Nose Injuries – When There Is No Doctor

Injuries to the nose are not uncommon; yet, when they happen, people tend to panic. Instead of letting the situations “lead you by the nose”, follow these simple first-aid measures, and stay in control:

Your nose is not merely an organ of smell. It’s a filter, a temperature controller, a passageway and sometimes even an alarm system. It is closely connected with your eyes, mouth, ears and head, both cosmetically and physically. So, when it is injured, to treat it you’ve got to look beyond your nose.

“In order to treat any injury to the nose, you must first understand the nature and extent of the injury,” say ENT surgeons. “Basically, there are three kinds of injuries: those that involve the nose and the head; those that affect the nose and the face; those that pertain only to the nose. Only after the kind of injury has been ascertained can proper treatment or first aid follow.”

The first two kinds of injuries are usually the result of a violent, perilous impact, like a fall from a great height, or a road accident. When the nose and the head are injured – and such cases are obvious even to a layman – the damage is serious and can occasionally be fatal. In all probability the victim will be unconscious and to render first aid would be impossible. Your only course of action is to rush the victim to a hospital and leave him in the hands of the doctors.

If the head is not hurt, that is, if the injury is only to the front of the face, then check the extent of the damage. Any injury to the eye directly, or even to the area around the eye, will need a doctor’s attention. You can try to control the bleeding of the nose, if there is any, but the person should be taken quickly to the hospital. Probably he will need the attention of the ENT surgeon and the ophthalmologist.

Injury to the nose and to the area around it, that is, the sides and below, could mean damage to the sinuses and upper jaw. Ask the victim to make as if he is biting on something. Difficulty and pain in moving his mouth indicate probable fracture of the upper jaw. In this case, too, though you could try to control the bleeding from the nose, the victim needs medical attention. An ENT surgeon and a dental surgeon may have to work together to repair the damage. Therefore, such a case should be quickly taken to the hospital.

The third type of injury is more commonplace. In this kind of injury, first aid can be given, but again, it will depend upon the cause and nature of the injury. Injuries to the nose can be broadly grouped as: external wounds; fractures; obstruction by foreign objects; bleeding from the nostrils.

EXTERNAL INJURIES

External injuries like abrasions, bruises, cuts and punctures can be treated as you do wounds. Clean the affected area, apply an antiseptic and bandage. Slight abrasions or cuts will heal with adequate care. Deep and extensive wounds should be shown to a doctor.

Fractures of the nose are easily detectable from the distorted shape of the nose, the constant pain and swelling. Fractures have to be splinted and set right, which can only be done by an ENT specialist.

Those with children will b familiar with the third type of nasal injury – that is, blockage of the passage due to insertion of foreign objects into the nose. “” Often, the child may not be aware that he has done something he shouldn’t have, says ENT surgeon. “”So the object remains in the nose for days and is discovered only when infection sets in. then, either the parents notice that the child’s nose is swelling, or the child complains of pain in the nose.”

However, even if you know that the child has pushed something up his nose, don’t try to extricate it yourself. You could push it in even further. Sometimes, lightly blowing the nose helps to dislodge the object. But if the object is edged, it may scrape or bruise the nose and bleeding may result. So it’s safest to take the child to a doctor, preferably an ENT specialist, as he is better equipped to deal with the problem.

NOSE BLEEDS

Nosebleeds or epistaxis can occur due to a number of reasons: Sudden climatic changes; a rise in blood pressure; a traumatic injury; high fever.

The air we breathe in has to be homogenised to the body temperature of 34°C before it reaches the lungs. The nose acts as a temperature controller. If the air is cold, the nose warms it; if the air is too warm, the nose cools it. In order to help it carry out its function, the nose is heavily lined with blood vessels. The supply of blood depends upon the difference in the body and atmospheric temperatures. When the temperature outside changes suddenly, as when we move from a warm climate to a cold place, or vice versa, the demands on the blood vessels can be extensive and, consequently, they are likely to rupture, resulting in a nosebleed.

A rise in blood pressure forces the blood vessels to enlarge and sometimes even burst. Since the capillaries in the nose are fine, they rupture more easily. Thus a nosebleed could be a symptom of hypertension. Also, during plane flights, if cabin depressurisation takes place, the difference in air pressure outside the body and within affects the blood vessels and some passengers could experience bleeding from the nose.

