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How to Cure Bad Tonsils: Management Options- Medicines, Surgery, and Home Remedies

Dr.Varun Tyagi
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How to Cure Bad Tonsils: Management Options- Medicines, Surgery, and Home Remedies

In case you are wondering whether recurring swollen tonsils can be treated permanently, the answer is YES! Although tonsillectomy is the only viable option to fix this forever, there are a number of measures you can take to prevent the episodes from coming again.

With this article, we will guide you through what is tonsillitis and how to spot it. We will then narrate to you the available medical and surgical options and what are their pros and cons followed by the golden rules for stopping re-occurring episodes.

Lastly, there are some interesting FAQs that will promptly help you comprehend the topic.

What are Tonsils and Tonsillitis?

First of all, the tonsils are glands while Tonsillitis is an infected gland. This is often confused by people and they pronounce it as “How to treat tonsils permanently”. To ease off, we will use the same wording in this article.

Tonsils are small oval-shaped glands located just at the back of the throat. They are two in number and are present on either side of the throat. It is difficult to visualize them, but they are remarkable during infection and can be spotted easily.

They serve by providing us immunity to fight against infections. However, the poor lads can themselves get infected.

Symptoms

The symptoms of infection usually include:

  • Painful sore throat for more than 2 days
  • Earache
  • Tonsils are reddened, swollen, congested, and with or without pus or exudates

How to Cure Tonsils Permanently?

The best way to treat tonsillitis is to remove the glands completely. This is called a tonsillectomy.

However, it is not performed without proper indications for adults and children. You should meet a set of conditions that are described under SIGN criteria (based on the UK medical norms):

  • 7 or more episodes of tonsillitis per year for 1 year
  • 5 or more episodes per year for 2 years (Total= 10)
  • 3 or more episodes per year for 3 years (Total= 9)
Additionally, Sleep Apnea is now considered an indication of tonsillectomy in children.

All the possible treatment plans include the following:

Medical Treatment

Antibiotics

Phenoxymethylpenicillin or Penicillin V is the antibiotic of choice. Ampicillin or Amoxicillin should be avoided initially. It is important to note that these have no role if the cause is viral.

Overusage only leads to developing resistance against the medicine and makes it difficult to treat the repeated infections.

Analgesia

Antipyretics such as PCM and Ibuprofen should be used to manage pain and fever. However, it only provides symptomatic relief and does not actually treat the underlying cause in case of acutely infected tonsils by bacteria.

Surgery

If you are still not convinced, you are probably heading toward tonsil removal already. Tonsillectomy is indicated as per the SIGN criteria mentioned above.

Regardless, there are a number of complications that can develop following surgery for removing tonsils.

These include:

  • Primary and Secondary Bleeding
  • Superimposed infection by another bacteria
  • Scarring

Home Remedies

The most effective treatment options for curing bad tonsils always involve natural practices that reduce the severity of symptoms and help in speeding up recovery.

Additionally, you are not exposed to invasive procedures such as surgery or the risk of scarring.

Best Home Remedies to cure tonsils include:

  1. Saltwater Gargles: This works like a charm every time and provides relief instantly. To do this, boil a glass of water to a maximum and allow it to cool. Test if you can drink the hot water once the temperature goes down a bit. Finally, add half a tablespoon of table salt to a glass of hot water and gargle deep as you can. It is observed that the max you can tolerate, the better the results are.
  2. Hydration: Often, dehydration can worsen tonsillitis. Therefore, the more you keep those tiny glands hydrated, the better the chances of a speedy recovery. Drink at least 3-4 liters of water a day to sustain the healing.
  3. Natural Herbs: Echinacea is one of the finest herbs that help fight off infections and boost your immunity. This can be used in spray form which is often available over the counter. Additionally, it provides relief from sore throat. Garlic is another natural home remedy that you test to bolster your immunity.
  4. Supplements: Vitamin C is an evergreen supplement you can take. It helps you strengthen your body and help you combat infections naturally. You can also try Strepsils to relieve manifestations.
  5. Warm Tea: Ginger garlic tea is an underestimated home remedy that provides rapid comfort from a painful throat. Additionally, this is another warm liquid that will help you keep the soreness away for a while.
  6. Improve Eating Habits: Consuming a vitamin- and mineral-rich diet, as well as avoiding foods and drinks that can irritate the throat, such as alcohol, spicy meals, and acidic fruits, can assist in preventing tonsillitis and promote the body’s natural recovery process.
  7. Avoid Strain on Vocal Cords: This goes without saying. Yes, using loud pitch or shouting can worsen the tonsils. You need to keep them well-rested and minimize their use so they have proper time to recover “politely”.
  8. Avoid Stress: Stress can impair the immune system, making the body more prone to illnesses. Stress management practices such as meditation, exercise, and deep breathing can enhance the immune system and lower the risk of tonsillitis.
  9. Maintain Sanitation: Washing hands routinely, covering the mouth and nose when coughing or sneezing, and minimizing direct contact with sick persons can all help to prevent the spread of germs, including tonsillitis.
  10. Get Sufficient Sleep: A good night’s sleep is vital to keeping a well-functioning immune system and combating infections. Try to sleep for at least 7-9 hours per night will significantly lower your chances of getting tonsillitis.
  11. Stop Smoking: Close your eyes and imagine your throat filled up with pus and smoke. It’s gruesome, is not it? That’s what your tonsils will feel when you light a cigarette. Listen to the fairy, and start your journey to quitting already.
  12. Avoid Alcohol: There is a myth that rum can help in easing off tonsillitis. No! It only makes them numb. Is it not similar to paralyzing an animal that is already dying?

Here is how you can make Ginger Tea in just 2 minutes:

Credits: GST Kitchen

FAQs

What are all the indications of Tonsillectomy?

There are 5 Absolute and 4 Relative indications of tonsillectomy. These include:

Absolute Indications

1. Recurring infection: This is the most prevalent symptom. Recurrent infections of the tonsils are defined as either of the following:

A. 7 or more episodes in one year
B. 5 episodes per year for two years
C. 3 episodes per year for three years
D. 2 weeks or more of missed school or work in one year.

2. Peritonsillar abscess: Tonsillectomy is performed on children 4-6 weeks after the abscess has been treated. The absolute indication in adults is a second attack of peritonsillar abscess.

3. Tonsillitis resulting in febrile seizures

4. Tonsil hypertrophy resulting in:

A. airway obstruction (sleep apnea),
B. difficulty in swallowing,
C. speech interference

5. Suspicion of cancer: In children, a one-sided swollen tonsil could be a lymphoma, while in adults, it could be an epidermoid carcinoma. An excisional biopsy is performed.

