<![CDATA[Safe in the City - City Trauma]]>Fri, 12 Feb 2016 12:06:26 +0200Weebly<![CDATA[City heat]]>Tue, 02 Feb 2016 14:54:08 GMThttp://safeinthecityct.weebly.com/city-trauma/city-heatThe core body temperature required for the maintenance of bodily functions  is  36.5 to 37.5 C, whilst hyperthermia (a condition in which excessive heat disturbs normal bodily functions) may be defined as a core body temperature of 40.0 to 41.5 C/ +38.3 C. 

​The recent heat waves experienced in the Cape have given rise to an increase in heat related incidents. These conditions occur when excess environmental heat overwhelms the body's thermoregulatory mechanisms.    Thermoregulation is the means by which the body is able to maintain an optimal functioning temperature, despite the ambient temperature of the surrounds and is achieved by mechanisms such as sweating and the dilation of peripheral blood vessels. 
Direct and indirect heat related incidents are poorly reported, and when death rates from other causes such as myocaridal infarction and respiratory compromise increase during a heat wave, it is generally not reflected statistically. In the USA, heat waves account for more deaths than all other natural disasters combined. The elderly, homeless and socially isolated remain more affected by heat waves.  


​The generation and maintenance of body heat may be dictated through metabolism, muscle activity, and the environmental temperature. In order to maintain a functioning temperature, when body heat rises, peripheral blood vessels dilate and cardiac output increases resulting in a shunting of blood flow closer to the surface where it can be cooled. Additionally, sweating aids cooling by providing water on the skins surface, which evaporates and in turn further cools the body. When there is a high environmental temperature and high humidity value, heat dissipation through evaporation may be hindered. 
People who exhibit limited mobility and impaired judgement may not be able to purposefully seek a cooler environment or shade themselves from the sun, reduce their physical activity and consciously replace lost fluids and salts due to sweating and over heating. Even with adequate water and salt intake, homeostatic mechanisms may break down and result in hyponatremia (loss of sodium) and cerebral edema. 
After seven to 14 days of continuous heat exposure, the body acclimatizes and adjusts to the environment by increasing the amount of sweat production, retaining salts and increasing cardiac stroke volume. 
 The risk factors for developing a heat syndrome may include:   ​
  • Generalized skin conditions (sunburn)
  • Dehydration
  • Alcoholism
  • Mental illness
  • Cardiopulmonary disease
  • Age >65 years
  • Stimulant abuse including: cocaine, amphetamines, MDMA (ecstasy)

Heat disorders 
Heat disorders include Heat Stroke and Heat Exhaustion 

​Heat stoke: 
​Heat stoke is a life threatening illness which results in the breakdown of the body's heat control systems and subsequent acute immunological and metabolic reactions to elevated body temperatures.   
Classic heat stroke may be defined as a rise in body temperature due simple exposure to high environmental temperatures which overwhelm thermoregulatory mechanisms. 

​Exertional heat stroke occurs when the body temperature rises in a healthy person who exercises strenuously in a hot environment. 
The onset of heat stoke is generally rapid, with patients presenting with weakness, headaches, chills, ataxia and nausea. Additionally, patients may report chest pain, shortness of breath and abdominal pain. The body temperature rises rapidly, sweating ceases and multiple body system failure occurs. Temperatures may be recorded at 40 C or greater, and the skin is usually hot and dry. The initial confusion, delirium and ataxia may be followed by unconsciousness.    ​
Victims should be immediately transported to hospital, and whilst waiting for the ambulance, patients should be removed from the hot environment if possible, clothing removed and applying tepid (not ice cold) water to the skin and fanning. The initial target temperature should be 38.9 C. Other therapies may include supporting of failing organ systems and the repletion of fluids with the correction of electrolyte abnormalities. 

​Heat exhaustion: 
Heat exhaustion is a profound weakness caused by the loss of water and salt due to sweating during heat exposure. 
Heat exhaustion may mimic other conditions including hypoglycemia, hyperthyroidism, ingestion of toxic substances, alcohol withdraw, arrhythmias and hypovolemia. Most victims are alert and anxious, and in some cases may be slightly confused. Symptoms may include thirst, malaise, headaches, myalgias, nausea and shortness of breath. Patients present with a normal to slightly elevated temperature.  
Patients should lie down in a cool area, with fluid and electrolytes being replaced with frequent small sips of water. Untreated heat exhaustion may lead to heat stoke if sweating stops. Patients should be advised to avoid heat and exertion for at least 24 hours after an episode of heat exhaustion.

Heat Cramps: 
Deep and painful spasms within the most actively used muscles and are a direct result of salt depletion. Affect muscles become harden and tender to touch, with spams which can be debilitating. 

