Overview Gastro-oesophageal reflux disease (GORD) is a common condition, where acid from the stomach leaks up into the oesophagus (gullet). It usually occurs as a result of the ring of muscle at the bottom of the oesophagus becoming weakened. Read more about the causes of GORD. GORD causes symptoms such...

Overview

Every year thousands of people die or are seriously injured in incidents. Many deaths could be prevented if first aid was given before emergency services arrive.

What to do

If someone is injured you should:

• first check that you and the casualty aren’t in any danger, and, if possible, make the situation safe
• if necessary, for an ambulance when it’s safe to do so
• carry out basic first aid

Read more about what to do after an incident.

If someone is unconscious and breathing

If a person is unconscious but breathing, and has no other injuries that would stop them being moved, place them in the recovery position until help arrives.

Keep them under observation to ensure they continue to breathe normally, and don’t obstruct their airway.

If someone is unconscious and not breathing

If a person isn’t breathing normally after an incident, call an ambulance and start CPR straight away. Use hands-only CPR if you aren’t trained to perform rescue breaths.

Read more about CPR, including instructions and a video about hands-only CPR.

Common accidents and emergencies

Below, in alphabetical order, are some of the most common injuries that need emergency treatment in the UK and information about how to deal with them:

• anaphylaxis (or anaphylactic shock)
• bleeding
• burns and scalds
• choking
• drowning
• electric shock (domestic)
• fractures
• heart attack
• poisoning
• shock
• stroke

Anaphylaxis

Anaphylaxis (or anaphylactic shock) is a severe allergic reaction that can occur after an insect sting or after eating certain foods. The adverse reaction can be very fast, occurring within seconds or minutes of coming into contact with the substance the person is allergic to (allergen).

During anaphylactic shock, it may be difficult for the person to breathe, as their tongue and throat may swell, obstructing their airway.

Call 999 or 112 immediately if you think someone is experiencing anaphylactic shock.

Check if the person is carrying any medication. Some people who know they have severe allergies may carry an adrenaline self-injector, which is a type of pre-loaded syringe. You can either help the person administer their medication or, if you’re trained to do so, give it to them yourself.

After the injection, continue to look after the person until medical help arrives. All casualties who have had an intramuscular or subcutaneous (under the skin) injection of adrenaline must be seen and medically checked by a healthcare professional as soon as possible after the injection has been given.

Make sure they’re comfortable and can breathe as best they can while waiting for medical help to arrive. If they’re conscious, sitting upright is normally the best position for them.

Read more about treating anaphylaxis.

Bleeding

If someone is bleeding heavily, the main aim is to prevent further blood loss and minimise the effects of shock (see below).

First, call for an ambulance as soon as possible.

If you have disposable gloves, use them to reduce the risk of any infection being passed on.

Check that there’s nothing embedded in the wound. If there is, take care not to press down on the object.

Instead, press firmly on either side of the object and build up padding around it before bandaging, to avoid putting pressure on the object itself.

If nothing is embedded:

• apply and maintain pressure to the wound with your gloved hand, using a clean pad or dressing if possible; continue to apply pressure until the bleeding stops
• use a clean dressing to bandage the wound firmly
• if bleeding continues through the pad, apply pressure to the wound  until the bleeding stops and then apply another pad over the top and bandage it in place; don’t remove the original pad or dressing, but continue to check that the bleeding has stopped

If a body part, such as a finger, has been severed, place it in a plastic bag or wrap it in cling film and make sure it goes with the casualty to hospital.

Always seek medical help for bleeding unless it’s minor.

If someone has a nosebleed that hasn’t stopped after 20 minutes, go to your nearest accident and emergency department.

Read more about how to treat minor bleeding from cuts and grazes and how to treat nosebleeds.

Haemostatic dressings and tourniquets

In certain situations, where bleeding is very severe and from the body’s extremities, such as the head, neck and torso, it may be appropriate to use haemostatic dressings or a tourniquet.

Haemostatic dressings contain properties that help the blood to clot (thicken) quicker. A tourniquet is a band that’s wrapped tightly around a limb to stop blood loss. Haemostatic dressings and tourniquets should only be used by people who have been trained to apply them.

