Category: Injury

Injury prevention and Safe practice are two vital instruments dancers and musical theatre performers should prioritise in their daily lives as they have direct benefits to the longevity of a dancers career, without these two tools their careers could end before they reach their 30’s or even mid 20’s.

Injury prevention has two essential categories: internal and external. Internal injury prevention focuses on injuries generated because of risk factors such as, lack of technical knowledge, fatigue, lack of sleep, rest, poor nutrition and weak muscles and bones. On the contrary, external injury prevention concentrates on the risk factors involving your environment such as: temperature, flooring e.g is it suitable flooring, clean, does it have slippery or hazardous debris; suitable clothing, the dancer’s spacial awareness and suitable footwear; the choreography being performed can also link to this. Safe practice is linked to activities that help prevent external and internal injuries from happening, these include: warmups/cooldowns, stretching, alignment, supporting injuries and body maintenance.

Learning how to properly perform a piece of movement is beneficial to the length of a dancer’s and musical theatre performers career as knowing the technique behind a particular movement such as, a jump is necessary in preventing an internal injury like a torn anterior cruciate ligament (ACL), and damage to the feet and back. A health and fitness Article on ‘Why Should You Bend Your Knees When You Hit the Ground After a Jump?’ states that ‘When you land following a jump, your knees are at risk for injury because a great deal of force is placed on your bones, muscles and joints’(Ipatenco, n.d.). This is why in styles of dance like ballet you are taught plies from very early stages so that the technique is instilled in the dancer and becomes the norm also known as muscle memory; this is a focus for ballet teachers to teach their students as it is the technical way to land a jump. There are many other internal risk factors that are the main concerns for performers, these concerns can also occur whilst performing a jump. For example, muscle fatigue as a result of lack of sleep can also lead to injuries when jumping as the muscle can not meet the demands of the activity. Not getting enough sleep and rest can be detrimental to a performer’s career as it deprives the body of the energy it needs to perform task thus, causing muscle fatigue, in addition to this lack of sleep makes it harder for us to store new memories as a part of the brain called the hippocampus is activated significantly less and this is responsible for storing long term memories. When we are asleep the hippocampus operates subsequently faster in storing memories, when we are sleep deprived this process has either not happened or has not happened efficiently resulting in the inability to store newer memories as the hippocampus is essentially full. The storing of memories are major in preventing internal injury as it reminds you of how you shouldn’t and should perform a movement, meaning the storing of memories are fundamental in reducing the risk of injury to a dancer. A newly published article (Himmer et al.,2019) performed a study on a number of participants focusing on the role of sleep in system consolidation, resulting in them finding that sleep deprivation has direct correlation to storing and retaining memories using the hippocampus and that it lost its relevance in which another part of the brain known as the posterior parietal cortex took over,“participants learned lists of German words through seven learning-recall repetitions. After a 12 hour interval, during which they either stayed awake or were allowed to sleep for 8 hours…hippocampus losing relevance and the PPC [the posterior parietal cortex] gaining in equal measure”. Furthermore, another crucial element dancers and musical theatre performers must focus on to prevent internal injury is their bones and muscles, correct nutrition and strengthening of muscle will be useful in averting an internal injury. Nutrients like vitamin C, D, and B12 are imperative in avoiding injury, vitamin C helps maintain bone and healthy skin, vitamin D is another one of the main nutrients that are needed to preserve bones and muscle health, lastly vitamin B12 is involved in ensuring the nervous system and red blood cells remain fully healthy also. These nutrients are indispensable as the force and pressure being put on your muscles and bones could be tremendously more damaging if they aren’t taken care of. Iron is another nutrient that is responsible for making red blood cells; a lack of iron could lead to iron deficiency anemia which is very harmful to a dancer as a symptoms of this include lack of energy and shortness of breath. Eating good sources of food containing these nutrients will be favourable to the dancer and musical theatre performer; having said nutrients on a daily basis will help strengthen your bones and muscles which will in turn be beneficial in preventing the likelihood of an injury due to poor nutrition. Although these foods are in charge of giving us the necessary nutrients they also contain proteins needed in repairing lean muscle in the body. Statistics from a website about “Healthy Diet For Dancers” states that “Without adequate protein levels to fuel muscles, a dancers body would not have the strength to perform…As much as 12% to 15% of a dancer’s overall diet should consist of lean proteins found in meat and poultry”(Bryant, n.d.) this shows the proteins are essential to a dancers dietary needs as they help make certain the process of repairing muscle tissue is inevitable. For these reasons I believe dancers should be methodical in making sure they are taking mandatory steps to prevent any internal injuries and elongate the performer’s career..

Making sure the external injury risk factors are kept to a minimum should be prioritised by performers as this will safeguard dancers and musical theatre performers as, these components usually lead to external injuries for example, bruises, cuts, blisters and lacerations. Reducing the debris can stop external injuries from happening, making sure the floor is swept after ever class acquire this goal as performers that may have been using the space prior most likely are to drop items and have may have outside waste on their shoe namely glass, and other sharp and damaging things. This could possibly lengthen the dancers career as no harm should come to performers as a consequence of debris on the floor. Equally removing any accessories that could cause bodily harm to yourself or another person, or any attachments that could fall off or out. This includes earrings, necklaces, bracelets and rings. To add the temperature of the room and layers of clothing are significant and should always be a focus of the performer as your core temperature in dance should always be between 65 and 67 degrees to keep the muscles warm to prevent pulling a muscle as stated in the online article ‘Choosing The Right Temperature for your Studio’ (Shoup, n.d.) This is because when the muscles are cold they are harder to stretch in contrast to your muscles being warm. During a class dancers and performers should try to remove layers of their clothing in order to regulate the core temperature. To conclude, I am convinced that external injury risk factors should be focused on as this can prevent injury and lengthen the performer’s career.

Safe practice focuses on the activities that performers do to prevent an injury from taking place. Exercises used to halt injuries consist of warming up before the class and cooling down after the class is finished, stretching the muscles that are going to be used during the performance allowing the muscles to loosen to stop any muscles from being pulled, having correct alignment during all activities performed as previously mentioned, not having correct technique could lead to an injury, lastly making sure that injuries are correctly supported will be advantageous in recovering from any injury. An online article on ‘Cooldown[s]’ enunciates that “Following this process will help you to recover properly from your dance classes It will optimise your next performance level, Make your body feel more energised and less achy, Make you feel less tired and feint [sic] after classes”(De Jorge-Chopra, n.d.). In summary, safe practice is required if a performer wants to have a lengthy career.

In and outside of my physical classes I use injury prevention techniques and safe practices to ensure that I don’t injure myself within or outside of the class. These techniques include me resting my body and getting sufficient sleep, making sure I wear layers and remove them when I feel it’s necessary to maintain the optimum body temperature and wearing suitable footwear that is specific to each dance style and class. I also make sure that I warm up my muscles and carry out cardio exercises in order to get my heart rate faster. I also self access my body during the war up incase that are any underlying pain that could lead to an injury. To improve my injury prevention and safe practices i think i should begin making written records with all the injuries I may be experiencing and safe practices i have used so that I know where to regularly stretch to allow me to identify improvements. To prevent internal and external risk I will aim to reduce the risk of injury by lessening the risk factors associated with injury and environmental hazards such as knowing the technique behind a movement and making sure the floor is suitable to dance on. Conclusively injury prevention and safe practices should be high-priority to dancer’s and musical theatre performers since if managed suitably and accurately it could lengthen your careers and not shorten it down drastically.

Crush injury is the damage of muscles, blood vessels, and other internal structures resulting from excessive pressure to an area causing local ischemia. Vehicular collisions, industrial incidents, natural disasters, particularly earthquakes or where buildings have collapsed due to bombing are among some of the typical cases in crush injuries.

Crush syndrome, also known as traumatic rhabdomyolysis is a systemic manifestation of crush injury. It involves the liberation of components, damaged proteins, ions from skeletal muscle into the circulation. The syndrome was first reported by Bywater’s and Stead in a case of 5 patients who were trapped under debris in London during World War II, which presented with injury to their extremities, following swollen limbs, hypovolemic shock, dark urine and renal failure leading to individual’s demise. The skeletal muscle is one of the significant muscle tissues in the human body with essential roles such as body movement, maintenance of posture, temperature regulation, storage and movement of materials and support, hence severe damage to it as extensive crush injury can result in high mortality.

A first characteristic in the pathogenesis of crush injury is the disruption of sarcolemma, resulting in becoming leaky. When the skeletal muscle is compressed from a crush injury, ion channels open in response to triggering off stretch receptors resulting in the influx of fluid and electrolytes, including sodium and calcium into the muscle fibres and release of large toxic skeletal muscle components into the circulation. Potassium, myoglobin, uric acid and phosphorus move out of the skeletal muscle into the surrounding extracellular environment, while sodium, calcium and water move down their concentration gradient into the intracellular environment, which results in swelling to the skeletal muscle cells.

Hypovolemia and toxin exposure are the major systematic features of crush syndrome. With the capillaries damaged, their permeability increases and large volumes of intravascular fluid accumulating the damaged muscles and the plasma will accumulate in the traumatised extremities leading to depleting intravascular volume and resulting in shock. Signs of shock include fast pulse rate, lowering of blood pressure, pale skin, nausea, dizziness and thirstiness. In addition to intravascular depletion, patients with crush syndrome are faced with a large toxin load and can develop life-threatening electrolyte abnormalities.