Any trauma inflicted on the nose – say, when you fall while running and hit your nose on the ground, or when a child is hit on the nose by a ball while playing – ruptures the blood vessels inside the nose. Often, in these cases, the bleeding may seem heavy, but if there is no fracture, it may not be grave. However, once you’ve stopped the bleeding, you should get the patient checked by the doctor.

Sometimes the trauma can be light, as when a person digs in too hard to clean the nostrils. In that case, the bleeding stops spontaneously after a few minutes.

A high fever may sometimes be accompanied by a nosebleed. Again, this is because of the nose having to adapt to the difference in temperatures of the body and the air outside. ENT surgeon says, “This is occasionally seen in typhoid cases where the temperature rises very high.”

When bleeding from the nose occurs, you should first prop up the patient. Don’t let him lie flat. If you do that, the blood will rush back and enter the throat making him choke or cough, thus increasing the pressure on his blood vessels and forcing out more blood. “Sometimes the blood that is thus forced back goes into the stomach and the patient then vomits it out through the mouth,” says ENT surgeon. “At such times, everyone panics because the patient has vomited blood. They don’t realise he’s merely throwing out what he has swallowed.”

Ideally the patient should be made to sit up; head bent over a bowl so that the blood can drip down from the nose. Pinch closed the nostrils, letting the patient breathe through his mouth. Often, this stops the bleeding. Or you could put an ice pack on the nose. To make the pack, put some crushed ice in a clean kerchief or cloth and pack it closely over the nose. Use crushed ice, not chunks, because it can be moulded around the nose, and even pressure applied. If ice is not at hand, give the patient a freshly-cut onion, or crushed garlic pods, or ammonium bicarbonate, to smell. The strong odour will repulse his sense of smell, forcing the nostrils to contract, and this stops the bleeding.

NOT SERIOUS

Nosebleeds are generally not serious. “In a normal person, the bleeding stops on its own after about five minutes,” says ENT surgeon. “That it lasts for a long time and that the flow is heavy are only impressions. What happens is that, in the absence of muscles in the nose, the tightly-packed blood vessels cannot contract. So the bleeding continues till clotting sets in. and that normally occurs in about five minutes. But if the bleeding does continue longer, don’t panic. Pinch the nostrils or use an ice pack to stanch the flow, which will happen after a while provided there is no serious damage. However, even if the bleeding stops you should get the injury examined by an ENT specialist to preclude complications later.”

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Comfy Feet, Healthy You

Our feet can be one of the most neglected aspects of our bodies, even though they do most of the hard work everyday. They are charged with carrying us through every trail life takes us on, and oftentimes they are stuffed deep in stinky, sweaty shoes. Take a peek at your feet right now. Are they loose and free and comfortable, or are they being neglected? I think one of the best things about growing up in South America is that I learned the importance of caring for my feet, as it was ranked right up there with dental care!

Brazilians value their foot health, and they treat their feet with the utmost care. Although every culture is different, some of the most serious side effects of bad health are neglected feet. For example, in diabetes, we check feet on every exam. This is because the first signs of complications from diabetes can often be seen in feet. What are your feet telling you about your health? Go ahead and buy those shoes that give them the extra comfort they need. Who knows, maybe that will help you be as active is you want to be as well. Here are some pointers on picking the right shoes, directly from Harvard:

Shop for shoes in the afternoon, as your feet expand throughout the day.
Wear socks that you would normally wear.
Walk in the shoes before purchasing, and trust your own comfort fit more than size!

As I think about the past 10 years in medical missions, I think the best stories are of being able to give someone the gift of new shoes. For many of us it’s easy to take for granted that we can have the right shoes we need. But, this is definitely a luxury in many parts of the world.

I think particularly of a woman I met in Africa, who walked five miles every day to work. Her feet looked so worn and tired, and all she had to wear were flip flops. Once I realized we wore the same size, I gave her my favorite running shoes that I was wearing that day. The colors looked so cheery on her feet, and definitely gave her an extra bounce as she walked the dirt road home. The look of relief on her face was priceless when I handed her those shoes. She could now walk to work with shoes that supported her. As I watched her step turn into a bounce, I was reminded how easy it is to take something as simple as good shoes for granted.

