foot health practitioners diploma course - unit seven

Foot Health Practitioner Diploma Course – Assignment Seven –

FOOT HEALTH PRACTITIONER

DIPLOMA COURSE

Assignment Seven

TUTOR TALK: All images in this lesson, unless stated otherwise, were taken from the

following source:

Wynn Kapit, Lawrence M. Elson (2004), The Anatomy Coloring Book 3rd Edition,

Publisher: Benjamin Cummings

HUNGER AND SUFFICIENCY

TUTOR TALK: The learning outcomes for this assignment are:

Explore the gastrointestinal tract

Identify the urinary system

Explore homeostasis

Explore communication with general practitioners and other medical officers

Justify professionality and ethics – your relationship to the patient

Understand some of the more common medical emergencies

TUTOR TALK: You will recall from the first assignment that the organism as a whole is

dependant upon the proper function of its individual cells, and that the cells are in turn

dependant upon the whole organism furnishing the needs of the individual cells. Nutrition

is the means by which the energy to drive all body systems is obtained. The cellular

processes of repair and growth, nerve impulse production and muscular contraction require

energy. This energy is derived from the chemical breakdown of foodstuffs. The process of

breakdown of foodstuffs is known as digestion. The movement of the breakdown products

through the walls of the intestine is absorption. The process by which the cells take in

nutritive products is known as assimilation. Oxygen obtained by respiration is used in the

chemistry and propulsion of the digestive process. The products of digestion are distributed

by the bloodstream. Fats are taken from the small intestine by the lymphatic circulation and

added to the bloodstream as the pulmonary veins enter the heart.


HUNGER AND SUFFICIENCY

Within the hypothalamus of the brain are two centres related to food intake, the hunger centre and

the satiety centre. The hunger centre stimulates the desire for ingestion of food, while the satiety

centre causes the sense of „fullness‟ and depresses the desire for further food.

According to the glucostatic theory, when blood glucose levels are low, we are stimulated to feed.

Once the blood glucose is raised the higher blood glucose level is thought to stimulate the satiety

centre to override the hunger centre, in order to depress the urge to ingest food. This feedback

mechanism is also supported by similar mechanisms controlling amino acid levels, lipid levels and

body temperature. Cold environments stimulate us to eat more whilst warm environments depress

hunger.

A further mechanism involves the organs of digestion. When distended by the presence of food, the

stomach, duodenum and small intestine activate a reflex that stimulates the satiety centre and

depresses the hunger centre. It has also been demonstrated that the hormone cholecystokinin,

secreted when fat enters the small intestine, inhibits feeding.

NUTRIENTS

Nutrients are chemical substances in food that provide energy, growth and repair materials and

substances necessary for body processes.

Six types of nutrient are recognised:

1. carbohydrates

2. lipids (fats)

3. proteins

4. minerals

5. vitamins

6. water

Carbohydrates, lipids and proteins are digested by enzymes in the gastrointestinal tract. Water is a

solvent and a suspension medium. It participates in hydrolysis, and acts as a lubricant, emulsifier and

coolant.


DIGESTION

Digestion is the process that makes food soluble. All foods must be rendered soluble before they can

pass into the bloodstream for transport around the body. Large, insoluble, complex molecules are

reduced to smaller, soluble molecules.

Food is digested inside a tube called the alimentary canal, or the gastrointestinal tract. This is a

continuous series of hollow organs that perform specific actions upon food substances as they

proceed along the tube.

Waves of muscular contractions called peristaltic waves move food along the gut. Circular muscles

in the wall of the gut contract behind the food and relax in front of it, pushing it forward.


THE GASTROINTESTINAL TRACT

(generalised view)


The gastrointestinal tract is 8-9 metres in length, and much of it is coiled to enable it to fit into the

abdominal cavity. As food progresses through the tract, it is progressively acted upon by chemicals

and enzymes. These are added and secreted at predetermined points, so that the breakdown of

substances is progressive, each stage dependent upon the previous stage.

THE ORAL CAVITY

The teeth are embedded in the alveolar sockets of the

alveolar processes of the fixed maxilla and mobile mandible.

Food is divided within the mouth by the incisor, canine and

premolar teeth into bite-sized pieces. These might be

swallowed directly or chewed (trituration) by the wide molar

teeth to increase the surface area. Controlled by the buccal

muscles of the cheeks and the active tongue with its sensory

taste buds, the bolus is mixed with saliva containing the

enzyme salivary amylase before deglutition (swallowing).

THE OESOPHAGUS

The oesophagus lies against the trachea. Food is prevented from entering the trachea by the

epiglottis, a muscular flap that closes off and defends the trachea when food is swallowed. The

oesophagus or gullet is approximately 25cm long, and is the narrowest part of the gastrointestinal

tract. At the level of the 10th thoracic vertebra it passes through the diaphragm and opens into the

stomach cavity by the cardiac orifice.

THE STOMACH

The stomach is described as a muscular „J‟-shaped hollow organ into which food enters by the

cardiac orifice. The size of the stomach varies with the amount of foodstuffs contained within. Food

is mixed with gastric juice, which consists of water, mineral salts, mucus, hydrochloric acid,

enzymes pepsinogen and rennin, and a protein compound known as the intrinsic factor – essential to

absorption of vitamin B12. Gastric juice begins the digestion process. Partially digested food, now

called chyle, is eventually passed out of the stomach through the pyloric sphincter into the

duodenum.


THE DUODENUM

The duodenum is about 25cms long. At its midpoint it receives the common opening of the

pancreatic duct and the common bile duct that carries bile, which is essential to fat emulsification,

from the liver and gallbladder. Pancreatic juice is a clear, colourless liquid composed of water, some

salts, sodium bicarbonate and enzymes. Pancreatic amylase is important to carbohydrate digestion,

trypsin is needed in protein digestion, and pancreatic lipase is the principal fat-digesting enzyme.

THE SMALL INTESTINE

From the pyloric sphincter to the iloecoecal valve, the small intestine is a little over 5 metres in

length. The jejunum is the middle part of the small intestine and is approximately 2 metres long.

Intestinal glands secrete intestinal juice, which helps to neutralise the acidic chyle and complete the

process of digestion. Intestinal juice is a clear yellow fluid that is slightly alkaline and contains water

and mucus. It serves as a vehicle for the absorption of substances from chyle as they come into

contact with the villi that line the inner surface of the small intestine – finger-like projections which

contain blood vessels, lacteal lymph vessels and nerves. This surface is where the greater part of the

digestion and absorption of water and nutrients occurs.


THE LARGE INTESTINE (COLON)

The colon has a larger lumen than the small intestine. About 1.5 metres long, it begins at the

ileocecal sphincter (valve), ascends, transverses and descends, forming an arch around the small

intestine, to enter the rectum. Much of the remaining water content of the food remnant is recovered

by the colon.