Special considerations 
The homeless population remain exposed to all weather conditions and as a result are vulnerable to the changes in weather, including heat waves.   
Individual measures and simple community projects based on awareness of keeping cool and drinking plenty of fluids during hot weather can effectively help prevent heat disorders. Shelters and street outreach personnel should be trained to detect the early signs of heat illness and provide prompt assistance. Hydration remains critical during hot weather, and individuals with poorly controlled diabetes ans alcoholism are at high risk of dehydration.  
- Weisskopf MG, Anderson HA, Foldy S, et al. Heat wave morbidity and mortality, Milwaukee, Wis, 1999 vs. 1995: an improved response? American Journal of Public Health 2002;92(5):830-833.
- Curriero FC, Heiner KS, Samet JM, et al. Temperature and mortality in 11 cities of the eastern United States. American Journal of Epidemiology 2002;155(1):80-87

An Injury and Prevention Awareness Project brought to you by Christiaan Barnard Memorial Hospital Trauma & Emergency Centre.

<![CDATA[Suicide bombing]]>Fri, 01 Jan 2016 08:00:05 GMThttp://safeinthecityct.weebly.com/city-trauma/suicide-bombing
The first recorded suicide bombing activities where reported after the battle of Leyte Gulf (23-24/10/1944) carried out by the Japanese military.  They employed a Kamikaze campaign which succeeded in destroying more Allied ships than all other Japanese naval operations in the Pacific combined, Pearl Harbor included. 

What makes the kamikaze unique among suicide attack campaigns is the extensive letters, poems, wills and memoirs that participants left behind. 
The rational behind the Kamikaze attacks is applicable to many suicide bombing activities and may be understood as follows:
IF my coalition is under dire threat from a powerful aggressor AND IF my death is a necessary cost of mitigating that threat THEN I respond to the members of my coalition as if all our members are relatively close kin AND my emotions and other mechanisms support a willingness to accept that death will result in a victory for my coalition. 
 - An Evolutionary Account of Suicide Attacks: The Kamikaze Case 2011

Suicide bombings: 
A suicide bombing attack may be defined as: a politically motivated, violent attack perpetrated by a self aware individual who actively and purposefully causes his own death by blowing himself up along with the chosen target. The perpetrators death is a precondition for the success of the mission.  
The technological improvements in explosive devices coupled with the growing ease of access to technological information have been said to be major factors resulting in the increase use of suicide bombings in terror attacks. 

The total cost a suicide bombers vest is estimated to be $150, and apart from malleable plastic explosives, is composed of components bought at the local tailor (stretch denim) and auto shop (ball bearings, wires, batteries, switches). 
​Apart from the potential to inflict many casualties, suicide bombing attacks are difficult to combat due to their ability to carry out these attacks where and when it will result in a maximum amount of damage. Such attacks may help to inspire religious or ideological zeal which further increases the threat to society. 
- The Phenomenon of Suicide Bombing A Review of Psychological and Nonpsychological Factors 2006

What happens during the blast: 
Primary injuries may include: 
  • Pulmonary barotrauma/ Blast lung
  • Tympanic membrane and middle ear rupture
  • Abdominal hemorrhage and perforation
  •  Eye rupture
  • Concussion/ head injury

Secondary injuries include: 
  • Penetrating or blunt injuries (from ballistic fragmentation)
  • Possible eye pentration

Tertiary injuries: 
  • Fractures and traumatic amputations
  • Closed and open brain injuries

Quaternary injuries:
  • Burns
  • Crush injuries
  • Closed and open brain injuries
  • Asthma, COPD or other breathing problems from smoke and toxins
  • Angina
  • Hyperglycemia
  • Hypertention

- Explosions and Blast Injuries A Primer for Clinicians

Staying safe during a blast
  • Stay calm!
  • Crawl under a sturdy structure like a table if things start falling around you
  • Stay away from glass, windows, mirrors and electrical equipment
  • Follow order of police or safety personnel
  • Do not attempt to move seriously injured people unless they are in obvious immediate danger
  • Stay away from kitchens, gas lines and fire hazards
  • Once outside, keep away from the building
  • Do not use elevators 
  • Lay flat (the best place to be in an event of an explosion is to lay flat on the ground).
  • Keep your mouth open and breath in small intervals. The chance of sustaining an injury to empty lungs is far smaller than when compared with holding your breath. 
  • Reduce your later profile
  • If you know an explosion is imminent, find a place bellow ground level and hide
After the attack
  • Duck and cover
  • Leave the building as quickly as possible, do not stop to retrieve personal possessions
  • The initial event may be followed by a secondary event, stay clear of the blast scene
  • Open doors carefully, watching for falling debris
  • Do not use matches or a lighter, sparks may trigger an explosion
  • Avoid using telephones, mobile phones and radios
  • Move away from side walks and streets, make way for emergency personnel
  • If you or a person you are near has suffered a life threatening injury, seek assistance from an official on the scene immediately 
  • Listen to emergency official on scene
  • Keep safe and move away from the area. avoid crowds. unattended cars and trucks, public transport and damaged buildings  
-  Adapted from: What to do if you are caught in a bomb blast (Zeeshan Usmani). The Verdict

An Injury and Prevention Awareness Project brought to you by Christiaan Barnard Memorial Hospital Trauma & Emergency Centre.

