WHY IS FIRST AID IMPORTANT TO PLASTIC SURGEONS?

Early forms of reconstructive surgery, including primitive nose jobs, are reported to have been carried out as early as 800 BC in India. During the First World War famous Plastic surgeons like Dr Harold Gillies was a founding figure in the history of plastic surgery. He created innovative procedures to help reconstruct the faces of badly injured soldiers and airmen, whose facial injuries were caused by bullet wounds and flying shrapnel and needed extensive bone, muscle and skin grafting to restore their appearance. Gillies introduced the tubed pedicle which used the patients’ own tissue to aid reconstructive surgery and reduce the chance of rejection.

In 1917, Dr Gillies carried out the first modern plastic surgery to rebuild the face of sailor Walter Yeo, performing a skin graft on severe facial injuries around his eyes. He received a knighthood for his work in 1930.

The Plastic Theatre, Queen Mary’s Hospital, 1917. Harold Gillies is seated on the right

This photo documents plastic surgery performed by Dr. Harold Gillies on WWI soldier, William M. Spreckley, a Lieutenant from the Sherwood Foresters Service in the British contingent, 16th battalion. Spreckley, at the age of 33, acted as Gillies’ 132nd patient and was admitted to the hospital on January 1917 due to a ‘gunshot wound nose.’

Of course, 100 years ago these techniques were mostly used on casualties of war but modern day cosmetic surgery is used for different reasons.

Modern day plastic (cosmetic) surgery is popular and here are the most common procedures being performed today;

Breast enlargement or reduction in Male & Females
Ear reshaping (Otoplasty)
Eyelid surgery (Blepharoplasty)
Facelift (Rhytidectomy)
Liposuction
Nose job (Rhinoplasty)
Tummy tuck (Abdominoplasty)
As with any type of surgery, plastic surgery has associated risks and complications.

The degree of risk depends on whether the surgery is in a small or large area, the level of experience of the surgeon and the age and overall health of the person having the procedure.

Complications from plastic surgery may include:

Bleeding, which may require a blood transfusion if severe
Pain and discomfort, which may require painkillers for a few days
Bacterial Infection, may require antibiotics or further surgery
Scarring may occur where incisions were made during surgery, but these will fade over time
Implant failure could leak and change shape, in which case further surgery may be needed
skin graft or flap failure where the skin graft or flap can die if the blood supply is restricted
You should discuss with your surgeon the risks associated with your particular type of plastic surgery before commencing
COMMON FIRST AID EMERGENCIES IN THE COSMETIC SURGEON’S PRACTICE

Many older people have cosmetic surgery to look and feel younger than their years. Visiting a cosmetic surgeon for the first time may cause a degree of anxiety and there is a possibility that a patient may lose consciousness for several reasons. Below are the most common First Aid Emergencies that may occur at the Cosmetic Surgeons clinic.

FAINTING

Fainting is when you lose consciousness for a short time because your brain is not getting enough oxygen. It is commonly known as “passing out.” A fainting spell generally lasts from a few seconds to a few minutes.

A brief feeling of light-headedness, dizziness, weakness, or nausea sometimes precedes fainting. Some people become aware that noises are fading away, or describe the sensation as “blacking out”.” A full recovery generally takes only a few minutes. If there is no underlying medical condition causing you to faint, treatment is not necessarily required. However, the risk is falling down and gaining a secondary injury such as a bang to the head.

In the Cosmetic surgeon’s office, fainting may be triggered by a number of factors, including:

Fear from having an examination or a procedure performed on them (especially in the genital area)

A sudden drop in blood pressure

Low blood sugar due to Diabetes Mellitus or from going too long without eating

Hyperventilation (rapid, shallow breathing) due to anxiety of having a cosmetic procedure

Dehydration from not ingesting enough fluids

Standing up too fast

Coughing too hard

Consuming drugs or alcohol

When someone near you faints, you can encourage blood flow to their head by raising their feet above the level of their heart. Alternatively, you can have the person sit with his or her head between their knees. Loosen tight collars, belts, or other tight clothing. Keep the person lying down or sitting for at least 10 to 15 minutes. A cool, quiet place is best. A cool drink of water may also help. If the person stops breathing, be prepared to perform CPR (Cardio-Pulmonary Resuscitation)

HEART ATTACK

A clot blocks the blood flow to the heart (heart attack), and damages heart muscle (plumbing or pipes of the body). Symptoms include chest pain, shortness of breath, and a blue or grey tinge to the skin. The victim often has an impending feeling of ‘Doom’. This condition is considered a medical emergency and the patient is encouraged to sit and rest, call 999/112, but urgent care may be required if the victim stops breathing in the form of CPR (see later).

CARDIAC ARREST

The most common cause of a cardiac arrest is a life threatening abnormal heart rhythm called Ventricular Fibrillation (electrics of the heart). Ventricular Fibrillation happens when the electrical activity of your heart becomes so chaotic that the heart stops pumping and quivers or ‘fibrillates’ instead. A cardiac arrest is an emergency. You can increase the person’s chances of survival by phoning 999/112 immediately and giving CPR. CPR means:

Chest compression (pumping the heart by external cardiac massage), to keep the circulation going until the ambulance arrives and giving rescue breathing (inflating the lungs by using mouth-to-mouth resuscitation)

HYPOGLYCAEMIA

Low blood sugar can be a dangerous condition. Hypoglycaemia is rare in people who are not living with Diabetes Mellitus (a chronic disease that affects the body’s ability to regulate blood sugar). The client in the plastic surgeons office may have forgotten to eat due to anxiety of a procedure and go into Hypoglycaemia where they will act erratically and may fall unconscious. A surgery drink is recommended as soon as possible. It is always a good idea to keep a can of coke in the surgeon’s office for this emergency.

STROKE

A stroke is a disruption in the blood supply to the brain. Most strokes are caused by blockages (usually blood clots) disrupting the brain’s blood supply. The brain depends on a supply of blood for the oxygen and nutrients it requires to function properly. When the blood supply is disrupted, brain cells are starved of oxygen and nutrients. This causes damage to the brain tissue. Strokes can affect people of any age but are more common in older people.

Some people have a temporary blockage in the blood supply to their brain which clears of its own accord, quickly and before any lasting damage to the brain is done. This is called a transient ischaemic attack (TIA).

Each person is affected differently by stroke and individual symptoms depend on which parts of the brain are affected and for what specific functions these parts of the brain are responsible. The severity of the symptoms depends on how much damage is done to the brain.

Face droops in one side

Arms are unable to raise

Speech problems (slurred speech, muddled words)

In more serious cases, the person might lose consciousness

If this occurs in the cosmetic surgeons office or waiting room it is essential to call 999/112 immediately so that medical intervention can limit the devastating affects a Stroke can bring.

It is essential that all staff at the office and surgery of the cosmetic surgeon are trained in common First Aid procedures for the above emergencies and these will all be covered on a one day Appointed Person Emergency First Aid course. I have only given you the common emergencies that will require immediate First Aid above, but there are many more occurrences that could require first aid. Every office should have a First Aid Box equipped with the necessary contents and an Accident Report Book and also a ‘Near Miss Report Book’. Any first aid situation should be written and signed by the First Aider for insurance purposes.

It is also recommended that every cosmetic surgeon considers owning an AED machine (Automated External Defibrillator) in their office.