Hypocalcemia occurs resulting from the massive influx of calcium into the affected muscle tissue. Hypocalcemia is especially dangerous when combined with hyperkalemia both which can occur upon reperfusion of ischemic tissue. Hyperkalemia arising from high levels of potassium entering into the systemic circulation can result in cardiac toxicity and death. High levels of potassium are known to be the second most common cause of early deaths following crush injury.

Prolonged compression from extensive crush injury leads to ischemia. Different tissues have different tolerances to the reduction in blood supply, and this is determined by how much energy the tissue consumes at rest and what capacity it has to generate this energy in anaerobic conditions. The peripheral nerves show the least resistance to ischemia, giving their high energy demands, minimal energy reserve and little capacity for anaerobic respiration. The limit blood supply, which in turn limits oxygen delivery, nutrient delivery and waste removal leads to severe damage to the function and structure of peripheral nerves and ultimately, the detrimental diminishment of peripheral pulses.

The duration of ischemia determines the degree of muscle injury. Skeletal muscle can tolerate warm ischemia for up to 2 hours without permanent histologic damage. Two to four hours of ischemia leads to irreversible anatomic and functional changes as a consequence of ischemia itself exhausting the muscles capacity for anaerobic respiration.

Accumulation of sarcoplasmic calcium in the skeletal muscle triggers contraction in attempt to contract, and ATP is diminished. Anaerobic respiration begins and increases amounts of lactate, that dissociates into lactic acid and hydrogen ions. Lactic acid diffuses out of the skeletal muscle, lowering pH and leading to acidosis, which when exposed to ischemia can cause damage to vital protein structures. The resulting calcium overload activates cytoplasmic neutral proteases that lead to the degradation of myofibrillar proteins. Calcium dependent phosphorylases are activated, and cell membranes are degraded. Additionally, nucleases are activated, and mitochondrial ATP production is reduced because of an inhibition of cellular respiration. The development of muscle necrosis will be most apparent in 6 hours of ischemia. If the ischemia persists, the injury due to ischemia and the histological changes will be maximum at 24 hours.

While reperfusion is critical, for reverse ischemia, it also exacerbates the injuries that are already present. Release of entrapments or reperfusion revascularisation results in an ischemia-reperfusion injury. Once compression is relieved, hypoxanthine is converted to xanthine with the use of oxygen which generates the formation of oxygen free radicals that cause damage to the skeletal muscle fibre by targeting the lipid-bilayer. The increase membrane permeability, results in oedema, the influx of fluid and ions. The breakdown products of cell membrane endothelial cells act as a chemoattractant that draws neutrophils to the damaged area. Although neutrophils have useful properties in terms of removing debris, they also promote the formation of cytotoxic substances which in turn produce damaging substances known as myeloperoxidase, that generate more damage within the skeletal muscle fibre.

Another event of traumatic rhabdomyolysis is acute kidney injury, which leads to kidney failure. Damage to the skeletal muscle results in the movement of fluid into the skeletal muscle which causes fluid depletion from the rest of the body causing hypoperfusion, and ultimately ischemia of the kidney, so the blood flow through the kidney is reduced. Another damaging effect of rhabdomyolysis is the allowance of myoglobin held within the skeletal muscle fibre into the circulation as well as into the kidneys where it can dissociate in acidic conditions and result in the formation of intratubular casts. These tubular casts are damaging to the structure and function of the kidney.

Myoglobin vaguely related to haemoglobin is a cytoplasmic hemoprotein consisting of a single polypeptide chain of 154 amino acids, expressed solely in both cardiomyocytes and oxidative skeletal muscle fibres. Containing various ligands, myoglobin can bind not only to oxygen but also carbon monoxide and nitric oxide. Myoglobin reversibly binds oxygen and facilitates its transport from the red blood cells to the mitochondria in the skeletal muscles during periods of increased metabolic activity. It also serves as an oxygen reservoir during periods of inactivity and helps to compensate for falling levels of oxygen.

The myoglobin released into the circulation is taken up by haptoglobin, an alpha two globulin, and disposed of by the reticuloendothelial system. In rhabdomyolysis, the binding capacity of haptoglobin becomes saturated, and free plasma levels rise. When myoglobin reaches between 0.5 and 1.5 mg / dL, myoglobinuria occurs. Myoglobin is not reabsorbed in the renal tubules, and when water reabsorption occurs, it becomes concentrated, resulting in dark tea-coloured urine. In the nephron, myoglobin reacts with Tamm-Horsfall that can obstruct the urine flow and result in leakage of the glomerular filtrate. When it is in an acidic environment, it dissociates into protein and ferrihemates.

Ferrihemates catalyses the formation of free radicals which in turn lead to lipid peroxidation in the renal tubules. The presence of myoglobin itself within the kidneys also triggers the production of vasoconstrictors that will contribute to renal dysfunction. Myoglobin then will scavenge nitric oxide and therefore reduce blood flow and vassal dilation. Besides, high levels of myoglobin are toxic to the kidneys resulting in nephrotoxicity.

Other secondary problems such as the development of compartment syndrome may also occur in crush injury. The skeletal muscle is located in compartments rigid non-compliant fascia; therefore, the pressure within a compartment is usually low, from 0 to 20mmHg. If compression remains, oedema or blood can accumulate due to its inability to expand, restricting the perfusion of that muscle fibre and hinder the function of the tissue. If that pressure is not released, it will lead to tissue necrosis, muscle tamponade and severe damage to skeletal muscle fibre and muscle as a whole. Signs of compartment syndrome include swell and muscle compartment, pain in that area, numbness and as pressure increases it can lead to weakness and even paralysis of that part of the body, developing ischemia and diminished peripheral pulses.

Muscle necrosis from extensive crush injury cannot be reversed. Therefore, it is vital to undertake interventions to limit the pathology of rhabdomyolysis. Volume resuscitation should be the priority to prevent the severe effects of crush injury. Undergoing intravenous isotonic saline, ideally one litre of fluid per hour until six litres of fluid in total is given before releasing the compression can reverse the hypovolaemic shock and minimise the electrolyte imbalances that are part of rhabdomyolysis and crush syndrome process.

Extensive crush injury to skeletal muscle is not compatible with life due to systemic and irreversible effects of crush syndrome. Ischemia-reperfusion injury is the primary mechanism of muscle injury which can result in sudden death. Further studies of new therapeutic agents including, ischemic preconditioning, and the use of medical gases or vitamin therapy, could significantly help experts develop strategies to inhibit ischemia-reperfusion injury.

Abstract

Soccer involves many physical interactions that can result in many severe injuries. Soccer injuries is not a reason not to play soccer. People can get injuries without playing soccer. Players just needs to know how to prevent from getting these risky injuries. This essay is targeting the footballers inform them how to prevent risky injuries.

Soccer is a great way to build endurance, improve speed, and promote fitness, all while enjoying the camaraderie of a team sport. Soccer is a relatively safe activity, but you can still get hurt.

Introduction

Soccer is a sport which includes a lot of physical contact which can lead to a injury. common soccer injuries: Ankle sprain, Wrist fracture, Kneecap bursitis, Meniscal tear, and Concussion

Football involves fast start-and stop motions and physical contact which can result in injury. There are many common football lesions such as Ankle sprain, Wrist fracture, Kneecap bursitis, Mescaline tear and concussion. Football is a great way to build endurance, improve speed and fitness, all while enjoying a team sport’s camaraderie. Soccer is an activity that is relatively safe but you can still get hurt.

An ankle sprain is a tear in the ankle’s ligaments. It’s very normal, but it’s a painful injury. When your ankle gets sprain you feel pain right after you, it’s hard to move and putting weight on it is very painful, causing a lot of pain. Two types of ankle sprains exist: Eversion ankle sprains — occur when the ankle rolls outwards and breaks the deltoid ligaments. Inversion ankle sprains — occur when the foot is bent upwards and the knee rolls inwards. The sprain on the inversion ankle is the more common. Then there’s Eversion. Some causes of an ankle sprain for your sport are Wearing the wrong type of shoes. That puts you in danger of twisting or even falling your ankle. Place unusual ligament stress. This could be walking or running on an uneven surface, jamming your foot or bending your ankle in an unusual manner

Wrist breaks are very popular and cause a variety of complications where there is a tear or split in one or more of the wrist’s bones. When you participate in sports, you may be at higher risk of having a broken bone in your hand and wrist if you have a smaller and more delicate bone disease (osteoporosis). It is important that a broken bone be healed as soon as possible. Otherwise, the bones might not heal properly aligned, which could affect your ability to do daily activities. Also, early treatment will help to minimize pain and rigidity.

Bursitis is swelling of a thin bag of fluid called a bursa. There are around 160 in the body, situated between tendon and bone joints. The bursa’s function is to assist tendon movement over the bone and help lubricate the joint. The symptoms of Bursitis Bursae may become inflamed as a consequence of overuse, or at times as a result of direct contact or trauma. The bursa becomes inflamed, swells up, causing pain over the area affected. Bursitis is more often a disease of overuse, triggered by frequent overlying tendon rubbing. Direct impact or trauma-related injuries are likely to be caused by leakage into the bursa.to protect the bursae should be iced and a protective bandage added.

