Heart Attack

What is a heart attack?

A heart attack (also called myocardial infarction and acute coronary syndrome) is when part of the heart muscle is damaged or dies because it isn't receiving enough oxygen. Normally, the blood in your coronary arteries carries oxygen to the heart muscle. Most heart attacks occur when a blockage slows down or stops the flow of blood through these arteries.
Heart attacks are usually treatable when diagnosed quickly. However, without treatment, heart attacks can be fatal.

What do women need to know about heart attacks?

Women are less likely to survive heart attacks than men. No one knows why. It may be that women don't seek or receive treatment as soon as men, or that they don’t recognize the symptoms of a heart attack, which can be different from the symptoms that men experience. It may be because women's smaller hearts and blood vessels are more easily damaged. Doctors are working on finding answers to these questions. Clearly, it makes sense to prevent heart problems before they start.

Symptoms

What are the symptoms of heart attack?

Symptoms of heart attack may include:

• Chest discomfort, which may feel like pain, pressure, tightness, heaviness or burning (also called angina).
• Pain or discomfort in the neck, shoulders, lower jaw, arms, upper back or abdomen.
• Shortness of breath that lasts more than a few seconds.
• Feeling lightheaded, dizzy or faint.
• Nausea and/or vomiting.
• Unusual sweating.
• Overwhelming fatigue.
• Feeling anxious.
• Heart palpitations (feeling like your heart is beating really fast, or out of rhythm).

Are the symptoms of heart attack different for women?

Like men, the most common heart attack symptom for women is pain or discomfort in the chest. However, women may also have a heart attack without having any chest pain. Women should be especially aware of the other possible symptoms of heart attack, including shortness of breath, sweating, fatigue and dizziness.

What should I do if I have symptoms of heart attack?

If you think you may be having a heart attack, it’s important to seek treatment right away. Follow these steps:

• Dial 911 or call an ambulance right away. Do not drive yourself to the hospital.
• After calling for emergency medical help, chew and swallow 1 uncoated adult aspirin (325 mg) or 4 uncoated baby aspirins (81 mg each). Don’t take the aspirin if you’re allergic to aspirin.
• If you are alone, unlock your door to let emergency help enter your home.
• Sit in a comfortable chair and wait for help.
• Keep a phone near you.

Causes & Risk Factors

What causes heart attack?

A heart attack occurs when part of the heart muscle is damaged or dies because it isn't receiving enough oxygen. The arteries that carry blood and oxygen to the heart are called coronary arteries. Blockages in one or more of the coronary arteries can reduce the flow of blood and oxygen to the heart.
Usually, a blockage starts with atherosclerosis. Atherosclerosis is the buildup of fatty deposits (called plaque) inside your arteries and the hardening of your artery walls. The buildup is like the gunk that builds up in a drainpipe and slows the flow of water. When plaques become cracked or damaged, blood clots can form. If a clot forms in one or more of the coronary arteries, the clots can slow down or stop blood flow to the heart.

Risk factors for a heart attack

• Smoking
• Diabetes
• Age--Risk increases for men older than 45 years of age and for women older than 55 years of age (or after menopause). About 83% of people who die from heart disease are 65 years of age or older.
• High cholesterol level
• High blood pressure
• Family history of heart attack
• Race--African Americans, Mexican Americans, Native Americans and native Hawaiians are at greater risk.
• Atherosclerosis (hardening of the arteries)
• Lack of exercise
• Stress
• Obesity
• Sex (Gender)--More men have heart attacks, although heart disease is the leading cause of death for American women.

Diagnosis & Tests

How is heart attack diagnosed?

You may need several tests to determine the cause of your symptoms.

• Electrocardiogram (ECG, or sometimes called “EKG”): Your doctor will want you to have an ECG. This test records the electrical activity of your heart. It can help diagnose heart rhythm problems or any damage that the decrease in blood flow may have caused to your heart.
• Blood tests: Your doctor will probably order blood tests to help diagnose your symptoms. When not enough blood flows to the heart, special proteins leak into the blood system. A simple blood test can detect these proteins. Your doctor will probably want to test your blood several times during the first 24 hours to 48 hours after yours symptoms start.