Several of the B vitamins and vitamin K are manufactured in the colon. The colon completes the

absorption of nutrients. Chyle is converted into faeces by the action of bacteria. After 3 to 10 hours

in the colon, chyle is solid or semi-solid. Faeces consists of water, inorganic salts, sloughed-off

epithelial cells from the mucosa of the gastrointestinal tract, bacteria, products of bacterial

decomposition and undigested food.

THE RECTUM

The rectum is the slightly dilated end of the colon, about 13cms long. It serves as a collecting

chamber for faeces prior to evacuation. It terminates in the anal canal.


THE ANAL CANAL

The anal canal is approximately 3-8cms long in the adult and leads from the rectum to the exterior.

Two sphincters control the anus – the inner one being of smooth muscle under autonomic control and

the outer sphincter being of striated muscle tissue under voluntary control.

THE URINARY SYSTEM

The metabolism of nutrients results in the production of wastes by body cells. These waste products

include carbon dioxide and water. Protein breakdown produces toxic nitrogenous waste such as

ammonia and urea. In addition to this, excess ions such as sodium, chloride, phosphate and sulphate

ions tend to exceed the body‟s requirements. These excess materials must be eliminated and the

volume of blood controlled to maintain homeostasis, and this is the function of the urinary system.

The urinary system maintains homeostasis by removal and restoration of selected amounts of water

and solutes.

THE URINARY SYSTEM


THE KIDNEYS

Two kidneys regulate the composition and volume of the blood and remove waste from the blood in

the form of urine. They also help to regulate blood pH and blood pressure. Urine is excreted from

each kidney via a ureter, and is stored in the urinary bladder until expelled from the body via the

urethra.

GROSS ANATOMY OF THE KIDNEY

Three areas of tissue can be distinguished when a longitudinal section of a kidney is viewed with the

naked eye.

1. The fibrous capsule surrounds the kidney

2. The cortex is a reddish-brown layer of tissue immediately beneath the capsule and between

the pyramids

3. The medulla is the innermost layer which consists of pale, conical-shaped striations called

the renal pyramids.

The hilus is the name given to the concave medial border of the kidney where the renal blood and

lymph vessels enter and leave.


The renal pelvis is a funnel-shaped structure that acts as a receptacle for the urine formed by the

kidney. The pelvis has a number of branches called calyces at its upper end, each of which surrounds

the apex of a renal pyramid.

Urine that is formed in the kidney passes through a papilla at the apex of a pyramid into a lesser

calyx, then into a greater calyx before passing through the pelvis into the ureter.

Within the kidney the renal artery divides into a great many arterioles and capillaries, mostly in the

cortex. Each arteriole leads to a glomerulus. This is a capillary repeatedly divided and coiled, making

a knot of vessels.

Each glomerulus is almost entirely surrounded by a cup-shaped organ called a Bowman’s capsule,

which leads to a coiled renal tubule. This tubule, after a series of coils and loops, joins a collecting

duct.

The collecting ducts pass through the medulla to open into the pelvis of the kidney.

There are thousands of glomeruli in the kidney cortex and the total surface area of their capillaries is

enormous.

A single glomerulus with its Bowman‟s capsule, renal tubule and blood capillaries is called a

nephron.

Hydrostatic pressure in the renal capillaries forces a liquid called glomerular filtrate through the

capillary walls into the Bowman‟s capsule. This filtrate contains urea, plus many useful substances

that are reabsorbed into the blood by the tubular part of each nephron. This leaves urine, which

drains out of the kidney.


Nephron structure

REABSORPTION

Glomerular filtrate flows out of the Bowman‟s capsules into the tubular part of each nephron. It is

here that reabsorption occurs. The walls of a nephron extract useful substances (glucose, etc) from

glomerular filtrate and pass them to the blood flowing through capillaries surrounding the nephron.

Removal of the useful substances changes glomerular filtrate into urine. Normally, urine is made up

of urea and small amounts of mineral salts dissolved in water. Urine drains out of the nephron into

collecting ducts that pass through the medulla to the pelvis of the kidney, and then into the ureters

which feed into the urinary bladder.

This is voided to the exterior when sensory feedback indicates fullness.

OSMOREGULATION

Reabsorption does not merely save useful substances from being lost from the body – it is also a

means of regulating the amount of water and dissolved minerals in blood and tissue fluid. The

technical term for this is osmoregulation because it regulates the flow of water between cells and the

blood.


After a large meal, or in a person suffering from diabetes, for example, the amount of sugar in the

blood begins to rise. At such a time the kidneys do not reabsorb all the glucose from the glomerular

filtrate, and so the excess passes out of the body in the urine. If large amounts of water are drunk, the

water content of the blood rises. Less water is then reabsorbed by the kidneys, and large amounts of

dilute urine are produced. But if the body contains too little water, the kidneys reabsorb a maximum

amount from the glomerular filtrate, leaving a small quantity of concentrated urine.

In hot weather the same process ensures that plenty of water is available for cooling the body by

perspiration from the sweat glands.

TUTOR TALK: As practitioners we will regularly come across patients who have been

prescribed „water tablets‟ (diuretics) to prevent accumulation of fluid in the chest or the

tissues. By removing a greater amount of water than usual, the kidneys reduce the total

volume of blood in circulation and thus lower the blood pressure, making the work of the

heart easier. Swollen legs and ankles are also reduced.

Diuretics are also sometimes employed in the treatment of Meniere‟s disease, where the

balance organs are malfunctioning.

All diuretics work on the kidneys and increase the frequency with which there is need to

pass urine.

Different diuretics work upon different parts of the kidney tubule. One common problem is

loss of potassium from the body (hypokalemia), which can cause confusion, weakness and

abnormal heart rhythms. Some diuretics are „potassium sparing‟ and others have a

potassium supplement added to make up for the loss.

Some diuretics can cause uric acid levels to rise, increasing the risk of gout. They may also

raise blood sugar levels, causing problems for diabetics.

Oedema can be a sign of kidney malfunction.

HOMEOSTASIS – AGAIN

The cells of the body are bathed in tissue fluid. This tissue fluid is derived from the blood plasma and

supplies cells with food and oxygen and removes their waste products.


Tissue fluid forms the environment in which the cells live – the internal environment of the body. A

number of organs are constantly adjusting the composition and physical characteristics of tissue fluid

so that it presents the cells of the body with as near perfect an environment as possible for efficient

function, growth and health. The main organs involved in this maintenance of homeostasis are the

lungs, skin, liver and kidneys.

Lungs control the amount of carbon dioxide and oxygen in tissue fluid. They do this by removing

carbon dioxide as fast as it is produced by respiration in cells, and by replenishing the oxygen as

soon as it is used by the cells.