<![CDATA[Summer time]]>Tue, 01 Dec 2015 06:30:02 GMThttp://safeinthecityct.weebly.com/city-trauma/summer-time

The statistics: 

The Western Cape receives 65.7% of the total number of visitors to the country, the majority of them arriving during peak season. This includes a total of 707 783 international arrivals, and 3 513 794 domestic arrivals through Cape Town International Airport. 20.6% of these visitors engage in outdoor activity, with an estimated 4.2% (177 306) of people visiting Cape Town spending their time on the beaches. 
-UNWTO World Tourism Barometer (2014)  

Why do we go to the beach? 
Human beings have always been attracted to large masses of water, the beach being no exception. The science driving people towards the white sands of the beach include a reduction in stress, with one study claiming a 32% chance of suffering from a heart attack if one does not indulge in an annual beach holiday. The vital Vitamin D absorbed through the suns rays (provided one makes use of appropriate sun protection) helps elevate serotonin levels, resulting in an alert, relaxed and happy mood.

Recent research has indicated that the perpetual sound of the waves crashing on the shore have the ability to alter brain wave activity helping to stimulate a calm and relaxed sate of being. The sea itself aids mental and physical health by just being in it. The high levels of magnesium found in salt water help calm nerves whilst the water itself can be a great source of physical entertainment and enjoyment. 

An additional benefit of an ocean visit may include Thalassotherapy (from the Greek word thalassa, meaning "sea") referring to the medical use of seawater as a form of therapy. It is based on the systematic use of seawater, sea products, and shore climate. The properties of seawater are believed to have beneficial effects upon the pores of the skin.

Staying safe on the beaches and knowing the dangers
Life Guards 
  • Life guards are stationed on the beach for your protection. Always take the time to familiarize yourself with their location and swim in demarcated areas only.
  • Always respect the life guards and listen to them.
  • Raise your arm to attract their attention if your in trouble. 

  • ​​It is estimated that everyday 10 people die from unintentional drowning, of which 2 are under the age of 14 years old. 80% of reported drownings are males. 
  • Factors that influence drowning risk include: lack of swimming ability, non existent physical boundaries,  lack of supervision, alcohol use and seizure disorders. 

  • Rip currents pose a particularly lethal threat to swimmers, and may be defined as a localized relatively thin strip of ocean with a rapid movement of water extending out to sea. It is most powerful at the surface and has been known to pull many swimmers far out to sea. 
  • Most swimmers panic and exhaust themselves fighting the strong current. If stuck in a rip current, one is advised to allow yourself to be carried by the current until it weakens, and swim at a 90 degree angle to escape it. 

Shark Awareness
  • The Western Cape is known throughout the world for the high prevalence of the great white shark. Most Cape Town beaches make use of a flag warning system:
  • Green flag = spotting conditions good
  • Black flag = spotting conditions poor
  • Red flag = high shark alert
  • White flag = a shark has been spotted and the siren will sound

  • An overexposure to the sun can cause significant skin damage and may be associated with certain skin cancers. Remember to pack enough sunscreen, re-apply as required and make use of a barrier such as an umbrella if required. Please refer to our previous post "Sun and the city" 2/4/2015.

  • ​The average sea temperature of the oceans surrounding Cape Town varies between 15 C and 18.5 C. Exposure to temperatures as low as 16 C can induce a state of mild hypothermia, despite a sunny day on the beach.
  • Always swim with a buddy and be aware of the beginning symptoms of hypothermia, including: disorientation, apathy, confusion and discoloration of the skin, particularly around the lips and fingers. 

- Rips are more deadly than bush fires and sharks. Australian Geographic 2013)
-- lifesaving.co.za
 - Hypothermia and cold exposure (Topic Review) 
​- sharkspotters.org.za

People to contact in an emergency: 

National Emergency number for drowning related incidents:
107 (Land Line)
021 480 770 (Cell Phone)

082 911
​084 124

NSRI (Left)
​021 449 3500

An Injury and Prevention Awareness Project brought to you by Christiaan Barnard Memorial Hospital Trauma & Emergency Centre.

<![CDATA[Tik tok]]>Sun, 01 Nov 2015 05:00:02 GMThttp://safeinthecityct.weebly.com/city-trauma/tik-tok
Methamphetamine = Tik
Tik or methamphetamine use in South Africa, specifically the Western Cape, has increased dramatically. The admission of patients seeking treatment for Tik abuse has increased by 49% since 2002. When compared to other provinces, the Western Cape has the highest rate of methamphetamine abuse, with 35% of drug users stating it is their primary drug of choice. 

It is a cheap street drug which has been believed to be introduced into communities through gang involvement within the Western Cape .Unemployment and poverty, specifically in the Cape Flats, may have contributed to the sharp increase in criminal activities that include a highly organized illegal drug economy involving the manufacture and sale of methamphetamine. 

​For a population of 1 million individuals in the Cape Flats, a prevalence of 20% implies that the population of methamphetamine users will be approximately 200 000.