Other tests your doctor may want you to have include:

• Echocardiogram: This test sends out sound waves that allow your doctor to get pictures of your heart. The pictures show your doctor how well your heart is pumping. It can also show if there are problems with your heart valves.
• Chest X-ray: This test allows your doctor to evaluate the size and shape of your heart. It also shows if there is any congestion (fluid) in your lungs.
• Nuclear imaging: This test involves injecting a very small amount of a radioactive substance into your blood. This substance travels to your heart. Then, a special camera or scanner uses the radioactive substance to produce pictures that show how well your heart is pumping. The radioactive substance is safe and leaves your body completely after the test is finished.
• Coronary angiography: This test is sometimes called cardiac catheterization. In this test, a long tube is inserted into a blood vessel. The tube is guided to the heart or arteries that carry blood to the heart. Then, a substance is injected into the tube. This substance is visible by X-ray. It allows your doctor to see where the blockage that caused the decrease in blood flow to your heart is located.

Treatment

How is heart attack treated?

Your treatment will depend on what is causing your symptoms. If you have an acute case of angina (chest pain), your doctor will probably give you nitroglycerin. Nitroglycerin can temporarily relieve your symptoms and improve blood flow to your heart. It does that by widening the arteries that carry blood to the heart.
If you are having a heart attack, your doctor may give you a medicine called a thrombolytic, or may choose to do an angiography and possibly an angioplasty or stent. A thrombolytic drug can help dissolve the blood clot that is blocking the coronary artery. An angioplasty is a procedure in which a tiny balloon is inserted through an artery in the arm or leg up to the heart. The balloon pushes open blocked coronary arteries. A small metal rod called a stent might be put into the artery where the blockage was to hold the artery open.
If an angioplasty and/or stenting are not appropriate, you may need coronary artery bypass surgery. This is a major surgery, in which the doctor takes either veins from your legs and/or an artery from your upper body to bypass the blockages in your coronary arteries. Coronary bypass surgery allows blood to flow to the area of the heart past the blockage.
Regardless of the treatment your doctor selects for you, the sooner you get medical help, the greater your chances of surviving a heart attack. Do not delay getting immediate medical attention if you are experiencing symptoms of heart attack.
Treatment of heart attack also includes medicines that you will need to take even after you leave the hospital. These medicines help improve blood flow to your heart, prevent clotting, and reduce the risks of having another heart attack. These medicines include: aspirin, beta blockers, statins, ACE inhibitors and fish oil. Your doctor will prescribe the medicines that are right for you.
If you have had a heart attack, your doctor will also talk to you about lifestyle changes you can make to prevent more heart problems.

What is a cardiac rehabilitation program?

Before you leave the hospital, your doctor will probably talk to you about enrolling in a cardiac rehabilitation program. A cardiac rehabilitation program provides information that will help you understand your risk factors. The program will also guide you to begin a heart-healthy lifestyle that can prevent future heart problems. You will learn about exercise and diet, and how to reach and maintain a healthy weight. You will also learn ways to control your stress level, your blood pressure and your cholesterol levels.
Your cardiac rehabilitation program will probably start while you are still in the hospital. After you leave the hospital, your rehabilitation will continue in a rehab center. The rehab center may be at the hospital or in another location.
Most cardiac rehabilitation programs last 3 to 6 months. Your doctor will talk to you about how often you need to attend the program. Once you enroll in a cardiac rehabilitation program, regular attendance is very important. The more you learn and make changes in your lifestyle to live a heart-healthy life, the better your chances of preventing more heart problems in the future.

Complications

What does depression have to do with my heart attack?

Depression is common after a heart attack. As many as 1 out of every 3 people who have a heart attack report feelings of depression. Women, people who have had depression before, and people who feel alone and without social or emotional support are at a higher risk of depression after a heart attack.
Many people who have depression don’t recognize it, seek help or get treatment. Being depressed can make it harder for you to recover physically. However, depression can be treated.

What is depression?

Depression is a medical illness, just like diabetes or high blood pressure. The emotional and physical symptoms of depression include some or many of the following:

• Feeling sad or crying often (depressed mood)
• Losing interest in daily activities that used to be fun
• Changes in appetite and weight
• Sleeping too much or having trouble sleeping
• Feeling agitated, cranky or sluggish
• Loss of energy
• Feeling very guilty or worthless
• Problems concentrating or making decisions
• Thoughts of death or suicide

How will I know if I am depressed?

People who are depressed have symptoms from the list above nearly every day, all day, for 2 or more weeks. Depressed mood and loss of interest in daily activities are two of the most common symptoms.
If you have some or all of the symptoms of depression, see your family doctor. Your doctor will ask you questions about your symptoms, your health and your family's history of health problems.

Prevention

What can I do to help prevent heart attack?

