave.
Follow the manufacturer's directions for adjusting the time, temperature and pressure of the autoclave cycle. Process the instruments as follows:
• Unwrapped instruments at 121°C for 20 minutes at 15 PSI above atmospheric pressure or at 134°C for 3-4 minutes at 30 PSI above
atmospheric pressure
• Wrapped instruments at 121°C for 30 minutes at 15 PSI above atmospheric pressure or at 134° C for 15 minutes at 30 PSI above atmospheric
pressure
When the autoclaving cycle is complete and the pressure reaches zero, open the door a centimeter or two to allow the steam to escape. Run the
drying cycle as recommended by the autoclave manufacturer until all the instruments are dry. It should take about 30 minutes. Using sterile tongs,
remove all the instruments, trays and packages. Allow them to cool to room temperature before storing.
Unwrapped items must be used immediately or may be stored in covered, dry, sterile trays for up to a week. Store wrapped packages in a warm, dry,
closed cabinet. Instruments remain sterile as long as the wrap is dry and intact.
Dry Heat
Dry heat may also be used to sterilise surgical instruments. Instruments can be wrapped in aluminum foil or placed in sterilisation trays before putting
them in the oven. Refer to tne manufacturer's directions to heat the oven. Instruments can be heated to any of the following to be considered
sterilised:
, 180°C for 30 minutes

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• Unwrapped instruments at 121° c for 20 minutes at 15 PSI above atmospheric pressure or at 134° C for 3-4 minutes at 30 PSI above
atmospheric pressure
• Wrapped instruments at 121°C for 30 minutes at 15 PSI above atmospheric pressure or at 134°C for 15 minutes at 30 PSI above atmospheric
pressure
When the autoclaving cycle is complete and the pressure reaches zero, open the door a centimeter or two to allow the steam to escape. Run the
drying cycle as recommended by the autoclave manufacturer until all the instruments are dry. It should take about 30 minutes. Using sterile tongs,
remove all the instruments, trays and packages. Allow them to cool to room temperature before storing.
Unwrapped items must be used immediately or may be stored in covered, dry, sterile trays for up to a week. Store wrapped packages in a warm, dry,
closed cabinet. Instruments remain sterile as long as the wrap is dry and intact.
Dry Heat
Dry heat may also be used to sterilise surgical instruments. Instruments can be wrapped in aluminum foil or placed in sterilisation trays before putting
them 1n the oven. Refer to the manufacturer's directions to heat the oven. Instruments can be heated to any of the following to be considered
sterilised:
• 1B0°C for 30 minutes

• 170°C for 1 hour
• 160°C for 2 hours
• 149 °C for 2. 5 hours
• 141°c for 3 hours
Allow the instruments to cool to room temperature inside the oven and store them as described above.
Notes

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Sterilization Dressing wounds, Care of cuts, wounds, burns and scalds
Dressing wounds, Care of cuts, wounds, burns and scalds
You should always cover a wound with a dressing to help prevent infection. Dressings also help stop bleeding by putting pressure on the wound.
Below are instructions for putting different types of dressing on a wound. For more information on using bandages to hold a dressing in place, control
bleeding, and support a limb see how to put on a bandage.
• For large wounds, use a pre-packed sterile wound dressing with a bandage attached, if you have one
• Otherwise, use a sterile pad and secure it with sticky tape. You could also use any clean, non-fluffy material, like a cloth scarf
• For small cuts or grazes you can use a plaster (adhesive dressing).
• If possible, always use disposable gloves to protect yourself and the person you're trying to help
• The pad needs to cover the skin at least a few centimetres around the wound
• Never touch the part of the dressing that will be in contact with the wound
• If blood seeps through the first bandage, don't remove it instead, place another dressing over the top
• If blood seeps through the second dressing, take off both dressings and apply a fresh dressing make sure you put firm pressure on the wound
to help stop the bleeding.
How to put a sterile wound dressing on a limb:
1. First, take the bandage out of the wrapper and unwind it until you get to the dressing pad but be careful not to touch the part of it that
touches the wound
2. Then hold the bandage on each side of the dressing pad and place the pad directly on the wound
3. Start by winding the short end of the bandage once around the limb to hold the dressing in place
4. Then wind the other longer end of the bandage around the limb until it covers the whole pad leave the short end of the bandage hanging free
so you can use it to tie a knot
5. To hold the bandage in place, tie the two ends together directly over the pad to keep firm pressure over the wound any knot will do, but use a
reef knot if you know how to
6. Once you've tied the bandage, you'll need to check the circulation in the hand or foot beyond where you've tied it press the fingernail or skin
beyond the bandage until it goes pale and then let go. If the colour doesn't come back within two seconds, the bandage is too tight so you'll
need to loosen it and retie it.
How to put on a sterile pad:
1. Hold the dressing or pad by the edges and place it directly on the wound
2. Use sticky tape to hold the pad in place
3. If you need to keep pressure on the wound to control the bleeding, use a rolled up bandage.
How to nut on ii nh=tc;;tP.r:

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touches the wound

2. Then hold the bandage on each side of the dressing pad and place the pad directly on the wound
3. Start by winding the short end of the bandage once around the limb to hold the dressing in place
4. Then wind the other longer end of the bandage around the limb until it covers the whole pad leave the short end of the bandage hanging free
so you can use it to tie a knot
5. To hold the bandage in place, tie the two ends together directly over the pad to keep firm pressure over the wound any knot will do, but use a
reef knot if you know how to
6. Once you've tied the bandage, you'll need to check the circulation in the hand or foot beyond where you've tied it press the fingernail or skin
beyond the bandage until it goes pale and then let go. If the colour doesn't come back within two seconds, the bandage is too tight so you11
need to loosen it and retie it.
How to put on a sterile pad:
1. Hold the dressing or pad by the edges and place it directly on the wound
2. Use sticky tape to hold the pad in place
3. If you need to keep pressure on the wound to control the bleeding, use a rolled up bandage.
How to put on a plaster:
1. First remember to clean and dry the skin around the cut. Unwrap the plaster and hold it by the protective strips on the back, with the pad
facing downwards
2. Peel back the strips enough so the pad is showing and place the pad on the wound
3. Carefully pull away the strips and then press down the edges of the plaster.
Notes

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Sterilization Dressing wounds, Care of cuts, wounds, burns a... Suturing
Suturing
This is process of wound closure in the human body which is done by the help of sutures and needle. In the human body wounds occur by injuries
and during surgical dissection. These wounds may have large area of torn skin layer. Suture are used stitch these torn layers.
Purpose of Suturing
Suturing is basically a wound closure technique where suture are used. The purpose of suturing arises when a person has deep cut in his body due
to some accident. A cut of 2-3 inch deep or greater in the skin layer should be sutured. These wound may occur when a person is careless or when
he meets with an accident. There is another cause for larger wound which may occur in the human body. During surgery a physician has to cut some
parts of the human organs to operate a inner organ in the body. These part can't be left opened after the operation are done these are to be
closed. Here the suturing method is followed.
Needle
The needle which is used for suturing is hook shaped which is curved and is made of the stainless steel. The curved portion helps in the process of
suturing. The needle size ranges from 20-25 gauges this is the optimum diameter of the needle to be used in the process.
Sutures
Sutures are materials which are used in the process of suturing. They are two types of sutures which based on the composition and function of the
suture.
• Absorbable
• Non absorbable
1. Absorbable:
These sutures are made of
• Catgut
• Dexon
• Polyglycollic acid
• Polyglactic acid
• Vicryl
Suture which are made of these materials are used for internal suturing methods they are used in surgery process. These sutures are degradable
within 60 days of time in the human body.
2. Non Absorbable:

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2- Non Absorbable:
These sutures are made of
• Nylon
• Polypropylene
• Braided polyester
• Polybutester
• Silk
Suture which are made of these material are used for external wound closure since they non degradable they are used for external suturing purpose
only.
Suturing Process
The suturing process is a simple as your stitches your clothes here a surgeon stitches your wounds with a needle and suture. They two maior
classification in the methodology of suturing
• Interrupted suturing
• Continuous suturing
The following media explains the Suturing techniques:
SUTURING
TEC UES

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1- Interrupted Suturing:
In this process we have wound of certain length which has to be sutured. Now the surgeon has the suture and needle ready. He first makes knot at
one end of the wound and another knot in the other end of the wound. Then if the length of the wound is large he makes more number of knots in
the wounded length.
2- Continuous Suturing:
In this process we have wound of certain length which has to be sutured. Now the surgeon has the suture and needle ready. He first makes knot at
one end of the wound and then starts stitching in wounded length as a cloth is stitched still last end of the wound. At last he puts a knot on the
other end of the wound and completes the process of suturing.
Notes

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Sterilization Dressing wounds, Care of cuts, wounds, burns a... Intravenous Therapy
Intravenous Therapy
Intravenous therapy is process of administrating fluid which is rich in nutrients to a person who is ill and not able to locomate by himself. These
nutrients are given to him through tubes since the person may be not capable to take food through there mouth. Intravenous fluids are given
through the veins of the human body.
Veins:
Veins are blood vessel which carries the impure blood to the heart. They are thin walled structured blood vessels. The larger veins are to be selected
since they may not stand the pressure of the intravenous fluid follow in them which may cause breakage of periphery veins.
Intravenous Fluids:
Intravenous fluids are rich in glucose, salt, NA+, K+, CL+, vitamins and minerals. This is made ready to use and to maintain the circulation of the
person.
Apparatus Required:
Intravenous fluid, catheter, cannula, trocar, intravenous tube, intravenous pole to hold the fluid bottle.
Intravenous Injection Site:

There are four sites in the human body for this purpose they are
• Veins of the forearm

• Veins of the dorsal hand
• Veins of the foot
• External jugular vein in the neck region.
Procedure of Administration
First a patient is made ready the intravenous pole is made ready with fluids in it. The patient is taken and the vein which is to be injected is found
by palpitating the vein. Then the vein is punctured with the help of the cannula which is of the size of 18 gauges or greater than that. Now cap of
the cannula is removed to let the air in the node of cannula to be pushed out by the out flowing blood of the veins. Now the intravenous tube is
fixed to the cannula and the valve are checked for proper flow of the intravenous fluid.
Then the amount of fluid is to be administered and blood pressure and other activities of the patient are to be recorded regularly. An approx o f 125
ml of fluid is to administered to the patient.
The following media explains about the starting an Intravenous Therapy:

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Cardiac arrest
Cardiac arrest
Heart Attack
Blood is supplied to the heart by two coronary arteries. These arteries can be narrowed by a fatty deposit, called atheroma, that accumulates on
their inner walls. A blood clot can form in the section of a coronary artery narrowed by atheroma (coronary thrombosis), blocking the artery and
causing myocardial infarction, in which an area of heart muscle dies. When the coronary arteries are narrowed but not altogether blocked and
when the workload on the heart is increased by exercise, the heart can become short of blood: the result is angina (angina pectoris). All these
conditions come under the term "coronary artery disease". The term "heart attack" is usually used to mean myocardial infarction but some people
use it to mean angina or attacks of severe breathlessness caused by heart disease.
Warning Signs of Heart Attack
Chest Pain: ++--- Skin: Skin becomes pale in colour

. Tightness
. Squeezing Pain
. Pressure
Pain in the neck, sh oulders
and at the upper back
Respiratory Problems:
. Cough -+--+-- Heart:
. Shortness of Breath . Arrhythmias
--++---',-- -Gastric:
. Nausea
. Vomiting
Overall Condition:
I . Anxious Feeling
. Fatigue
. Weakness
. Loss of Consciousness
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E-SOOK ASSESSMENT EMAIL QUESTION & ANSWER SESSION
023020
HEART ATTACK (Myocardial Infarction)

Never Ignore These 11 Heart Symptoms
1. Chest Discomfort. It's the most common sign of heart danger

2. Nausea
3. Indigestion
4. Heartburn
5. Stomach Pain
6. Pain that Spreads to the Arm
7. You Feel Dizzy or Lightheaded
8. Throat or Jaw Pain
9. You Get Exhausted Easily
10. Snoring
11. Sweating
The Symptoms, during a heart attack, will typically last for 15 minutes or longer. Seconds of symptoms typically are not ( due to) your heart. Also
'days on end' of symptoms are typically not a heart attack either, but it can be worthwhile to contact your physician.
ANGINA PECTORIS
Angina pectoris is pain or discomfort in the chest caused by inadequate blood supply to the heart. There are two main forms of angina pectoris:
stable angina and unstable angina.
stable angina is angina pectoris that has been occurring in episodes for weeks or months, each time after about the same amount of exercise but
rarely when the patient is at rest. With stable angina, there is only a low risk of a heart attack occurring in the near future.
Unstable angina is angina pectoris that began only recently or occurs at rest or occurs following much less exercise than the patient was in the
habit of doing previously: with unstable angina there is a high risk of a heart attack occurring in the near future.
• Angina and the pain of myocardial infarction are similar in location and character but the pain of myocardial infarction is usually more severe
and longer-lasting.
• Some patients with myocardial infarction have only mild pain, and some will be reluctant to call it "pain" at all, preferring "weight" or
''heaviness".
• Angina comes on after a few minutes' exercise and forces the patient to stop or slow down, then goes away after a few minutes' rest.
• The amount of exercise needed to bring on angina is often less in the morning than in the evening, less after than before meals, and less when
exercising in the cold than in warmer temperatures.
• It is not very important whether a patient has unstable angina or a n1yocardial infarction. The important thing is to recognize that the pain
is coming from the heart and that it is getting worse.

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is coming from the heart and that it is getting worse.
Chest pain is probably con1ing from the heart if:
• It is felt:
1. In the middle of the chest under the breast bone (sternum); AND/OR
2. In the left arm or in the neck and lower jaw
• It is described by the patient as:
1. "heavy" or "like a heavy weight on the chest";

2. "a tightness";
3. \\a pressing";
4. "a squeezing" and
5. The patient clenches one fist over the centre o f his chest when trying to say what he feels.
• It:
1. Is consistent of different episodes in the same patient,

2. Is like pain previously happening on exercise but more severe;
3. Comes on gradually;
4. Lasts from 30 minutes to one to two hours;
5. Is accompanied by breathlessness, nausea, and sweating.
Pain is probably not con1ing from the heart if it is:
• Felt in the lower abdomen or upper jaw;

• Described as "sharp" or "stabbing";
• Pain that starts suddenly;
• Pain that the patient can point to with one finger;
• A stab that lasts a few seconds and is felt in a small area near the left nipple;
• Pain felt on one side of the chest that gets worse with deep breathing;
• Likely to be associated with tenderness at the rib extremities near the breastbone;
• Pain:
1. With a "burning" rather than a "heavy" or "pressing" character;

2. Associated with an acid taste in the mouth;
3. Coming on after meals and not exercise;

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• Pain:
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1. With a "burning" rather than a "heavy" or "pressing" character;

2. Associated with an acid taste in the mouth;
3. Coming on after meals and not exercise;
4. Lasting for many hours and not just for 30 minutes to one or two hours;
5. This pain is more likely to be due to gastro-oesophageal reflux disease.
What to do in a case of myocardial infarction or unstable angina
• Seek medical advice with a view to evacuation: act promptly, because the benefit of treatment for myocardial infarction is reduced after only
a few hours' delay and is largely lost after 24 hours.
• Before seeking medical advice, collect the following information:
1. Age
2. Smoking habits
3. Presence of diabetes mellitus
4. History of heart disease in mother, father, brothers, or sisters
5. Duration of pain
6. Pulse rate and rhythm
7. Blood pressure
8. Ability o f patient to breathe comfortably lying flat.
• While awaiting evacuation or if evacuation is impossible, have the patient stay in bed except to go to the toilet.
• Restrict the patient to a light diet with fluids as desired.
• Give acetylsalicylic acid (Aspirin), 150 mg {half a tablet) orally, at once and then daily.
• Give metoprolol, 50 mg orally, twice daily; UNLESS:
1. The blood pressure is less than 120 mmHg systolic; OR

2. The pulse rate is less than 65 beats per minute; OR
3. The patient has asthma.
What to do in a patient with stable angina
• Give acetylsalicylic acid (Aspirin®), 150 mg (half a tablet) orally, daily.


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• Give acetylsalicylic acid (Aspirin), 150 mg (half a tablet) orally, at once and then daily.

What to do in a patient with stable angina
• Give acetylsalicylic acid (Aspirin®), 150 mg (half a tablet) orally, daily.


• Restrict the patient to activities that do not cause pain.

• Advise the patient strongly not to smoke.
Complications of myocardial infarction

CONGESTIVE HEART FAILURE
If the area of heart affected by myocardial infarction is extensive, there may not be enough heart muscle to pump blood effectively; this causes:
• In severe cases:
1. Extreme difficulty breathing, made worse when the patient lies flat;
2. Low blood pressure;
3. Cool, blue or grey, sweaty face, hands and feet;
4. If the blood pressure is less than 90mmHg systolic, cardiogenic shock is present; this is nearly always fatal;
• In moderate cases:
1. The above signs and symptoms, except that blood pressure remains normal;
• in mild cases:
1. Breathlessness made worse by lying flat and, after one or two days, swelling (oedema) of the ankles.
ABNORMAL HEART RHYTHM (CARDIAC ARRHYTHMIA)

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ABNORMAL HEART RHYTHM (CARDIAC ARRHYTHMIA)
• The dead (infarcted) area of heart muscle can give rise to abnormal heart rhythms, most often during the first 24 hours after the myocardial
infarction.
• In most cases, the abnormal rhythm consists of fast heart beats that may become chaotic: this can cause sudden death.
• The dead area of heart muscle can block the normal pathways through which the heart is triggered to contract, causing it to beat at a very
slow rate - usually 30-40 beats per minute: the result is a fall in blood pressure, faintness and, in some cases, breathlessness.
What to do in a case of congestive heart failure

In severe cases:
• Give frusemide, 40 mg intravenously (preferably) or intramuscularly; AND

• Morphine, 5-10 mg intravenously (preferably) or intramuscularly;
• If there is no improvement in 30 minutes, give frusemide, 80 mg intravenously (preferably) or intramuscularly.
In moderate cases:
• Give frusemide, 40 mg intravenously (preferably) or intramuscularly, and repeat if there is no improvement in 30 minutes.
In mild cases:
• Give frusemide, 20 mg intramuscularly
What to do in a case of abnormal heart rhythn1
• If you cannot feel a pulse, begin caraiopufmonary resuscitation.