The menisci are helpless to wounds in which there’s both compression and bending over the knee. Meniscus tears are common in contact sports, like football. It is additionally common for the meniscus to be harmed in conjunction with other knee wounds A sports pharmaceutical doctor will audit side effects, and thrust along the interior and exterior of the knee for ranges of delicacy. He/she will moreover move the knee around in a few ways which will cause torment. He/she may moreover arrange x-rays to search for any intense or wear-and-tear harm to the knee. Depending on the comes about of the over assessment, the doctor may arrange an attractive reverberation imaging (MRI) filter of the knee to see at the knee structures more clearly.

Concussion is caused by a solid affect to the head that leads to issues with considering or other neurological side effects. Concussions can happen in any don when there’s a blow to the head, neck, or body that sends a solid constrain to the head. The side effects of concussion incorporate cerebral pain, cognitive issues such as mental fogginess or changes in memory, issues with adjust and coordination, behavioral changes such as fractiousness, and moderated response time. In spite of the fact that most concussions are not related with misfortune of awareness, brief misfortune of awareness can happen. In cases of suspected sport-related concussion, competitors ought to promptly be evacuated from play and evaluated by a doctor or other authorized wellbeing care proficient. Evaluation starts with assessment for genuine signs of damage such as serious migraine, neck torment, twofold vision, weakness or shivering within the arms or legs, spewing, seizure, or diminished level of awareness.

To conclude, Soccer includes speedy start-and-stop movements and physical contact, which can lead to harm. There are numerous common soccer wounds like Lower leg sprain, Wrist break, Kneecap bursitis, Mescaline tear, and Concussion. Soccer may be a incredible way to construct continuance, move forward speed, and advance wellness, all

Bibliography

1. “Meniscus Tear Symptoms, Diagnosis & Treatment: UPMC.” UPMC Sports Medicine, www.upmc.com/services/sports-medicine/conditions/meniscus-tear.
2. Mike, Mike Walden. “What Is Bursitis? – Symptoms, Causes and Treatment Explained.” Sportsinjuryclinic.net, 30 Aug. 2019, www.sportsinjuryclinic.net/sport-injuries/bursitis.
3. “Hand & Wrist Fractures – Sports Medicine.” Mayo Clinic, Mayo Foundation for Medical Education and Research, sportsmedicine.mayoclinic.org/condition/hand-wrist-fractures/#.
4. Muth, Christopher C. “Sport-Related Concussion.” JAMA, American Medical Association, 27 Feb. 2018, jamanetwork.com/journals/jama/fullarticle/2671029.

Anoxic brain injury, sometimes confused as traumatic brain injury, occurs when the brain becomes deprived of oxygen for a prolonged period of time. The brain, just like every organ, requires a continuous flow of oxygen to function normally. Roughly after six minutes, neural cells begin to die, and normal brain function will begin to cease. The severity of harm and consequences are dependent on the damaged areas of the brain. According to Ramiro and Kumar (2015), “Anoxic brain injury is the leading cause of mortality and morbidity among cardiac arrest survivors.” Medical and nursing management can become challenging because of the unknown outcomes. And although nurses may have the skills required to improve one’s recovery, it is still vitally important to have evidence-based resources to help attain more successful results.

The main objective is to educate and to expand one’s knowledge on the subject of anoxic brain injury. In order to further educate others, nurses must know the physiology, pathophysiology, predisposing factors, and clinical manifestations involved. Understanding the affected organ and its function, along with the physiological process of the injury helps to better nursing management and care for those who may be affected.

Basic Conditioning Factors

B.S. is a 79-year-old married, Caucasian female patient who was medically diagnosed with anoxic brain injury. Her past medical history includes hypertension, hyperlipidemia, chronic obstructive pulmonary disease (COPD), lymphedema, congestive heart failure, a previous myocardial infarction (MI), and depression. The patient is 5’7”, weighs 105.5 kilograms (kg), and has a BMI of 36.41. B.S.’s attending physician was Dr. Christopher Yee, and the nurse providing care was Singrid.

B.S. was admitted to Long Beach Memorial Medical Center (LBMMC) originally as full code status patient but was changed to do not resuscitate (DNR) status by the durable power of attorney (DPOA), has allergies to macrodantin and sulfa, and eats nothing by mouth. The patient’s respiratory specimen resulted positive for metapneumovirus, and was placed on contact and droplet precautions. B.S. was not alert and oriented to person, place, time, and event. The patient was intubated and sedated. She was unresponsive to voice, physical stimulation, and pain, but opens eyes spontaneously.

Erik Erikson, a well-known American-German psychologist, believed that personality developed in a predetermined series of stages from infancy to adulthood. His theory of psychosocial development is centered on the impact of social experiences across the lifespan. According to Erikson’s theory, B.S.’s major developmental level is Integrity versus Despair. This final stage of Erikson’s theory is considered late adulthood; it begins at the age of 65 and ends with death. During this stage, one reflects on their life and all of what they may have accomplished and may feel a sense of satisfaction or failure. It is the reality that their life is coming to an end. Those who are proud of their accomplishments will have a feeling of integrity. On the contrary, those complaining about regrets, not having enough time, and not finding the meaning of life will have a sense of despair (Leifer and Fleck, 2013). As care was provided for B.S. and considering her past medical history of depression, despair was evident at this stage in her life.

Anatomy and Physiology of the Involved Organ

The lungs are a pair of organs that sit on the right and left of the chest and are divided into lobes. The right lung is composed of three lobes and the left is composed of two. The cardiac notch, which is located on the left lung, allows for space for the heart. The two lungs are connected to the trachea, also known as the windpipe, by the main bronchus that branches off into the right and left bronchi. Both the right and left bronchi branch off into smaller tubes called bronchioles. At the end of each bronchiole branch are little air sacs called alveoli. The alveoli is a very important structure of the lungs, because this is where gas exchange occurs. The base of the lungs is bordered by the diaphragm. As being the foundation of the respiratory system, the main function of the lungs is to perform gas exchange by way of the alveoli. Carbon dioxide and oxygen are exchanged to and from in the blood to perfuse tissue (Marieb, Hoehn, and Hutchinson, 2018).

The heart is an organ made up of four chambers and a few valves. It is located at the middle of the chest. The muscular organ is roughly the size of a clenched fist and weighs less than one pound. The four chambers include the following: right and left atrium and right and left ventricle. The heart is the center of the circulatory system with the primary responsibility of pumping blood and supplying the necessary nutrients and oxygen to the body. The right atrium receives deoxygenated blood from the superior and inferior vena cava, which then flows into the right ventricle and to be pumped to the lungs via the pulmonary artery. Once the blood reaches the lungs, gas exchange occurs and oxygenated blood is emptied to the left atrium through the pulmonary vein. The blood then moves into the left ventricle to be pumped through the aorta to be able to perfuse the body (Marieb, Hoehn and Hutchinson, 2018).

The brain has many functions, some of which include our senses, emotions, language, thinking and memory. The skull surrounds the brain and also protects it from injury. The cerebrum, cerebellum, pons, and medulla are the four structures that compose the brain. Each structure is significant in its own way and function. The cerebrum divides into two subparts: the right and left hemisphere. Its functions include the following but are not limited to: initiation and coordination of movement, temperature, touch, vision, hearing, problem solving, and learning. The cerebellum’s primary function is to regulate motor movements and control posture, balance, and speech. The pons and medulla make up the brainstem. The pons relays messages to the cerebellum, regulates breathing, and involved in sleeping, waking, and dreaming. The medulla regulates involuntary life sustaining functions such as breathing, swallowing, and heart rate. The medulla is the most important part of the brain. Without it, one would die (Marieb, Hoehn, and Hutchinson, 2018).

Pathophysiology

Unfortunately, one of the leading causes of mortality and neurologic disability after cardiac arrest is anoxic brain injury (Ramiro and Kumar, 2015). Predisposing factors include cardiac arrest, drowning, trauma, drug overdose, or poisoning. More than 356,000 people in the United States (US) annually suffer from cardiac arrest. Survival rates after hospital discharge is about 10% among adults and of that percentage, 9% survive with good neurological function (Newman, 2018). According to Paterson and Bruins research (2018), survival rates were poor for those aged 80 years or older. Of the 838 patients Paterson and Bruins studied, 285 were eighty years old or older. Of those 285 patients, 4.1% to 12.6% survived one year post cardiac arrest. Advancing age is associated with poor outcome and reduced survival rates following cardiac arrest (Paterson and Bruins, 2018).

