Manual Medical and Psychiatric Lifebelts

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    Post Comment. Cooling the face and head may promote beneficial brain cooling.

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    The efficiency of some cooling techniques has been questioned. It has been argued that placing cold packs over major blood vessels in the neck, groin and axillae and immersion of the body in cold water or covering it with iced towels may promote shivering and cutaneous vasoconstriction, thus actually impeding cooling efficiency.

    Providing Care for Medical Patients with Psychiatric Issues: Depression and Suicide in Children

    Traditionally, immersion in an ice-water bath, combined with vigorous skin massage to minimize cutaneous vasoconstriction, has been recommended as the treatment of choice, once the patient is brought to a medical facility. This method of cooling has several disadvantages: there are the nursing difficulties posed by the need to administer oxygen and fluids and to monitor blood pressure and the electrocardiogram continuously, and there are the hygienic problems of contamination of the bath with the vomitus and diarrhoea of comatose patients.

    This method of cooling can reduce the core temperature by 0. Measures to prevent convulsions, seizures and shivering should also be initiated at once. Tracheal intubation to protect the airway, insertion of a cardiac catheter to estimate central venous pressure, placement of a gastric tube and insertion of a urinary catheter may also be included among additional recommended measures. For the prevention of heat stroke, a wide variety of human factors should be taken into account, such as acclimatization, age, build, general health, water and salt intake, clothing, peculiarities of religious devotion and ignorance of, or liability to neglect, regulations intended to promote public health.

    Prior to physical exertion in a hot environment, workers, athletes or pilgrims should be informed of the work load and the level of heat stress they may encounter, and of the risks of heat stroke. The level of activity should be matched to the ambient temperature, and physical exertion should be avoided or at least minimized during the hottest hours of the day. During physical exertion, free access to water is mandatory. Since electrolytes are lost in sweat and the opportunity for voluntary ingestion of water may be limited, thus delaying restitution from thermal dehydration, electrolytes should also be replaced in case of profuse sweating.

    Proper clothing is also an important measure. Clothes made of fabrics which are both water-absorbent and permeable to air and water vapour facilitate heat dissipation. Miliaria is the most common skin disorder associated with heat load. It occurs when the delivery of sweat onto the skin surface is prevented due to obstruction of the sweat ducts.

    Sweat retention syndrome ensues when anhidrosis inability to release sweat is widespread over the body surface and predisposes the patient to heat stroke. Miliaria is commonly induced by physical exertion in a hot, humid environment; by febrile diseases; by the application of wet compresses, bandages, plaster casts or adhesive plaster; and by wearing poorly permeable clothes. Miliaria can be classified into three types, according to the depth of sweat retention: miliaria crystallina, miliaria rubra and miliaria profunda.

    Miliaria crystallina is caused by retention of sweat within or just beneath the horny layer of the skin, where tiny, clear, non-inflammatory blisters can be seen. This type of miliaria is otherwise symptomless, the least distressing, and heals spontaneously in a few days, when the blisters break out to leave scales.

    Miliaria rubra occurs when intense heat load causes prolonged and profuse sweating. It is the most common type of miliaria, in which sweat accumulates in the epidermis. Red papules, vesicles or pustules are formed, accompanied by burning and itching sensations prickly heat. The sweat duct is plugged at the terminal portion. The production of the plug is attributable to the action of resident aerobic bacteria, notably cocci, which increase in population greatly in the horny layer when it is hydrated with sweat.

    They secrete a toxin which injures the horny epithelial cells of the sweat duct and provokes an inflammatory reaction, precipitating a cast within the lumen of the sweat duct. Infiltration by leukocytes creates an impaction which completely obstructs the passage of sweat for several weeks. In miliaria profunda, sweat is retained in the dermis, and produces flat, inflammatory papules, nodules and abscesses, with less itching than in miliaria rubra.

    The occurrence of this type of miliaria is commonly confined to the tropics. It may develop in a progressive sequence from miliaria rubra after repeated bouts of profuse sweating, as the inflammatory reaction extends downwards from the upper skin layers. Tropical anhidrotic asthenia. The term achieved currency during the Second World War, when troops deployed to tropical theatres suffered from heat rash and heat intolerance.