• Seek medical advice.
• If the pulse is slow, give atropine, 0.6 mg intravenously (preferably) or intramuscularly: repeat twice if there is no response in 10 minutes or if
there is an initial effect but the pulse slows again later.
Heart Attack Stroke

Blood Clot Blocks Blood Clot Blocks
Blood Flow to the Heart Muscle Blood Flow to the Brain

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Stroke
Stroke is a loss of brain function caused by failure of blood supply to the brain. The loss of function can be temporary, when it is called a transient
ischaemic attack (or a "ministroke"), or permanent.
Common causes of stroke are:
• Blockage of an artery supplying blood to the brain (ischaemic stroke), which is caused in turn by:
1. A plaque or clot (thrombus) that has formed inside the artery from accumulated fats and other substances (atherosclerosis); this causes
65-75 °/o of strokes; OR
2. A clot formed in a blood vessel elsewhere in the body that has travelled to the brain (embolism); this causes 5-10°/o of strokes;
• Bleeding into the brain (haemorrhagic stroke) from a ruptured artery supplying blood to the brain; this is the cause of about 20 °/o of strokes
and is more often fatal than other forms of stroke; there are two types of haemorrhagic stroke:
1. Intracerebral haemorrhage, caused by rupture of a vessel inside the brain;

2. Subarachnoid haemorrhage, caused by rupture of a vessel on the surface of the brain.
Signs and symptoms

Typical patterns of signs and symptoms in stroke:
• Symptoms gradually progress over hours or days;

• In many cases, periods of stability or improvement of the patient's condition, followed by further worsening;
• In a few cases, particularly of embolism or haemorrhage, onset of symptoms over minutes with no further worsening.
The commonest pattern of symptoms in stroke is:
• Weakness of the face, arm and hand, and leg on one side of the body; note:
1. The patient may complain not of weakness but of "clumsiness" or "heaviness" or even "numbness", but you will find weakness when you
examine him;
2. Weakness of the face is shown by drooping of the corner of the mouth;

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• Weakness of the face, arm and hand, and leg on one side of the body; note:
1. The patient may complain not of weakness but of "clumsiness" or "heaviness" or even "numbness", but you will find weakness when you
examine him;
2. Weakness of the face is shown by drooping of the corner of the mouth;
3. In stroke, the patient can still wrinkle the forehead;
4. If the mouth droops and the forehead on the side of the droop is smooth, the diagnosis is probably Bell's palsy;
• Abnormal speech ( especially if the right side of the body is affected) with thick, slurred speech, difficulty finding words, or complete inability to
speak or understand.
When you examine the patient you will find:
• The arm and leg weak and floppy on examination; note:
1. If you are not sure if an arm is weak, ask the patient to hold both arms straight out in front of him: a weak arm will drift down and away from
the body over the next 10 to 15 seconds.
Less con1mon symptoms in stroke are:
• Dizziness and staggering;

• Blurred or double vision, often with weakness of one side of the face and the opposite side of the body;
• Loss of vision in one eye lasting a minute or two.
What to do immediately
• Seek medical advice: evacuation may or may not be needed, and, if needed, may or may not be urgent, depending on the circumstances.
• If there is any reason to suspect head injury, seek medical advice immediately.
• Otherwise, before calling for medical advice, do the following:
1. Have the patient lie flat in bed with the body, shoulders, and head at the same level: allow a single pillow if the patient is uncomfortable lying
flat;
2. Check the blood pressure , pulse rate and level of consciousness.
• Blood pressure:
1. Blood pressure is usually increased soon after a stroke;

2. Systolic blood pressure above 170 mmHg or below 120 mmHg suggests a poor outcome: these patients should normally be evacuated as soon
as possible;

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as possible;
3. Blood pressure that is very high in a young patient suggests cerebral haemorrhage, and these patients also should be evacuated urgently.
• Pulse rate: A rapid, irregular pulse suggests that an embolism has caused the stroke: this requires medical treatment in hospital.
• Consciousness: If consciousness is impaired, have the patient evacuated urgently.
• Give the patient a sip of water: if there is any difficulty swallowing, or if the patient coughs or splutters, you will have great difficulty caring
for the patient on board.
• Have this additional information ready when you speak to the doctor:
1. The patient's age and detailed past medical history;

2. Any evidence of treatment for:
i) High blood pressure;
ii) Diabetes - if the patient is on treatment for diabetes and is drowsy or confused blood sugar levels may be low (hypoglycaemia): give sugar,
by mouth if the patient can swallow or glucagon, lmg intramuscularly, if the patient cannot swallow.
iii) Epilepsy - occasionally, repeated fits can cause weakness of one side of the body resembling stroke;
iv) Any evidence of cocaine or amphetamine use.
What not to do immediately
• DO NOT give supplementary oxygen.

• D O NOT give anything by mouth to any patient with impaired consciousness.
• DO NOT give anything by mouth to any patient until you are sure that they can swallow water normally.
Transient ischaemic attack {TIA}

A TIA is defined as symptoms of stroke that go away in less than 24 hours. In most cases they go away much faster, usually in a few minutes.
A TIA often means that the patient will have a major stroke in the near future.
What to do
• Measure the pulse and blood pressure; if the blood pressure is high or low, or the pulse 1s very fast or irregular, seek medical advice
immediately.
• Give acetylsalicylic acid {Aspirin), lSOmg orally at once, and then daily.
• Have the patient seen by a doctor at the next port.
• Seek medical advice about the need for evacuation if a second TIA occurs which lasts longer than the first or affects more of the body.
Notes
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Cardiac arrest - Asphyxia
Asphyxia
Asphyxia (suffocation)
The human body requires air with an oxygen content of approximately 20.9°/o by volume. When the oxygen concentration falls below about 19°/o by
volume mental confusion and impaired mobility rapidly occur. Mental confusion is particularly dangerous because the victim may not be capable of
understanding the situation and they are likely to require help to escape from a hazardous location. At lower oxygen levels, unconsciousness takes
place rapidly and, if the victim is not removed quickly, permanent brain damage or death may result.
In most cases, oxygen deficiency occurs in enclosed spaces with the following conditions.
• When large quantities of cargo vapour are present

• When large quantities of inert gas or nitrogen are present
• Where rusting of internal tank surfaces has taken place.
In addition to displacing oxygen, combustion-generated inert gas also has the added danger of potential exposure to carbon monoxide.
Synlptoms of asphyxia
The symptoms of asphyxia may include:
• Breathing difficulties (this is the main symptom that may result in a blue appearance of the skin)
• Increased rate and depth of respiration
• Strenuous breathing (with a snoring sound)
• Loss of consciousness.
Medical treatment for asphyxia or the affects or toxic materials

In cases where someone has not been completely overcome by the effects of exposure to gas or toxic materials, symptoms will be giddiness,
confusion and an inability to stand up properly or walk straight.
In many cases, a person overcome by exposure to gas or toxic materials will have managed to leave the affected area in an attempt to summon
help, only to collapse unconscious nearby.
Medical treatment for exposure to gas will depend on the amount inhaled, the period of exposure and the nature of the gas or toxic materials.
However, treatment typically consists of:
• Removing the casualty to a safe area

• Providing artificial respiration (airways, breathing, circulation (ABC))
• Administering oxygen.

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• Breathing difficulties (this is the main symptom that may result in a blue appearance of the skin)
• Increased rate and depth of respiration
• Strenuous breathing (with a snoring sound)
• Loss of consciousness.
Medical treatment for asphyxia or the affects or toxic materials

In cases where someone has not been completely overcome by the effects of exposure to gas or toxic materials, symptoms will be giddiness,
confusion and an inability to stand up properly or walk straight.
In many cases, a person overcome by exposure to gas or toxic materials will have managed to leave the affected area in an attempt to summon
help, only to collapse unconscious nearby.
Medical treatment for exposure to gas will depend on the amount inhaled, the period of exposure and the nature of the gas or toxic materials.
However, treatment typically consists of:
• Removing the casualty to a safe area

• Providing artificial respiration (airways, breathing, circulation (ABC))
• Administering oxygen.
Professional medical advice and treatment should always be obtained where a person has been overcome by gas.
The advice given in MFAG deals with the chemicals and substances detailed in the IMDG Code and covers: diagnosis of poisoning, first aid, poisoning
complications, toxicity hazards, emergency treatment, chemical tables including indices and a list of medicines.
Notes