Burns and scalds

If someone has a burn or scald:

• cool the burn as quickly as possible with cool running water for at least 20 minutes, or until the pain is relieved
• call 999 or seek medical help, if needed
• while cooling the burn, carefully remove any clothing or jewellery, unless it’s attached to the skin
• if you’re cooling a large burnt area, particularly in babies, children and elderly people, be aware that it may cause hypothermia (it may be necessary to stop cooling the burn to avoid hypothermia)
• cover the burn loosely with cling film; if cling film isn’t available, use a clean, dry dressing or non-fluffy material; don’t wrap the burn tightly, because swelling may lead to further injury
• don’t apply creams, lotions or sprays to the burn

For chemical burns, wear protective gloves, remove any affected clothing, and rinse the burn with cool running water for at least 20 minutes to wash out the chemical. If possible, determine the cause of the injury.

In certain situations where a chemical is regularly handled, a specific chemical antidote may be available to use.

Be careful not to contaminate and injure yourself with the chemical, and wear protective clothing if necessary.

Call for immediate medical help.

Read more about how to treat burns and scalds.

Choking

The information below is for choking in adults and children over one year old. Read what to do if a baby under one year old is choking.

Mild choking

If the airway is only partly blocked, the person will usually be able to speak, cry, cough or breathe. In situations like this, a person will usually be able to clear the blockage themselves.

If choking is mild:

• encourage the person to cough to try to clear the blockage
• ask them to try to spit out the object if it’s in their mouth
• don’t put your fingers in their mouth to help them because they may accidentally bite you

If coughing doesn’t work, start back blows (see below).

Severe choking

If choking is severe, the person won’t be able to speak, cry, cough or breathe, and without help they’ll eventually become unconscious.

To help an adult or child over one year old:

• Stand behind the person and slightly to one side. Support their chest with one hand. Lean the person forward so that the object blocking their airway will come out of their mouth, rather than moving further down.
• Give up to five sharp blows between the person’s shoulder blades with the heel of your hand (the heel is between the palm of your hand and your wrist).
• Check if the blockage has cleared.
• If not, give up to five abdominal thrusts (see below).

Don’t give abdominal thrusts to babies under one year old or to pregnant women.

To perform abdominal thrusts on a person who is severely choking and isn’t in one of the above groups:

• Stand behind the person who is choking.
• Place your arms around their waist and bend them well forward.
• Clench one fist and place it just above the person’s belly button.
• Place your other hand on top of your fist and pull sharply inwards and upwards.
• Repeat this up to five times.

The aim is to get the obstruction out with each chest thrust, rather than necessarily doing all five.

If the person’s airway is still blocked after trying back blows and abdominal thrusts:

• Call for help and ask for an ambulance. Tell the operator that the person is choking.
• Continue with the cycles of five back blows and five abdominal thrusts until help arrives.

The person choking should always be seen by a healthcare professional afterwards to check for any injuries or small pieces of the obstruction that remain.

Drowning

If someone is in difficulty in water, don’t enter the water to help unless it’s absolutely essential.

Once the person is on land, if they’re not breathing, open the airway and give five initial rescue breaths before starting CPR. If you’re alone, perform CPR for one minute before calling for emergency help.

Find out how to give CPR, including rescue breaths.

If the person is unconscious but still breathing, put them into the recovery position with their head lower than their body and call an ambulance immediately.

Continue to observe the casualty to ensure they don’t stop breathing or that their airway becomes obstructed.

Electric shock (domestic)

If someone has had an electric shock, switch off the electrical current at the mains to break the contact between the person and the electrical supply.

If you can’t reach the mains supply:

• don’t go near or touch the person until you’re sure the electrical supply has been switched off
• once the power supply has been switched off, and if the person isn’t breathing, call for help and ask for an ambulance

Afterwards, seek medical help – unless the electric shock is very minor.

Fractures

It can be difficult to tell if a person has a broken bone or a joint, as opposed to a simple muscular injury. If you’re in any doubt, treat the injury as a broken bone.

If the person is unconscious, has difficulty breathing or is bleeding severely, these must be dealt with first, by controlling the bleeding with direct pressure and performing CPR.

If the person is conscious, prevent any further pain or damage by keeping the fracture as still as possible until you get them safely to hospital.

Assess the injury and decide whether the best way to get them to hospital is by ambulance or car. For example, if the pain isn’t too severe, you could transport them to hospital by car. It’s always best to get someone else to drive, so that you can deal with the casualty if they deteriorate – for example, if they lose consciousness as a result of the pain or start to vomit.

However, if:

• they’re in a lot of pain and in need of strong painkilling medication, don’t move them and call an ambulance
• it’s obvious they have a broken leg, don’t move them, but keep them in the position you found them in and call an ambulance
• you suspect they have injured or broken their back, don’t move them and call an ambulance

Don’t give the casualty anything to eat or drink, because they may need an anaesthetic (numbing medication) when they reach hospital.