A healthy lifestyle can help prevent heart attack. This includes:

• Quitting smoking if you smoke, and avoiding secondhand smoke.
• Keeping a healthy diet that is low in fat and low in cholesterol.
• Exercising regularly.
• Managing your stress.
• Controlling your blood pressure.
• Managing your blood sugar level if you have diabetes.
• Seeing your doctor regularly for check-ups.

Will I have to take medicine for the rest of my life?

Probably. If you have had a heart attack, your doctor will probably want you to take certain medicines for a long time to reduce your risk of more heart problems. Your doctor can answer any questions you have about these medicines, such as the benefits and risks of taking them.
Aspirin can reduce the risk of a heart attack. Your doctor may want you take a low dose of aspirin each day to keep your blood from forming clots that can eventually block the arteries. Talk to your doctor about the risks and benefits of aspirin therapy.
Antiplatelet drugs can also help stop blood clots from forming. Blood clots can block the arteries that carry blood and oxygen to the heart (called the coronary arteries) and cause a heart attack or a stroke. These drugs are especially important to take for at least a year if you have had a stent placed in your heart.
Beta blockers are a group of drugs that lower the heart rate and blood pressure. They help improve blood flow to the heart.
ACE inhibitors are a group of drugs that can help if your heart is not pumping blood well. This medicine helps open (dilate) your arteries and lower your blood pressure. This improves blood flow.
Statins are a group of drugs that are used to lower “bad” cholesterol (also called LDL, or low-density lipoprotein) levels and may help increase “good” cholesterol (also called HDL, or high-density lipoprotein). If you have had a heart attack, your doctor may prescribe a statin.

I’m a woman. Can estrogen replacement therapy reduce my risk for heart disease?

No. Estrogen replacement therapy, also called hormone replacement therapy (HRT), was prescribed by doctors because they hoped it could help guard against certain diseases as well as treat the symptoms of menopause. It was once thought that HRT could help protect against heart disease. New studies have shown that when it comes to heart health, HRT actually does more harm than good. If you’re taking HRT to help prevent heart disease, talk to your doctor about whether you should stop.

Questions to Ask Your Doctor

• What is the likely cause of my heart attack?
• How serious was my heart attack?
• What course of treatment do you recommend? Do I need medicine? Surgery?
• Do I need to participate in a cardiac rehabilitation program?
• When can I return to normal physical and sexual activity?
•  What is my risk of having another heart attack?
• Are my family members at an increased risk of heart attack?
• Do I need to take medicine(s) to prevent another heart attack?
• Will the medicine(s) interact with any of the medicine(s) I already take?
• What lifestyle changes should I make at home to prevent another heart attack?

Cord blood and stem cells.

About Cord Blood

What is cord blood?

Cord blood, also called “placental blood”, is blood that remains in the umbilical cord and placenta following the birth of a baby. During pregnancy, the umbilical cord functions as a lifeline between mother and child. After a baby’s delivery, the cord blood present in the umbilical cord could offer hope for the child or members of the family.

What are cord blood stem cells?

Cord blood is a rich source of haematopoietic stem cells (HSCs), which are primarily responsible for replenishing blood and regenerating the immune system. They have the unique ability to differentiate into various cell types found in blood as depicted in the diagram below:

and immune cells

Red Blood

Carry oxygen to all cells in body

Why Bank Cord Blood

Top 5 reasons why you should consider cord blood banking

• 1 in 217 individuals may need a haematopoietic stem cells (HSCs) transplant by the age of 70 according to a scientific paper published in 2008.
• It is once-in-a-lifetime chance to collect cord blood – a readily available source when needed in the future.
• 60% higher chance of locating a matching cord blood unit in the family versus bone marrow.
• Research showed that patients have a lower chance of complications in transplants when they receive stem cells from a relative.
• Some of the most common cancers are treatable with a stem cell transplant. For instance, lymphoma and leukaemia are two of the top 10 common cancers for adults and among the top 5 most common childhood cancers in India.

• Cord Blood Processing

• Stem cell isolation is a critical step in cord blood banking. It affects the number of stem cells that can be harvested or recovered from the cord blood. Cell recovery rates are critical because a higher number of stem cells could enhance the success of the transplant or treatment.

• How Are Stem Cells Used

• Stem Cell Transplantation

• This is done to reconstitute a patient's blood and immune system, following treatments such as chemotherapy or radiotherapy, which destroys blood cells.

• The stem cells are infused directly into the patient's bloodstream, which migrate to the bone marrow. Inside the bone marrow environment, the stem cells begin differentiating into the three blood cell types - red blood, white blood and platelets. This initiates the regeneration of the patient's blood and immune system.