The patient’s past medical history of hypertension, COPD, and CHF contributed to her event of respiratory failure, cardiac arrest, and ultimately anoxic brain injury. Hypertension is chronic elevation of blood pressure. When long-term, it can cause end-organ damage, which then results in increased mortality and morbidity rates. This can occur from increased tension on the arteries and heart related to the central nervous system, abnormal function of the renin-angiotensin-aldosterone system, endothelial dysfunction, genes, and environmental factors. COPD is a group of chronic lung conditions that progresses over time. It causes chronic inflammation and irritation to the small airways of the lungs, resulting in bronchoconstriction. Narrowing of these vessels will allow less air to flow in and out of the lungs. Because COPD includes emphysema, chronic bronchitis, and asthma, signs and symptoms will vary. CHF is the inability of the heart to efficiently pump blood forward to meet the demands of the body. Both hypertension and COPD contribute to the development of CHF by increasing systemic and pulmonary vascular resistance. The increased pressure on the vessels causes the heart to work harder. Overtime, the heart will thicken and increase in size, because of the increasing demands. Although the heart is still able to pump blood, it is not as effective (Hinkle and Cheever, 2018).

As previously mentioned, B.S,’s condition of COPD, resulting in increased pulmonary vascular resistance, contributed to her incident of respiratory failure. Failure for gas exchange to occur or having too much carbon dioxide results in respiratory failure. Being deprived of oxygen will cause shortness of breath and a feeling of not receiving enough air to breathe in. Skin, lips, and fingernails may become discolored due to the lack of oxygen. Increased carbon dioxide will cause rapid breathing and altered level of consciousness (Hinkle and Cheever, 2018).

Because the lack of tissue perfusion related to decreased oxygenation and the patient’s history of CHF, consequently, the heart’s electrical activity begins to malfunction. In a matter of time, the heart stops pumping, cessation of breathing occurs, and the patient becomes unconscious. If cardiac arrest is not treated almost immediately, death can follow (Hinkle and Cheever, 2018).

Anoxic brain injury is the primary outcome of cardiac arrest. If cells, specifically neural cells, are deprived of oxygen for more than six minutes, cell death occurs. Abrupt interruption of cerebral blood flow will cause brain injuries (Hinkle and Cheever, 2018). Such injuries are significantly linked to neurological disability ranging from mild deficits to vegetative states (Ramiro and Kumar, 2015).

B.S. was admitted to LBMMC Emergency Department (ED) on February 7, 2020, with a chief complaint of respiratory distress. The patient was found having shortness of breath, agonal breathing, and bradycardic at home by Emergency Medical Services (EMS). Per daughter, B.S. was sick with an upper respiratory infection (URI) for one week with the only signs and symptoms of a cough. On ED arrival, the patient went into pulseless electrical activity (PEA) arrest. Return of spontaneous circulation (ROSC) was achieved after cardiopulmonary resuscitation (CPR), two rounds of epinephrine, calcium gluconate, and bicarbonate. The patient was emergently intubated and hypothermia protocol was initiated. A computed tomography (CT) of the head and a computed tomography angiography (CTA) of the chest was ordered. CT of the head presented no abnormalities; however, the CTA of the chest was concerning for pneumonia. Empiric antibiotics with fluids were administered. Electrocardiogram (EKG) showed Sinus Rhythm with a Left Bundle Branch Block (LBBB) and discordant ST elevation.

On February 12, 2020, B.S. appeared intubated and sedated. The patient was unresponsive to voice, physical stimulation, and pain. Pupils were equal, round, and reactive to light; pupil size was 3 millimeters, sluggish to reaction, and moved spontaneously. According to the Richmond Agitation-Sedation Scale, the patient was categorized as (-4). On the Glasgow Coma Scale, B.S. scored 4:1:T. Upper and lower extremities were flaccid and generalized 3+ edema was present. A Foley catheter and orogastric tube were placed to help facilitate urination and feedings, respectively. Ventilator settings were as follows: assist-control, set respiratory rate of 24, set tidal volume of 450, FiO2 30%, and PEEP of 5. Teaching Plan

Although patient B.S. was intubated and sedated, teaching was still accomplished before every medication administration and procedure that was done. The content that was taught included what medications B.S. was administered and specifically why it was prescribed to her, why passive range of motion (PROM) was being performed, and why turning her every two hours was being done. The student nurse used verbal explanations as way of her teaching method. The medications that were taught were the following: heparin, white petrolatum, pantoprazole, furosemide, and piperacillin. The goal for B.S. was to be able to demonstrate knowledge as to why her medication was being administered, PROM, and turning every 2 hours was performed by way of explaining the concepts taught by the end of shift. The interventions to help achieve the patient’s goal include using slow and simple speech, therapeutic communication techniques, and a calm and quiet learning environment. Because the patient was not able to verbally communicate, the student nurse was not able to validate if learning had taken place.

Article Summary

The purpose of the nursing research article entitled, Communicating with Patients’ Families and Physicians About Prognosis and Goals of Care (Milic et al., 2015), was to improve the communication skill set among critical care nurses while speaking with physicians and patients’ families about prognosis. Statistics show that one-fifth of patients in America receiving care in the intensive care unit (ICU) die shortly after or have decreased functional outcomes. Implementing palliative care is an essential part of medical care in the ICU. To do so, the nurse must be actively involved in communicating such things to the patients’ family. It is part of the nurse’s responsibility to communicate effectively, and often times prognosis and goals of care are not discussed with the patient’s family members, leaving the family in psychological distress (Milic et al., 2015).

The method used to promote effective communication skills was that of an 8-hour-long educational workshop. Nurses from the University of California San Francisco Medical Center who provided care in the following units were encouraged to participate: medical-surgical, cardiac, neurological ICU, emergency department, and those on the rapid response team. Roles and communication techniques were outlined. All those who participated in the study practiced the various skills by way of role play sessions. The learning outcome for the workshop itself was to assess understanding of prognosis and goals of care by patients’ families; communicate the needs of patients’ fam¬ilies to physicians; advo¬cate for family members’ informational and emo¬tional needs; and develop skills for coping with stress, moral distress, and compassion fatigue (Milic et al., 2015).

The educational workshop was held from March of 2011 through April of 2013 with a total of 82 nurses participating. An increase in confidence and communication skills were reported by most, if not all of the participants through a follow-up survey. Of the total nurses who participated, 78 nurses reported a great increase of awareness of their roles and responsibility in ICU communication. Communication is an important aspect in all of health care, especially in critical care. To be more successful in promoting discussion of prognosis and care, nurses require an excellent communication skill set.

Injuries of any sorts are a painful ordeal. In the event that you or somebody near you has gotten injuries in view of the blame of others you will normally be upset and irritated. On the off chance that the injury is the immediate consequence of an incident that you had met in light of somebody’s carelessness you will normally feel furious. Anyway feeling furious won’t remove your torment and personal injury, so you should stay concentrated on what to do on the off chance that you or your friends and family is sufficiently sad to be a casualty of an incident. In the event that you are sufficiently reasonable you will promptly start the way toward making a personal injury compensation claim once you have recalled yourself from the injury.

Incident is a horrible event in anybody’s life. So we can comprehend the agony and injury that you and your family will experience whether you or anybody from your family meets with an incident. As the experience may be horrible and you probably won’t be rationally energetic we are here to attempt and limit your agony by advising you what you ought to do in such an hour of individual emergency. We can obviously can’t limit your sorry yet in any event demonstrate to you an approach to limit your money related weight by recommending that you can make a personal injury compensation claim.

It doesn’t make a difference whether the incident occurred in a working environment, car accident, commercial center or wherever where the obligation of guaranteeing your wellbeing is the obligation of the general population or authority who is the proprietor of the spot. Let us first discuss about the accident that occurs in the work environment. Guaranteeing the wellbeing of the specialists is principally the obligation of the proprietor/association for which you are working. In the event that an incident happens on account of the carelessness of the association, at that point the association/proprietor is obligated for lawful oppression for disregarding the wellbeing standards. Nearby you can likewise make personal injury compensation claims.

Personal injury claim cases will deal with your medicinal costs, loss of your pay and other related issues. The personal injury compensation will likewise consider your agony and enduring settlements and different harms. The compensation claims is ordinarily mulls over your past, present and future doctor’s visit expenses. As you won’t probably work for at some point, you will subsequently lose your acquiring. Compensation claims ought to likewise incorporate the loss of wages on account of the incident that you endured. Like we had said before it doesn’t make a difference whether you had met with the incident in working environment or in light of the driver’s carelessness or because of carelessness of a shop-proprietor as long as you endured damage on account of other careless conduct you can make a personal injury compensation claim. To put forth a fitting defense for pay get the help of a pay legal advisor/lawyer who won’t charge you an expense yet take it from the insurance agency or the individuals who were in charge of your incident.

Have you been a casualty of personal injury? On the off chance that you have been a casualty of personal injury and might want some more data encompassing the issue, you have gone to the correct spot. In the event that you have been liable to personal injury you might encounter genuine interruptions in both your own and expert life. On the off chance that you have been associated with an incident that was not your blame, you might be qualified to get compensation.

In the event that you have been a casualty of individual damage, you might be qualified to get compensation for your misfortunes. How about we start our exchange by illuminating who is qualified to battle for personal injury benefits. Any individual who has been liable to a physical or mental injury because of the carelessness of another might be qualified to get compensation. Some basic physical injuries that typically get remuneration incorporate, yet are not constrained to, back agony, head wounds, neck torment, broken bones, and whiplash. Mental injuries incorporate things, for example, wretchedness and post awful pressure issue. In the event that the carelessness of another has caused you any physical or mental mischief, it is recommended that you contact a lawyer quickly to decide if you are qualified to get personal injury compensation.