Relative Indications

1. Diphtheria carriers who are resistant to antibiotics.

2. Streptococcal carriers who may spread the infection to others.

3. Unresponsive to medical therapy chronic tonsillitis with foul taste or halitosis.

4. Recurrent streptococcal tonsillitis in a valvular heart disease patient.

How to Tell if it is Bacterial or Viral Tonsillitis?

Most cases are usually viral, however, it is somewhat easier to spot a bacterial one with the proper knowledge. The most common bacteria causing tonsillitis is Streptococcal Tonsillitis.

Differentiation between viral and bacterial tonsillitis can be done based on Centor Criteria. A score of 3 out of 4 indicates high suspicion of bacterial tonsillitis.

1. Fever more than 38-degree celsius
2. Tender Anterior Cervical Lymphadenopathy
3. Tonsillar Exudates/Pus
4. No associated cough

When are Antibiotics Indicated?

Antibiotics should be taken if 3 out of 4 features are present from Centor Criteria. The best antibiotic of choice for bacterial-infected tonsils is Phenoxymethylpenicillin (Penicillin V).

Why Ampicillin or Amoxicillin is not prescribed for suspected Tonsillitis?

Rash in Infectious Mononucleosis after Amoxicillin or Ampicillin

Penicillin V is preferred over Ampicillin or Amoxicillin. This is because the latter can cause a pruritic maculopapular rash in Infectious Mononucleosis, which is a differential diagnosis of tonsillitis.

What if NOT Bacterial Tonsillitis and Tonsillectomy is not indicated?

If there is viral tonsillitis and there are no indications of tonsillectomy mentioned above, it is always best to give supportive treatment. The ideal way starts with the best medicine- an antipyretic such as Paracetamol or Ibuprofen.

What are the Complications of Tonsillitis?

Tonsillar Cyst Complication of Tonsillitis

Several unfavorable outcomes can develop if proper care is not given to the infected tonsils. Emergency care would be necessary if the following develop:

1. Peritonsillar Abscess
2. Quinsy
3. Otitis media
4. Chronic Tonsillitis
5. Parapharyngeal abscess
6. Cervical abscess
7. Subacute Bacterial Endocarditis

DVT Symptom Checker: Quiz for Deep Vein Thrombosis in Leg

Dr.Varun Tyagi
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DVT Symptom Checker: Quiz for Deep Vein Thrombosis in Leg

In case you are curious about how to check for symptoms of DVT at home, we have a simple quiz based on 10 questions that will help you better understand the diagnosis. If you have Deep Vein Thrombosis, this questionnaire-based symptom checker will guide you on what you should do next.

Please note, this is a tool made to quickly grasp the manifestations. It is important to note that this should not be compared with professional care. It is strongly advised to always seek medical help if you have any kind of illness.

Do I have DVT in my Leg- Quiz

DVT Quiz
Do you have Swelling
Start Over

Are you confused between DVT and Varicose Veins?

Check out this article on “DVT vs Varicose Veins” to clear all doubts!

What is DVT?

DVT is an acronym used for Deep Vein Thrombosis. In medical terms, it is known as Phlebothrombosis.

It is a semi-solid blood clot that usually forms in the deep veins of the leg, however, it can originate from anywhere in the body. It is considered fatal as the blood clot has a high risk of developing pulmonary embolism and sudden death.

Sites

The most common sites for the formation of a thrombus (blood clot) are the Soleal veins which are found in the leg.

The clots in soleal veins later propagate proximally, often becoming detached to cause acute massive pulmonary embolism or moderate-sized emboli can cause pyramidal/wedge-shaped pulmonary infarcts.

The three sites where Deep Vein Thrombosis can originate are:

1. Pelvis

They seem to be reasonably common and involve the internal iliac veins.

Women suffering from PID (pelvic inflammatory disease) are at higher risk of developing DVT.

For men, prostatic veins can be the site of origin. Even though a rectal or vaginal examination may help, it is difficult to identify in clinical practice.

2. Leg

It is very common in the veins of the soleus muscle in the calf. Femoral vein/iliofemoral vein blood clots can occur simultaneously with calf vein thrombosis or individually, causing adductor canal tenderness.

Ilio-femoral vein blood clots are prevalent on the left side because of its long course/ compression by the right iliac artery/often owing to the presence of a web at its entrance into the Inferior Vena Cava.

The prevalence rate of having DVT in both legs is 30%, which should be distinguished from bilateral pedal edema caused by other reasons such as hypoproteinaemia, renal failure, and heart causes.

3. Arm

It can arise naturally, as a result of cervical rib compression, contributing factors of thoracic inlet syndrome, or the arm having been in the hyperabduction state for a lengthy period of time (e.g., painting the ceiling), after axillary lymph node block dissection, after axillary radiotherapy, and periodically as a complication of venepuncture.

Causes

The reason for DVT is hypothesized through the “Virchow’s Triad“. This includes:

  1. Stasis
  2. Hypercoagulability
  3. Vein Wall Injury

The 12 causes of Deep Vein Thrombosis include:

  1. After Childbirth
  2. Trauma to the legs, ankles, things, or pelvis
  3. Excessive use of muscles
  4. Immobility: Bedridden patients, passengers on long-distance flights or buses (Traveller’s thrombosis).
  5. Disabling underlying conditions, fatness, lack of mobility, bed rest, pregnancy, 6 weeks after the postpartum period, oral contraceptives (increases the risk by 5 times), and estrogens are all examples of risk factors.
  6. Postoperative thrombosis (most common cause): This is more common after the age of 40. The incidence rate after major surgery is 30%. Both legs are affected in 30% of cases. Typically seen following prostate surgery, hip surgery, major abdominal surgery, gynecological surgery, and cancer surgery. Bed rest for more than three days after surgery raises the risk of DVT.
  7. In visceral cancers such as cancer of the pancreas or stomach, spontaneous blood clot formation is common. It is frequently the migrating type.
  8. Thrombus can begin in a venous tributary and spread into the main vein.
  9. Thrombocytosis, polycythemia vera.
  10. Thrombophilia and Deficiencies of antithrombin 111, protein C, protein S, and factor V of Leiden.
  11. Recent heart attacks, heart failure, and nephrotic syndrome are all possibilities.
  12. Thrombosis can occur in those who sit glued to computers for a long time (‘ethrombosis’).
  13. Smoking

Here is a video on how these blood clots form:

