A brief guide that could save a loved one in their hour of need
The sudden death of actress Natasha Richardson and Jade Goody's cancer has highlighted the value of acting fast with illness, writes Dr Ciara Kelly
Sunday March 22 2009
LAST week, we witnessed the very sad, sudden death of the vibrant and talented actress Natasha Richardson, made all the more shocking coming after a relatively-minor head injury following a fall on a ski slope in Canada. There's always a sense of disbelief when celebrities experience any kind of loss or tragedy, as we tend to view them as different to ourselves and somehow insuperable, but here yet again we have seen that not to be the case.
In this instance, Ms Richardson developed a bleed in her brain following her fall, most likely because she had a pre-existing aneurysm -- or weakness in a blood vessel. This meant that even a relatively trivial head injury, or indeed no injury at all, could result in a brain haemorrhage and her untimely death.
This tragic event will probably cause a 'Natasha Richardson effect', like the 'Jade Goody effect' and the 'Kylie Minogue effect' before it, with doctors' surgeries throughout the country experiencing an upsurge of people attending with headaches, in genuine fear that they too might have an aneurysm despite its improbability. But what signs should you lookout for to safe guard you and your family's health?
And if you are unlucky enough to have worrying symptoms, what should you actually do?
Symptoms needing urgent attention:
As a good general rule, in the case that you, or anyone you know, experiences any of the following; Severe headache, chest pain, high fever, seizure, facial or limb weakness, sudden difficulty speaking, or a rash that does not blanch (go white) under a glass, should seek medical advice immediately from a GP or, failing that, an A&E department.
But let me try and provide a short guide on what to do when faced with common serious illness.
Head Injury
In instances where there's any loss of consciousness or severe trauma to the head you should always attend an A&E department for review
Following any kind of blow to the head you should remain vigilant for 24 hours afterwards for any of the following signs, drowsiness, visual disturbances, dizziness, vomiting, speech problems or gait problems. If any of these occur you should attend A&E directly as an emergency.
Chest pain
Any central, crushing chest pain or chest tightness should be regarded as a heart attack or myocardial infarction until proven otherwise.
If it occurs you should call an ambulance immediately and take two disprins/aspirins while you wait for its arrival. Do not hang about hoping it will settle.
Stroke
The most common cause of adult disability is not always recognised in the community, despite an recorded incidence of 8500 per annum in Ireland alone.
Getting to hospital rapidly (within three hours) for early intervention can make a big difference to a patient's prognosis.
The act FAST guidelines are probably the best system for people to follow. In other words, in the presence of facial weakness, (ask them to smile or stick out their tongue) arm or leg weakness, or speech difficulties, it's time to go to hospital.
Fever
Temperature above 37.5 degrees Celsius is a common symptom particularly in children with infections. Any persistent or high fever (above 39 degrees) needs review by a doctor.
In the meantime measures should be taken to lower the fever and prevent dehydration. Avoid wrapping the person in warm blankets and clothes despite the fact that they will feel cold. Instead strip them down, use tepid sponging, and cold drinks to cool them, in addition you should use paracetamol and or ibuprofen products to reduce their fever.
Fever with a rash is a special case and should always be reviewed. Fever with a petechial rash -- that is one that does not blanche when pressed under a glass or looks quite like dark red freckles -- should be regarded as meningitis until proven otherwise.
In this instance speed is everything and you should call 999 or present to your GP for immediate review. Never, ever wait and see with these symptoms, it could be the difference between life and death.
Seizure
In the presence of someone having a seizure, you should lie them on the ground on their side loosen ties or any tight clothes around their throat and make the area safe for them by clearing a space around them. Again call an ambulance.
Choking
Choking is a common and often preventable cause of death. In the presence of someone you suspect of choking -- often clutching their throat, short of breath and changing colour -- you should look in their mouth for any obvious blockage that you can remove with your fingers, then lean them forward to prevent the blockage going further down into their windpipe. then, with the heel of your hand, give five sharp blows between their shoulder blades.
If that does not restore their breathing, perform abdominal thrusts by putting your arms around them from behind and clasping your hands together then thrusting upwards and inwards into the region just below their rib cage. Keep repeating this until you clear their throat.
With a very small child, the easiest method is to lie them face down with their head low and bang firmly on their back until they can breathe again. Do not give up -- it may save their life. Again call the ambulance.
Severe breathing difficulties from any cause including asthma is a medical emergency; you should call an ambulance, attempt to use any inhalers you may have available and wait for help to arrive.
In instances where croup is causing the breathing difficulties, do not steam your child but bring them outside into the cool air to help relieve them.
Bleeding
In the event that someone is bleeding from a wound, apply really firm pressure to stem the blood loss, even if that is painful for the person involved. Continue to press on the wound irrespective of how long it takes until either the bleeding has stopped or medical help has arrived.
The above is clearly a very condensed guide to what to do in the case of medical emergency and is no substitute for seeking help.
Ideally, when in doubt over someone's health or if your instinct is that someone's really unwell, always seek medical advice promptly. Don't wait for somebody else to do it or for serious symptoms to resolve themselves.
A good first-aid course, teaching you basic resuscitation techniques, is something everyone should undertake and should be part of every school's curriculum. The world is full of people who wish they knew CPR when a loved one collapses suddenly -- don't be one of them.
Lastly, get yourself a good book on common medical problems and their management for the shelf. Failing all that, stick this on your fridge.
Dr Ciara Kelly is a general practitioner in Wicklow