Skin helps to maintain the internal environment at 37ºC, the ideal working temperature for cellular

processes. It does so by means of sweat glands, blood vessel shunts, hair erection, and shivering.

Liver and pancreas work together to precisely control the amount of glucose in blood and tissue

fluid. The liver also keeps amino acids and proteins at correct levels by the process of deamination.

This produces ammonia, which is very poisonous to the body, so it is immediately converted into

urea and passed into the bloodstream.

Kidneys remove the urea produced by deamination from the bloodstream and excrete it diluted in

water as urine. Ammonia and urea contain nitrogen. Nitrogenous excretion is essential to life.

Lungs, skin, liver and kidneys are excretory organs – they rid the body of waste produced by

metabolic processes that would prove toxic to the body and would disrupt the cellular environment if

allowed to accumulate.

Water may be present in the body in excessive amounts, and might dilute the blood and tissue fluid

to dangerous levels. The kidneys remove the excess in order to void it from the body. But if

dehydration threatens, the kidneys reabsorb a great proportion of the water that passes through them,

retaining it so that the body can continue to function until the requirement can be met by drinking or

ingestion of water-containing foodstuffs.

Excretion is an important part of homeostasis.

TIME FOR TEA: Now take a break, you have earned it. Then, try the self-test questions

below.


1. Another name for the gastrointestinal tract is the _____.

2. Name three types of nutrient.

3. Food is propelled along the GI tract by _____.

4. What is the product that leaves the stomach called?

5. The finger-like projections on the inside wall of the small intestine are called ______.

6. Renal pyramids are found in the ______ of the kidney.

7. What passes through the walls of Bowman‟s capsules?

8. Amino acids are controlled by the process of ______.

9. What are the four principal excretory organs?

10. Oedema can be a sign of what?

Mark this test yourself – from the text.

RECORD CARDS AND MEDICAL HISTORY TAKING

Keeping of treatment records is a legal requirement. Any treatment given to a patient must be noted

upon an appropriate retrieval system with date and details of the treatment given and any

observations made at the time. This can be protective to the patient and to the practitioner too.

The system is usually a Record Card and this is recommended as being compact, reliable and easy to

update. Useful diagrams may be printed on the card and provide a quick reference guide to positions

of lesions.

Surgery based practitioners may prefer to keep records on computer. This is fine, but back-up your

records frequently to be safe. Remember to register with the Data Registry.

The record should carry details of the patient – name, address, date of birth, and note any relevant

medical history, medical condition and medication currently being taken. Details of the patient‟s

General Practitioner (GP) should also be carried on the record – name, practice address and

telephone number. The date „first seen‟ should be noted, along with any presenting signs and

symptoms.

Details of your findings and any action taken should be written on the appropriate grid, and should

be terse, concise and technical in nature.

It is necessary to identify the position of a lesion precisely…. “left foot, third toe, apex”, “left foot

second metatarso-phalangeal joint”, or “left foot first lateral sulccus”.


You will note that in all cases we write our notes in the same order, always starting with location

(where it was), then identifying the lesion (what it was), and finally indicating our treatment (what

we did). In the case of callus reduced or heloma durum enucleated using a scalpel having identified

the location and lesion there is no need to mention the treatment since this will be assumed to have

been with a blade. Mention of a treatment mode need only be made if you did something other than

use a scalpel.

Callus is “reduced” or “pared”. Nails are “cut”, “trimmed”, “burred” or otherwise “reduced”.

Medicaments should be definitely identified.

The aim is to tell what you discovered, what you did about it, what with and how, in as few words as

possible to tell the complete story. The intention should be that any other person reading your

account will understand exactly what happened on any occasion and that the details are not in

question. One good test of record writing skills is to imagine yourself reading out your record in

court – to the Judge. What will the Judge think of your “cutting hard skin” or “digging out a corn”?

“Reducing callus” or “enucleating an heloma durum” sounds so much more professional and in

keeping with our vocation.

When writing notes we need to identify „where it was‟. This we do using easily identified landmarks.

The first step is to indicate which foot, left or right. We then need to be more specific and relate the

lesion to a specific area (joints make very easily recognised landmarks, therefore these are what we

usually use). Then, if necessary, give detail, such as medial, lateral, plantar or dorsal. As with the use

of the blade some things are assumed. For example, if the lesion is to be found at a metatarso-

phalangeal joint, it will be assumed that this is on the plantar aspect, unless you specify otherwise.

Therefore there is no need to mention it. Likewise a lesion on an inter-phalangeal joint will be

assumed to be dorsal unless your notes state otherwise.

The following diagram will hopefully help you to sort out what is where.


Landmarks of the foot

To make note making easier and quicker we use a system of abbreviations. Here follows a list of the

most commonly encountered words and phrases together with their accepted abbreviated forms.


B/F Both feet L/F Left foot

R/F Right foot Cal Callus

H.D. Heloma Durum (hard corn) H. Molle Heloma Molle (soft corn)

H. Mille Heloma Milliare (seed corn) V.P. Verruca Pedis

Ant. Anterior Post. Posterior

MPJ Metatarso-phalangeal joint IPJ Inter-phalangeal joint

PIPJ Proximal inter-phalangeal join DIPJ Distal inter-phalangeal joint

Prox. Proximal Dist. Distal

Red. Reduced Med. Medial

Lat. Lateral Fld. Filed

Cld. Cleared E.P.B. Elastic Plaster Bandage

S.C.F. Semi-compressed felt M/foam Molefoam

F/web Fleecy web T/gauze Tube gauze

T/foam Tube foam Pre. Before

Post After Op. Operation

Esp. Especially Chlor. Gluc. Chlorhexadine gluconate

H Haemorrhage C With

HWF Hydrous Wool Fat

Using the abbreviations, and with reference to the Landmarks (plus remembering those pieces of

information which can be assumed) we can start to write our notes. These should end up looking like

the following examples:

B/F nails cut & Fld. + red C bur as needed

R/F 5th PIPJ cal + HD F/Web

L/F 1st MPJ Med. aspect Cal

Pre Post Op Clor Gluc 0.5% w/v in 70% v/v DEB

B/F 2-3 MPJ cal + H. Mille × 6 F/Web

L/F 5th DIPJ med. Aspect H. Molle HWF + F/Web

B/F Heel margins Cal (esp. Med.)

Pre post Op Chlor Gluc. 0.5% w/v in 70% v/v DEB

B/F Nails Cut & Fld.