Credits: Science Animated

Signs and Symptoms

In a nutshell, the following are the features of DVT:

  1. 60% of the time it is silent.
  2. The first symptom is fever.
  3. Calf swelling which is tight, tender, warm, pale/bluish, and shining.
  4. Positive Signs- Homan’s, Mose’s, or Neuhof’s signs
  5. Positive Inverted Champagne Bottle Sign
  6. Components of pulmonary embolism
Important: Calf swelling + Positive Homan's sign (pain on dorsiflexion) > THINK OF DVT EVEN IN ABSENCE OF RISK FACTORS OR SKIN CHANGES

Earliest Signs

  1. Fever is the first symptom.
  2. Pain along with swelling in the calf and thighs is frequent. The pain is frequently so acute that the patient is unable to flex (or move) the leg.
  3. The skin on the leg is stretched and shiny, and it is tense, painful, hot, pale, or bluish.
  4. Positive Homan’s sign: Calf discomfort caused by passive forceful dorsiflexion of the foot with an extended knee.
  5. Mose’s sign: Squeezing the lower section of the leg from side to side produces pain. Gentleness is essential, or else it may detach a clot and trigger an embolus to develop.
  6. Neuhof’s sign is characterized by thickness and profound soreness felt while assessing a patient deep in the calf muscles.
  7. Often these DVTs are undetected and show abruptly with pulmonary embolism symptoms such as chest discomfort, shortness of breath, and hemoptysis.

How to Check for DVT at Home?

Deep Vein Thrombosis is a lethal diagnosis and being careless with it can be deadly. There are plenty of guides around the internet that explain the steps of performing various tests at home to check for a blood clot in your leg.

We strictly advise you not to perform such tests and these should be exclusively performed by trained physicians.

Incorrectly performing the procedure can lead to the detachment of the clot and cause it to travel to vital organs where it can cause Pulmonary Embolism in the Lungs, Stroke in the brain, Atrial fibrillation or cardiac arrest in the heart, and ultimately, death.

If you think you have DVT, we recommend you visit A&E and get yourself checked promptly so that emergency drugs are started immediately. Any delay in the diagnosis can be life-threatening.

Diagnosis

The diagnosis involves three components which are:

1. Physical Examination

This includes checking for signs and symptoms of Deep Vein Thrombosis which are discussed above. Additionally, checking the pulse is a crucial part of the examination.

2. Imaging Studies

USG Doppler (Ultrasound Venous Doppler with Duplex Scanning)

This can detect the presence of blood clots in the deep veins. It will exhibit a non-compressible vein that is wider than normal.

Venogram

After establishing a tourniquet to the superficial system, contrast material is injected into the venous system to provide a clear image of the veins. This distinguishes between occlusive and non-occlusive blood clots. However, given that it is invasive, it is not routinely used.

Other Imaging Tests

  • VQ Scan (Ventilation-Perfusion Scan)
  • X-rays are not useful
  • ECG may be done for Pulmonary Embolism

Blood Tests

  • D-Dimer- The most useful and frequently performed blood test.
  • Other relevant test includes the study of fibrin degradation products (FOP).
  • The D-dimer test measures cross-linked degradation products and interpret plasmin activity on fibrin.
  • A negative D-dimer test is more useful.
  • Other blood tests like CBC (Complete Blood Count), PT (Prothrombin time), and Activated Partial Thromboplastin Time (aPTT) are frequently performed in addition to D-Dimer.

Well’s Score Mnemonic for DVT

Following is an acronym for Well’s Score which is used to predict the risk for Deep Venous Thrombosis:

  • BEST CAP (1 score for each) (-2 for Alternative Diagnosis Likely)
  • Bedridden >3 days/ Past surgery within 12 weeks
  • Entire leg swollen
  • Swelling- Entire leg or Calf Swelling >3cm
  • Tenderness
  • Collateral Superficial Veins
  • Active Cancer
  • Paralysis, Paresis or Plaster, Previous DVT< Pitting Oedema
Clinical FeaturesPoints
Active cancer (on treatment, treated in the last 6 months or palliative)1
Paralysis, Paresis, or Plaster Immobilisation of the lower limb1
Bedridden for 3 days or more, or major surgery in the past 12 weeks requiring general or regional anesthesia1
Localized tenderness along the distribution of the deep venous system1
Entire leg swollen1
Calf Swelling 3cm larger than the symptomatic leg1
Collateral superficial veins (non-varicose)1
Pitting edema in the affected leg only1
Previous DVT1
Alternate Diagnosis is at least as likely as DVT-2
Well’s Scoring System for Deep Vein Thrombosis

It is important to note that the Do I have DVT in my Leg Quiz above does not take into account one of the factors from this table- “Alternate Diagnosis is at least as likely as DVT”.

Differential Diagnosis

There are 6 possible differential diagnoses that can be closely related to Deep Vein Thrombosis:

  1. Baker’s cyst rupture
  2. Plantaris tendon rupture
  3. Haematoma in the calf muscle
  4. Superficial thrombophlebitis
  5. Cellulitis
  6. Arterial Occlusion

Additional Notes on Differential Diagnosis of DVT

  • Arterial Occlusion
    • 6P features of Acute Limb Ischemia
      1. Pain (Sudden)
      2. Pallor
      3. Paralysis
      4. Paraesthesia (Numbness)
      5. Perishing cold
  • Superficial Thrombophlebitis
    1. Sore Legs (Painful legs)
    2. Swollen Varicose Veins
    3. No calf tenderness
    4. High D-Dimer
    5. Treatment- NSAIDs

Treatment

Initial Care

  • Rest, limb elevation, and crepe bandaging of the entire limb.
  • Anticoagulants (blood thinners) are started as soon as possible to minimize the risk of a pulmonary embolism.

Fixed Blood Clot

In cases where the thrombus is fixed, anticoagulants (blood thinners) are administered through IV access.