​Continued use of drugs usually results in criminal, health and social problems, and drastic physical changes of the abuser. 
- Substance abuse in the Western Cape Province of South Africa: insights through mathematical modelling  

The effects of Tik on your body: 
It has been estimated that 15% of individuals who try methamphetamine will be life time users. Tik may be ingested in the following ways:
  • Smoked
  • Sniffed/ Snorted 
  • Injected
  • Eaten (including being consumed in beverages) 
  • Or mixed with other drugs
Once ingested, Tik has a profound effect on the central nervous system. Users describe this feeling as a sudden rush of pleasure lasting for several minutes, followed by a euphoric high that lasts between 6 and 12 hours.  The drug releases a surge of dopamine causing an intense rush of pleasure or prolonged sense of euphoria. 

The immediate state of euphoria is dependent on the method of ingestion, with users reporting the greatest "highs" when injecting the drug. 
In addition to affecting cognitive abilities, these changes in brain chemistry can lead to disturbing, even violent behavior. Tik, as with all stimulants, causes the brain to release high doses of adrenaline (the body's "fight or flight" mechanism) inducing anxiety, wakefulness and intensely focused attention, known as "tweaking." When users are tweaking, they exhibit hyperactive and obsessive behavior. 

Repeated use  actually changes the Tik user's brain chemistry, destroying the brain's pleasure centers and making it increasingly impossible to experience further sensations of pleasure. Although studies have shown that the affected tissues may be able to regenerate, the process can take years, and the repair may never be complete. 
- How Meth destroys the body. Frontline News

The signs of Tik abuse
  • Loss of appetite and weight loss
  • Aggression
  • Dilated pupils
  • Rapid speech
  • Anxiety
  • Psychotic symptoms (hallucinations and delusions)
  • Headaches
  • Over-confidence
  • Insomnia
  • Changes in dress, friends and slang
  • Drug paraphernalia: light bulbs, glass straws (so-called 'lollies' or 'popeyes')

In need of HELP? 

Dept of Social Services………….....……..…… 021 370-4800 
SANCA…………………………………..............…….021 397-2196 
Cape Town Drug Counseling Centre….…..021 447-8026 
Narcanon………………………………............…….021 975-6591

Narcotics Anonymous…………….....….………088 130-0327

An Injury and Prevention Awareness Project brought to you by Christiaan Barnard Memorial Hospital Trauma & Emergency Centre.

<![CDATA[Fever!]]>Thu, 01 Oct 2015 14:00:04 GMThttp://safeinthecityct.weebly.com/city-trauma/fever

Although many cases of severe trauma and complex medical conditions pass through the doors of the Christiaan Barnard Memorial Hospital ER, a child presenting with a fever is always considered an acute emergency. Such patients always receive prompt and efficient medical assistance right in the ER.   

What is a fever? 

Fever is one of the most common acute presentations in childhood, with many children presenting as only mildly unwell or agitated. A fever may be described as medical condition in which the body temperature is greater  than 37 C (98.6 F). In practice, a fever is considered significant when the body temperature is above 38 C (100.4F). The hypothalamus found in the midbrain is the structure responsible for regulating the body's temperature, and performing adjustments according to activity level and time of day. 

In response to an infection, illness or other cause, the hypothalamus will increase the body temperature. Researchers believe this increase in body temperature is the natural response of the body in an attempt to "fight" off infections and make the body a less comfortable place for them.   

What cause a fever? 

  1. Infection - Most fevers are caused by infections or other illness. Through stimulating natural defense mechanisms, a fever may help the body fight infection.
  2. Overdressing - As infants are unable to regulate their body temperature as efficiently as adults, they may be more prone to acquiring a fever if over dressed or kept in a hot environment. 
  3. Vaccinations - Infants and children may present with a low grade fever after being immunized.  

Teething: Although teething may cause a slight rise in body temperature, it will probably not be responsible for a temperature higher than 37.8 C (100 F).

When a fever becomes serious...

It is always important to consider both the overall condition of the child and the temperature reading together. Children with a temperature less than 38.9 C (102 F) often do not require medication unless they are uncomfortable or are obviously distressed UNLESS the child is 3 months or younger. If the child is still...

  • interested in playing
  • eating and drinking well
  • alert and smiling at you
  • has a normal skin colour

...then chances are your child is alright and requires effective monitoring only. A loss of appetite alone may not indicate a serious fever, rather pay attention to the amount a child drinks and the frequency of urination.  
- Healthy Child Monitoba. Caring for a child with a fever. 

Measuring a child's temperature

Rectal temperature measurement:
(38 C/ 100.4 F)
First lubricate the thermometer with a lubricant, place the child belly down across your lap or face up with their legs bent towards the chest. Insert the thermometer into the anal opening about 1.5 to 2.5 cm or until the tip of the thermometer is fully in the rectum.  Stop if any resistance is felt. Wait for the thermometer to obtain a reading and write it down as well as the time of day. Remove the thermometer and clean as required.