• The first  cord blood transplant was performed in 1988 in France, which successfully treated a 5-year old boy with Fanconi's Anaemia. To date there have been more than 30,000  cord blood stem cell transplants reported worldwide.

  Cellular Therapies

  Many newer applications are still undergoing development. In some cases, like spinal cord injury and heart attacks, the cells are directly injected into the damaged tissues. Some of the benefits experienced appear to be due to new blood vessel formation, which restores blood flow to damaged tissue.
  As these treatments develop, we expect to see cord blood stem cells used in different ways. In some cases, the stem cells will be treated in the laboratory to make new cell types before use. In other cases, they will be delivered directly into the damaged tissue.

  DISEASES TREATED WITH STEM CELLS

  Haematological Disorders

  Haematological Stem Cell Disorders
  • Aplastic Anaemia (Severe)
  • Fanconi Anaemia
  • Paroxysmal nocturnal haemoglobinuria (PNH)
  Acute Leukaemias
  • Acute Lymphoblastic Leukaemia (ALL)
  • Acute Myelogenous Leukaemia (AML)
  • Acute Biphenotypic Leukaemia
  • Acute undifferentiated Leukaemia
  • Acute Myelo-monocytic Leukaemia
  Chronic Leukaemia
  • Chronic Myelogenous Leukaemia
  • Chronic Lymphocytic Leukaemia
  • Juvenile chronic Myelogenous Leukaemia
  • Juvenile Myelomonocytic Leukaemia
  Myeloproliferative disorders
  • Acute myelofibrosis
  • Agnogenic myeloid metaplasia
  • Polycythaemia Vera
  Lymphoproliferative disorders
  • Non-Hodgkin’s lymphoma
  • Hodgkin’s disease
  • Prolymphocytic leukaemia
  • Chronic Granulomatous disease
  • Neutrophil actin deficiency
  • Reticular dysgenesis
  Myelodysplastic Syndromes
  • Refractory Anaemia
  • Refractory Anaemia with ring sideroblasts
  • Refractory Anaemia with excess blasts
  • Refractory anaemia with excess blasts in transformation
  • Chronic myelo-monocytic leukaemia
  • Beta Thalassaemia Major
  • HbE Beta Thalassaemia
  • Pure Red Cell Aplasia
  • Sickle Cell Disease
  Inherited Platelet abnormalities
  • Amegakaryocytosis - I
  • Congenital thrombocytopenia
  • Glanzmann thromboasthenia
  • Essential Thrombocythaemias
  Histiocytic disorders
  • Familial erythrophagocytic Lymphohistiocytosis
  • Histiocytosis X
  • Haemophagocytosis

  Metabolic Disorders

  Liposomal Storage Disease
  • Mucopolysaccharidosis
  • Hurlers Syndrome
  • Hunters Syndrome
  • Scheie syndrome
  • Sanfillipo syndrome
  • Morquio syndrome
  • Macroteaux-Lamy syndrome
  • Sly syndrome
  • Beta Glucuronidase deficiency
  • Adrenoleukodystrophy
  • Mucolipidosis II
  • Krabbe disease
  • Gauchers disease
  • Niemann-Pick disease
  • Wolman disease
  • Metachromatic leukodystrophy

  Immunological Disorders

  Phagocytic disorders
  • Chediak-Higashi syndrome
  • Ataxia – telangiectasia
  • Kostmann syndrome
  • Leukocyte adhesion deficiency
  • DiGeorge syndrome
  • Bare Lymphocyte Syndrome
  • Omonn’s syndrome
  • Severe combined immune deficiency
  • SCID with adenosine deaminase deficiency
  • Absence of T & B cells SCID
  • Absence of Tcells, Normal B Cells SCID
  • Common variable immune deficiency
  • Wiscott Aldrich Syndrome
  • X-linked Lymphoproliferative disorder
  Plasma cell disorders
  • Multiple Myeloma
  • Plasma cell leukaemia
  • Waldenstorm’s macroglobulinemia
  Other Inherited disorders
  • Lesch-Nyhan syndrome
  • Cartilage-hair hypoplasia
  • Osteopetrosis

  Other malignancies

  Breast Cancer 
  • Metastatic Breast Cancer
  • Inflammatory Breast Cancer
  • Triple Negative Breast Cancer