Updates on the Management of DVT with Anticoagulants

According to the 2020 NICE CKS Guidelines in the UK, the following is a summary of updates that were made:

  • First line- DOACs– Apixaban or Rivaroxaban as first-line Management for Deep Vein Thrombosis (2020 NICE Guidelines for the UK)
    • Not Suitable- Then LMWH followed by
      • Dabigatran or Edoxaban
      • Vitamin K Antagonist (VKA, i.e. Warfarin)
  • Cancer- DOAC unless contraindicated
  • If Severe Renal Impairment (eg. GFR<15/min)- LMWH, Unfractionated Heparin or LMWH followed by Warfarin
  • If Anticoagulation is CONTRAINDICATED (eg. recent hemorrhagic stroke)- Surgical Thrombectomy (Percutaneous Mechanical Thrombectomy)
  • Length of Anti-coagulation
    • At least 3 months (3-6 months)
  • DVT in Pregnancy
    • Antiphospholipid Syndrome (specifically “triple positive” in guidance)- Aspirin + LMWH
    • Both DOACs and Warfarin are contraindicated during pregnancy
    • Any pregnant woman presents with suggestive features of Deep Vein Thrombosis
      • start LMWH until the diagnosis is ruled out

Here,

  • DOAC- Direct Oral Anticoagulants
    • Dabigatran
    • Apixaban
    • Rivaroxaban
    • Edoxaban
  • LMWH- Low Molecular Weight Heparin
  • GFR- Glomerular Filtration Rate

Free Floating Blood Clot

A free thrombus is dangerous as it can travel anywhere in the body and cause fatality. If it reaches the lung, this will result in Pulmonary Embolism. Therefore, it is necessary to treat them urgently. It is usually done by:

  • Fibrinolysis
  • Thrombectomy using Fogarty’s catheter
  • IVC filter

Prevention

  • Care must be made to ensure good leg posture with no pressure on the calf muscles.
  • During significant surgeries, such as laparoscopic surgeries, a pressure bandage must be put on the legs. Elevation, massage, elastic compression bandage, early mobilization, and sustaining hydration are all important postoperative strategies.
  • To prevent inefficient blood circulation, several techniques such as progressive static compression, elastic stockings, electrical stimulation of leg muscles, and pneumatic compression can be used.
  • Dextran 70, 500 mL intravenously during surgery and another 500 mL 24 hours later, can also be administered to combat DVT.
  • Smoking increases blood viscosity and should be discouraged.
  • Patients taking contraceptive pills or estrogens should halt the medication 6-8 weeks before any elective procedures.
  • Blood thinners (Anticoagulants- DOAC) should be started prophylactically to reduce the risk of pulmonary embolism.

Sequale

  • Pulmonary embolism- 15%
  • Venous gangrene; infection
  • Chronic venous hypertension around the ankle producing venous ulcers-chronic venous insufficiency, partial recanalization
  • DVT recurrence- 30%
  • Proximal thrombus propagation- 20-30%

FAQs

When to choose between D-Dimer or USG for DVT?

This can be answered based on Well’s Score. If the well’s score is 2 or more, then perform USG of Legs instead of D-Dimer. Similarly, if the score is less than 2, D-Dimer is sufficient.

What if already on the maximum dose of Rivaroxaban?

If a patient is already on DOAC (Direct Oral Anti-coagulants) and presents with calf pain, edema, and swelling, then request D-Dimer and arrange USG legs within 24 hours (Preferred within 4 hours). A combination of Warfarin and LMWH is started additionally.

When to say DVT is Likely or Unlikely?

If the Well’s Score >_2 = DVT Likely. Otherwise, Well’s Score <2 = DVT Unlikely.

How can you have DVT without knowing?

It is mostly the case because 60% of the cases are silent and do not have any presentation or symptoms. Therefore, it is crucial to not miss any critical signs such as tenderness in the calf, swelling of the entire leg, previously documented DVT, and any discoloration of the leg.

Additional Resources

ABCDE Approach to Chest X-ray: Complete Guide

Dr.Varun Tyagi
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ABCDE Approach to Chest X-ray: Complete Guide

If you are familiar with the basics of X-ray, the next step involves the interpretation of the Chest X-Ray. For this, an ABCDE approach to Chest X-Ray is widely used. This mnemonic is widely used worldwide by medical students as a checklist for evaluating the CXR.

In this post, we will provide you with a step-by-step approach to the ABCDE acronym and explain the same with images so that you grab the concepts from scratch.

Overview: ABCDE Approach to Chest X-Ray

When examining a chest radiograph, it is critical to take a methodical approach. The following ABC technique is simple to remember, so when it comes to tests and you are asked to discuss a chest X-ray, you can keep to these fundamentals even if you have no idea what is going on!

  • A: Airway
    • examine the trachea, mainstem bronchi on the right and left, and intermediate bronchi.
  • B: Breathing
    • Examine the lungs to check if they are evenly inflated and compare the lung fields.
    • Examine the borders of each lung.
    • Examine the four silhouettes.
  • C: Circulation
    • Examine the cardiac size.
    • Take a look at the great vessels (pulmonary vessels and aorta).
    • Examine the mediastinum and hilum.
  • D: Disability
    • Look for a fracture, particularly one of the ribs or the shoulder girdle.
  • E: Everything else
    • Check for air under the diaphragm.
    • Check for the edges for surgical emphysema.
    • Check for breast shadows.
    • Check for any foreign bodies and other ‘unnatural presences’.

Need this guide in PDF Format to go through it again?

Yes, Gimme the Guide

A: Airway

What to Look for (Airway)?

  1. Tracheal Deviation
  2. Angle of Carina

How to Look for Airway?

  1. At the Top: Begin at the top and work your way down, following the trachea (1). It should be in the midline. It splits at the carina (2), branching into the left mainstem bronchus (3) and the right mainstem bronchus (4).
  2. On the Left: The airway terminates on the left at the bifurcation of the left mainstem bronchus, where it divides into the upper lobe bronchus (5) and lower lobe bronchus (6).
  3. On the Right: The right mainstem bronchus gives off the upper lobe bronchus (7) and continues inferiorly as the intermediate bronchus (8) on the right. The airway terminates at the bifurcation of the intermediate bronchus, where it divides into the middle lobe (9) and lower lobe (10) bronchus.

Interpretation of Normal Airway

The trachea is central.

B: Breathing

Chest X-rays do not reveal many particular illnesses (e.g., pneumonia, bronchial cancer, etc.), but rather pathological indicators that might provide insight into the underlying disease process. The followings are some diseases and symptoms to be aware of while ABCDE approach to Chest X-ray:

What to Look for (Breathing)

  • Consolidation/Airspace shadowing
  • Air bronchogram
  • Collapse (atelectasis)
    • right upper lobe collapse
    • middle lobe collapse
    • right lower lobe collapse
    • left upper lobe collapse
    • left lower lobe collapse
    • complete lung collapse
  • Pneumonectomy
  • Solitary mass lesion
  • Multiple mass lesions
  • Cavitating lung lesion
  • Fibrosis
  • Pneumothorax
  • Tension pneumothorax
  • Hydropneumothorax
  • Pleural effusion
  • Pulmonary edema
  • “Bat’s wing’ pattern shadowing
  • Septal lines

How to Look for Breathing?