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Psychological/Psychiatric Problems
Psychological/Psychiatric Problems
According to World health Organization {WHO), 1948, Health is a state of complete physical, mental and social well-being, and not merely the
absence of disease or infirmity. There is not a single precious thing in this world without a good health. Health is the most important thing for a best
life but neglected by most people, most of the time in their lives. People rather prefer to run after money and other material things than their own
health and that too at the cost of their health. Health is a metabolic efficiency. Sickness is a metabolic inefficiency. Nobody is totally healthy or
totally sick. Each of us is a unique combination of health and sickness. And each of us has a unique combination of abilities and disabilities, both
emotional and physical and spiritual.
Healthy habits and healthy thinking are secrets to a healthy mind and body. Along with maintaining cleant habits, health and hygiene, healthy
thinking does a great deal of good for good health.
Am I fat? Am I too skinny? I'd be happy if I were taller, shorter, had curly hair, straight hair, a smaller nose, bigger muscles, longer legs - are thoughts
that are detrimental to being healthy. Self-esteem is all about how much people value themselves, the pride they feel in themselves, and how
worthwhile and healthy they feel. Body image is how someone feels about his or her own physical appearance.
staying Healthy at Sea

i
It is very essent al to maintain healthy and hygienic living and working conditions on board merchant ships due to the following reasons:
• Lack of immediate specialized medical facilities such as hospitals and qualified speacialist Doctors on board.
• Non-availability of immediate medical help out at sea.
• Limited man power and non-availability of replacements/substitutes for injured/sick persons.
• Risk of spread of infections and contagious diseases within confined and limited accomodation areas.
• International regulations for health and hygiene.
• Commercial pressures for minimizing delays in ship's operations and business life-cycle.
However, a ship is equipped with medicines and equipment as stipulated by WHO regulations and medical help could be sought through Radio Medical
Advice at any given time with the advanced communication system and technology available on board. First aid and further medicare can be
provided to the injured/sick persons as per the advice from shore based medical facilities, until hospitalization/further treatment of the person can be
arranged for !LO and WHO regulations require all ships plying the high seas to comply with the requirements and regulations governing health and
hygiene of seafarers.
Due to the nature of the living conditions, the job on board and exposure to varying atmospheric conditions, seafarers are prone to get affected by
certain illnesses. Care should be execrised to mitigate the chances of such occurances.
General advice for Seafarers

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certain illnesses. Care should be execrised to mitigate the chances of such occurances.
General advice for Seafarers
• Carry whatever medication you are required to take and your Doctors prescription including those medicines which you generally use for minor
problems such as headache, upset stomach, insect bites, etc. The ship's medicine chest and the ports may not have what works best for you.
The prescription will help to convince any suspicious customs officials to let you keep your necessary drugs. If misadventure happens and your
medicines are lost, stolen, or confiscated, the prescription will also help you to obtain replacements.
• Keep yourself, your work area and your living quarters clean at all times. Wash your hands thoroughly before eating. Use cutlery to eat, not
your hands. Be extra careful and maintain hygiene when you are in common areas as diseases may spread from the infected to the non
infected in such areas.
• Be moderate with liquor, food, and sunshine. If you can avoid too much consumption of alcohol, a lot of rich food, and baking in the sun, you
are more likely to stay healthy.
"Four C's" of stress management:
• Control. With a friend, discuss whatever is stressing you out and look for ways to control, or at least minimize, its impact on you. This may
mean learning to accept that some situations are beyond your control and are simply not worth worrying about.
• Challenge your thoughts. Learn to change the way you think about a difficult situation by viewing it as an opportunity or a challenge to
overcome rather than a crisis.
• Commitment. Identify your priorities and live by them. If family and friends are the most important part of your life, for instance, don't over
commit to work or volunteer activities and shortchange loved ones. If you do, you will feel conflict, guilt, and frustration.
• Community_ Turn to your family and friends for emotional support, as well as for concrete help. For example, perhaps they can babysit your
kids so you can have an hour to yourself to blow off steam on the jogging path.
Four Cs of stress management

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S�No�I/
Psychiatric Problems Stay healthy
Stay healthy
Your doctor might do any of the following to help you stay healthy:
• Determine your risk for certain problems.

• Measure your height, weight, cholesterol levels and blood pressure.
Assessment
Now, shall we learn how obesity is assessed? Obesity can be assessed by the following procedures.
• Body weight
It is a common method used to determine the degree of obesity.
The following table will speak about the degree of obesity.
01o body weight excess of normal Degree of obesity
25 Mild
50 Moderate
75
100
I Severe
Very severe
• Body mass Index
It does not require any standard tables. It is also called Quetlet index.
BMI = weight (kg)/ height2 (m)
Have a look at the following table to get a brief idea about grading of obesity.

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• Body mass Index
It does not require any standard tables. It is also called Quetlet index.
BMI = weight (kg)/ height2 (m)
Have a look at the following table to get a brief idea about grading of obesity.
I Body Mass Index
>40
Grading of Obesity
Grade III
30 - 40 Grade II
25 - 29.9 Grade I
<25 Not obese
Grades of obesity is given in the following animation

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• Waist circumference
An inch tape is used measure the waist circumference. This is the most commonly used tool by clinicians to evaluate obesity. Men are termed as
obese, if their waist circumference is greater than 40 inches {>102 cm) and for women it is greater than 35 inches {>88 cm).
• Waist to hip ratio
Waist measurement (in cm) I hip measurement (in cm)
Gender Waist to Hip Ratio Condition
Male >1.0 Obese
Female >0.85 Obese
Normal waist to hip ratio is o. 7
• Measurement of body fat
To measure body fat at the triceps, abdomen and sub scapular and sub coastal sites various skin fold calipers are used. They are
1. Harpender calipers
2. Lange calipers
3. USA MRNL calipers
• Ponderal index {PI)
The ratio of height to the cube root of weight is ponderal index. PI less than 13 is associated with obesity.

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3. USA MRNL calipers
• Pondera! index (PI)
The ratio of height to the cube root of weight is ponderal index. PI less than 13 is associated with obesity.
PI= height (inches)/3vweight (lbs)
• Broka's index
This measurement is accurate and easy to calculate. The formula is
height (cn1)- 100 = ideal weight in (kg)
• Recommend tests to check your general health or to find certain diseases.

• Provide immunizations (vaccines) to reduce your risk of getting diseases such as mumps, tetanus, typhoid and hepatitis.
The following media explains about the Immunisation Schedule:
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Simple habits and precautions can help you remain healthy and minimize the risks of ill-health:
• Avoid using any type of tobacco product.

• Do not breathe cigarette smoke.
• Exercise regularly.
• Eat a healthy diet.
• While driving use seat belts.
• Don't drink and drive. Don't get into a car with a driver who has been drinking alcohol or using drugs.
• Wear protective headgear when riding a motorcycle.
• Wear appropriate gear when playing sports.
• Never swim alone.
• Talk to your parents or your doctor if you're feeling really sad or if you're thinking about harming yourself.
• Avoid situations where violence or fighting may cause you to be physically injured.
• If you have sex, use condoms to avoid pregnancy and sexually transmitted diseases.
• See your doctor regularly.
The following animation tells you about the various healthy habits to be followed_
Healttiy tia6its

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Shown is the healthy habits to keep healthy. Click on the parts.
( Do exercise J
( Avoid drink ]
r
[Eat Healthy Food)
Avoid smoke ] Do Regular

PAP Smear
Avoid unsafe sex Check Regular

Blood & Urine
Test
(Reduce overweight] ( Wear seatbelt i
(Wear headgear]
022031
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Psychological/Psychiatric Problems Maintaining Good Health
Maintaining Good Health
Do my habits really affect my health?
• Very much so. All of the major causes of death (such as cancer, heart disease, stroke, lung disease and injury) can be prevented by your
lifestyle and the choices you make.
• Don't smoke or chew tobacco .
• Smoking and using tobacco are very dangerous habits. Smoking causes many deaths every year. More preventable illnesses (such as
emphysema, mouth, throat and lung cancer and heart disease) are caused by tobacco usage than by anything else. The sooner you quit the
better.
Lin1it How n,uch Alcohol You Drink
• This means no more than 2 drinks a day for men and 1 drink a day for women. One drink is equal to 1 can of beer (12 ounces), a 4-ounce glass
of wine or a jigger (1 ounce) of liquor.
• Too much alcohol can damage the liver and contribute to some cancers, such as throat and liver cancer. Alcohol also contributes to deaths
from car wrecks, murders and suicides.
Eat Healthy
A healthy diet has many health benefits. Heart disease, certain cancers, stroke, diabetes and damage to your arteries can be linked to what you
eat. By making healthier food choices, you can also lower your cholesterol and lose weight.
The healthy choice of foods is given in the below animation_

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Carrying too much weight increases your risk for high blood pressure, high cholesterol, diabetes, heart disease, stroke, certain cancers, gallbladder
disease and arthritis in the weight-bearing joints (spine, hips or knees). A high-fiber, low-fat diet and regular exercise can help you lose weight.
Exercise
Exercise can help prevent heart disease, high blood pressure, diabetes, osteoporosis and depression. It can also help prevent colon cancer, stroke
and back injury. You'll feel better and keep your weight under control if you exercise regularly. Try to exercise for 30 to 60 minutes, 4 to 6 times a
week, but remember that any amount of exercise is better than none.
Don't Sunbathe or Use Tanning Booths

Sun exposure is linked to skin cancer, which 1s the most common type of cancer in the United States. It's best to limit sun exposure and wear
protective clothing and hats when you are outside. Sunscreen is also very important. It protects your skin and will help prevent skin cancer. Make
sure you use sunscreen on exposed skin (such as your face and hands). Choose a broad-spectrum sunscreen with at least an SPF of 15 and one
that blocks both UVA and UVB light.
Practice Safe Sex

The safest sex is between 2 people who are have sex with each other only and who don't have a sexually transmitted infection {STI) or share
needles to inject drugs.
Use latex condoms and a spermicide (a product that kills sperm) gel or cream. Talk with your doctor about being tested for STis.
Control Your Cholesterol Level

If your cholesterol level is high, keep it down by eating right and by exercising. You can also decrease your cholesterol level by limiting how much
cholesterol you eat and by quitting smoking.
Control High Blood Pressure

High blood pressure increases your risk for heart disease, stroke and kidney disease. To control it, lose weight, exercise, eat less sodium, drink less
alcohol, don't smoke and take medicine if your doctor prescribes it.
Keep Your Shots Up to Date

Adults need a tetanus-diphtheria booster every 10 years. Your doctor may substitute one Td booster with Tdap, which protects you against
pertussis (whooping cough). You should also get a flu shot each year. Ask your doctor if you need other shots or vaccines.
Ask your Doctor About Other Cancer Screenings

Adults over age 50 should ask their doctor about being checked for colorectal cancer. Men over age 50 should discuss with their doctor the risks and
benefits of being screened for prostate cancer.
Should I have a Yearly Physical check?