Things being what they are, you might be qualified to apply for compensation, however for what reason would it be a good idea for you to? Applying for compensation is very valuable to you. In spite of the fact that you may never have the chance to recoup from all injuries caused to you, you can recuperate from any monetary strain that the harm has caused you. Emergency clinic bills, drugs, and treatments are not modest. In the event that you have endured a budgetary misfortune as a result of another person’s oversights, contact a lawyer today to petition for personal injury compensation. You ought not to need to languish over another person’s bad behaviors!

Are you a victim of a personal injury? If yes, you would certainly need to gather as much information you could in order to be well aware of it. In case you are a subject to personal injury, you certainly might be experiencing some serious commotions both in your professional and personal life. If you are engaged in a road accident which was not your fault, you certainly will be worthy for receiving a compensation for it. In this post, I am going to be discussing what is a personal injury along with why it is significant for you to file a claim and how you can do it. Let me now start the discussion with clarifying who is eligible for personal injury compensation. Any person who has been a subject to any sort of psychological or physical trauma due to the negligence of another person, he/she may be eligible for receiving injury compensation.

Some common physical injuries that mostly have better chances of receiving compensation include back pain, neck pain, whiplash, broken bones and head injuries. The psychological traumas include stuff like post-traumatic stress disorder and depression. In case the negligence of another person has caused you any psychological or physical injury, it is highly recommended to you to get in touch with an attorney instantly to check whether you are eligible for receiving personal injury compensation. So, you may effortlessly apply for accident claim, but the question that arises here is that why should you apply for it? It is necessary for you to know that applying for compensation is highly beneficial for you. However, you might never have the chance to get recovered from the damages that occurred to you but you can recover from any financial strain that this incident has caused you.

You surely need to keep in mind that therapies, hospital bills and medications certainly are not cheap nowadays. In case you have suffered from a financial loss due to some other person’s fault, you surely need to get in touch with an attorney right away to file your personal injury compensation. You surely not need to suffer at all with some other person’s wrongdoings or negligence. In case you are not able to locate a professional attorney by yourself, don’t worry, as you can effortlessly contact your nearby personal compensation office. This office can particularly help you get started on filing your claim and also provide you assistance in locating a professional attorney. In case you are injured due to some other person’s negligence, you almost have 3 years (depending on the condition) to file your injury claim.

In case your claim case goes to court, you might go for a long trial period to get its result. In the beginning, your hired attorney is going to collect all the required material which will then be forwarded to the medical professionals to determine whether or not an injury is occurred in reality or not. Once it gets determined, you will then certainly be eligible for compensation. At the end of the case, a settlement amount will be proposed to the other party who is involved in the compensation case. If they agree to the amount, you will then receive your compensation amount and case will be closed. However, if the other party doesn’t accept or turndown the settlement amount, your reimbursement case will continue to trial and then the settlement amount will be determined by the case judge.

You need to keep one thing in mind that the injury reimbursement amount will not be handed over you to overnight. It surely is going to take some time to get processed. There are many attorneys who also provide claim advice to their clients, which they certainly can use to get their reimbursement in a short time period. Most of the people today don’t have the idea about whether the injury that has occurred is serious or not or is it eligible for an individual damage reimbursement entitlement. So, it is for those people that they need to know no matter how minor or severe your injury is you surely are eligible for an individual damage reimbursement entitlement.

Claiming individual damage reimbursement in UK is not new. There are multiple companies who gets numerous advertisements published in magazines and newspapers for keeping the people aware of the ways they can claim compensation. Furthermore, they also educate people about the injuries for which they can make claim. Accidents are certainly horrendous in any person’s life nowadays. So, we can certainly understand about the injury and agony you and your family is going through when your loved one meets with an accident. As the experience can be unbearable and you won’t probably have the strength to work, well, we are here to help you limit your torment by advising what you can do in such kind of emergency situation. We will certainly help you release the stress of the complete claim process and make a personal injury claim for you.

We currently are working with some of the well-reputed solicitors who have the expertise in helping their clients with claiming the maximum amount of compensation for their personal injury. It certainly not make any sort of difference whether the personal injury you have faced has occurred on a road, at workplace or any place. Guaranteeing the security of the specialists is the principal duty of the association or the proprietor for whom you are working.

Motorcycle riders are unfortunately prone to road accidents as compared to other road users because they are limited when it comes to protecting themselves. These accidents are becoming more rampant over the years and it is advisable that you take extreme measures to protect yourself as a motorcyclist. Injuries that are sustained during a motorcycle accident can be very fatal and can also lead to death. When you suffer a motorcycle injury then you need to hire a Motorcycle Accident Attorney in Illinois so that he can be able to fight for your rights and help get good compensation for your injuries from the Insurance Company.

Some of the causes for these motorcycle accidents are unforeseen because most of the time the accident happens within a flash of a minute that you barely have time to prevent it. Most motor vehicle drivers get distracted on the road through chatting or talking on the phone, talking to a passenger, changing music on the radio, looking for something in the car, eating while driving and so on. Other drivers could be worn out as a result of the day’s work and end up having sleepy bouts when driving. As a result, they end up ramming into a Biker without knowing thereby causing an accident. There is also drunk driving where a driver drives under the influence of alcohol.

Other times the accidents can be as a result of changing lanes without much careful thought especially the motorcycle riders because they can fit on a small space on the road. They do this mostly to avoid traffic jam. So when they maneuver into a lane without due diligence they end up ramming into a moving or a standby vehicle or truck. In most cases, it is the Biker who suffers the injuries that could be fatal or even lead to death. Unfortunately this may happen even if the Biker has full protection gear such a helmet, arm and leg wear and gloves. This is because unlike a vehicle the motorcycle is not cushioned thus it does not protect or prevent you from severe injuries.

Once you are involved in an accident, the first thing you ought to do is check for fatality of the injuries you or any other person involved has sustained. Then you call for an ambulance and report the accident to the local law authorities. From there call your attorney to meet you in the hospital so that he can begin the investigation process of your accident to ascertain how best to represent you in getting compensated for the injuries you have sustained. He will get statements from witnesses, collect evidence on the ground in form of pictures and so on. You need to be fully or well compensated because such accidents cost a lot of money in terms of medical bills, emergency treatments, surgeries or therapy. You may be required to use your own money for the treatment of your injuries. Loss of income due to your inability to return to work as a result of the injuries you sustained. Pain and suffering, change of lifestyle, cost of long-term treatment in case you suffer permanent disability because of the injuries and so on.

In conclusion, it is vital to get an Attorney who will make sure that all of your rights are protected and fight hard to get you the recovery that you deserve. The legal processes can be very long and draining so it is advisable to seek for an experienced Attorney with a good track record of winning such cases so that you get well compensated for your injuries.

Abstract

High exposure to hazards and unsafe behaviors are the most important factors contributing to ocular injuries and visual problems at the workplace. Evidence show high prevalence of ocular injuries in Asian countries. However, in Malaysia, very little is known about the ocular injuries and visual problems of workers in construction industries. A cross-sectional study was conducted on 385 workers (770 eyes, 378 males and 7 females). A comprehensive ocular assessment was done by using Reichert Portable Slit Lamp and a questionnaire was designed to assess the environmental hazards, behavior factors as well as the awareness. The prevalence of ocular injuries is 66.2% (n=255 eyes). Environmental factors were the major causes of ocular injuries and visual problems to the construction workers. There were significant differences found between the occurrence of ocular injuries to dust (70.4%, n=271, p=0.000), chemical (75.8%, n= 292, p=0.000), excessive heat (68.1%, n=262, p=0.000), equipment (60.5%, n= 233, p=0.001), fall (54.8%, n= 211, p=0.000) and limited working space (52.7%, n=203, p=0.002). Lack of knowledge (78.7%, n=303), inadequate training (69.3%, n=267) and low compliancy (62.3%, n=240) were observed. The awareness towards the environment (71.7%, n=276), behavioral awareness (65.7%, n=253) and their stress level (67.5%, n=260) were considered low. The findings indicate high prevalence of ocular injuries among construction workers, poor behavior and awareness among construction workers in Malaysia. Eye safety assessments, training and monitoring are required to improve the eye safety and health at the the workplace.

Introduction

Construction workers are bound to face unpredictable and dangerous situations at the construction sites. Lately, the ophthalmic emergencies departments has experienced a rise in patients, particularly construction workers, as they intensely suffer from ocular injuries. Whether these ocular injuries are treated or left untreated, it can impair their quality of life and their working capabilities. In fact, the ocular injuries may show a substantial loss of working days and show a cost for the health system (Gobba et al., 2017).

The work environment is the main setting that affects a vital part of an individual’s wellbeing. The surroundings of the work area in any field can impact the medical state and productivity of workers (Chauhan et al., 2014). When comparing work environments, the most physically challenging and hazardous environment is in the construction sites. Construction workers are exposed to all kinds of environmental hazards, which arise due to manual handling, tools, small areas, work handled from high heights, excavations, irregular working hours and exposed to different weather conditions. Exposure to these environmental factors may cause industrial accidents to occur (Mock et al., 2017).