Is Team Training Effective at Healthcare Sites?

In the June 2016 issue of the Journal of Applied Psychology the authors Eduardo Salas, Lauren Benishek, Megan Gregory and Ashley Hughes in an article titled “Saving Lives: A Meta-Analysis of Team Training in Healthcare” set out to answer the question as to whether team training is effective in healthcare, whether it leads to reduced mortality and improved health outcomes.

Their research stated that a preventable medical error occurs in one in every three hospital admissions and results in 98,000 deaths per year, a figure corroborated in To Err is Human. Teamwork errors through failure in communications accounts for 68.3% of these errors. Thus, effective team training is necessary to reduce errors in hospitals and ambulatory sites.

The authors used a meta-analysis research method to determine whether there are effective training methods in the healthcare setting that can have a significant impact on medical errors, which would in turn improve outcomes and reduce costs by eliminating the costs associated with the errors. A meta-analysis is a broad research of existing literature to answer the research questions posed by the research team or authors.

The research team posed three questions to answer:

1. Is team training in healthcare effective?

2. Under what conditions is healthcare team training effective?

3. How does healthcare team training influence bottom-line organizational outcomes and patient outcomes?

The team limited its meta-analysis to healthcare teams even though there is a great deal of research available about the effectiveness of team training in other industries and service organizations. The team believes that healthcare teams differ significantly from teams in other areas in as much that there can be much greater team fluidity in healthcare. That is, team membership is not always static, especially at sites such as hospitals and outpatient surgical centers. There are more handoffs at these sites.

Although there is greater fluidity in team membership at healthcare sites, roles are well defined. For instance, a medical assistant’s role at a primary care site is well defined even though different MA’s may be working with one physician. These roles are further defined and limited by state licensure. As the research team stated in their article, “these features make healthcare team training a unique form of training that is likely to be developed and implemented differently than training in more traditional teams… ”

The team assessed their research of articles using Kirkpatrick’s model of training effectiveness, a widely used framework to evaluate team training. It consists of four areas of evaluation:

1. Trainee reactions

2. Learning

3. Transfer

4. Results

Reaction is the extent to which the trainee finds the instruction useful or the extent to which he enjoys it. Learning is defined as a relatively permanent change in knowledge, skills and abilities. The authors note that team training is not a hard skill, as learning to draw blood. Rather, it is a soft knowledge skill. Some researchers question whether it is possible to measure the acquisition of these soft team skills effectively. The team of authors effectively argue that it can.

Transfer is the use of trained knowledge, skills and abilities at the work site. That is, can team training be effectively applied in the work setting? Results are the impacts of the training on patient health, the reduction of medical errors, the improved satisfaction of patients and a lowering of costs in providing care.

In order to assure that the changes in these four areas were ‘real’ the team only used literature that had both pre-assessments and post-assessments to see if there were statistically significant changes in the four areas.

Using this assessment rubric the team was able to answer the three questions that it posited. First, team training in healthcare is effective. Healthcare team training closely matches training in other industries and service organizations.

Secondly, training is effective, surprisingly, regardless of training design and implementation, trainee characteristics and characteristics of the work environment. The use of multiple learning strategies versus a single training strategy does not matter. Simulations of a work environment are not necessary. Training can occur in a standard classroom.

Training is effective for all staff members regardless of certification. Training of all clinical personnel as well as administrative staff is effective. Team training also is effective across all care settings.

Lastly, the team’s meta-analysis shows that within the Kirkpatrick rubric team training is effective in producing the organizational goals of better care at lower costs with higher patient satisfaction. In the rubric trainee reactions are not nearly as important as learning and transfer in producing results. It is important that trainers use both pre-training assessments and post-training assessments to measure whether there learning of skills, knowledge and abilities were learned and whether these were transferred to the work site. Effectiveness of training should always be assessed in order that training programs can be consistently improved.

In my September 2017 newsletter “Team Meetings” I described the elements of good team training as well as provided a link to the American Medical Associations team training module as part of Stepsforward series of learning modules. You can find this newsletter online here. With these training instructions as a beginning healthcare providers can learn to work more effectively as teams and thus produce better care at a lower cost with higher satisfaction of both patients and providers.