You can read more about specific broken bones in the following pages:

• broken ankle
• broken arm or wrist
• broken collarbone
• broken nose
• broken toe
• fractured ribs
• hip fracture

Heart attack

A heart attack is one of the most common life-threatening heart conditions in the UK.

If you think a person is having, or has had, a heart attack, sit them down and make them as comfortable as possible, and call for help for an ambulance.

Symptoms of a heart attack include:

• chest pain – the pain is usually located in the centre or left side of the chest and can feel like a sensation of pressure, tightness or squeezing
• pain in other parts of the body – it can feel as if the pain is travelling from the chest down one or both arms, or into the jaw, neck, back or abdomen (tummy)

Sit the person down and make them comfortable.

If they’re conscious, reassure them and ask them to take a 300mg aspirin tablet to chew slowly (unless you know they shouldn’t take aspirin – for example, if they’re under 16 or allergic to it).

If the person has any medication for angina, such as a spray or tablets, help them to take it. Monitor their vital signs, such as breathing, until help arrives.

If the person deteriorates and becomes unconscious, open their airway, check their breathing and, if necessary, start CPR. Re-alert the emergency services that the casualty is now in cardiac arrest.

Poisoning

Poisoning is potentially life-threatening. Most cases of poisoning in the UK happen when a person has swallowed a toxic substance, such as bleach, taken an overdose of a prescription medication, or eaten wild plants and fungi. Alcohol poisoning can cause similar symptoms.

If you think someone has swallowed a poisonous substance, call for help to get immediate medical help and advice.

The effects of poisoning depend on the substance swallowed, but can include vomiting, loss of consciousness, pain or a burning sensation. The following advice is important:

• Find out what’s been swallowed, so you can tell the paramedic or doctor.
• Do not give the person anything to eat or drink unless a healthcare professional advises you to.
• Do not try to cause vomiting.
• Stay with the person, because their condition may get worse and they could become unconscious.

If the person becomes unconscious while you’re waiting for help to arrive, check for breathing and, if necessary, perform CPR.

Don’t perform mouth-to-mouth resuscitation if the casualty’s mouth or airway is contaminated with the poison.

Don’t leave them if they’re unconscious because they may roll onto their back, which could cause them to vomit. The vomit could then enter their lungs and make them choke.

If the casualty is conscious and breathing normally, put them into the recovery position and continue to monitor their conscious state and breathing.

Read more about treating someone who’s been poisoned and treating alcohol poisoning.

Shock

In the case of a serious injury or illness, it’s important to look out for signs of shock (see below).

Shock is a life-threatening condition that occurs when the circulatory system fails to provide enough oxygenated blood to the body and, as a result, deprives the vital organs of oxygen.

This is usually due to severe blood loss, but it can also occur after severe burns, severe vomiting, a heart attack, bacterial infection or a severe allergic reaction (anaphylaxis).

The type of shock described here isn’t the same as the emotional response of feeling shocked, which can also occur after an accident.

Signs of shock include:

• pale, cold, clammy skin
• sweating
• rapid, shallow breathing
• weakness and dizziness
• feeling sick and possibly vomiting
• thirst
• yawning
• sighing

Seek medical help immediately if you notice that someone has any of the above signs of shock. If they do, you should:

• call for help as soon as possible and ask for an ambulance
• treat any obvious injuries
• lie the person down if their injuries allow you to and, if possible, raise and support their legs
• use a coat or blanket to keep them warm
• don’t give them anything to eat or drink
• give them lots of comfort and reassurance
• monitor the person – if they stop breathing, start CPR and re-alert the emergency services

Stroke

The FAST guide is the most important thing to remember when dealing with people who have had a stroke. The earlier they receive treatment, the better. Call for emergency medical help straight away.

If you think a person has had a stroke, use the FAST guide:

• Facial weakness – is the person unable to smile evenly, or are their eyes or mouth droopy?
• Arm weakness – is the person only able to raise one arm?
• Speech problems – is the person unable to speak clearly or understand you?
• Time to call for ambulance – for emergency help if a person has any of these symptoms

 

Resources : NHS UK

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

Acanthosis nigricans is the medical term for darkened, thickened patches of skin that usually develop in the armpit and around the groin and neck.

It’s not a condition in itself, but can be a sign of an underlying health problem. These underlying conditions aren’t usually serious, although occasionally acanthosis nigricans can be sign of cancer.

Signs and symptoms

Dark, velvety patches

 

If you have acanthosis nigricans, you’ll have thickened, brownish-grey or black patches of skin.