Talk to your family doctor about your risk factors and what tests and exams are right for you.
Ladies - Check Your Breasts

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HIGHLIGHT REMOVE HIGHLIGHT CALCULATOR CONVERTER "
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Use latex condoms and a spermicide (a product that kills sperm) gel or cream. Talk with your doctor about being tested for ST!s.
Control Your Cholesterol Level

If your cholesterol level is high, keep it down by eating right and by exercising. You can also decrease your cholesterol level by limiting how much
cholesterol you eat and by quitting smoking.
Control High Blood Pressure

High blood pressure increases your risk for heart disease, stroke and kidney disease. To control it, lose weight, exercise, eat less sodium, drink less
alcohol, don't smoke and take medicine if your doctor prescribes it.
Keep Your Shots Up to Date

Adults need a tetanus-diphtheria booster every 10 years. Your doctor may substitute one Td booster with Tdap, which protects you against
pertussis (whooping cough). You should also get a flu shot each year. Ask your doctor if you need other shots or vaccines.
Ask your Doctor About Other Cancer Screenings

Adults over age 50 should ask their doctor about being checked for colorectal cancer. Men over age 50 should discuss with their doctor the risks and
benefits of being screened for prostate cancer.
Should I have a Yearly Physical check?

Talk to your family doctor about your risk factors and what tests and exams are right for you.
Ladies - Check Your Breasts

Breast cancer is the second most common cause of death for women. Have your doctor check your breasts every 1 to 2 years until you're 40. After
age 40, you should have a yearly clinical exam and a mammogram.
Get Regular Pap Smears

Cancer of the cervix in women can be detected by regular Pap smears. Start having them when you begin having sex or by age 18. You'll need them
once a year at first, until you've had at least 3 normal Pap tests. After this, you should have them at least every 3 years.
Notes
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Psychological/Psychiatric Problems Eating Disorders
Eating Disorders
• Eating disorders are more than just going on a diet to lose weight or trying to make sure you exercise every day. They're extremes in eating
behavior the diet that never ends and gradually gets more restrictive, for example. Or the person who can't go out with friends because he or
she thinks it's more important to go running to work off a piece of candy.
• The most common types of eating disorder are anorexia nervosa and bulimia nervosa (usually called simply "anorexia" and "bulimia"). But
other food-related disorders, like binge eating disorders, body image disorders, and food phobias, are showing up more frequently than they
used to.
The following media explains Eating Disorder:

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Binge Eating Disorder
• This eating disorder is similar to anorexia and bulimia because a person binges regularly on food {more than three times a week). But, unlike the
other eating disorders, a person with binge eating disorder does not try to compensate for the excessive intake by purging the food.
• Anorexia, bulimia, and binge eating disorder all involve unhealthy eating patterns that begin gradually and build to the point where a person
feels unable to control them.
Please find out the correct choice for anorexia nervosa and bulimia nervosa

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Psychological/Psychiatric Problems Eating Disorders Anorexia Nervosa
Anorexia Nervosa
People with anorexia have an extreme fear of weight gain and a distorted view of their body size and shape. As a result, they can't maintain a
normal body weight. Some people with anorexia restrict their food intake by dieting, fasting, or excessive exercise. They hardly eat at all and the
small amount of food they do eat becomes an obsession. Other people with anorexia do something called binge eating and purging, where they eat a
lot of food and then try to get rid of the calories by forcing themselves to vomit using laxatives, or exercising excessively. Some signs in a person
with Anorexia
• Becomes very thin, frail, or emaciated

• Obsessed with eating, food, and weight control
• Weighs herself or himself repeatedly
• Counts or portions food carefully
• Only eats certain foods, avoiding foods like dairy, meat, wheat, etc.
• Exercises excessively
• Feels fat
• Withdraws from social activities, especially meals and celebrations involving food
• May be depressed, lethargic, and feels cold a lot
• It is related to low self esteem condition

• This type of condition is very much popular among adolescent
• It is a mental condition
• It is not characterized by binge eating
• The sufferer goes on drastic diet.
• The sufferer may exercise intensively
With anorexia, the body goes into starvation mode, and the lack of nutrition can affect the body in many ways such as:
• A drop in blood pressure, pulse, and breathing rate

• Hair loss and fingernail breakage
• Loss o f menstrual periods in women
• Lanugo hair a soft hair that can grow all over the skin
• Lightheadedness and inability to concentrate
• Anemia
• Swollen joints
• Brittle bones
Notes
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HELP I I I
PASSWORD HOME EXIT
Psychological/Psychiatric Problems Eating Disorders Bulimia Nervosa
Bulimia Nervosa
Bulimia is similar to anorexia. With bulimia, a person binge eats (eats a lot of food) and then tries to compensate in extreme ways, such as forced
vomiting or excessive exercise, to prevent weight gain. Over a period of time, these steps can be dangerous. Bulimia nervosa is an eating disorder
characterised by repeated episodes of binge eating usually followed by self induced vomiting, misuse of laxatives of diuretics, fasting or excessive
exercise.
To be diagnosed with bulimia, a person must be binging and purging regularly, at least twice a week for a couple of months. Binge eating is different
from going to a party and "pigging out" on pizza, then deciding to go to the gym the next day and eat more healthily. People with bulimia eat a large
amount of food (often junk food) at once, usually in secret. The person typically feels powerless to stop the eating and can only stop once he or
she is too full to eat any more. Most people with bulimia then purge by vomiting, but may also use laxatives or exercise excessively.
The following media explains the Bulimia:
Bulimia Nervosa

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Although anorexia and bulimia are very similar, people with anorexia are usually very thin and underweight but those with bulimia may be a normal
weight or even overweight. Some signs in a person with Bulimia are:
• Fears weight gain

• Intensely unhappy with body size, shape, and weight
• Makes excuses to go to the bathroom immediately after meals
• May only eat diet or low-fat foods (except during binges)
• Regularly buys laxatives, diuretics, or enemas
• Spends most of his or her time working out or trying to work off calories
• Withdraws from social activities, especially meals and celebrations involving food
With bulimia, constant vomiting and lack of nutrients can cause these problems:
• Constant stomach pain

• Damage to a person's stomach and kidneys
• Tooth decay (from exposure to stomach acids)
• "Chipmunk cheeks," when the salivary glands permanently expand from throwing up so often
• Loss of menstrual periods in women
• Loss of the mineral potassium (this can contribute to heart problems and even death).
Notes
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S�No�
I/Psychiatric Problems Eating Disorders Norovirus
Norovirus
What is Norovirus?
Norovirus is a type of gastrointestinal illness which is spread by eating food or touching a surface that is contaminated with the virus. It's also
spread when people come in direct contact with someone with the virus. Most commonly known as the stomach flu, norovirus is not usually serious
but can last one to two days. Because norovirus is contagious, there is a higher risk of spreading the illness when people are in close contact with
each other, such as on a ship.
How to Prevent Illness?

Although gastrointestinal illnesses like norovirus are contagious, there are ways that seafarers on board ships can prevent it or contain it.
On board ships, there are some simple steps to take that could help prevent contracting an illness. They are:
• Washing hands before and after eating and smoking.

• Using hand sanitizer often.
• Washing hands properly after using the bathroom.
• Isolating the sick person.
• Drinking plenty o f water.
• Resting and maintaining a strong immune system.
• Avoiding close contact when there is an outbreak of a contagious/infectious disease.
• Removing and cleaning clothing and linens that have been contaminated during illness.
What to Do if You Contract Norovirus?
• The symptoms of Norovirus include nausea, vomiting and stomach cramping and may be accompanied by a low-grade fever, muscle aches and
a headache.
• Unfortunately, there is no anti-viral medication that can fight off the illness. If you have fallen ill, make sure to drink plenty of fluids since the
illness can cause dehydration (from vomiting and diarrhea). Juice and water are the best options.
The following animation briefs about the oral rehydration given comn1ercially and home made_

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< Prev Next > • 7/10 (19/03/2021) HIGHLIGHT REMOVE HIGHLIGHT CALCULATOR CONVERTER
HIV I AIDS
HIV I AIDS
AIDS strands for Acquired Immune Deficiency Syndrome is caused by HIV(human immuno virus). The ultimate goal of HIV is to decrease or destroy
the host immune systems and leads to death, this noncommunicable disease spread by unsafe sex, shared needle, infected blood or tissue
transplantation and infected mother to fetus. In this unit will help to understand about AIDS and it's mode of infections. And also you will get brief
knowledge about various prevention method and types of treatments of HIV/AIDS.
Common Questions about HIV/AIDS
1. Tell Me about HIV Medicines?