R/F 1st MPJ Cal. SCF pad with Aperture + EPB

R/F Ant. Heel Margin H. Mille

Pre Post Op Chlor Gluc 0.5% w/v in 70% v/v DEB


B/F nails cut & Fld. + 1st red C bur

B/F 2nd PIPJ cal + HD SCF C aperture, HWF, EPB

L/F 5th PIPJ HD H irrigated with normal saline. Melolin + T/gauze

Pre post Op Chlor Gluc 0.5% w/v in 70% v/v DEB

You will note from these examples that there is a set order involved. Always write your notes in the

same order, starting from the nails, then onto the toes, thence to the ball of the foot and finally the

heel. Keeping to a set pattern ensures that things don‟t get forgotten. You would be wise to always

work in the same order as well and for the same reason. In addition, if all of your notes follow the

same pattern, then no-one can later accuse you of adding detail in later. For the same reason we

never leave gaps, but always start the next entry on the line immediately beneath the previous entry,

and always finish each entry with the phrase „Pre Post Op Chlor Gluc 0.5% w/v in 70% v/v DEB‟.

This clearly indicates that each entry is concluded.

Abbreviations should be confined to only the approved contractions. Do not invent your own! Tell

the story, the whole story, and nothing but the story. Remember that a patient has the right to see

their own record and this cannot be denied. Write nothing on the record that is not completely

appropriate and proper.

COMMUNICATION WITH GENERAL PRACTITIONERS

AND OTHER MEDICAL SPECIALISTS

1. When corresponding with a Medical Advisor it is important to write concisely so that the

letter contents can be quickly assimilated and acted upon. Medics have no time for lengthy

pleasantries or involved explanations and letters of this sort will be passed to junior staff or

confined to the waste paper basket.

2. Any correspondence should be clearly written, or better, typed on your letter-headed paper,

which would carry your name, qualifications, practice address and telephone number. All

letters should be clearly dated.

3. The presentation of the medical history and your findings must be written in acceptable

manner to catch the eye and engage the attention. The letter should begin by stating the

problem and your involvement….

“This gentleman attended my surgery this morning with pain in the right, fourth toe

cleft…”


This must be followed by a resume of known relevant medical history and any other factor

you feel to be important…..

“He has been a Type II diabetic for 15 years and is generally well controlled by

drugs. There is a history of fracture of the right fourth metatarsal 18 months ago. The

wearing of industrial protective footwear is obligatory as this man is a foundry

worker.”

4. It is important not to presume or assume, or otherwise „tell‟ the GP the diagnosis. Diagnosis

is the province of the GP and your conclusions may be resented, rejected or simply be found

incorrect.

It is perfectly reasonable to suggest that this:

“may be…”, “is suggestive of…” or “is consistent with the appearance of…..”, or

“The pain is suggestive of and consistent with a fracture of the fourth metatarsal

head”.

5. Continue your letter with a summary of your findings and concerns:

“There is gross oedema of the dorsum of the right foot and localised pain proximal to

the fourth digit which is affecting the gait…”

6. Ask for advice, help with diagnosis, or an opinion:

“I would value your diagnosis. Perhaps you would advise me upon future

management…?”

7. This is an excellent starting point for future contact with medical practitioners in your area. A

professionally-styled letter will be noted and you will be recognised as a worthy specialising

practitioner who can help the GP in his work – something for which he is always seeking.

8. Sign personally, keep a copy, and send first class post.

A good example can be seen below.


Jim E Nail MPract, MidMPod. 2 Longlegs Lane, Neebraice, NE1 6EE Tel. 001 2058

Dr Dolittle MBChB 17th June

2023

The Group Practice

10 Green Bottles Way

Neverlands

2CU NE1

Re: Mr T.Rubble d.o.b. 12 / 3 / 45 of 27 Limpet Down, Hotfoot 2CU 4FE

Dear Dr Dolittle,

This gentleman attended my surgery this morning complaining of pain in the right fourth toe cleft.

He has been a Type II diabetic for 15 years and is generally well controlled with drugs. There is a

history of fracture of the right fourth metatarsal 18 months ago. Wearing of protective industrial

footwear is obligatory as this man is a foundry worker.

On examination there is gross oedema of the dorsum of the right foot and localised pain proximal to

the fourth digit which is affecting gait. The pain is suggestive of and consistent with a fracture of the

fourth metatarsal head.

I would value your diagnosis of this case. Perhaps you would advise me upon future management…?

Yours sincerely,

J Nail

Jim E Nail

Use this letter as a template to formulate your own letters. The simple format of the letterhead is

worth consideration.


COMMUNICATING WITH YOUR PATIENT

Although we would wish to make our patient comfortable and put them at ease, it is best to retain a

slight formality towards them. If it should be necessary to instruct them in some aspect of foot care

the job is made easier and more effective if a slight distance is maintained. Friendly, but not familiar

is the level to aim for.

If the patient is new to us or has not previously needed our services, they may be feeling a measure

of trepidation. Adrenaline will be flowing, the effect of which is to create a heightened awareness

and unease. In this state some patients act in a distracted manner and can say and do somewhat

surrealistic things. Do not show much surprise at this but put them at ease by instructing them simply

and explicitly so that they know what to do and exactly what is expected of them. The patient may

well have precipitated the condition to be presented, but would not wish to be made to appear

foolish.

The manner adopted should be non-intimidating, caring, positive and attentive. After going through

the preliminary routine of making out a Record Card, taking details of the patient and their GP, and

asking the all-important questions about allergies, arthritis, asthma, heart conditions, diabetes and

current medication, ask them to tell you about their foot problems. Put up the foot on the leg-rest and

listen closely, for there will often be a torrent of information unleashed. Listen carefully, interrupting

only to clarify your understanding or ask for supplementary explanation to help your understanding.

Having heard and questioned, examine the foot visually. Only then is it necessary to touch the foot,

using the hands gently but firmly to turn and manipulate the foot.

The foot should be handled by the toes or by its outer border. Grip the foot firmly and keep the

holding hand still. The fingers must be kept still and well away from the instep area. Many patients

are genuinely frightened of being tickled, and many will cite this as the reason for not having

previously attended for treatment. Stroking movements with the fingers or thumbs must be

suppressed.

If work is to be done upon the foot, now is the time to pre-op. Explain what the patient will feel and

what you are going to do before you do it. Discuss what you see as the immediate treatment whilst

you busy yourself with your preparations. Wear gloves if you perceive any need. If a blade is to be

used, let the patient see you open the sterile packet and mount the new blade untouched upon its

handle.

Begin work gently, allowing the patient to see that their worst fears are not to be realised. Look up at

your patient from time to time and make firm eye contact as you explain what you have found or

intend to do further. Looking up as you speak is particularly important, especially so if your patient

is hard of hearing – they may need to lip-read.


Advise and instruct your patient as the case requires, but not in a dictatorial or officious manner. The

best way is to speak conversationally, in an adult manner. A smile goes a long way – especially with

elderly clients who may not have much contact with other people. If further visits are to occur you

should discuss a „treatment plan‟ that would be pursued over a period of time.