It is basic knowledge that Black = Air and White = No Air. There are a total of 5 steps that you must follow for the ABCDE approach to Chest X-Ray:

  1. Are the lungs evenly expanded?
  2. Examine the lung fields for white areas (shadows):
    • Contrast the left and right apexes.
    • Contrast the left upper zone with the right upper zone.
    • Contrast the left and right mid zones.
    • Contrast the lower left zone with the lower right zone.
  3. Examine the borders of each lung.
  4. Examine the costophrenic angles.
  5. Examine the four silhouettes
    • Right Heart Border: The absence of the right heart border denotes a lack of air in the middle lobe (due to collapse or consolidation).
    • Left Heart Border: Lack of the left heart border suggests a loss of air in the lingula (the equivalent of the left lung’s middle lobe).
    • Right and Left Hemidiaphragm: The absence of a distinct diaphragmatic silhouette implies a loss of air in the lower lobe (collapse or consolidation) or the presence of anything between the diaphragm and the lower lobe of the lung (e.g. fluid).

Interpretation of Normal Breathing

The lungs are uniformly expanded and the lung fields are clear.

C: Circulation

What to Look for (Circulation)

  • Dextrocardia
  • Cardiomegaly (enlarged heart)
  • Left atrial enlargement
  • Widened mediastinum
  • Hilar enlargement
  • Hiatus hernia

How to Look for Circulation?

  1. Examine the cardiac size. The width of the heart should not be greater than half the total width of the thorax.
  2. Take a look at the great vessels (pulmonary vessels and aorta).
  3. Because the Latin word for heart is ‘cor’ (as in cor pulmonale), remember to look at the ‘core‘ of the X-ray.
    • Check the mediastinum, both hilum, and for a hiatus hernia.

Interpretation of Normal Circulation

The heart size is normal. There is no shift of the mediastinum. The mediastinal contours and hilum appear normal.

D: Disability

What to Look for (Disability)

  • Fractures of the ribs and other bony anomalies

How to Look for Disability?

  1. Examine the ribs for any fractures (#) or bony abnormalities. Remember to rotate the Xray 90 degrees.
  2. Bring your gaze closer to the CXR and examine the borders of each individual bone for fractures. Examine each bone for regions of blackness and compare the density of the bones on both sides. They ought to be the same.
  3. Repeat the examination, searching for any fractures or bone abnormalities in the vertebrae, clavicles, or shoulder girdle.
Why Rotation of CXR?

This is due to the fact that when you look at an xray, your eyes are accustomed to look at the structure of the lungs and heart, among other things. Rotating the picture, on the other hand, confuses your brain, and your eyes focus on the more dense sections (ribs and other bones), making it easier to identify a fracture or skeletal irregularity.

Interpretation of No Disability

I cannot see a fracture or bony abnormality.

E: Everything Else

What to Look for (Everything Else)

  • Air under the diaphragm (pneumoperitoneum)
  • Subcutaneous emphysema/Surgical emphysema
  • Mastectomy
  • Foreign bodies and medical interventions

How to Look for Everything Else?

  1. Examine the hemidiaphragm for air under the diaphragm. Due to the location of the heart, both hemidiaphragm normally peak in the center, with the right hemidiaphragm being higher than the left (not due to the liver). Areas of calcification beneath the right hemidiaphragm (gallstones) and dilated loops of the bowel under the hemidiaphragm are two more intra-abdominal findings that may be observed.
  2. Examine the margins of the body and the whole film for surgical emphysema.
  3. Look for breast shadows in female patients. A prior mastectomy might be indicated if one breast is smaller or absent (may explain secondary lung metastasis). Look for masses in the axillae and lower neck.
  4. Look for ‘other strange presences‘ and foreign bodies.

Interpretation of Normal “Everything Else”

There is no evidence of air under the diaphragm, surgical emphysema, or any foreign body.

Need more? Read our complete guide on Chest Xrays:

Basics of Reading Chest X-Ray

If you have any queries on our “ABCDE approach to Chest X-Ray Interpretation”, please leave feedback or query in the comments below.

Basics of Reading Chest X-ray: Complete Guide | CXR for Beginners

Dr.Varun Tyagi
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22
Basics of Reading Chest X-ray: Complete Guide | CXR for Beginners

You are probably here because you questioned yourself- “How to Read Chest Xray?”. Chest Xray is one of the most common modalities of modern medicine used to interpret differential diagnosis in clinical practice. However, it can be challenging for beginners to understand and properly read the chest X-Ray without proper training and guidance.

By the end of this article, you will grab the basic concepts of reading chest xray, including the anatomy of Xray and differentiating between normal vs abnormal.

In this article, we will provide you with step-by-step instructions for interpreting, tips for identifying structures and abnormalities, and the typical findings which you should not miss.

How to Read an Xray?

The systematic approach to presenting an Xray involves 6 steps. These are:

  1. Read TYPE and PROJECTION in Xray
  2. Read the Patient’s Name
  3. Read the Date when the X-ray was taken
  4. Ensure film quality is adequate
  5. Start ABCDE assessment
  6. Read a concise summary at the end

Examples

1. Type and Projection in Xray

Type- PA view, Projection- Chest. Therefore, this is a PA Chest Xray.

2. Patient’s Name

This is a PA Chest Xray of John.

3. Date

This is a PA Chest Xray of John which was taken on 29th January 2023.

4. Adequate Film Quality of Xray

This is a PA Chest Xray of John which was taken on 29th January 2023. The film is not rotated and there is adequate inspiration.

5. ABCDE assessment

This is a PA Chest Xray of John which was taken on 29th January 2023. The film is not rotated and there is adequate inspiration.

A: The trachea is central.
B: The lungs are uniformly expanded and the lung fields are clear.
C: The heart size is normal. There is no mediastinal shift. The mediastinal contours and hila appear normal.
D: There is no fracture or bony abnormality.
E: There is no evidence of air under the diaphragm, surgical emphysema, or any foreign body.

Read the Complete Guide on ABCDE Assessment

How to Interpret a Normal Chest Xray

Best Chest Xray

It is crucial to understand the anatomy of a normal chest x-ray before proceeding to abnormal CXR. There are 8 steps in total that must be learned:

5 Minutes 5 minutes

  1. Determine the Side

    Determine the Side of Chest Xray

    When you are looking at the CXR, the left side of the radiograph corresponds to the patient’s right side. Similarly, the right side of the radiograph is the patient’s left side. Therefore, you must be able to identify the side of the CXR as:

    1. Patient’s LEFT SIDE
    2. Patient’s RIGHT SIDE

    Imagine that the patient is always facing you to help you recall this. This applies to both PA and AP films.