The advent of HIV medicines has changed the way we treat and people live with HIV. But they are complex, expensive and often hard to take.
But don't let rumor and myth turn you off to medications. Learn all you can about medications before starting.
2. I'm Positive. Can I Still Plan A Family?
Years ago, if a woman was infected with HIV, it meant that she lost all hope of having children. The fear of transmitting her HIV to her unborn
baby was too high of a risk for most women. But now HIV medications and the acceptance by physicians to the idea of HIV positive women
getting pregnant has given women new hope in fulfilling their dream of becoming pregnant and having children.
3. I'm Already Positive ...Do I Need To Use Condoms?
The question is a common one heard in HIV practices and prevention clinics across the country. "My partner and I are both HIV positive. Do we
still need to use condoms?" Simply put, the answer is a resounding YES!
4. How Can I Protect Myself and Others?
The key to prevention is education. And the first thing we teach is to use condoms with each and every sexual contact; oral, vaginal or anal.
Latex condoms are our best weapon in the fight against new HIV infections. Use them every time.
5. How Bad Is The HIV Epidemic?
Twenty years after the HIV epidemic began, new infections continue. People are living longer but some populations are seeing an alarming
increase in new cases. And the problem in sub-Sahara Africa is at a critical level.
6. How Do I Choose The Right Doctor?
Choosing the right doctor can be very difficult. Because HIV is a rapidly changing and very complex discipline, make sure the doctor you
choose cares for many HIV positive patients on a regular basis. You have to feel comfortable with your doctor and in his or her abilities. Make
a list of questions, traits you are looking for in a doctor and your concerns and then start looking.
7. How to Tell Someone You Have HIV?
It could be the hardest thing you would ever have to do; telling a loved one, family member, or partner you have HIV. But there is a way to do
so that will limit the stress, shock, grief and pain for you and the person you are telling.
8. Know Your HIV Status.
Simply put, everyone should know their HIV status, both for their health and safety and that of their partner. But how do you know if you are
at risk for HIV? It is wise to think that you are always at a risk and take the necessary precautions at all times.
.............................................................................................................................. v

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HIV I AIDS Prevention of AIDS
Prevention of AIDS
HIV infection and AIDS

Gaining and understanding HIV information is the most important way to stop the spread of AIDS and m1nim1se risks. HIV is a complex and very
confusing disease. Myths and misconceptions make it difficult for those living with HIV. There is so much HIV information and AIDS information on the
Internet it's hard to decide which is accurate. We can help. Learn a bit about HIV/AIDS.
Since 1981, when HIV/AIDS was first recognised as a new illness, scientists have learned much about how a person becomes infected with HIV. The
virus is spread through contact with an infected person's body fluids, especially through blood, semen and vaginal fluids. The Human
Immunodeficiency Virus (HIV) weakens the body's immune defences by destroying CD4 (T-cell) lymphocytes, which are a group of white blood cells
that normally help guard the body against attacks by bacteria, viruses and other germs. When HIV destroys CD4 lymphocytes, the body becomes
vulnerable to many different types of infections. These infections are called opportunistic because they have an opportunity to invade the body
when the immune defences are weak.
HIV infection also increases the risk of certain cancers, illnesses of the brain (neurological) and nerves, body wasting and death . The entire
spectrum of symptoms and illnesses that can happen when HIV infection significantly depletes the body's immune defences, is called acquired
immunodeficiency syndrome or AIDS.
Suppression of
Immune System
\�+---- 2. Spreading - Viremia

Opportunistic Infections e.g.
Protozoa (P Carinil)
Viruses
Bacteria
)
�=+=='._..)
Kaposi's Sarcoma ...------,••
4. Exit
Genitals
II
023020

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HIV J AIDS Prevention of AIDS About the Virus
About the Virus
There are two species of HIV known to exist: HIV-1 and HIV-2.
HIV-1 is the virus that was initially discovered and termed LAV. It is more virulent, more infective, and is the cause of the majority of HIV infections
globally. The lower infectivity of HIV-2 compared to HIV-1 implies that fewer of those exposed to HIV-2 will be infected per exposure. Because of its
relatively poor capacity for transmission, HIV-2 is largely confined to West Aftrica.
This highly mutable virus belongs to Retroviridae family. It is a spherical, enveloped virus having nucleocapsid and contains two identical single
stranded RNA. rt consists of a number of structural genes (gag, pol, env), and non-structural genes (tat, Nef, Rev, Vif, LTR) each structural genes
responsible for producing particular proteins, each proteins code for particular functions.
GAG: It is responsible for producing Nuleocapside proteins like:
• pl? (forms outer core-protein layer)

• p24 (forms inner core-protein layer)
• p9 (is component of nucleoid core)
• p7 (binds directly to genomic RNA)
ENV: It is responsible for producing Envelope glycoproteins like:
• gp41 (is transmembrane protein associated with gp 120 and required for fusion)
• gp120 (protrudes from envelope and binds CD4)
POL: It is responsible for producing Enzymes like:
• p64 (has reverse transcriptase and Rnase activity)

• pSl (has reverse transcriptase activity)
• PlO (is protease that cleaves gag precursor)
• P32 (is integrase)
HIV Virus
Shown is the cross section of HIV "irus. Click on the parts.

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• P32 (is integrase)
IIlVVirus
Shown is the cross section of HIV "irus. Click on the parts.
Matrix
Capsid
Protease RNA
lntagrase
Reverse
[
Transcriptase Li id
MemCrane )
917061
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ShowTOC I
HIV J AIDS Prevention of AIDS HIV life Cycle
HIV Life Cycle
Entry
HIV can only replicate (make new copies of itself) inside human cells. The process typically begins when a virus particle bumps into a cell that
carries on its surface a special protein called CD4. The spikes on the surface of the virus particle stick to the CD4 and allow the viral envelope to
fuse with the cell membrane. The contents of the HIV particle are then released into the cell, leaving the envelope behind.
Reverse Transcription and Integration

Once inside the cell, the HIV enzyme reverse transcriptase converts the viral RNA into DNA, which is compatible with human genetic material. This
DNA is transported to the cell's nucleus, where it is spliced into the human DNA by the HIV enzyme integrase. Once integrated, the HIV DNA is
known as provirus.
Transcription and Translation

HN provirus may lie dormant within a cell for a long time. But when the cell becomes activated, it treats HIV genes in much the same way as human
genes. First it converts them into messenger RNA (using human enzymes). Then the messenger RNA is transported outside the nucleus, and is used
as a blueprint for producing new HIV proteins and enzymes.
Assembly, Budding and Maturation

Among the strands of messenger RNA produced by the cell are complete copies of HN genetic material. These gather together with newly made HIV
proteins and enzymes to form new viral particles, which are then released from the cell. The enzyme protease plays a vital role at this stage of the
HN life cycle by chopping up long strands of protein into smaller pieces, which are used to construct mature viral cores.
The newly matured HIV particles are ready to infect another cell and begin the replication process all over again.
The following media explains the HIV replication:

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HIV/ AIDS Prevention of AIDS HIV Transmission
HIV Transmission
Paths of Infection
HN can be transmitted through:
• Unprotected vaginal, anal and oral sex.

• Direct blood contact, which may occur through needle sharing, transfusions, accidents in health care settings, or certain blood products.
• Mother to baby; before or during birth or through breast milk.
HIV Transmission Routes

HN can enter the body through open cuts or sores and by directly infecting cells in the mucous membranes. Transmission can happen in the mouth,
the eyes, vagina, penis (through the urethra), in the anus and rectum. HIV cannot cross healthy, unbroken skin.
The most common methods of transmission of HIV are:
Sharing
Unprotected
needles
sex with an
with
infected
infected
partner
person
Almost eliminated as risk factors for HIV transmission are:
Transmission
Infected
from infected
from blood
mother to
products
fetus
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in the genitals and the rectum, or may pass through cuts and sores. HN can also be transmitted through oral sex. Conditions such as bleeding gums
and poor oral health increase the risk of transmission through oral sex.
Non-sexual Transmission: HIV can be transmitted by contact between infectious fluids and bleeding cuts or open sores ,n the skin. However,
healthy, intact skin does not allow HIV to enter the body, and provides an excellent barrier against the virus.
Sharing Needles: Sharing syringes to inject medicines, hormones, steroids or illegal drugs can pass blood directly from one person's blood stream to
another's. It is a very efficient way to transmit HN.
Blood Transfusion: HIV can occur when the blood transfusion occurs between HIV infected person and the uninfected person.
Other Blood Products: Besides whole blood, platelets, red blood cells also transmitted HN.
Organ Donation: HIV can occur when an HIV infected person donates the organs or tissue to an uninfected HIV person for transplant purposes.
Mother to Infant Transmission: It is possible for a mother who has HIV to pass the virus to her fetus, by exposure to blood and vaginal fluids
during birth, or through breast milk during feeding.
Infectious Fluids
HIV can be transmitted from an infected person to another through:
• Blood
• Semen (including pre-seminal fluid)
• Vaginal secretions
• HIV can also be transmitted through breast milk-expressed through feeding, 1n limited circumstances where there 1s exposure to large
quantities.
Non-Infectious Fluids
• Saliva
• Urine
• Tears
• Sweat
• Feces
• Vomit
Notes
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HIV/ AIDS Prevention of AIDS Signs and Symptoms
Signs and Symptoms
HIV Signs and symptoms vary with the duration of infection. Based on the duration the infection can be classified as:
• Acute Infection
• Latent Reservoir
• Onset of Disease - AIDS
Acute Infection ( Acute Retroviral Syndrome)
• This period lasts for 6 to 12 weeks after initial infection until anti-HIV antibodies are detectable.
• If acquired by sexual activity, the virus enters the body in infected macrophages in semen or vaginal secretions. Dendritic cells in the mucosa!
linings bind the virus shed by macrophages and carry it to the lymph nodes where CD4+ and T4 cells become infected. During the course of
the disease, the virus migrates to other cell types.
• Initially, HIV infection produces a mild disease that is self-limiting. This is not seen in all patients and about 30°/o remain asymptomatic during
the initial period of infection. In the period immediately after infection, virus titer rises (about 4 to 11 days after infection) and continues at a
high level over a period of a few weeks. The patient often experiences some mononucleosis-like symptoms fever, rash, swollen lymph glands,
but none of these is life-threatening. There is an initial fall in the number of CD4+ cells and a rise in CDS+ cells but they quickly return to near
normal. At this stage virus titers are very high with as many as one hundred million virus particles per milliliter of plasma.
• During the first two weeks of infection, CD4+ cells in the lymphoid tissue of the alimentary tract decline. This has two results: Local
immunodeficiency and chronic immune activation. Immune activation results from translocation of bacteria across the damaged mucosa of the
alimentary tract.
• There is a "window period" of seronegativity during which an infected person does not give a positive western blot HIV test or ELISA, even
though the viral load is high and the patient may exhibit some symptoms. This seronegative period can last for six months before
seroconversion although the latter usually occurs between one and four weeks after infection.
Latent Reservoir
As a result of the strong immune defense, the number of viral particles in the blood stream declines and the patient enters clinical latency. Little
virus can now be found in the bloodstream or in peripheral blood lymphocytes and, initially, the number of blood CD4+ cells is only slightly decreased.
Nevertheless, the virus persists elsewhere, particularly in lymph nodes and here viral replication continues as follicular dendritic cells interact with
more CD4+ cells that become infected. The virus is also replicated by macrophages.
Although the number of HIV particles in the bloodstream is much reduced during clinical latency, the virus is detectable. After the initial peak of
virus, the virus reaches a "set point" during latency. This set point predicts the time of onset of clinical disease. With less than 1000 copies/ml of
blood, disease will probably occur with a latency period of more than 10 years. With less than 200 copies/ml, disease does not appear to occur at
all. Most oatients with more than 100.000 cooies oer ml. lose their CD4+ cells more raoidlv and oroaress to AIDS before 10 vears. Most untreated "'