Oral temperature measurement: 
(37.5 C/ 99.5 F)
Wait 20 to 30 min after your child has eaten or drunk any liquids. Make sure the mouth is clean and free of gum or sweets. Place the tip of the thermometer under the tongue and request the child to close their lips around it. Remind them not to bite down and relax whilst breathing normally through their nose. Wait for the thermometer to obtain a reading and write it down as well as the time of day. Remove the thermometer and clean as required.  

Axiliary temperature measurement: 
(37.2 C/ 99 F)
Generally, an axiliary temperature reading is not as accurate as a rectal or oral temperature. Remove the child's shirt and undershirt and place the thermometer under an armpit, which should touch the skin only, and not any clothing. Ask the child to fold their arms across their chest to help hold the thermometer in place and wait for the thermometer to obtain a reading and write it down as well as the time of day. Remove the thermometer and clean as required.

It's time to go to the ER when: 
  • An older child has a temperature higher than 39 C/ 102.2 F
  • An infant younger than 3 months old has a rectal temperature of 38 C/102.2 F
If an older child has a fever of less than 39 C/ 102.2 F and: 
  • refuses any fluids or seems to ill to drink
  • has any signs of frequent diarrhea or vomiting
  • has signs of dehydration 
  • still has a fever after 24 hours (children younger than 2 years) or 72 hours (children older than 2 years)
  • specifies a complaint (eg: sore throat)
  • has a chronic medical problem such as heart disease
  • has a rash
  • cries inconsolably
  • presents with extreme lethargy and difficulty walking
  • has a stiff neck, severe headaches 
  • develops a rash or purple spots that look like bruises on the skin
  • any difficulty breathing
  • has a seizure
  • has abdominal pain
  • leans forward and drools
When in doubt, report to the ER.
- The Nemours Foundation/Kids Health. 1995 - 2015 Seattle Children's Hospital

An Injury and Prevention Awareness Project brought to you by Christiaan Barnard Memorial Hospital Trauma & Emergency Centre.

<![CDATA[City seizures]]>Tue, 01 Sep 2015 13:13:43 GMThttp://safeinthecityct.weebly.com/city-trauma/city-seizures

Roughly 1 in 100 people in South Africa have epilepsy, and 75% of people will have had their first seizure before the age of 20.  Epilepsy is the most common neurological condition, and affects people from all social and racial backgrounds, regardless of their intelligence.

Any one may develop epilepsy at any stage of life.
Most people believe that seizures and epilepsy are terms that may be used to describe the same phenomenon. The term "seizure" refers to a single occurrence whilst epilepsy may be defined as two or more unprovoked seizures
A seizure is the physical manifestation of a sudden electrical surge within the brain, affecting how a person acts and responds for a short time. This aberrant electrical activity is caused by complex changes occurring in the nerve cells. These brain cells either excite or inhibit corresponding brain cells from sending messages. When a seizure occurs, there is an imbalance between exciting and inhibitory activity, and the resulting chemical imbalance may lead to surges of electrical activity, resulting in seizures. 
The nature of seizures may vary, as different lobes of the brain are responsible for different functions, behaviors, movements and experiences. 
-Understanding Seizures and Epilepsy. Comprehensive Epilepsy Program. 

The types of seizures

In simple partial seizures, a confined area of the brain is effected by abnormal electrical discharges. The manifestation of symptoms are specifically related to area of the brain affected, by means of example, if the area near the left frontal lobe (the frontal lobe is responsible for right arms movement).  is affected, the right arm may involuntarily be lifted up and the head may turn towards the the lifted arm.  People are completely conscious and aware of the surroundings. A simple partial seizure may progress to a complex partial seizure.
A complex partial seizure may follow from a simple partial seizure and is characterized by an abnormal electrical discharge in a small area of the temporal lobe which quickly spreads to other nearby areas. The seizure is usually marked with an aura phase lasting 1 to 2min during which people lose touch with their surroundings. Consciousness may be impaired but is not lost completely. 
A generalized seizure may be produced by electrical impulses from throughout the entire brain, with the specific part of the brain generating the seizure being referred to as the focus.  A generalized tonic clonic or grand mal seizure is the most dramatic and most common generalized seizure. It is categorized by general body stiffing (tonic phase) lasting 30 to 60 seconds, followed by a phase of violent jerking (clonic phase) also lasting 30 to 60 seconds, after which the patient goes into a deep sleep or post ictal phase. It can be typical for patients to injure themselves during a seizure, and urinary incontinence is not unusual.  
Commonly, people may stare, chew or smack their lips involuntarily, utter meaningless sounds, resist help or move arms and legs in a strange purposeless way. This state may last for several minutes, and most people may not remember what happened during the event. Some may recover fully, whilst others may experience a spreading of the electrical discharge to adjacent areas of the brain, or to the other side of the brain, resulting in a generalized seizure. 
-Diagnosis and Acute Management of Seizures in Adults. Hospital Physician Nov 2008


Know your triggers, prevent seizures. 