  2. Identify Mediastinum

    Identify Mediastinum on CXR

    The mediastinum is the thoracic cavity’s center compartment. It includes the heart, the major arteries, the esophagus, the trachea, the phrenic nerve, the vagus nerve, the sympathetic chain, the thoracic duct, the thymus, and the central lymph nodes (including hilar lymph nodes).

  3. Spot Pulmonary Vasculature

    Spot Pulmonary Vasculature on Xray

    The typical lung vascular pattern includes the following characteristics:

    1. Vertically branching arteries and veins to upper and lower lobes
    2. On an upright CXR, the top lobe vessels are smaller in diameter than the lower lobe vessels.

    The two pictures above are similar and show normal chest radiograph mediastinum and pulmonary vascular markings. The level at which the pulmonary vessels enter and exit the lungs is indicated by the white dotted line.

    The vessels are highlighted in red, and you can see that the vessels that branch higher (above the white dotted line) are often smaller than the ones that branch downwards (the vessels below the white dotted line). This is owing to gravity’s impacts.

    In pulmonary venous hypertension, the veins branching upwards might grow bigger than the ones branching downwards.

  4. Identify Normal Lung Markings

    Identify Normal Lung Markings

    The marks on the lungs are really blood vessels in the lungs. They are apparent on a chest radiograph because the iron in the blood absorbs the X-rays. When each lung is split into thirds from the inside to the outside, the regular lung markings change.

  5. Identify the Structures

    Identify the Structures on CXR

    Ideally, you should make out 9 structures immediately after looking at the CXR. These structures include:

    1. Trachea (light blue)
    2. Carina – spinal level T5 (black dotted line)
    3. Aortic arch/knuckle (green)
    4. Descending thoracic aorta (green dotted line)
    5. Left ventricle (yellow)
    6. Left hemidiaphragm (pink)
    7. Right hemidiaphragm (purple)
    8. Right atrium (red)
    9. Superior vena cava (blue)

    The left heart border is formed by the left ventricle, and the right heart border is formed by the right atrium. On a normal chest radiograph, neither the left atrium nor the right ventricle is visible.

    Because the right ventricle is anterior and the left atrium is posterior, there is no discernible boundary on a chest X-ray.

  6. Identify Additional Structures

    Identify Additional Structures on Xray

    There are 8 more structures you should be able to read on a normal x-ray:

    1. Clavicle (green)
    2. Posterior rib (red)
    3. Anterior rib (yellow)
    4. Right costophrenic angle (purple)
    5. Left costophrenic angle (pink)
    6. Right hilum (containing the right hilar lymph nodes) (light blue)
    7. Left hilum (containing the left hilar lymph nodes) (blue)
    8. Lung apex ( pl . apices) (orange)

  7. Identify Parts of the Lung

    Identify Parts of the Lung on Chest X-Ray

    Once you have identified the anatomical structures, you can then make out parts of the lung on CXR:

    1. Trachea
    2. Carina – spinal level T5
    3. Left mainstem bronchus
    4. Right mainstem bronchus
    5. Left upper lobe bronchus
    6. Left lower lobe bronchus
    7. Right upper lobe bronchus
    8. Intermediate bronchus
    9. Middle lobe bronchus
    10 . Right lower lobe bronchus

  8. Identify Lobes and Fissures

    Identify Lobes and Fissures

    The 5 lobes and 3 fissures which you can find on a chest xray are:

    1. Right upper lobe (pink)
    2. Middle lobe (purple)
    3. Right lower lobe (blue)
    4. Left upper lobe (pink)
    5. Left lower lobe (blue)
    6. Horizontal (lesser) fissure
    7. Right oblique fissure
    8. Left oblique fissure

    Important points to note:

    1. The horizontal (lesser) fissure separates the right upper lobe from the middle lobe.
    2. The right oblique fissure separates the middle lobe from the right lower lobe.
    3. The left oblique fissure separates the left upper lobe from the left lower lobe.

Film Quality

Before considering the potential anomalies on a chest radiograph, you must first evaluate the technical quality of the film to verify the picture is adequate. There are two things to look out for.

  1. Rotation
  2. Adequate inspiration: Adequate inspiration is necessary because excessively shallow inspiration can cause the heart to seem artificially enlarged, producing the impression of cardiomegaly. Furthermore, if the lungs are not appropriately inflated, the arteries at the lung bases may seem more prominent, giving the misleading impression of consolidation or collapse.
Some physicians may additionally want that you remark on whether the film's exposure is acceptable. This is no longer essential, as photos that are over- or under-exposed are terminated very immediately by the radiographer and retaken.

You may also use the mouse to adjust the contrast and brightness of a computer X-ray viewer to compensate for poor exposure.

1. Rotation

Examine the spinous processes of the upper thoracic vertebrae. If the patient is not rotated, they should lie halfway between the medial ends of the clavicle.

When the patient is rotated, the spinous processes of the upper thoracic vertebrae deviate to the left or right rather than lying midway between the medial ends of the clavicles.

Left Rotation: The patient is rotated to the left, with the medial ends of the clavicles deviated to the left of the spinous processes of the upper thoracic vertebrae.

Right Rotation: The patient is rotated to the right, with the medial ends of the clavicles deviated to the right of the spinous processes of the upper thoracic vertebrae.

This rule of ration applies to both PA and AP views. A normal Xray should not be rotated.

It is critical to examine rotation since a rotated film might make the heart and mediastinum appear bigger or smaller than they are.

Normal vs Rotated Film

You can easily make out when a film is rotated and hence not adequate.

2. Adequate Inspiration

If the hemidiaphragm is at or below the level of the sixth anterior rib, the inspiration is acceptable. If eight or nine posterior ribs are seen in the lung fields, this also suggests appropriate inspiration.

Adequate vs Inadequate Inspiration Films

Understanding Chest Xray

Best Chest Xray

Chest Xray Views

There are primarily two views that are often performed. These are AP and PA views.

  • AP or Anteroposterior view- The view is from front to back.
  • PA or Posteroanterior view- The view is from back to front

A PA (posterior-anterior) erect chest X-ray is the standard view. Unless otherwise specified, all chest X-rays are taken PA erect. Unless it says AP or supine, you should always presume a chest radiograph is PA erect.