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Latent Reservoir
As a result of the strong immune defense, the number of viral particles in the blood stream declines and the patient enters clinical latency. Little
virus can now be found in the bloodstream or in peripheral blood lymphocytes and, initially, the number of blood CD4+ cells is only slightly decreased.
Nevertheless, the virus persists elsewhere, particularly in lymph nodes and here viral replication continues as follicular dendritic cells interact with
more CD4+ cells that become infected. The virus is also replicated by macrophages.
A lthough the number of HIV particles in the bloodstream is much reduced during clinical latency, the virus is detectable. After the initial peak of
virus, the virus reaches a "set point" during latency. This set point predicts the time of onset of clinical disease. With less than 1000 copies/ml of
blood, disease will probably occur with a latency period of more than 10 years. With less than 200 copies/ml, disease does not appear to occur at
all. Most patients with more than 100,000 copies per ml, lose their CD4+ cells more rapidly and progress to AIDS before 10 years. Most untreated
patients have between 10,000 and 100,000 copies per ml in the clinical latency phase.
Loss of CD4+ Cells and Collapse of the Immune Response

The immune system fails to control HIV infection as the CD4+ T helper cells are the target of the virus. Also follicular dendritic cells can be infected
with HIV and these also diminish in number over time. Moreover, dendritic cells present antigen to CD4+ cells and may bring the virus into contact
with these cells at the time that they are stimulated to proliferate by antigen.
During the course of infection, there is a profound loss of the specific immune response to HIV because:
• Responding CD4+ cells become infected. Thus, there is clonal deletion leading to tolerance. The cells that proliferate to respond to the virus
are infected and killed by it
• Epitope variation can lead to escape of HIV from the immune response
• Activated CD4+ T cells are susceptible to apoptosis. Spontaneous apoptosis of uninfected co4+ and COB+ T cells occurs 1n HIV-infected
patients. Also there appears to be selective apoptosis of HIV -specific COB+ cells
• The number of follicular dendritic cells falls over time, resulting in diminished capacity to stimulate CD4+ cells
There is thus a relentless decline of CD4+ cells with especially a loss of those specific to HIV. This occurs from the very beginning of infection and is
permanent when chemotherapy is not taken. The period of clinical latency varies in length from as little as 1 to 2 years to more than 15 years.
Onset of Disease - AIDS

Over the next few years after the infection, as CD4 cells continue to die, skin problems and mouth ulcers develop more often. Recurring herpes and
varicella-zoster infections (shingles) can occur. Many people develop diarrhea, fever, unexplained weight loss, joint and muscle pain, and fatigue. Old
tuberculosis infections may reactivate even before AIDS develops. Tuberculosis is one of the most common AIDS-related infections in the developing
world.
Notes
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Save Notes I Prevention of AIDS Diagnosis
Diagnosis
The specimen required for various laboratory tests and diagnosis to determine infection includes:
• Plasma
• Serum
• Saliva
Serology
The diagnosis of HIV infection is usually based on serological tests.
Antibody Tests
HIV antibody can be detected in HIV infected people because antibodies will raise when antigen enters into the body.
EUSA
ELISA test is to screen for HIV antibodies. In this test the patient's blood samples are added to microplate wells coated with HIV antigen, incubated,
and then washed. The wells are incubated with enzyme conjugate, washed, and coated with substrate that changes to green if patient's serum is
positive for HIV antibody.
The following media explains the ELISA:

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Immunofluorescence
Immunofluorescence assay is a technique that is used to detect the presence of an infection. Immunofluorescence employs antibodies to which
fluorochromes are covalently attached. The fluorochrome is attached to the Fe portion of the antibody rather than the antigen-binding end. Thus
i
the ant body is still able to bind to its epitome.
Western blots
Western blot is a confirmatory and not a screening test that uses electrophoresis to separate specific viral proteins. For results to be considered
positive, reaction of antibody to 3 proteins must occur.
l 2 3 4 5
gp 160
gp 120 gpl60
gpl20
p 65 p66
p 55 pSS
pSl
gp 41
gp41
p31
p 31
p24
p 24
p17
plS
p 17
1. Positive control (strong) 2. Positive control (weak)

3. Negative control 4. Indeterminate profile
5. Indeterminate profile (highly suggestive)
023020
Reverse transcriptase assay

Reverse transcriptase assay, which measures the enzyme activity of released HIV particles

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3. Negative control 4. Indeterminate profile

5. Indeterminate profile (highly suggestive)
023020
Reverse transcriptase assay

Reverse transcriptase assay, which measures the enzyme activity of released HIV particles
Cell fusion assay

Human immunodeficiency viruses (HIV)-induced cell fusion is a critical pathway of HIV spread from infected cells to uninfected cells. A rapid and
simple assay was established to measure HIV-induce cell fusion useful to rapid screen for HIV inhibitors that block HIV cell-to-cell transmission. The
coculture of HIV-infected cells with uninfected cells at 37 degree C for 2 hours resulted in the highest cell fusion rate. Using this cell fusion assay, it
was identified that several potent HIV inhibitors targeted the HIV gp41 core. These antiviral agents can be potentially developed as antiviral drugs
for chemotherapy and prophylaxis of HIV infection and AIDS.
Antigen Tests
Antigens are the substances found on a foreign body or germ that trigger the production of antibodies in the body. The antigen on HIV that most
commonly provokes an antibody response is the protein P24. Early in HIV infection, P24 is produced in excess and can be detected in the blood
serum.
P24 antigen tests are not usually used for general HIV diagnostic purposes, as they have a very low sensitivity and they only work before antibodies
are produced in the period immediately after HIV infection. They are most often used as a component of 'fourth generation' tests.
Virus Isolation
• HIV can be cultured from lymphocytes in peripheral blood. The number of circulating infected cells varies with the stage of diseases.
• Higher titers of virus are found in the plasma and in peripheral blood cells of patients with AIDS.
• HIV can be grown in lymphocyte cultures containing abundant CD4-reactive larger cells. Primary isolates of HIV grow very slowly compared
with laboratory-adapted strains and is successful in only 70 to 90°/o of cases. Therefore virus isolation is mainly used for the characterization
of the virus.
HIV
(mature form)
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© _EDA 2020
Viral Nucleic Acid Test

This is accomplished by probes or by PCR techniques.
Polymerase chain reaction (PCR)

A PCR test (Polymerase Chain Reaction test) can detect the genetic material of HIV rather than the antibodies to the virus, and thus can identify
HIV in the blood within two or three weeks of infection. The test is also known as a viral load test and HIV NAAT (nucleic acid amplification testing).
The following media explains the Polymerase Chain Reaction:

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Application of PCR:
• HIV detection in newborn

• Window period
• Resolution of indeterminate ELISA/WB
• Characterization of isolates
• Measurement of virus load.
Advantages of PCR over other techniques:
• Highly sensitive can detect 10 ng of DNA