Seizures may often be associated with particular triggers, or changes in your daily habits or routine. Some of the common behaviors and factors that may trigger an epileptic seizure include

  • Stress and anxiety
  • Alcohol or drug abuse
  • Change in sleep schedules, feeling very tired, or significant sleep deprivation
  • Skipping or missing a dose of anti-seizure medication
  • Over stimulation of visual sensors such as a flashing television screen
  • Hormonal changes in women, often from pregnancy or menstruation
  • Mental strain
There is no way to predict what will trigger a seizure in an individual and some may occur for no apparent reason. However, many people are able to recognize that certain behaviors or action are associated with seizure activity. One can consider the following tips for aiding in preventing a seizure: 
  • Get plenty of sleep each night, stick to your regular sleep scheduled.
  • Learn stress management and relaxation techniques.
  • Avoid drugs and alcohol.
  • Take all of your medications as prescribed. 
  • Avoid bright, flashing lights and other visual stimuli.
  • Skip TV and computer time whenever possible.
  • Avoid playing video games.
  • Eat a healthy diet.
- Borrowed form: www.everydayhealth.com

An Injury and Prevention Awareness Project brought to you by Christiaan Barnard Memorial Hospital Trauma & Emergency Centre.

<![CDATA[The winter chill]]>Sat, 01 Aug 2015 14:49:18 GMThttp://safeinthecityct.weebly.com/city-trauma/the-winter-chill
Whilst most of us come home to a heater or fire place, many of the Cities residence are left out in the cold and wet to fight off the chill of winter. The real threat of hypothermia is ever present and can be compounded by wet conditions and wind chill factors due to the progression of cold fronts across the Cape peninsula.   

Cold fronts create our wet and cold winter weather 
A cold front may be defined as the leading edge of a cooler mass of air, replacing a warmer mass of air at ground level, lying within a fairly sharp surface trough of low pressure. Within this weather system, the cooler (and thus more dense) air wedges beneath the less dense warmer air, lifting it. This upward motion of warmer air causes a lowered pressure along the cold front which may result in showers when enough moisture is present. 
A cold front may move faster than a warm front, and thus would be likely to produce more rapid changes in weather. As the cold air is denser than warm air, the warm is rapidly replaced by  cold air at the proceeding "front". They commonly bring a narrow band of precipitation, following along the edge of the cold front, bringing rain along with the cool temperatures. 
- D. Roth. Unified Surface Analysis Manual. Hydrometeorological Prediction Centre. 2006 

The cold and hypothermia 
Hypothermia may be defined as a core (internal) body temperature of less than 35 C.  The normal body temperature ranges between 36.6 to 37.7 C, which ensure adequate functioning of body systems. When temperature values fall bellow the normal range, and hypothermia begins to take hold, body systems such as the cardiovascular and respiratory system may begin to malfunction

The body may lose heat through various mechanisms, including: 
  1. Radiation: loss of heat to the environment due to the temperature gradient, and may be affected by factors such as surface area and the temperature gradient itself. 
  2. Conduction: the molecular transfer of heat energy through direct contact between objects. Water may conduct heat away from the body 25 times faster than air due to a greater density and thus a greater heat capacity.
  3. Convection: a process of conduction where in one of the objects is in motion. Molecules against the surface are heated, move away and then replaced by new molecules which are also heated. The rate of convective heat loss depends on the density and velocity of the moving substance. 
  4. Evaporation: the loss of heat when water changes sate from a liquid to a gas. This may occur due to perspiration, sweating and respiration. 

Prevention and treatment hypothermia: 

Those individuals at high risk of presenting with hypothermia include the sick, the frail, the poor and people with disability. Preventing hypothermia may be achieved through the following actions: 

  1. Cover yourself: wear a hat or similar protective clothing to prevent the loss of body heat from your head, face and neck. 
  2. Over exertion: avoid activities that would cause you to sweat profusely. 
  3. Wear layers: wear loose fitting layered lightweight clothing
  4. Keep dry: stay as dry as possible.

If someone is hypothermic, how can I help? Always remember to RESTORE WARMTH SLOWLY.

  • Bring the person indoors.
  • Remove wet clothing and dry the person off, if needed.
  • Warm the person's trunk first, not hands and feet. 
  • Warm the person by wrapping him or her in blankets or putting dry clothing on the person.
  • If using hot water bottles or chemical hot packs, wrap them in cloth; don't apply them directly to the skin.
  • Begin CPR if necessary.
  • Give warm fluids. Give the victim a warm drink if conscious.
  • Once the body temperature begins to rise, keep the person dry and wrapped in a warm blanket. Wrap the person's head and neck, as well.
- The Backpacker's Field Manual, Rick Curtis, Random House, New York, 2005
- Kees H Polderman. .Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med 2009

An Injury and Prevention Awareness Project brought to you by Christiaan Barnard Memorial Hospital Trauma & Emergency Centre.