We are clinicians, working within parameters of clinical governance and recognised regimes. We are

technicians, understanding necessary technique and how to apply it for the benefit of our clients. And

we are sign-posters when we need to be, directing our patients to other practitioners where other

specialist expertise is required. So we must take our responsibilities seriously whilst at the same time

recognising the boundaries of our abilities. This understanding is absolutely essential to practice, and

we must never lose sight of it. We must practice within our abilities and remain objective, constantly

reappraising our treatments and assessing our results.

Practice is made more interesting if we strive to widen our abilities and expand our skill-base. Our

patients have a right to expect us to be current in our understanding and application, and we must

undertake to pursue our professional occupational development (POD) with due diligence.

PROFESSIONALITY AND ETHICS – YOUR RELATIONSHIP TO THE PATIENT

The professional person has certain qualities. The professional is self motivating and self-critical,

capable of autonomous decision-making, planning and action. However, the practitioner should

understand the relationship with other professionals and recognise when to refer.

Professionality requires a recognition of, and compliance with, accepted standards of behaviour

towards both colleagues and patients.

Many of the rules concern compliance with the law. Other rules are based on moral values. Morality

and law are inextricably combined in the practices that a professional person undertakes to follow in

order to protect his/her person, his/her colleagues, and the all-important patient.

The patient and the welfare of the patient are always the focus of consideration. The patient, when

receiving the attention of a professional, must be given total and undivided attention. The session

should be free, so far as is possible, from the interruption of ringing telephones and other intrusion.

All must be done to ensure that the patient receives full consideration of their case and address of

their problems without distraction.


The professional enters into a consultation unburdened with personal concerns. Such personal

concerns and thoughts must be set aside and not brought into the consulting room. Private life must

be separated from work so that only the professional image is seen by the patient. However, certain

standards of behaviour are expected from a professional even in leisure time and pursuits.

Despite giving our full personal attention, support and empathy to the patient, we must not allow

ourselves to become emotionally involved with them and their troubles.

SOME GUIDELINES:

Give your full, undivided attention when „in session‟

Put your own personal interests and difficulties aside, so that they do not influence your

judgement

Concentrate upon the present patient – forget about the previous one

Do not carry over problems from previous sessions

Wear a white coat or uniform – this is a demonstration of your status – and serves as a barrier

Wear your badge of qualification – this protects your professional image

Be seen by the patient to wash your hands before commencing treatment on them

You determine the treatment, not the patient – but take into account their preferences

Communicate clearly and freely, but never gossip

Help if you can, but do not allow emotional involvement with a patient or their problems.


STANDARDS OF BEHAVIOUR – Professional bodies require certain standards from their

membership:

“Members shall, at all times, conduct themselves with dignity becoming to their calling and

place service before self”

“No member shall accept for treatment any patient, knowing the said patient to be already

receiving treatment from another practitioner, without the consent of the practitioner”

“Acceptance of a patient obligates the practitioner to deliver the best treatment of which they

are capable, irrespective of race, creed or social standing”.

The practitioner must be seen to treat all patients even-handedly and without favour, dispensing

treatment and advice to each according to their need.

MEDICAL EMERGENCIES

Medical emergencies can occur anywhere, at any time. Whilst a patient is in our care we are

responsible for their welfare. It is always a good thing to know what to do in any given situation, and

perhaps even more importantly, ensure that we do not take the wrong action.

As practitioners in the medical field we are expected to know how to behave in a medical

emergency. Since many of our patients will be elderly, diabetic and poorly exercised because of their

foot problems, there is a concentration of those who are most likely to need assistance.

It is recommended that knowledge be kept current and refreshed, preferably by annual revision, but

at the very least every third year. Every practitioner should hold a current First Aid Certificate.

The situations detailed here are those that we are most likely to encounter in the course of our

practice.

ASTHMA

This is a distressing condition in which the muscles of the air passages go into spasm and constrict,

making breathing (particularly breathing out) very difficult. Asthma attacks can be triggered by an

allergy, or nervous tension. Often there is no obvious cause. Many sufferers are prone to sudden

attacks at night.


Regular asthma sufferers generally know how best to cope with an attack. They usually carry

medication in the form of a “puffer” aerosol. The majority of these drugs act to dilate the air

passages, easing breathing.

RECOGNITION

There will be:

Difficulty in breathing, with a markedly prolonged breathing-out phase.

There may be:

Wheezing as the casualty breathes out.

Distress and anxiety; the casualty may speak only with difficulty and in whispers.

Blueness of the skin (cyanosis).

In a severe attack, the effort of breathing will exhaust the casualty. Rarely, he or she may

become unconscious, and stop breathing altogether.

TREATMENT

Your aim is:

To ease breathing.

To seek medical aid if necessary.

1. Reassure and calm the casualty.

2. Help her to sit down, leaning slightly forward and resting on a support. Ensure a good supply

of fresh air.

3. If the casualty has medication, let them use it.

IF the attack is a first attack, is prolonged, or does not respond toe medication, or if the casualty is in

severe respiratory distress, dial 999 for an ambulance. Check and record the casualty‟s breathing and

pulse rate every 10 minutes.

IF the attack is mild and eases, the casualty should not need immediate medical attention, but should

be encouraged to tell her doctor of the attack.


FAINTING

A faint (also known as syncope) is a brief loss of consciousness caused by a temporary reduction of

blood flow to the brain. Unlike shock, the pulse becomes very slow, though it soon picks up and

returns to normal. Recovery is usually rapid and complete.

A faint may be a reaction to pain or fright, or the result of emotional upset, exhaustion, or lack of

food. It is more common, however, after long periods of physical inactivity, especially in warm

atmospheres. Blood pools in the lower part of the body, reducing the amount available to the brain.

RECOGNITION

There will be:

A brief loss of consciousness; the casualty will fall to the floor.

A slow pulse.

Pallor.

TREATMENT

Your aims are:

To improve blood flow to the brain.

To reassure the casualty as she recovers, and make her comforable.

1. Lay the casualty down, and raise and support her legs to improve the blood flow to the brain.

2. Make sure she has plenty of fresh air; open a window if necessary.

3. As she recovers, reassure her and help her sit up gradually.

4. Look for and treat any injury sustained through falling.

If she does not regain consciousness quickly, check breathing and pulse, and be prepared to

resuscitate if necessary. Place her in the recovery position and dial 999 for an ambulance.

If she starts to feel faint again, place her head between her knees and tell her to take deep breaths.


MINOR WOUNDS

Prompt first aid can help nature heal small wounds and deal with germs.

But you must seek medical advice:

If there is a foreign body embedded in the wound.

If the wound is at special risk of infection (such as a dog bite, or puncture by a dirty object).

If a non-recent wound shows signs of becoming infected.

Good Wound Care:

First wash your hands thoroughly.

Avoid touching the wound with your fingers (use disposable gloves if possible).

Don‟t talk, cough, or breathe over the wound or the dressng.