• PCR requires less sample material
Prognostic Test
The following may be useful as prognostic tests:-
• HIV antigen
• Serial CD4 counts
• Neopterin
• 82-microglobulin
• Viral load
Of these tests, only serial CD4 counts and HIV viral load are still routinely used.
CD4 Counts
Despite the increasing use of HIV-RNA assays, measurement of CD4 still has important value in monitoring disease progression and response to
antiviral chemotherapy. Where CD4 count gives an indication of the stage of disease, the measurement of HIV viral load tells us where the disease is
going.
Antiviral Susceptibility Assays

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• Highly sensitive can detect 10 ng of DNA
• PCR requires less sample material
Prognostic Test
The following may be useful as prognostic tests:-
• HIV antigen
• Serial CD4 counts
• Neopterin
• 82-microglobulin
• Viral load
Of these tests, only serial CD4 counts and HIV viral load are still routinely used.
CD4 Counts
Despite the increasing use of HIV-RNA assays, measurement of CD4 still has important value in monitoring disease progression and response to
antiviral chemotherapy. Where CD4 count gives an indication of the stage of disease, the measurement of HIV viral load tells us where the disease is
going.
Antiviral Susceptibility Assays

Due to the increasing range of anti-HIV agents available, there is increasing pressure on the provision of antiviral susceptibility assays. There are
two types of antiviral susceptibility assays: phenotypic and genotypic assays.
Notes

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HIV/ AIDS Prevention of AIDS Treatment
Treatment
"Prevention is better than cure" - more so in the case of HIV J AIDS. Though drug treatment is evolving there is no permanent treatment as yet for
the HIV infection. Study and research is constantly in progress for vaccines and permanent medical remedies. Presently the known treatment and
medical practices are:
• Antiretroviral Drug Treatment

• Combination Therapy
• Modes of Drug Actions
Antiretroviral Drug Treatment

This is the main type of treatment for HIV or AIDS. It is not a cure, but it can stop people from becoming ill for many years. The treatment consists
of drugs that have to be taken every day for the rest of a person's life.
The aim of antiretroviral treatment is to keep the amount of HIV in the body at a low level. This stops any weakening of the immune system and
allows it to recover from any damage that HIV might have caused already. The drugs are often referred to as:
• Antiretroviral
• Anti-HIV or anti-AIDS drugs
• HIV antiviral drugs
• ARV's
Combination Therapy
• Taking two or more antiretroviral drugs at a time is called combination therapy. Taking a combination of three or more anti-HIV drugs is
sometimes referred to as Highly Active Antiretroviral Therapy (HAART).
• If only one drug was taken, HIV would quickly become resistant to it and the drug would stop working. Taking two or more antiretroviral's at
the same time vastly reduces the rate at which resistance would develop, making treatment more effective in the long term .
• The most common drug combination given to those beginning treatment consists of two NRTis combined with either an NNRTI or a "boosted"
protease inhibitor. Ritonavir is most commonly used as the booster. It enhances the effects of other protease inhibitors so tney can be given iA
lower doses. An example of a common antiretroviral combination is the two NRTis - Zidovudine and Lamivudine, combined with the NNRTI -
Efavirenz.
• Some antiretroviral drugs have been combined into one pill, which is known as a 'fixed dose combination'. This reduces the number of pills to be
taken each day.
• The choice of drugs to take can depend on a number of factors, including the availability and price of drugs, the number of pills, the side v
< >

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HELP I I I
PASSWORD HOME EXIT
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erreccs or cne orugs, i:ne 1aooracory mornconng requ1remencs ano wnecner i:nere are co-ouscer pacKs or nxeo oose como1nac1ons ava1lao1e. 1111osc
people living with HIV in the developing world still have very limited access to antiretroviral treatment and often only receive treatment for the
diseases that occur as a result of a weakened immune system. Such treatment has only short-term benefits because it does not address the
underlying immune deficiency itself.
Modes of Drug Actions
Antiretroviral drug class Abbreviations First approved to How they attack HIV
treat HIV
Nucleoside/Nucleotide NRTis, nucleoside 1987 NRT!s interfere with the

Reverse Transcriptase analogues, nukes action of an HIV protein
Inhibitors called reverse
transcriptase, which the
virus needs to make
new copies of itself.
Non-Nucleoside Reverse NNRTis, non- 1997 NNRTis also stop HIV

Transcriptase Inhibitors nucleosides, non- from replicating within
nukes cells by inhibiting the
reverse transcriptase
protein.
Protease Inhibitors Pis 1995 Pis inhibit protease,

which is another protein
involved in the HIV
replication process.
Fusion or Entry Inhibitors 2003 Fusion or entry inhibitors

prevent HIV from binding
to or entering human
immune e:ells.
Jntegrase Inhibitors 2007 Integrase inhibitors

interfere with the
integrase enzyme, which
HIV needs to insert its
genetic material into
human cells.
NRT!s and NNRT!s are available in most countries. Fusion/entry inhibitors and integrase inhibitors are usually only available in resource-rich countries. ,..
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integrase enzyme, which
HIV needs to insert its
genetic material into
human cells.
NRT!s and NNRT!s are available in most countries. Fusion/entry inhibitors and integrase inhibitors are usually only available in resource-rich countries.
Protease inhibitors are generally less suitable for starting treatment in resource-limited settings due to the cost, number of pills which need to be
taken, and the particular side effects caused by protease drugs.
The following media explains the HIV Treatment:
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E-BOOK ASSESSMENT I EMAIL QUES TION & ANSWER SESSION
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Hepatitis
Hepatitis
Viral hepatitis (hepatitis A, B, and C)

Viral hepatitis is an infection of the liver by one of the hepatitis viruses. The three commonest viruses {A, B and C) are not related to one another,
cause three different sets o signs and symptoms, and have in common only the fact that they cause hepatitis.
HEPATITIS A VIRUS INFECTION

Hepatitis A virus {HAV) infection is common throughout the world. When children are infected they rarely become ill but as living standards rise more
people escape infection until adult life, when hepatitis with visible symptoms of illness is more likely to occur. The illness caused by HAV infection can
i
be prevented by immunisat on. There is no specific treatment for HAV infection or illness.
HAV is spread only by faecal - oral transmission and is present in the patient's faeces long before the illness appears. Most transmission occurs in the
patient's home and most patients have had direct contact with an infected person. Occasional cases are acquired from food, usually inadequately
cooked shellfish.
Signs and symptoms
• Onset two to seven weeks a fter infection

• Fatigue
• Feeling unwell
• Nausea
• Loss of appetite
• Fever
• Pain in the upper right segment of the abdomen (over the liver)
• A week or so later, appearance of dark urine
• Pale faeces
• Jaundice (yellow colouring of skin and itching), peaking after a week or two then declining: onset of jaundice is associated with a lessening of
fever and of feeling unwell.
COMPLICATIONS
• Severe liver failure in some patients who acquire HAV infection when already infected with the hepatitis B or hepatitis C virus.
What to do
• Follow contact precautions.

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I I I I I: First Aid Kit

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E-LEARNING X :.

First Aid Kit

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CREAM AND OINTMENTS

Save Notes B I x, Font Name Font Size > 1 !: :: 1}

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Contents of lifeboat first aid kit

Sodium chloride tablets, lg, 100s Bottle 1 Heat cramps

Amoxicillin(SOO mg)+Clavulanic Broad-spectrum

Bandage, elastic, 10-cm roll, 12s Box 1

Bandage, gauze, roll, sterile, 10cm x

Bandage, absorbent, adhesive, 2cm

Pad, sterile, 10cm x 10cm, 100s Box 2

Lister bandaoe scissors Item 1

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Amoxicillin(SOO mg)+Clavulanic Broad-spectrum

Bandage, elastic, 10-cm roll, 12s Box 1

Bandage, gauze, roll, sterile, 10cm x

Bandage, absorbent, adhesive, 2cm

Pad, sterile, 10cm x 10cm, 100s Box 2

Lister bandage scissors Item 1

Syringe, hypodermic cartridge holder Item 2

Tape, adhesive, surgical, Scm x Sm

Low-reading clinical thermometer Item 2

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Right Lung ------'--....--_

Right Femoral -...,;;......=._...lo4

Right Ffbula --------:--..

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E-BOOK ASSESSMENT I EMAIL QUESTION & ANSWER SESSION

• ANTERIOR OR VENTRAL: In front of or front

TERMS RELATED TO BODY MOVEMENTS:

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E-BOOK ASSESSMENT I EMAIL QUESTION & ANSWER SESSION

TERMS RELATED TO BODY MOVEMENTS:

Special n1ovements: Occur only within certain joints .

E-BOOK ASSESSMENT I EMAIL QUESTION & ANSWER SESSION

Body structure and functions Functions of important parts and systems

Functions of important parts and systems

Anatomy and Physiology

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100% MEDICAL FIRST AID (MFA) I ARVIND RATHORE I I

E-BOOK ASSESSMENT I EMAIL QUESTION & ANSWER SESSION

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The Imn1une Systen1

Thoughts and Attitude

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E-BOOK ASSESSMENT I EMAIL QUESTION & ANSWER SESSION

• Describe the functions of bone

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E-BOOK ASSESSMENT I EMAIL QUESTION & ANSWER SESSION

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E-BOOK ASSESSMENT I EMAIL QUESTION & ANSWER SESSION

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E-BOOK ASSESSMENT I EMAIL QUESTION & ANSWER SESSION

.' '' . . . ' . " '" ' "

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E-BOOK ASSESSMENT I EMAIL QUESTION & ANSWER SESSION

• Sutures: the immovable joints between the bones of the skull.

1. Sagittal suture: connect the parietal bones.