  Rational of High-dose chemotherapy with stem cell transplant

  High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacingblood - forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood, bone marrow of the patient or a donor or umbilical cord blood are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.
  • Ewings sarcoma 
  Neuroblastoma 
  • Childhood Central Nervous System Germ Cell Tumors
  • Childhood Extra-cranial Germ Cell Tumors
  Renal Cell Carcinoma
• Renal Cell Carcinoma
• Metastatic Renal Cell Carcinoma

• How Is Cord Blood Collected

  • Collection of your baby’s cord blood 

  • After the baby is born, the umbilical cord will be clamped and within minutes, the obstetrician or caregiver will drain the cord blood into a sterile double-wrapped single-use blood bag. This procedure is painless and risk-free to both you and your baby. It takes about 3 minutes and does not alter the birthing process in any way. It can be done with either a vaginal or caesarean delivery.

    The Future of Stem Cells

    Future application of cord blood stem cells

    The list of stem cell treatable diseases continues to grow at a rapid pace. With the potential to become different cell types, scientists are exploring the possibility of using cord blood stem cells to treat some of the most common life-threatening diseases such as heart diseases and stroke. Thus, saving your baby’s cord blood now can ensure your child's access to his/her own stem cells for such cellular therapy in the future.

White Blood

Fight Injection

Platelets

Assist blood clotting in case of injury

Learn to Say No to an Antibiotics Prescription (and When You Should Say Yes)

Despite all our knowledge that antibiotics don’t kill viruses and the undeniable risk of overuse to public and personal health, doctors routinely prescribe antibiotics when the drugs aren’t necessary, found a recent Consumer Reports survey of 1,000 adults. This can lead to the growth of “superbugs”—bacteria that can’t be controlled even with multiple drugs—and serious consequences.

MRSA and other resistant bacteria infect at least two million people in the United States annually, killing at least 23,000. Several major medical organizations, including the American Academy of Family Physicians and the American Academy of Pediatrics, have recently tried to correct antibiotic misuse by explaining when the drugs are and aren’t needed.

1. Ear infections

When to say no: Most ear infections improve without drugs, especially in children two and older. Wait two to three days to see if symptoms subside.

When to say yes: Drugs may be needed right away for babies six months and younger with ear pain, children from six months to two years with moderate to severe ear pain, and children two and older with severe symptoms.

2. Eczema

When to say no: Antibiotics don’t relieve most causes of itchy, red skin. Instead, moisturize or ask your doctor to recommend a medicated cream or ointment.

When to say yes: If there are signs of a bacterial infection, such as bumps or sores full of pus, honey-colored crusting, very red or warm skin, and fever.

3. Eye infections

When to say no: Doctors often prescribe prophylactic antibiotic eyedrops after treating eye diseases, such as macular degeneration, with injections. But antibiotic drops are rarely needed after such procedures and can irritate your eyes.

When to say yes: If you develop a bacterial eye infection, marked by redness, swelling, tearing, pus, and impaired vision.

4. Respiratory infections

When to say no: Colds, flu, and most coughs and cases of bronchitis are caused by viruses. Strep throat is bacterial but accounts for only about one third of cases in children. If you suspect strep, get tested to find out for sure.

When to say yes: If a cough lasts longer than 14 days or a strep test comes back positive.

5. Sinus infections

When to say no: Sinusitis is usually viral. Bacterial sinus infections often clear up in a week or so even if they are not treated.

When to say yes: If symptoms are severe, don’t improve after ten days, or get better but then worsen.

6. Urinary tract infections

When to say no: For older patients, particularly those who live in long-term-care facilities, doctors often prescribe antibiotics when a routine test finds bacteria in urine. But if patients don’t have symptoms, the drugs won’t help.

When to say yes: You have symptoms: burning during urination and a strong urge to “go” often.

Cereal Bowl for Weight Loss

My biggest rule with breakfast: stop eating carb-only meals (jumbo bagels, I’m talking to you). They might give me a quick rush, but they’re missing the protein I need for energy in the morning. I also make sure to fit in calcium. (Experts recommend we get at 1,000 mg of calcium in our diet every day).

Cereal is a quick way to get key breakfast nutrients in one simple bowl: fiber from grains and fruit and calcium and some protein from milk. But: It’s easy to over-pour, which can triple your calorie intake and set you up for a mid-morning blood-sugar crash. If you’re a cereal lover, use this chart (and measuring cups!) to see what a true healthy cereal portion looks like. If it’s a lot smaller than you’re used to, don’t worry. The fiber from the fruit is more satisfying than it looks.