<![CDATA[Stroke]]>Wed, 01 Jul 2015 14:53:33 GMThttp://safeinthecityct.weebly.com/city-trauma/strokeWhilst many of the admissions passing through the Christiaan Barnard Memorial Hospital ER are of a traumatic nature, many potentially life threatening medical conditions are simultaneously dealt with. Following the recent appointment of a Neurologist, together with a long standing Neurosurgeon, the hospital is able to accommodate the patient presenting with a Stroke or Cerebral Vascular Accident (CVA) and provide the most appropriate care and treatment options. 

A stroke or CVA may be defined as a disorder involving a sudden, focal interruption of cerebral blood flow that results in a neurological deficit. 

A transient stroke or Transient Ischemic Attack (TIA) is differentiated from a CVA by virtue of neurological symptoms typically lasting less than 1 hour and without evidence of cerebral infarction (permanent brain cell damage) arising from a partially blocked artery. 

A stroke involves the arteries of the brain, either the anterior circulation (internal carotid) or posterior circulation (branches of the vertebral or basilar arteries) and are the 4th most common cause of death and the most common cause of neurologic disability in adults. 


Different strokes for different folks...
A Stroke may be categorized as either ischemic (occurring in 85% of cases) or hemorrhagic (15%) in nature. Ischemic strokes occur when a blood vessel that supplies blood to an area of the brain is blocked by a locally formed blood clot (thrombotic stroke)  or a blood clot from elsewhere (embolic stroke), whilst a hemorrhagic stroke may be characterized by a bleed into the brain tissue due to a break in the blood vessel adjacent to the brain tissue. Hemorrhagic stokes may be further divided into subarachnoid and intracerebral bleeds, varying in the anatomical area of injury. 

- Biller J, Love BB, Schneck MJ. Vascular diseases of the nervous system: ischemic cerebrovascular disease. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds.Bradley's Neurology in Clinical Practice

The symptoms associated with a stoke may be related to the area of the brain injured. The diagram on the right depicts the areas of the brain, and their function. For example, and area of injury overlying the posterior left frontal lobe will result in an impairment of speech function as the Motor speech area of Broca is located in this area. 
The acronym FAST helps identify the symptoms of a stoke and helps to highlight the necessity for rapid transport to a centre able to provide for the needs of such a patient. 


- Morgenstern LB, Hemphill JC 3rd, Anderson C, Becker K, Broderick JP, Connolly ES Jr, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke
  • Manage high blood pressure or high cholesterol by working with your doctor.
  • Manage diabetes. Keep your blood sugar levels within a target range.
  • If your doctor recommends that you take aspirin or a blood thinner, take it. This can help prevent a stroke.
  • Take your medicine exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
  • Don't smoke or allow those around you to smoke.
  • Limit alcohol to 2 drinks a day for men, and 1 drink a day for woman.
  • Maintain a healthy weight. 
  • Do activities that raise your heart rate. Get at least 30min of exercise on most days of the week. 
  • Eat heart healthy foods, including: fruits, vegetables, high-fiber foods, and foods low in sodium, saturated fat, trans fat and cholesterol. 
Stroke prevention:

- Furie KL, Kasner SE, Adams RJ, Albers GW, Bush RL, Fagan SC, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke
An Injury and Prevention Awareness Project brought to you by Christiaan Barnard Memorial Hospital Trauma & Emergency Centre.

<![CDATA[City car crash]]>Tue, 02 Jun 2015 14:54:45 GMThttp://safeinthecityct.weebly.com/city-trauma/city-car-crash

The sight of a car accident has unfortunately become a very common occurrence on the roads of South African, with many patients presenting with varying injuries subsequently admitted to the Christiaan Barnard Memorial Hospital Trauma and Emergency Centre. The WHO names 10 countries responsible for 62% of all road fatalities, with South Africa mentioned in this category.  

The cause of traffic accidents may be attributed to: 

  • Veering out of lane
  • Excessive speed
  • Running a red light
  • Not yielding to a pedestrian          
  • Tailgating 
  • Not yielding to another vehicle 

Common Injuries sustained due to traffic accidents include:
  • Strains
  • Contusions
  • Back Strains
  • Fractures
  • Lacerations 
-Motor Vehicle Accidents, Claims by nature of injury (2005-2009)

As road users, how can we help reduce the amount of road accidents and practice safe driving? 

10 Tips for safe driving: 

Attentiveness - Remaining alert at all times to what's going on around you is important for drivers of all experience levels, not just those who are learning how to drive. Your split second reactions could mean the difference between being in a crash, or avoiding one.

Scanning the road - Many crashes happen because people only watch the car in front of them. Always scan ahead and around the car, in order to anticipate crashes before they happen.

Buffer zones - It can take up to 13 metres to stop a regular car doing just 48 km/h; even more if your tyres are under inflated, it's wet or the road is slippery. Keep ample space between you and the car in front and increase that space at higher speeds.

Driving to conditions - Rain, wind, glare, gravel and night driving all pose their own unexpected threats. Slow down, always drive within your comfort zone and observe advisory signs on the road; they're there for a purpose.