MINOR EXTERNAL BLEEDING

Minor bleeding is readily controlled by pressure and elevation. A small adhesive dressing is

normally all that is necessary. Medical aid need only be sought if the bleeding does not stop, or if

the wound is at special risk of infection.

TREATMENT

Your aim is:

To minimise the risk of infection.

1. Wash your hands thoroughly in soap and warm water.

2. If the wound is dirty, clean it by rinsing lightly under running water.

3. Pat gently dry with a sterile swab or clean tissue.

4. Temporarily cover the wound with sterile gauze. Clean the skin around it with soap and

water (or a degreasing cleanser). Swab away from the wound and use a new swab for each

stroke.

5. Pat dry, then cover the wound with an adhesive dressing (plaster).


If there is a special risk of infection, advise the casualty to see her doctor.

SPRAINED ANKLE

While a broken ankle should be treated as a fracture of the lower leg, a sprain (usually caused by a

wrench) can be treated by the RICE procedure.

RECOGNITION

There will be:

Pain, increased by movement or by putting weight on the foot.

Swelling.

TREATMENT

Your aims are:

To relieve pain and swelling.

To seek medical aid if necessary.

1. Rest, steady, and support the ankle in the most comfortable position.

2. Cool a recent injury to reduce the swelling, by applying an ice pack or cold compress.

3. Wrap the ankle in a thick layer of padding, and bandage firmly.

4. Raise and support the injured limb.

5. Advise the casualty to rest the ankle, and to see his doctor if pain persists.

If you suspect a broken bone, secure and support it. Take or send the casualty to hospital.

FRACTURE OF THE FOOT

Fractures affecting the many small bones of the foot are usually caused by crushing injuries. These

fractures are best treated at hospital.


RECOGNITION

There may be:

Difficulty in walking.

Stiffness of movement.

Bruising and swelling.

TREATMENT

Your aims are:

To minimise swelling.

To arrange removal to hospital.

1. Raise and support the foot to minimise swelling.

2. Apply an ice pack or cold compress.

3. Take or send the casualty to hospital, keeping the foot elevated.

BLEEDING VARICOSE VEINS

Veins in the legs contain one-way valves that keep the blood flowing towards the heart. If these

deteriorate, blood collects behind them, causing distension. The “varicose” vein has taut, thin walls

and is often raised, stretching the skin (the characteristic “knobbly” appearance). It can be burst by

surprisingly gentle knocks and will bleed profusely. If bleeding is not controlled, shock may

develop.


TREATMENT

Your aims are:

To bring blood loss under control.

To arrange urgent removal to hospital.

To minimise shock.

1. Lay the casualty on her back and raise the injured leg as high as possible. This may reduce or

stop the bleeding.

2. Expose the site of the bleeding and apply firm direct pressure over a sterile dressing or clean

pad, or with your fingers, until bleeding is controlled.

3. Remove garments such as garters or elastic-topped stockings that may be impeding blood

flow back to the heart.

4. Place a large, soft pad over the dressing. Bandage it firmly to exert even pressure, but not so

tightly that the circulation is impeded.

5. Dial 999 for an ambulance. Keep the injured leg raised and supported until the ambulance

arrives.

INJURIES TO THE LOWER LEG

The sturdy shin bone (tibia) of the lower leg usually requires a

heavy blow to break it (for example, from the bumper of a moving

vehicle).

The thinner splint bone (fibula) can be broken by the type of

twisting injury that sprains the ankle. Because the load-bearing

shin bone remains intact, the casualty may be able to walk, and

may be unaware that a fracture has occurred.


RECOGNITION

There will be:

Localised pain.

There may be:

A recent blow or wrench of the foot.

An open wound.

Inability to walk.

TREATMENT

Your aims are:

To immobilise the leg.

To arrange urgent removal to hospital.

1. Help the casualty to lie down, and carefully steady and support the injured leg, holding the

leg at the knee and ankle. If necessary, gently expose and treat any wound.

To Transport the casualty:

If you have to transport the casualty on a stretcher, place extra padding (for example, rolled

blankets) on either side of the legs, from the upper thigh to the foot. Secure with broad-fold

bandages at the thigh and knee, and above and below the fracture. Make sure all knots are on

the opposite side of the injury. Tie a figure-of-eight around the feet and ankles with a narrow-

fold bandage.

2. Straighten the leg using traction, pulling gently in the line of the shin.

3. Dial 999 for an ambulance. If the ambulance will arrive quickly, support the leg with your

hands until it arrives.


If the ambulance will be delayed, splint the injured limb to the sound one.

Gently bring the sound limb alongside the injured one.

Maintaining support at the ankle, gently slide bandages under the knee and ankles. Position

them above and below the fracture, and at knees and ankles, avoiding the fracture if it is close

to a joint.

Insert padding between the knees and ankles, and between the calves.

Tie the bandages around ankles and knees, then above and below the fracture. Bandage

firmly, but avoid jerky movements.

FOREIGN BODIES IN THE EYE

A speck of dust or grit, or a loose eyelash floating on the white of the eye can generally be removed

easily. However, a foreign body that adheres to the eye, penetrates the eyeball, or rests on the

coloured part of the eye (the pupil and iris) should not be removed by a First Aider.

RECOGNITION

There may be:

Blurred vision, pain, or discomfort.

Redness and watering of the eye.

Eyelids screwed up in spasm.

TREATMENT

Your aim is:

To prevent injury to the eye.

DO NOT touch anything sticking to, or embedded in, the eyeball, or on the coloured part of the eye.

Cover the affected eye with an eye pad, bandage both eyes, then take or send the casualty to the

hospital.


1. Advise the casualty not to rub their eye. Sir them down facing the light.

2. Gently separate the eyelids with your finger and thumb. Examine every part of the eye.

3. If you can see the foreign body, wash it out using a glass or an eye irrigator, and clean water

(sterile, if possible).

4. If this is unsuccessful then, providing the foreign body is not stuck in place, lift it off with a

moist swab, or the damp corner of a tissue or clean handkerchief.

If the object is under the eyelid, grasping the lashes, pull the upper lid over the lower lid. Blinking

the eye under the water may also make the object float clear.

CHEMICAL BURNS TO THE EYE

Splashes of chemicals in the eye can cause serious injury if not treated quickly. They can damage the

surface of the eye, resulting in scarring and even blindness. Be especially careful, while irrigating the

eye, that contaminated rinsing water does not splash you or the casualty. Wear protective gloves if

they are available.

RECOGNITION

There may be:

Intense pain in the eye.

Inability to open the injured eye.

Redness and swelling in and around the eye.

Copious watering of the eye.

TREATMENT

Your aims are:

To disperse the harmful chemical.

To arrange removal to hospital.

DO NOT allow the casualty to rub or touch the eye.