Construction workers that revealed unacceptable behaviors at work such as poor knowledge and refusing to wear personal protective equipment strongly increased the chances of developing eye injuries. It was found that these factors contributed to health consequences 10-20 times more in economically developing countries than those in developed countries (Jazari et al., 2018).

The construction workers are being thrown into the sites instead of getting proper training during their probation phase. This can contribute to the occurrence of ocular injuries as the construction workers lack a sense of awareness in terms of the environmental hazards as well as practicing unsafe behaviors (Shamsudin et al., 2015).

In Malaysia, it was found that out of 935 cases with ocular injuries, 440 of them were of work-related ocular injuries, majorly from workers in the construction industry. This was due to environmental factors and their behavioral compliancy towards wearing personal protective eyewear. A total of 86.59% of the workers did not wear personal protective eyewear (Min et al., 2016). Studies have shown that the workers who have a higher possibility of getting injured are immigrants, rather than native-born laborers. Immigrants are currently over-populated in construction work (Adhikary et al., 2017). The construction laborers are essentially bounded in exploitative conditions, restraining them with policies that does not offer much protection (Dutta, 2017). The existing knowledge and awareness about the safety of the surroundings at work is insufficient. It is imperative to increase one’s understanding through applying safe working practices to avoid industrial accidents from occurring (Netto & Hamedon, 2017).

The eye injuries such as subconjunctival hemorrhage, penetrating intraocular foreign body, chemical burns and lacerations, commonly occurred due to environmental hazard exposure and workers’ behaviors in terms of ignorance and compliancy towards wearing personal protective equipment (Almoosa et al., 2017). Despite extensive efforts that have been made to reduce the possibility of getting injuries in the construction industry, many studies are not comprehensive in this respect (Soltanzadeh et al., 2016). Hence, it is imperative to find the root causes so that safety measures can be done to avoid or prevent the occurrence of the ocular injury (Kumari & Daigavane, 2017).

Methods

Study Design

The research is a quantitative method, whereby the data collected from the questionnaire was more towards numerical approach. A cross-sectional survey was done using purposive sampling technique. Workers were evaluated using a validated structured questionnaire and an ocular observation using the appropriate equipment to determine the ocular health status of construction workers who were exposed to occupational hazards at a point of time, between June 2018 to February 2019.

Unit of Analysis

As the research was intended to determine the environmental factors, behavioral factors as well as awareness that is causing the ocular injuries and visual problems, data was collected from each construction worker and hence, the unit of analysis is the individual.

Sampling Frame and Sample Size

The sampling frame defines all elements in the population from which the samples are drawn. The sampling frame for this research were construction workers, in Malaysia. They were identified through phone calls and meetings with the site supervisor, project engineer or person-in-charge. The sample size was decided based on scientific table guidelines given by Krejcie and Morgan (1970). As the population of construction workers in Malaysia are beyond 100000, the sample size required to establish representativeness for generalizability was 384.

Inclusion Criteria

The target population falls under the inclusive criteria, whereby construction workers in the age range of 18-55 years, with no systemic disease, and have been working at the site for more than five months. The participants voluntarily agreed to participate in the study and were allowed to withdraw at any time. Prior to that, a consent form was given beforehand to the participants.

Exclusion Criteria

The exclusion criteria were participants suffering from any systemic disease such as diabetes mellitus, hypertension or atherosclerosis as it may alter the accuracy of the results. Besides that, participants who are not construction site workers were excluded from the study.

Reliability Testing

A questionnaire was given to assess the environmental, behavioral factors as well as the awareness contributing to the ocular injuries. Reliability test was used to measure the internal consistency of the environment, behavior and awareness of the construction workers. The environmental factors consisted of six questions. The scale showed a high level of internal consistency, in which the Cronbach’s α was of 0.701. The behavioral factors which had 3 items had a cronbach’s α of 0.902 and awareness, which consisted of 3 items, had a cronbach’s α of 0.771.

Data Collection

The data collection for this research was conducted from June 2018 to February 2019. The participants are individuals exposed to any type of occupational hazards at the construction site, in the age range of 18 years old to 55 years old. A consent form was given to the participants prior to the examinations. The results were obtained by assessing the ocular health status of the individuals exposed to occupational hazards. Presence of any ocular injuries from the eyelids, lashes, cornea, conjunctiva and crystalline lens were assessed.

Data Analysis

The data collected was analyzed through the Statistical Package for Social Sciences (SPSS). It provided evidence on the environmental hazards, behavioral factors as well as awareness towards the ocular injuries and visual problems. Descriptive and Chi square analysis was made. The association between the ocular injuries and the factors was assessed. The conclusion was made based on the outcome of the data that was collected and analyzed. Hence, the correlation of the possibility of the occurrence of ocular injuries and the factors was determined.

Ethical Consideration

Ethical approval to conduct this study was obtained from the Postgraduate School in Management and Science University, Shah Alam. The consent to perform the assessments to the construction workers from the appropriate companies was obtained. Before conducting the assessments, the construction workers involved in this project were given a consent form.

Results

Out of the 385 construction workers, it was found majority of them were Bangladeshi’s (74.22%, n=285), followed by Indonesians (9.64%, n =37), Malaysians (8.33%, n=32), Pakistanis (4.17%, n=16), Myanmar’s (3.13%, n=12) and Nepal (0.52%, n=2). A total of 64.9% (n=250) of the construction workers did not wear personal protective eyewear. After the eye assessments, it was found that 66.2% (n=255) of the construction workers had ocular injuries. Among the 255 construction workers that had ocular injuries, majority of them had pterygium (54.60%, n=184 eyes), followed by foreign body (28.18%, n=95), subconjuctival hemorrhage (9.20%, n=31 eyes), corneal haze (4.74%, n=16 eyes), laceration (1.78%, n=6 eyes), corneal burn (1.20%, n=4 eyes) and traumatic cataract (0.30%, n=1 eye). When assessing their visual status, majority of the construction workers (83.76%, n=645) had a good visual acuity of less than 6/9. About (15.58%, n=129) had a visual acuity below 6/12. Only a small number of construction workers had poor visual acuity of worse than 6/18 (0.66%, n=5). The environmental exposures causing the ocular injuries to the construction workers had p values of less than 0.05. Hence, it is statistically significant to the occurrence of the ocular injuries. However, behavior and awareness were not statistically significant to the occurrence of the ocular injuries to the construction workers as the p value is above 0.05. The behavior in terms of the knowledge on personal protective eyewear, adequate training provided, compliancy towards wearing PPE and awareness of the hazards were assessed using Likert scale. It was found that the knowledge (78.7%, n=303), training (69.3%, n=267) and compliancy (62.3%, n=240) were low. When assessing the awareness, it was found that the construction workers had low awareness towards the surroundings at work (71.7%, n=276), poor behavioral awareness (65.7%, n=253) and had low pressure at work (67.5%, n=260).

Conclusion

The prevalence of ocular injuries and visual problems were determined through this research and environmental factors (dust, chemical, excessive heat, equipment, fall and limited working space) showed statistical significance to the occurrence of ocular injuries and visual problems, while the construction workers exhibited poor behavior and a lack of awareness. Hence, through this research, organizations as well as the government will determine the severity of the existing situation and hence, implement newer policies in Malaysia to lessen the occurrence of injuries. Not only will the newer policies reduce the occurrence of ocular conditions, but it will also reduce the overall injuries of the construction worker. As construction workers obtain more information regarding their ocular health status, they will take the appropriate steps to prevent injuries from occurring and be more aware of environmental hazards at the construction sites. Students will also benefit from this research as it will help them gain more insights in the body of knowledge.

History of Rock Climbing

Indoor and outdoor bouldering has become a widespread popular sport, which deservedly has been recognised as a suitable sporting event for the upcoming 2020 Tokyo Olympic Games (Jones and Johnson, 2016). Indoor and outdoor bouldering is known now as a well-known sporting activity. The location of this sport usually are indoor climbing facilities with artificial holds, boulders, slabs, and volumes, where as outdoor bouldering uses the environment such as, rock surfaces, rock boulders, or even slabs (Jones and Johnson, 2016).

The objective of participating in rock climbing for participants is to complete a pre-designed route. If the participant falls or uses a different coloured boulder, then this would be classed as a failed attempt Jones and Johnson, 2016). There is a variety of colour coordinated climbing routes which are listed as “grades”. Each colour represents a varied type of difficulty to challenge the climber’s ability. The movements associated with rock climbing may include descending, ascending, and climbing sideways (Jones and Johnson, 2016). However, traditional climbing focuses on equipment such as ropes, clips, and supporters who attached the rope and act as a counter weight for support in case the climber falls (Jones and Johnson, 2016). Sport climbing can take place in either indoor or outdoors. The objective is too complete the set route, along with being attached by a rope. The climber must connect their rope to each fixed anchor point of the wall during the ascent (Jones and Johnson, 2016).

Rock climbing has gained an enormous popularity, it was known more than several years ago, it was estimated that in 2003 1.27 million individuals participated in regular, rock climbing activity (British Mountaineering Council 2003). Fast forward 13 years forward and since 2016, there has been a huge development in the popularity of climbing with an increase 386 indoor climbing facilities, where as in 1988, there was only 40 climbing gyms in Britain (British Mountaineering Council 2016).