The patient is standing with their anterior chest against an X-ray film. The X-ray tube is preferably situated 6 feet behind the patient so that the X-rays travel posterior-anterior.

To guarantee proper inspiration, the patient takes a deep breath and holds it during the X-ray.

On the other hand, when a patient is unable to stand, an AP (anterior-posterior)/supine CXR is done (e.g. Intensive Care Unit or A&E Resuscitation). The X-ray tube is situated in front of the patient, and the X-rays are directed anteriorly and posteriorly.

When compared to PA films, the main drawback of AP/supine films is that the mediastinum and heart size seem wider on an AP/supine film due to venous distension and magnification.

As a result, you SHOULD NOT make any comments on the cardiac or mediastinal size on an AP/supine film.

Why is a PA view preferred?

PA view is preferred because of two reasons:

  1. Accurate cardiac size measurement owing to low magnification.
  2. The scapulae can be moved out of the way by rotating them.

Why is the Erect view preferred?

An erect view is best because of the following reasons:

  1. Gas ascends: This makes pneumothorax and free air beneath the diaphragm easier to identify.
  2. Fluids descend: Pleural effusion is more easily recognized because fluid flows downhill.
  3. Blood vessels and lungs in physiological form (if done supine, the mediastinal veins and upper lobe vessels may be more swollen than normal, leading to misinterpretation).

Other Views

1. Lateral CXR

Lateral CXR is utilized to provide additional views of the lungs and heart, as well as further information on the anatomical position of lesions. It is hardly used nowadays because CT provides better information.

2. Expiratory PA Erect CXR

Expiratory PA erect CXR is used seldom to aid in the detection of a suspected pneumothorax or bronchial blockage with air trapping.

Difference between PA vs AP view Chest Xray

PA vs AP view Chest Xray
FeaturesPA viewAP view
Position of clavicleObliqueHorizontal
ScapulaAway from the lung fieldOver the lung field
Spirolamina angleInverted ‘V’Not significant
Difference between PA and AP view on CXR

PA is the most common X-Ray done whereas AP is usually done when the patient cannot stand and an XRay machine is brought to him on the bed and a view is taken from anterior to posterior.

The point to add is that there is apparent Cardiomegaly in the AP view compared to the PA view because there is a slight magnification of the heart since the heart is away from the view capturing film.

Cardiomegaly on Chest Xray

Chest xray cardiomegaly
  • A/B x 100 = cardio ratio
  • In the PA view, Cardiomegaly when the ratio is more than 50%
  • In AP view, Cardiomegaly when the ratio is more than 60%

Erect vs Supine Position

erect vs supine cxr

There is a fundal view in an erect position because all the air in the stomach comes into the fundus when the patient is standing.

Inspiratory vs Expiratory

inspiratory vs expiratory chest xray
inspiratory vs expiratory chest xray 2

If the anterior end of the 6th or 7th rib reaches the mid-clavicular line of the diaphragm, it is Inspiratory Xray.

Counting Ribs on Chest Xray

Counting ribs CXR

Two points can just help you quickly count ribs from top to bottom:

  • The front opaque appearing side of the ribs is actually its posterior side.
  • Ribs are counted from the anterior sides.
Counting ribs chest xray

Before we proceed, let us see what structures lie in a normal Chest Xray:

Best Chest Xray

The Chest Xray is usually divided into three zones:

Zones in Chest xray
  • Upto 2nd rib- First zone
  • 2nd to 4th rib- Second zone
  • 4th to 6th rib- Third zone

Now let’s proceed to start studying the Xray.

Lucency and Opacity in Chest Xray

Lucency

Anything that appears dark or black on a chest xray is said to be lucent.

  • This is because of less density.
  • The black color appears because of AIR.

Opacity

Anything that appears light or white on a chest xray is said to be Opaque.

  • This is because of high density.
  • White color appears because of Bones and soft tissues.

Therefore, we can conclude the following easily:-

Increase in lucency:

  • Increase in air
  • Decrease in soft tissues or absence of bone

Increase in Opacity:

  • Increase in soft tissue or abnormal bone
  • Decrease in air

The basic approach when seeing a chest xray always sequentially as:-

  1. Define whether the xray is normal or abnormal
  2. If the xray is abnormal, where is this abnormality
  3. Extent of abnormality
  4. What is the final diagnosis

Before we proceed to pathological approaches to Chest X-Rays, let’s see what layers the xrays hit when they enter the body. Note this strengthens further basics:

Muscle> Ribs> Pleura> Lung

Talking about when Hyperlucency (increase in blackness) or Hyperopacity (increase in whiteness) occurs:

Unilateral Lung Hyperopacity

Hyperopaque lung
  1. Consolidation- Replacement of air by something abnormal
  2. Atelectasis- Collapse of the lung resulting in loss of air

Also seen in Plethora, i.e, an increase in vascularity.

The differential diagnosis of three important causes of unilateral (one side) opaque thorax are:-

1. Atelectasis- the collapse of the lung

Atelectasis of Lung Basics
  • Displacement of interlobar fissure: because the lobes of the lung collapse, the fissures in between the lobes move up or down because of the hyperinflation of the normal lobe against the collapsed lobe. This is the most reliable direct sign of Collapse.
  • Mediastinal shift: The structures on the mediastinum shift to the side of collapsed lung
  • Crowding of ribs
  • Elevation of hemidiaphragm
  • Sharp-defined margins of opacity

2. Consolidation- replacement of air

Consolidation
  • No mediastinal shift
  • Ill-defined margins of opacity
  • Air bronchogram sign: visualization of air in bronchus surrounded by alveolar opacity

Positive Airbronchogram sign is seen in:

  • All except interstitial (viral) pneumonia
  • Pulmonary edema (water replaces air)
  • ARDS (Acute respiratory distress syndrome)
  • Goodpasture syndrome (blood)
  • HMD (Hyaline membrane disease)
  • Pulmonary alveolar proteinosis (macrophages congested in alveoli making crazy paving pattern)

Air bronchogram sign is NOT seen in:

  • Lung abscess
  • All except bronchoalveolar carcinoma

3. Pleural effusion-accumulation of fluid

Normally, there is no air in pleura. But effusion in pleura can occur.

  • Mediastinal shift: which is on the opposite side, i.e, structures shift to the opposite side of pleural effusion.

Note: Pleural effusion and Haemothorax cannot be differentiated because soft tissue cannot be differentiated on Chest Xray.