1. Hold the affected eye under gently running cold water for at least 10 minutes. Make sure you

irrigate both sides of the eyelid thoroughly. You may find it easier to pour the water from an

eye irrigator or glass.

2. If the eye is shut in a spasm of pain, gently but firmly pull the eyelids open. Be careful that

contaminated water does not splash the sound eye.

3. Cover the eye with a sterile eye pad or pad of clean, non-fluffy material.

4. Take or send the casualty to hospital.

HYPOGLYCAEMIA

TREATMENT

Your aims are:

To raise the sugar content of the blood as quickly as possible.

to obtain medical aid, urgently if the casualty is unconscious.

FOR AN UNCONCIOUS CASUALTY

1. Open the airway by lifting the chin and tilting the head, and check and record breathing,

pulse, and level of response. Be prepared to resuscitate if necessary.

2. Turn the casualty into the recovery position

3. Dial 999 for an ambulance.

FOR A CONSCIOUS CASUALTY

1. Help the casualty to sit or lie down, and give her a sugary drink, sugar lumps, chocolate, or

other sweet food.

2. If the casualty‟s condition improves quickly, give more sweet food or drink, and let her rest

until she feels fully recovered. Advise her to see her doctor.

If her condition does not improve, examine her for other causes of confusion and tremor, and treat as

necessary.


Diabetes Mellitus

This is a condition in which the body fails to regulate the concentration of sugar (glucose) in the

blood.

An organ called the pancreas normally produces a hormone, insulin, that controls blood sugar levels.

Without insulin, sugar accumulates in the blood, causing hyperglycaemia. Diabetics must balance

the amount of sugar in their diet with insulin injections or tablets; too much insulin and too little

sugar can cause hypoglycaemia.

Most diabetics are aware of the risk of hypoglycaemia if, for example, they miss a meal or over-exert

themselves, and may carry sugar lumps or glucose tablets to raise their blood sugar levels quickly.

Hyperglycaemia

Prolonged high blood sugar can result in unconsciousness, but the diabetic is likely to drift into this

state over several days. The signs of this type of diabetic coma are dry skin, a rapid pulse, deep,

laboured breathing, and possibly a faint smell of acetone (nail-varnish remover) on the casualty‟s

breath. Urgent hospital treatment is required.

HEART ATTACK

A heart attack most commonly occurs when the blood supply to part of the heart muscles is suddenly

obstructed – for example, by a clot in one of the coronary arteries (coronary thrombosis). The effect

depends largely on how much of the heart muscle is affected. Many casualties recover completely.

Drugs that aid recovery include special medicines called thrombolytics, which dissolve the clot, and

ordinary aspirin, which “thins” the blood. The main risk during any heart attack is that the heart will

stop.


RECOGNITION

There may be:

Persistent crushing, vice-like pain, often radiating from the heart. Unlike the pain of angina,

it does not ease with rest, and indeed may occur at rest.

Breathlessness, and discomfort high in the abdomen, like severe indigestion.

Sudden faintness or giddiness.

A sense of impending doom.

“Ashen” skin, and blueness at the lips.

A rapid pulse, becoming weaker.

Collapse, often without any warning.

TREATMENT

Your aims are:

To minimise the work of the heart.

To summon urgent medical aid and arrange removal to hospital.

1. Make the casualty comfortable. A half-sitting position, to ease strain on the heart, with head

and shoulders supported and knees bent, is often best.

2. If the casualty is conscious, give him one aspirin tablet and tell him to chew it slowly.

3. Dial 999 for an ambulance, and say that you suspect a heart attack. If the casualty asks for

his doctor, call both the emergency services and the doctor. Check breathing and pulse

constantly, and be prepared to resuscitate if necessary.


ACUTE HEART FAILURE

Heart failure is a condition in which the heart muscle is strained and fatigued – for example,

following a coronary thrombosis. Acute attacks often occur at night. They may appear similar to an

asthma attach with severe breathlessness, often, but not always, accompanied by other signs and

symptoms of heart attack. Follow the treatment for heart attack.

CARDIAC ARREST

The term “cardiac arrest” describes and sudden stoppage of the heart. It may be the result of a heart

attack; other causes include severe blood loss, suffocation, electric shock, anaphylactic shock, drug

overdose, and hypothermia.

Cardiac arrest is characterised by the absence of pulse and breathing. You must commence

resuscitation as soon as possible because, without oxygen, the heart muscle and brain will deteriorate

rapidly.

RECOGNITION

There will be

Absence of pulse.

Absence of breathing.

TREATMENT

Your aim is:

1. To keep the heart muscle and brain supplied with oxygen until an ambulance arrives.

2. Check for breathing and a pulse on any unconscious casualty.

3. If both are absent, dial 999 for an ambulance and begin the sequence of resuscitation.

Ventricular Fibrillation

This is the most common cause of sudden cardiac arrest. It is an electric storm that originates in a

damaged ventricle, or one deprived of oxygen. The electrical heart impulse becomes chaotic, and the

muscles fail to contract in harmony.


The use of defibrillators

Ventricular Fibrillation can often be reversed by the early application of a controlled electric shock

from a machine called a defibrillator, now carried by most ambulances. The role of the First Aider is

to keep the brain supplied with oxygen, by means of cardiopulmonary resuscitation, until a

defibrillator can be brought to the casualty and used by a trained operator.

EXAMINING AND TREATING AN UNCONSCIOUS CASUALTY

Your Aims Are:

To maintain an open airway.

To assess and record the level of response.

To treat any associated injuries.

To arrange, if necessary, urgent removal to hospital.

1. Open the airway by lifting the chin and tilting the head. Check breathing and pulse, and be

prepared to resuscitate if necessary. Check and record the casualty‟s level of response.

IF She starts to vomit, immediately place her in the recovery position.

2. Examine the casualty quickly but systematically to identify any severe external bleeding or

major fractures. Try to avoid stepping over an unconscious casualty.

DO NOT try to give an unconscious casualty anything by mouth.

DO NOT move the casualty unnecessarily, because of the possibility of spinal injury. Never

attempt to make an unconscious person sit or stand upright.

DO NOT leave an unconscious casualty unattended.

3. Control any bleeding and support suspected fractures. As you work, look for less obvious

injury or conditions. Smell her breath, and look for needle marks. Look for warning

bracelets, lockets or cards. Ask bystanders for information.

4. Place the casualty in the recovery position.

If the casualty does not regain full consciousness within 3 minutes, dial 999 for an ambulance.

Record breathing and pulse rate, and level of response, every 10 minutes.


If the casualty regains full consciousness within 3 minutes, and remains well after a further 10

minutes, advise her to see her doctor.

MEDICAL EMERGENCIES

FIRST AID

Skilled emergency first aid treatment can do a great deal to save life and reduce the effects of injury.

The first person available at an accident is unlikely to be a doctor, nurse or an ambulance

professional. The vital link between the casualty and trained professional help is YOU.