Different Types of Rock Climbing

However, within the rock-climbing industry, there is a competitive element. Professional rock-climbing athlete’s partake in indoor climbing, indoor speed climbing, indoor bouldering, and indoor para-climbing. From the list above, only indoor climbing has been accepted for the 2020 Tokyo Olympic Games (Jones and Johnson, 2016). With the increase of physical activity of rock climbing benefitting the welfare of the British citizens, the increase in participating in rock climbing can more than likely increase the percentage of climbing-related injuries meaning an increased percentage of using doctors, physicians, or the NHS for muscular skeletal injuries (Jones and Johnson, 2016).

Indoor bouldering is designed for the climber to participate in low level movements, achieved on a pre-determined route (Jones and Johnson, 2016). Both indoor/outdoor bouldering and soloing do not require as much equipment (ropes, clips, supporter), where-as traditional and lead climbing do. The brutality of the impact of an injury from falling when climbing can depend from the length of the fall and the positioning of the landing. However, no research is presentable to state in the injury incidence in any type of rock climbing (Jones and Johnson, 2016). Although, Campbell et al., (2015) provide statistical information that the likeliness of a climber injuring themselves when participating within indoor climbing ranges from 0.01-0.097 injuries over 1000 hours.

Percentages and Injuries Regarding Rock Climbing

Reported injuries occurring with rock climbing vary between 10% and 81%, where as the irrespective of causing an injury is between 10% to 50% of injuries (Jones, Asghar, & Llewellyn, 2008, (Josephsen et al., 2007, Neuhof et al., 2011, Woollings et al., 2015). Although, more statistical research from Paige, Fiore, & Houston (1998) suggest that between 28%-81% is the cause for self-inflicted trauma-based injuries and, 33%-44% of participants may inflicted chronic, overused injuries (Backe et al., 2009, Jones, Asghar, & Llewellyn, 2008, Woollings et al., 2015, Wright, Royle & Marshall, 2001).

Other injuries when climbing could include shoulder which account for 17% of all injuries and the elbow 8% (majority upper limbs) (Jones and Johnson, 2016), lower limb injuries such as the ankle or foot are usually obtained with falling and the impact from the ground (Jones and Johnson, 2016).

However, focus of this assignment is to study the most reoccurring injury through any variation of rock climbing, finger injuries. It is known that finger injuries are the most common injury within the rock-climbing community, averaging around 33%-52% of climbers sustained (Gerdes, Hafner & Aldag 2006, Rohrbough, Mudge & Schilling, 2000, Schöffl et al., 2015, van Middelkoop et al., 2015).

Finger injuries are usually caused with excessive strain from contractile and non-contractile tissue. This is usually obtained when a great amount of strain is applied when participating is a challenging movement (Jones and Johnson, 2016). Other movements which could inflict on going damage to the fingers is when a climber refuses too “fall” when their feet are no longer within contact of the wall and refuse to let go, resulting in the use of only the upper body limbs to hold their position. Participating in this manor may result in chronical overused injuries from exertion, repetition, and forceful movements on the fingers over numerous climbs (Jones and Johnson, 2016). If so, injuries such as mal-aligned healing and tissue damage located in the fingers and upper limbs (Jones and Johnson, 2016). Campbell et al., (2015) research also agrees with the previous statement due to presenting similar results from their research. It was reported the majority of injuries when rock climbing was 4.2% of injuries over 1000 hours, but 93% of the injuries was due to overuse.

An Impact on Finger Injuries from A Variety of Variables

The above statements suggest the most common injury for climbers who participate in any variation of climbing suffer from the same finger related injuries. With this being said, the hands/fingers are the most vital part of climbing. A climber’s fingers are there to support, stabilise, and ascending when necessary. The previous journals regarding subject of damaging A1-4 pulleys when climbing, it shows the reader that further research on the subject of A1-5 pulleys is required and whether other variables contribute to the reoccurring injury i.e., weight, height, age, sex, or time.

When research related articles regarding finger injuries and whether or variables were to be accounted for the re-occurring injury, it was reports from Woollings, McKay, & Emery, (2015) that women are more likely to sustain sprains compared to be men, whereas males were recorded at a higher percentage than females to suffer from lacerations and fractures. Although, Woollings, McKay, & Emery, (2015) controversially contradict their previous statement by stating there was no evidence to suggest that there is a difference between sexes on the likelihood for injury.

Age was also thought to be a factor for an increase of reoccurring injuries. Furthermore, five studies informed Woollings, McKay, & Emery, (2015) stating there was no increased percentage of risk depending on age. Although, the systematic review showed an increased hand/finger injury within older climbers. Furthermore, one study showed within younger climbers, reinjury is more common with younger climbers, rather than older climbers (Woollings, McKay, & Emery, 2015). Furthermore, a systamtic review, conducted by Woollings et al., 2015 invesigated if the years of climbing aligned with an increase of injury. 3 papers were studied, and the results suggested that there was no significance between years and injury. Although, 4 other papers suggested that their injuries and years of climbing do have a significant injury risk factor. It was thought that after the 5-year period of participating in climbing will increase the chances of injury or re-occurring injuries (Woollings et al., 2015). It was also noted that climbers who participate climbing with the first year will have a higher increased percentage of sustaining an injury (Woollings, McKay, & Emery, 2015)

Woollings et al., (2015) also presented information regarding whether participating in climbing activities increased the risk factor for injury depending on the duration of the session. Results showed that there was no relative connection between an increased duration of time whilst climbing. Information was highlighted participating in any variation of climbing once per wee increased the risk of injury (Woollings et al., 2015).

Bodyweight was also reviewed by Lion et al., (2016) and Woollings, McKay, & Emery, (2015) regarding whether bodyweight had a significant impact on finger injuries when climbing. Results showed that there was no evidence to suggest that a difference in weight could potentially increase the risk factor of finger injury. Although, other resources researched whether a difference in weight could increase the percentage of injury (Lion et al., (2016, Woollings, McKay, & Emery, 2015).

The above research suggests that either there is not enough evidence to present any valuable rationale to discuss whether other variables would have an impact on finger injuries during climbing.

The most interesting results was presented from Woollings et al., (2015) and (Woollings, McKay, & Emery, (2015) regarding years and injuries. It shows that climbers who are relatively new (1st year climbing) and any climbers who exceed the 5-year mark are more likely to suffer finger injuries or reoccurring injuries. Jones & Johnson, (2016) state finger injuries sustain for 33-52% of all rock-climbing related injuries thus, leading to finger injuries being the most reoccurred injury with chronic overuse.

Why Fingers?

According to Jones & Johnson, (2016), the most overused fingers during climbing are the ring and middle fingers. These fingers are usually the centre piece of complicated holds to support the climber’s bodyweight. There is a variety of different grip/hand techniques which apply substantial pressure and stress to the fingers. However, depending on the technique of the grip, evaluating the type of injury to the technique used could diagnose the injury more accurately (Jones & Johnson, 2016).

A climber’s technique for grip could determine whether they have the ability to complete the coordinated route (Jones & Johnson, 2016). Depending on the grip, it depends on the designed route, whether this is big, medium, or small hold, but this depends on the climber’s hands size and ability for this to be seen as a strength or weaknesses.

As previously mentioned, each climbing facility will design and coordinate the difficulty of each route and depending on the colour of the route suggests how difficult the route could potentially be. When a climber progresses further into their development of their climbing ability, they should be able to progress onto the next difficulty of routes. This is when more variations of grip techniques would be introduced such as the open crimp, hooked, crimp, pocket, pinch, and under cling (Jones & Johnson, 2016).

By introducing different grip techniques shows that the holds for the more challenging routes will incorporate smaller hand holds, resulting in the use of crimp grip. This is due too the amount of force and pressure that can be generated from this variation of a hand grip (Jones & Johnson, 2016). The crimp grip is known to be one of the favourited grips within rock climbing due to its volume of force it can generate from the middle and ring finger (Jones & Johnson, 2016). To use this technique, it requires the ring finger to control the revolving movement of the hand, running length ways across the axis.

The difference between the crimp grip and closed crimp grip is the different sized rocks used on. If the rock is small and hard to gain any contact with the hand, then using the closed crimp grip would be suitable.

All fingers are within contact with the finger board by the distal finger tips (index, middle, and ring fingers) and the palms of the hand with the thumb placed over the index finger. Both holds as described above are designed to aid the climber’s performance. Depending on the type of hold is required, 2 different techniques are issued to generate the most power within a small hold. It is most commonly known for climbers to injure their fingers regularly from these holds due to falling or slipping whilst performing this technique (Kubiak, Klugman, and Bosco (2006).

A1-A5 Pulleys

There are 5 different types of pulley’s, all located in each finger. A1 starting near the palm and ending at A5 at the end of the finger. With each pulley contributing to the open and closed crimp grips, each tendon is under immense stress. Schöffl et al., (2015) experimented within the sport of rock climbing, examining the most common injuries over 4 years. The results showed that the pulley’s are the most common injury for rock climbers. It was also noted by Schöffl et al., (2015) that the A2-A4 are vitally important too climbers due to connecting to the underlining bone. It should also be noted that A1,3, and 5 are merely for support and A2-A4 can withstand pressure and exert power and strength.