For an even more filling breakfast, add a tablespoon of your favorite chopped nuts, such as walnuts or almonds.

Your Birth Month Could Predict About Your Future Health

Your birthday dictates your zodiac sign, but new research suggests that it may also affect various aspects of health later in life. Keep in mind: The impact of birth season is far from definitive; heredity and environment play a far bigger role.

Fall Birthdays

1. Better physical fitness: A study in the International Journal of Sports Medicine found that school-age boys born in November scored an average of ten percentile points higher on tests of cardiorespiratory fitness, handgrip strength, and lower-body power compared with those born in April. Fall babies’ mothers are pregnant in the summer, when vitamin D levels surge. Vitamin D affects fetal physical development.

2. Food allergies: People with autumn birthdays were 30 to 90 percent more likely to develop food allergies than those born in other seasons, according to Johns Hopkins University research. Fall babies are exposed to less skin-protecting vitamin D early in life, which could make them more likely to develop a sensitivity to food allergens through the skin.

Winter Birthdays

3. Left-handedness: Men born during this season are more likely to be lefties than those born during other times of the year, according to new Austrian and German research. High levels of testosterone in utero can make left-handedness more likely—and longer periods of daylight during the summer can trigger a testosterone surge at a crucial time during fetal development when handedness might be influenced.

4. Premature birth: Babies conceived in May (and typically born in February) are 10 percent more likely to arrive prematurely than those conceived during other seasons, a 2013 study found. Expectant mothers’ exposure to flu in the last trimester may be why. Pregnant women should get vaccinated for flu.

Spring Birthdays

5. Melanoma: Spring-born people have a 21 percent greater chance of developing melanoma than those born in the fall, reported a 2014 study in the International Journal of Epidemiology. Exposure to UV light during the first few months of life may affect the body’s susceptibility to developing melanoma as an adult. That said, lifelong habits— using sunscreen year-round, not tanning, wearing hats and sunglasses—go a long way toward protecting you against all forms of skin cancer.

6. Earlier menopause: In an Italian study of nearly 3,000 postmenopausal women, those born in spring were more likely to reach menopause just before age 49; those born in the fall were likelier to enter menopause about 15 months later. Fall women might be born with a greater number of eggs.

Summer Birthdays

7. Nearsightedness: Summer babies are more prone to need glasses for distance, found a study in the journal Ophthalmology. This may be because of the amount of light babies are exposed to right before and after they’re born. Research in animals has shown this can affect normal eye development.

8. Mood swings: People born during summer months are more likely to have “cyclothermic temperament,” or rapid fluctuation between sad and happy moods. Light and temperature exposure may affect brain chemicals that regulate mental health.

Treating a Sprained Ankle

A sprain occurs when one or more of the ligaments has been stretched, twisted, or torn. It is the most common ankle injury. In a minor sprain, some of the fibers within the ligament are stretched. In more serious sprains, the ligament may be torn. Minor sprains can be treated at home. Serious sprains need medical attention and may even require surgery. The pain can be excruciating. If in doubt, take the injured person to the hospital for an X-ray.

Use RICE to remember treatment steps.

R = Rest. I = Ice. C = Compression. E = Elevation.

What to Look For

• With a severe injury, the patient may not be able to bear weight on the leg.
• Pain in and around the joint. The patient may feel faint with the pain.
• Swelling, and later bruising, around the joint

First Aid for a Sprained Ankle

1. Rest the leg. The patient should stop the activity that caused the injury. Help her to sit down and rest the ankle. Support it in a raised position.

2. Cool with ice. Cool the ankle to reduce pain and swelling. Ideally wrap a bag of ice or frozen peas in a cloth and place it on the ankle. Do not put ice straight onto the skin, as it will cause a cold burn. Leave the ice in place for about 20 minutes.

3. Apply pressure. Leave the compress in place if it is small or wrap a layer of soft padding, such as a roll of cotton wool, around the ankle. Apply pressure with a compression support or compression bandage to help limit swelling. This should extend from the toes to the knee.

4. Elevate the ankle. Raise and support the ankle so that it is higher than the hip to prevent swelling. Advise the patient to rest the ankle. If you suspect serious injury, take the patient to the hospital.

5. Check circulation. Make sure that the bandage is not too tight. Press on a toenail until it turns white, then let go. The color should return quickly. If it does not return, the bandage is too tight; remove it and reapply. Recheck every 10 minutes.

6. Reapply the cold compress over the bandage every two to three hours. Remove the bandage at night and do not sleep with an ice pack on the injury.