Blind spots -To avoid blind spots when changing lanes, always check over your shoulder first. Also, you can help to reduce blind spots by ensuring your side mirrors are turned out far enough to see the entire width of the lanes beside you.

Driving tired, intoxicated, drugged or distracted - A standard drink, some prescription drugs, doziness or having your mind elsewhere can reduce attentiveness and make reflexes slow. It's that split second reaction that counts.

Plan your route - If you're confused about where you're going there's more scope for making mistakes in traffic. Slowing right down will help you absorb an unfamiliar environment and drive with more confidence.

Night driving - Lack of visibility makes night driving hazardous. Slow down if you're having trouble seeing and in rain. Also, try shifting your gaze slightly away from oncoming headlights and adjust your rear view mirror to reduce the glare from behind.

Country roads - Country roads can be narrow, winding, rough and full of surprises - such as live stock, large trucks and potholes. Adhere to advisory signs, don't be tempted to speed, avoid the edges of roads (but be ready to slow down and move over for passing vehicles), and always remain alert, even if the road looks quiet.

Seat belts - Seat belts will limit your contact with the car's interior on impact and spread the forces over more of your body to protect against injury. Without a seat belt and airbag, you can suffer serious injury in a head on collision at just 29km/h.

- NRMA Safe Driving 2015

An Injury and Prevention Awareness Project brought to you by Christiaan Barnard Memorial Hospital Trauma & Emergency Centre.

<![CDATA[Burns! Burns! Burns!]]>Sat, 02 May 2015 15:52:12 GMThttp://safeinthecityct.weebly.com/city-trauma/burns-burns-burnsBurn wounds are a common admission to the Christiaan Barnard Memorial Hospital ER, with the frequency of admissions increasing in the winter months. When considering burn injuries, (please refer to our previous post under Trauma and emergency Centre: Feeling the heat of the kitchen 12/7/2014):   
Serious burns requiring hospitalization include:

- Greater than 15% burns in an adult
- Greater than 10% burns in a child
- Any burn in the very young, the elderly or the infirm
- Any full thickness burn
- Burns of special regions: face, hands, feet, perineum
- Circumferential burns
- Inhalation injury
- Associated trauma or significant pre-burn illness: e.g. diabetes

Whilst this month looks into the surgical treatment of burns, it is important to remember that many minor burn wounds can be treated at home. Remember: 
- Management of Burns. WHO Surgical Care at the District Hospital. 2003

Burn care requires a series of ongoing, but separate, interventions until healing of all wounds, whether operated or non-operated, is achieved. Multiple staged and non-staged surgical procedures may be necessary followed by substantial clinical care including optimal nutrition, fluid management and infection prevention.
Intensive Care services are very often a necessary component of daily care for patients with extensive or complicated burn injuries. The management of burn patients requires significant attention to pathophysiologic changes caused by the systemic response to the burn injury. Patients require meticulous evaluation and correction of fluid & electrolyte, metabolic, cardiopulmonary, homeostatic and infectious abnormalities

This labor-intensive daily critical care evaluation and management in addition to various surgical procedures are absolutely necessary to achieve satisfactory outcomes.

Surgical treatment 
An escharotomy may be defined as a surgical incision through burn eschar (necrotic skin). The procedure is usually performed within the first 24 hours of burn injury. 

(Burn eschar has an unyielding, leathery consistency and is characterized by denatured proteins and coagulated vessels in the skin, which are the result of thermal, chemical or electrical injury.)

Debridement is the removal of loose, devitalized, necrotic, and/or contaminated tissue, foreign bodies, and other debris on the wound using mechanical or sharp techniques (such as scraping, rongeuring, or cutting). 

The level of debridement is defined by the level of the tissue removed, not the level exposed by the debridement process.

Excision is a surgical procedure requiring incision through the deep dermis (including subcutaneous and deeper tissues) of open wounds, burn eschar, or burn scars. 

An excision entails the surgical removal of all necrotic tissue. Burn scars may also be excised in preparation for surgical reconstruction.
Skin grafting reduces the number of days in the hospital and usually improves the function and appearance of the burned area, especially when the face, hands, or feet are involved.

An thin superficial layer of non-burnt skin is surgically removed, meshed and attached to the freshly excised or debrided area to allow for adhesion to cover the wound.
- Surgical Management of the Burn Wound and Use of Skin Substitutes. American Burn Association. 2009

Consider some of the information provided in the infographic to help prevent burns in the home:
Serious burns requiring hospitalization include:

- Greater than 15% burns in an adult
- Greater than 10% burns in a child
- Any burn in the very young, the elderly or the infirm
- Any full thickness burn
- Burns of special regions: face, hands, feet, perineum
- Circumferential burns
- Inhalation injury
- Associated trauma or significant pre-burn illness: e.g. diabetes

An Injury and Prevention Awareness Project brought to you by Christiaan Barnard Memorial Hospital Trauma & Emergency Centre.