Bollen, (1990) and Tropet et al., (1990) realised the potential with the A2-A4 pulleys, but also the dangers which may come with rupturing the pulleys. The positives of using the open and closed crimp grip is that the A2 can uphold up to 40kg. However, when participating in rock climbing, an average climber could be over exposing this weight in an excessive amount of force thus leading too damaging, tearing, or rupturing the pulleys (Klauser et al., 2002).

References

1. Backe S, Ericson L, Janson S, Timpka T. Rock climbing injury rates and associated risk factors in a general climbing population. Scandinavian Journal of Medicine & Science in Sports. 2009;19(6):850-6.
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18. Tropet Y, Menez, D., Balmat, P, Pem, R., Vichard, P. Closed traumatic rupture of the ring finger flexor tendon pulley. The Journal of Hand Surgery. 1990;15:745-7.
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Introduction

Penetrating traumatic brain injury (pTBI) remains one of the most devastating and lethal forms of trauma. Prognosis is generally poor and, for those who survive long enough to make it to the hospital, the management of penetrating brain injury presents complex challenges to medical and surgical providers in the civilian sector. Recent experiences in Operation Iraqi Freedom and Operation Enduring Freedom have provided opportunities to study and refine the surgical and medical management of pTBIs that may impact civilian evaluation and management of similar traumas. These experiences demonstrated that aggressive pre-hospital and emergency department resuscitation, followed by immediate surgical management and post-operative intensive care to monitor for and intervene on surgical and medical complications could significantly improve patient outcomes. We begin with a brief case vignette that will introduce a comprehensive discussion on the epidemiology, pathophysiology, evolution of current surgical and medical therapies, complications, and prognostic indicators that may improve outcomes in these challenging cases.

Epidemiology

Penetrating traumatic brain injury (pTBI) is the most lethal form of traumatic head injury. Approximately 70-90% of these victims die before arriving at the hospital, and 50% of those who survive to reach the hospital die during resuscitation attempts. Approximately 32,000-35,000 civilian deaths are attributed to penetrating brain injury each year, with firearms-related injuries being the leading cause of mortality. Less than 20% of civilians who reach a trauma center will undergo a neurosurgical procedure.

Mechanism of Injury

Traumatic brain injury is the result of energy being transferred from an object to the human skull and underlying brain. The penetrating object has kinetic energy that is proportional to the projectile equal to the mass times the square of its velocity (Ek=1/2mv2). Most non-bullet penetrating objects, such as nails or knives, impart less damage to the skull and brain because they have less kinetic energy to transfer on impact. Bullets tend to have less mass, but travel at higher velocities, though bullet velocities can vary based on a number of factors, such as the muzzle velocity, travel through the air, and travel through the impacted target. Modern firearm projectile velocities can range from 200m/s in handguns to more than 1000 m/s in some rifles. High velocity bullets fired from rifles have the potential to do more damage than bullets fired from handguns, though some large caliber handgun rounds are of sufficient mass to make up for their lower velocities with regard to kinetic energy. Other factors to consider include the distance from which the round was fired, the yaw, or tumbling that occurs when the bullet impacts soft tissue, and whether the bullet design causes it to deform or fragment on impact. Bullets fired from closer ranges often cause more damage than when the same bullet is fired from a longer distance. Non-deforming projectiles have a tendency to yaw inside tissue, which increases penetration and results in a moderate wound cavity size, while deforming rounds have more superficial penetrations, but form larger wound cavities.

Pre Hospital Care

Pre-hospital management has developed an increasingly important role in the care of pTBI patients and has the potential to significantly impact outcomes. Pre-hospital care is focused on minimizing secondary injury and delivering the patient to a trauma center alive. This is achieved through effective airway maintenance and optimizing oxygenation, ventilation, and cerebral perfusion. General measures to achieve this include elevating the patient’s head to 30 degrees and maintaining the head in a midline position. Systolic blood pressures 90mmHg should be targeted and maintained. Additionally, oxygen saturation >90%, a PCO2 between 35-40 mmHg (if capnography is available) are common pre-hospital and resuscitation goals.

Emergency Departmental Care

Aggressive resuscitation following pTBI has been associated with improved survival. Furthermore, it is recommended that aggressive therapy be continued through the resuscitation phase, even in patients with initially low GCS scores, as patients who may benefit from hyperosmolar therapy and surgery may be overlooked based on the initial poor neurological exam upon presentation. Treatment in the emergency department should include correction of hypotension and hypoxia, airway maintenance to include placement of a surgical airway if there is co-existing oromaxillofacial trauma, control of any associated hemorrhaging (i.e. packing facial wounds), hyperosmolar therapy with mannitol or hypertonic saline, correction of traumatic coagulopathy, placement of a cervical immobilization device, an urgent CT scan of the head and neck, and tetanus and antibiotic prophylaxis. Plain films are not necessary if a CT is obtained. Seizure prophylaxis is typically started in the emergency room. Excessive crystalloid should be avoided, and colloid is contraindicated given the association with elevated ICPs. Steroids, including recent trials evaluating the use of progesterone in severe TBI, have either shown no benefit or increased risk of death and should also be avoided. Blood products should be available for transfusion, as well as cryoprecipitate, prothrombin complex concentrates and, in rare cases, recombinant Factor VIIa to help control bleeding.

Surgical Management

The surgical treatment of penetrating brain injury has evolved significantly over the past century. Prior to 1889, pTBI patients did not typically undergo surgery due to ineffective hemostasis and poor post-operative infection control. Dr. Harvey Cushing was the first to develop a formal approach to the management of pTBI.

A challenging aspect to the surgical management of pTBI is the selection of appropriate surgical candidates. There is extensive literature that has attempted to identify which patients may benefit from surgery. Poor prognostic indicators have previously been identified as old age, low admission GCS, abnormal pupil reactivity, bi-hemispheric involvement, path of the projectile, and loss of the basal cisterns on imaging. A GCS of 3-5 and/or a projectile path crossing the midline at the level of the corpus callosum, through the bilateral thalami, basal ganglia posterior fossa/brainstem or through an area 4cm above the dorsum sellae containing the vessels of the Circle of Willis known as the “zona fatalis” has historically resulted in the withholding of surgical care.

Post-Operative Medical Management

Post-operative management of pTBI patients is critical to improving survivability and functional outcomes and requires a multidisciplinary approach. For approximately two weeks following the onset of injury, close monitoring of intracranial dynamics allows secondary injury to be identified and for prompt intervention when this occurs. Intracranial hypertension is common, and may be associated with, decreased cerebral perfusion pressures (CPP), cerebral ischemia, seizures, vasospasm, arteriovenous fistula formation, or traumatic aneurysm rupture as a direct result of pTBI. Maintaining ICP 60mmHg using general measures (head mid-line, head of bed elevated to 30 degrees, control of pain and temperature) hyperosmotic therapy, sedation, neuromuscular blockade, and induced hypothermia may improve outcomes by limiting secondary injury. TCD can help monitor cerebral blood flow as well as assess for evidence of developing cerebral vasospasm in the setting of traumatic subarachnoid hemorrhage.

Patients who have sustained pTBI are at higher risk for the development of non-neurologic complications as well. For example, pTBI patients are at high risk for Acute Respiratory Distress Syndrome (ARDS). This condition is also associated with the use of fluids and vasopressors used to maintain an adequate CPP. When this occurs, patients may require extracorporeal membrane oxygenation or high frequency oscillations since hypercapnea and prone positioning can worsen secondary brain injury. Patients also require observation of their cardiovascular status (to include cardiac rate, rhythm, and blood pressure), monitoring for the development of diffuse intravascular coagulopathy, infection, kidney injury, and skin breakdown.

References

1. Rosenfeld JV, Bell RS, Armonda R (2015) Current concepts in penetrating and blast injury to the central nervous system. World J Surg 39: 1352-1362.
2. Joseph B, Aziz H, Pandit V, Kulvatunyou N, O’Keeffe T, et al. (2014) Improving survival rates after civilian gunshot wounds to the brain. J Am Coll Surg 218: 58-65.
3. Aarabi B, Tofighi B, Kufera JA, Hadley J, Ahn ES, et al. (2014) Predictors of outcome in civilian gunshot wounds to the head. J Neurosurg 120: 1138-1146.
4. Department of Defense 2015. DOD Worldwide Numbers for TBI. Defense and Veterans Brain Injury Center.
5. Zafonte RD, Wood DL, Harrison-Felix CL, Millis SR, Valena NV (2001) Severe penetrating head injury: a study of outcomes. Arch Phys Med Rehabil 82: 306-310.
6. Coronado VG, Xu L, Basavaraju SV, McGuire LC, Wald MM, et al. (2011) Surveillance for traumatic brain injury-related deaths–United States, 1997-2007. MMWR Surveill Summ 60: 1-32.
7. Aarabi B, Mossop C, Aarabi J (2015) Surgical Management of civilian gunshot wounds to the head. Handb Clin Neurol 127: 181-193.
8. CDC (2014) Injury Prevention and Control: Traumatic Brain Injury-Severe Traumatic Brain Injury.