    It is a modality of sweat retention syndrome encountered in hot, humid tropical environments. It is characterized by anhidrosis and miliaria-like rashes, accompanied by symptoms of heat congestion, such as palpitation, rapid pulsation, hyperthermia, headache, weakness and gradually to rapidly progressing inability to tolerate physical activity in the heat.

    It is usually preceded by widespread miliaria rubra. The initial and essential treatment of miliaria and sweat retention syndrome is to transfer the affected person to a cool environment. Application of chemical bacteriostats is effective in preventing the expansion of microflora, and is preferable to the use of antibiotics, which may lead these micro-organisms to acquire resistance.

    The impactions in the sweat duct slough off after about 3 weeks as a result of epidermal renewal. In this article, a variety of techniques are described which can be used to minimize the incidence of heat disorders and reduce the severity of cases when they do occur. Interventions fall into five categories: maximizing heat tolerance among exposed individuals, assuring timely replacement of lost fluid and electrolytes, altering work practices to reduce exertional heat load, engineering control of climatic conditions, and use of protective clothing.

    Factors outside the worksite which may affect thermal tolerance should not be ignored in the evaluation of the extent of exposure and consequently in elaborating preventive strategies. For example, total physiological burden and the potential susceptibility to heat disorders will be much higher if heat stress continues during off-duty hours through work at second jobs, strenuous leisure activities, or living in unremittingly hot quarters.

    In addition, nutritional status and hydration may reflect patterns of eating and drinking, which may also change with season or religious observances. Candidates for hot trades should be generally healthy and possess suitable physical attributes for the work to be done. Obesity and cardiovascular disease are conditions that add to the risks, and individuals with a history of previous unexplained or repetitive heat illness should not be assigned to tasks involving severe heat stress.

    Various physical and physiological characteristics which may affect heat tolerance are discussed below and fall into two general categories: inherent characteristics beyond the control of the individual, such as body size, gender, ethnicity and age; and acquired characteristics, which are at least partly subject to control and include physical fitness, heat acclimatization, obesity, medical conditions and self-induced stress.

    Workers should be informed of the nature of heat stress and its adverse effects as well as the protective measures provided in the workplace. They should be taught that heat tolerance depends to a large extent upon drinking enough water and eating a balanced diet. In addition, workers should be taught the signs and symptoms of heat disorders, which include dizziness, faintness, breathlessness, palpitations and extreme thirst.

    They should also learn the basics of first aid and where to call for help when they recognize these signs in themselves or others. Management should implement a system for reporting heat- related incidents at work. Body dimensions. Children and very small adults face two potential disadvantages for work in hot environments. First, externally imposed work represents a greater relative load for a body with a small muscle mass, inducing a greater rise in core body temperature and more rapid onset of fatigue.

    In addition, the higher surface-to-mass ratio of small people may be a disadvantage under extremely hot conditions. These factors together may explain why men weighing less than 50 kg were found to be at increased risk for heat illness in deep mining activities. Early laboratory studies on women seemed to show that they were relatively intolerant to work in heat, compared with men.

    However, we now recognize that nearly all of the differences can be explained in terms of body size and acquired levels of physical fitness and heat acclimatization. However, there are minor sex differences in heat dissipation mechanisms: higher maximal sweat rates in males may enhance tolerance for extremely hot, dry environments, while females are better able to suppress excess sweating and therefore conserve body water and thus heat in hot, humid environments. Although the menstrual cycle is associated with a shift in basal body temperature and slightly alters thermoregulatory responses in women, these physiological adjustments are too subtle to influence heat tolerance and thermoregulatory efficiency in real work situations.

    When allowance is made for individual physique and fitness, men and women are essentially alike in their responses to heat stress and their ability to acclimatize to work under hot conditions. For this reason, selection of workers for hot jobs should be based on individual health and physical capacity, not gender. Very small or sedentary individuals of either sex will show poor tolerance for work in heat.

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    Severe maternal hyperthermia over-heating due to illness appears to increase the incidence of foetal malformation, but there is no evidence of a similar effect from occupational heat stress. Although various ethnic groups have originated in differing climates, there is little evidence of inherent or genetic differences in response to heat stress. All humans appear to function as tropical animals; their ability to live and work in a range of thermal conditions reflects adaptation through complex behaviour and development of technology.