Therefore it is important that you should understand the essentials of life saving.

The aims of First Aid:

To preserve life

To limit the effects of the condition

To promote recovery

Giving first aid can be dangerous, so always be watchful for your personal safety. Do not put

yourself at risk. Although there are no cases on record of virus infections (hepatitis B or HIV) being

passes on through mouth-to-mouth resuscitation, there is a small theoretical risk. You must be aware

that such conditions may be spread by blood-to-blood contact.

Action At An Emergency

The first aider should:

Assess the situation

Take in what has happened quickly and calmly

Look for dangers to yourself and to the casualty

Never put yourself at risk

Make the area safe

Protect the casualty from danger

Do not try to do too much yourself


Assess the casualty and give emergency aid

Get Help

Quickly ensure that any necessary specialist help has been summoned and is on the way.

THE A B C OF LIFE

ASSESS THE AIRWAY

Management of the airway is our top priority.

In an unconscious casualty the tongue may fall back to block the airway. By tilting the head back

and lifting the chin forward, the tongue is drawn away from the back of the throat.

Open the airway by tilting the head and lifting the chin. Loosen any tight clothing around the

casualty‟s neck.

Remove and obvious obstruction from the mouth. This includes loose dentures, though well fitting

dentures can be left in place. Don‟t waste time searching for hidden obstructions.

Place one hand along the casualty‟s hairline and press down to tilt the head (keep the thumb and

index finger free to close the nose if artificial ventilation is required). At the same time lift the chin

using two fingertips of the other hand under the point of the chin.

ASSESS THE BREATHING

Always establish that your casualty is breathing. Put your head close to that of the casualty and

whilst looking down at the chest, look, listen and feel for breathing.

If the casualty is breathing:

ASSESS THE CIRCULATION

Next you must establish that your casualty has a carotid pulse. Feel the Adam‟s Apple on the throat.

Place three fingers between the windpipe and the muscle that runs beside it. Check this for at least

five seconds. This is to establish whether or not the casualty has a pulse in order to determine your

next actions.


THE CAROTID PULSE is found in the neck, and is the pulse to locate in an emergency situation to

assess if the brain is receiving blood and oxygen.

IF NO BREATHING OR PULSE IS DETECTED, APPLY CARDIOPULMONARY

RESPIRATION.

Chest compressions are performed with the rescuer‟s hands placed on the chest, two or three finger-

breadths away from the point of the breastbone. This ensures that the compressions are always

performed on the mid to lower third of the sternum, thus avoiding compression of the stomach or

upper abdominal organs. The compressions must always be in the midline of the sternum.

The rescuer should keep the arms straight and perpendicular to the casualty‟s chest so that the

rescuer‟s weight will assist the compression of the chest.

The sternum should be depressed 4-5cms at a rate of 100 compressions per minute.

After 30 compressions, two breaths should be given. Breath is exhaled gently into the casualty‟s

lungs so that the chest rises. Each breath should be of about 2 seconds duration.

Following every tenth breath check the carotid pulse.

Continue until help arrives.

UNCONSCIOUSNESS

Unconsciousness can occur when there is an interruption to the normal activity of the brain.


CAUSES OF UNCONSCIOUSNESS

F – Fainting

I – Infantile Convulsions

S – Shock

H – Heart Attack

S – Stroke

H – Head Injury

A – Asphyxia

P – Poisoning

E – Epilepsy

D – Diabetes

When a casualty becomes unconscious, for whatever reason, there are two main threats to their life,

these being:

the tongue blocking the airway

the casualty vomiting, and inhaling and choking upon this vomit.

When a casualty becomes unconscious, all the muscles of the body relax. As the tongue is a muscle,

the casualty must have the airway opened for them by use of a simple chin lift manoeuvre, or they

will die through lack of oxygen to the brain. The stomach and the sphincters that retain the stomach

contents are also composed of muscle. When a casualty becomes unconscious, these muscles also

relax, allowing stomach contents to regurgitate into the mouth with a risk of blocking the airway.

This can be prevented by simply turning the casualty into the recovery position or turning them using

the log roll.

THE RECOVERY POSITION

1. The casualty should be placed on their side, half on their front, with their head lower and air

way clear to allow free drainage of fluid.

2. The position should be stable.

3. Any pressure on the chest should be avoided.

4. It should be possible to turn the casualty onto their side and return to their back easily and

safely in the event of them requiring resuscitation.


5. Good observation of, and access to, the airway should be possible.

6. The position itself should not give rise to any injury to the casualty.

7. Check limbs frequently for any restriction to circulation from body weight.

SHOCK

Shock is always present when someone is ill or injured.

Is it the decree of shock which can be life threatening.

The main function of the blood is to carry oxygen and nutrients to all of the body tissues via the

circulatory system. When this system fails and insufficient oxygen reaches the tissues, then shock

will develop.

CAUSES OF SHOCK

Shock will occur for many reasons such as:

Respiratory Failure (Breathing Problems)

Cardiac Impairment (Heart Problems)

Reduced Blood Volume

o External Bleeding

o Internal Injuries (Bleeding)

o Severe Burns or Scalds

o Fractures

Infection may cause septic shock (septicemia)

Anaphylactic Shock (allergic reactions)

Dilation of the arteries causing lowering of the blood pressure (faint)


THE MANAGEMENT OF SHOCK

Treatment for shock is directly related to its cause. In general, if we follow the Primary Assessment,

then we are already treating for shock.

Loosen tight clothing at the neck and waist

Ensure there is adequate airway

Check the casualty is breathing

Check circulation

Control any external bleeding and be able to recognise that there may be internal bleeding

Improve the blood supply to the brain by raising the legs above the level of the heart

(providing there are no signs of internal injury or fracture present)

Arrange for urgent removal to hospital when necessary

Talk to and reassure the casualty at all times

Maintain body temperature by keeping the casualty protected by a blanket either placed under

or over them


SIGNS AND SYMPTOMS OF SHOCK

Skin will appear pale (while cold and clammy)

Breathing is distressed

General attitude is anxious/frightened

Pulse may be slow and weaker in a simple faint but will become stronger and return to a

normal rate as the casualty improves.

The next assignment carries information on the endocrine system and diabetes mellitus.

TUTOR TALK: With this assignment you will find the question paper relating to the

work you have completed in the last assignment. All that remains to do is to complete the

question paper and return it to the College for marking. Complete the self-test in this lesson

and check your answers against the text. Your tutor is always available to explain anything

that you do not understand.

© Copyright Reserved

“First we form habits, then they form us. Conquer your bad habits or they will conquer you.”

Rob Gilbert


STUDENT NOTES: Please use the space below for recording what you consider to be

any pertinent information or notes. You may find it helpful to refer back to it later on!

foot health practitioners diploma course - unit seven

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