The patches will be dry and rough, feeling similar to velvet. They may also be itchy.

These patches may occur anywhere, but are usually seen around the neck, in the armpit, around the groin and sometimes in other skin folds. Occasionally, the skin over the joints of the fingers and toes may be affected, as well as the lips, palms of the hands and soles of the feet.

The patches usually develop slowly over time. Patches that grow and spread quickly are more likely to be associated with cancer. In these cases, the mouth, tongue, throat, nose and windpipe may also be affected.

Tiny growths on the skin

You may also have lots of tiny finger-like growths from the patches. This is known as papillomatosis.

There may also be skin tags around the affected area. These are small flesh-coloured or pigmented growths that hang off the skin and look a bit like warts.

When to see your GP

Acanthosis nigricans is usually harmless, but as it can be a sign of something serious it’s a good idea to see your GP if you think you have it. They may suspect acanthosis nigricans just by looking at your skin.

If the cause isn’t clear, you may have blood tests to check your blood sugar or hormone levels, and you might need additional tests such as an endoscopy or X-ray.

What causes acanthosis nigricans?

Acanthosis nigricans sometimes occurs in people who are otherwise in good health, particularly dark-skinned people of African descent.

However, in most cases it’s a sign of an underlying problem or condition such as obesity, diabetes or abnormal hormone levels. Some of the main causes of acanthosis nigricans are outlined below.

Obesity

Acanthosis nigricans is usually the result of obesity. This is known as obesity-associated acanthosis nigricans.

It occurs because obesity can cause insulin resistance (when the body is unable to properly use the hormone insulin), which may lead to high levels of insulin in the blood, affecting the skin cells.

Insulin resistance can also cause type 2 diabetes, so acanthosis nigricans can be an early sign that you have diabetes or are at risk of developing the condition.

Syndromes and hormone problems

Acanthosis nigricans is sometimes associated with an underlying syndrome or hormone problem, such as:

• polycystic ovary syndrome – a condition that affects how a woman’s ovaries work, which can cause excessive body hair, irregular periods, infertility, acne and weight gain
• Cushing’s syndrome – symptoms such as weight gain, bruising and stretch marks caused by very high levels of the hormone cortisol in the body
• acromegaly – where the body produces too much growth hormone, leading to the excess growth of body tissues over time
• underactive thyroid (hypothyroidism) – where your thyroid gland does not produce enough hormones, causing symptoms such as tiredness and weight gain

This type of acanthosis nigricans is known as syndromic acanthosis nigricans.

Medication

Acanthosis nigricans is sometimes triggered by medicines, including insulin, corticosteroids, and hormone treatments such as human growth hormone or the contraceptive pill.

This is known as drug-induced or medication-associated acanthosis nigricans.

Genes

In rare cases, acanthosis nigricans can be caused by a faulty gene inherited directly from your parents. This is known as familial or benign genetic acanthosis nigricans.

This type is usually passed on in an autosomal dominant pattern, which means it can be passed on if only one of your parents carries the faulty gene.

Cancer

If the dark skin patches come on suddenly and spread quickly, it may be a sign you have cancer (usually stomach cancer). This is known as malignant acanthosis nigricans.

This is a rare condition that tends to affect middle-aged or elderly people, regardless of their weight or ethnic background.

The patches are more severe and the mouth, tongue and lips may also be affected. The skin may also become irritated and itchy.

How acanthosis nigricans is treated

Treatment for acanthosis nigricans aims to correct the underlying cause of your symptoms. This will usually cure the acanthosis nigricans or significantly improve the appearance of your skin.

Treatments that may be recommended include:

• losing weight, making changes to your diet and taking medication to reduce the level of insulin in your blood
• taking medication to correct your hormone levels – read about treating Cushing’s syndrome, treating polycystic ovary syndrome and treating an underactive thyroid
• switching to a different medication if it’s triggering your symptoms
• surgery, chemotherapy, or radiotherapy for cancer

There’s no specific treatment to get rid of the patches, but a dermatologist (skin specialist) may be able to recommend treatments such as creams or tablets that may help improve the look of your skin.

Outlook

Most cases of acanthosis nigricans are harmless and not a sign of anything serious. The skin patches often fade with time as the underlying condition is treated.

If you have inherited acanthosis nigricans from your parents, your patches may gradually get bigger before staying the same or eventually fading on their own.

Only in cases where there is underlying cancer is the situation very serious. If the tumour is successfully treated, the condition may disappear, but unfortunately the types of cancer that cause acanthosis nigricans tend to spread quickly and a cure is often not possible.

Resources : NHS UK

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.