Unilateral Lung Hyperlucency

hyperlucent lung
  • Rotation: apparent increase in the air gap
  • Scoliosis
  • Mastectomy
  • Poland syndrome (absent pectoralis major muscle)
  • Airway obstruction
  • Large pulmonary embolus
  • Pneumothorax

A small mnemonic to quickly grab the names:

POEMS

  • P- Poland syndrome/Pneumothorax
  • O- Oligemia/Obstruction (like Pulmonary embolism)
  • E- Emphysema
  • M- Mastectomy/Mucous plug
  • S- Swyer’s James syndrome

ABCDEF Approach to Reading Chest X-Ray

Before Analyzing

Before Analyzing Chest Xray, ABCDEF approach for preliminary check can be used as:

A: AP or PA view

B: Body Position

C: Confirm the Name of the patient on film

D: Date of Xray

E: Exposure adequate?

F: Films for comparison

Analysis of Chest XRay

Again, an ABCDEFGHI approach can be used to recall the steps of the Analysis of Chest Xray. It can be related as:

A: Airways- Initially check tracheal deviation, and then check for hilar adenopathy or enlargement

B: Bones / Breast Shadows- Check for fracture of ribs, scapula, or clavicle)

C: Cardiac Silhouette- Cardiac Enlargement/ Costophrenic Angles- Check for sharp angles, if blunt could be pleural effusion

D: Diaphragm- Check for free air, which could mean perforation peritonitis/ Digestive tract

E: Extra-thoracic tissues / Edges- Apices for fibrosis, pneumothorax, pleural thickening, or plaques)

F: Fields- Check for alveolar filling in lung fields / Failure- Alveolar air space disease with prominent vascularity with or without pleural effusions

G: Gastric Bubble- Visible at the left upper abdomen

H: Hilum- Check for lymph node enlargement

I: Insertion / Artefacts: Check for any external object appearing in the xray film

What is an X-Ray?

X-rays are a form of ionizing radiation. They are part of the electromagnetic spectrum and have enough energy to trigger ionization. They have higher energy than ultraviolet (UV) waves but less energy than gamma rays.

What is Radiation in Chest Xray?

The transmission of energy in the form of particles or waves is referred to as radiation.

On the other hand, Ionising radiation is radiation with enough energy to produce ionization, which is the process by which radiation takes an electron from an atom’s outer shell.

Thus, ionizing radiation can trigger chemical alterations in physiologically essential substances (e.g. DNA).

The application of Ionising radiation includes the following:

  • Plain film X-rays
  • Contrast investigations
  • Computed tomography (CT)
  • Nuclear medicine
  • PET Scan (Positron Emission Tomography)

How are Xrays Produced?

In simple words, hitting a high-energy electron beam on a tungsten target results in the production of Xrays. If the electron has enough energy, it can knock out another electron from the tungsten atom’s inner shell.

As a result, electrons from higher energy levels fill the vacancy, causing X-rays to be produced. Because the X-ray manufacturing process is inefficient (0.1%), the bulk of the energy in the electron beam is wasted as heat.

This is why better cooling solutions for X-ray tubes are necessary. The generated X-rays pass through the body and onto a detecting device, which creates an image.

Structures can only be visible if there is enough contrast between them and the surrounding tissues (contrast is the difference in absorption between one tissue and another).

Production of Image on Xray Film

The picture on the X-ray film that results is a two-dimensional (2D) depiction of a three-dimensional (3D) structure.

The X-ray beam is absorbed in proportion to the cube of the atomic number of the various tissues through which it travels when traveling through a patient. According to tradition, the more radiation that hits a detector, the darker the picture.

As a result, the less “dense” a substance is, the more X-rays pass through and the darker the film. In contrast, the more ‘dense’ a substance is, the more X-rays it absorbs and the film appears whiter. Those with a low density seem darker than materials with a high density.

How are Xray Processed and Stored?

Radiographs are produced onto X-ray film in some hospitals, but most now employ a computer-based digital film storage system to store X-ray pictures, removing the need for film.

PACS is the abbreviation for this system (Picture Archiving and Communication System). Doctors and other healthcare professionals may examine the pictures (radiographs) on a computer screen, making it simple to edit the image (for example, increasing the contrast, zooming in/out, and so on).

The benefits include increased accessibility, cost savings, and no more lost films. The downsides are the initial expense and the possibility of a system failure, which might be disastrous.

What are the considerations for Radiation Hazards?

Radiation dangers develop as a result of radiation damage to cells. Actively dividing cells (such as bone marrow, lymph glands, and gonads) are especially vulnerable. Cell death, mitotic inhibition, and chromosome/genetic damage resulting in mutations are all examples of the damage.

The kind and extent of cell damage from these Xrays vary depending on the following factors:

  • Radiation dosage and dose rate
  • Amount of tissue exposed
  • Type of radiation (alpha particles, X-rays, neutrons, etc).

IRMER 2000

The Ionising Radiation (Medical Exposure) Regulations 2000, enacted in 2000, establish the fundamental procedures for radiation safety for patients. They refer to three key individuals involved in the patient’s protection.

  1. The Referrer (a doctor or other accredited health professional seeking the exposure, such as an emergency nurse practitioner):
    • must give appropriate and relevant clinical information to allow the practitioner to justify the exposure.
  2. The Practitioner (often a radiologist who justifies the radiation):
    • On a case-by-case basis, decides on the necessary imaging and justifies any radiation exposure. The potential advantages must outweigh the risks to the patient (for example, a CT head scan on a one-year-old adds a 1/500 lifetime risk of cancer and raises the likelihood of cataract development). As a result, the benefits of this scan must outweigh the hazards to the kid).
  3. The Operator (often a radiographer who handles the practical aspects):
    • checks that the preceding two processes have been done correctly
    • maintains as little legitimate exposure as possible by:
      • reducing the number of X-ray films obtained
      • directing the X-ray beam to the desired location
      • Using ultrasonic or magnetic resonance imaging (MRI) instead of mobile X-rays wherever practical.

Xrays in Pregnancy

There is often a debate on whether X-rays are safe during pregnancy or not. Ideally, one should always avoid exposure to radiation in pregnant women. Further points worth noting include:

  • Reduce radiation exposure to the abdomen and pelvis.
  • Ask each woman of reproductive age if she is pregnant, and avoid exposing pregnant women to radiation. The most essential time is between 3 and 4 months gestation when fetal organogenesis is taking place and the fetus is radiosensitive. If feasible, X-rays of the abdomen and pelvis should be performed when fetal sensitivity is low (i.e. post – 24 weeks gestation, or ideally until the baby is born).
  • At any moment throughout pregnancy, exposure to distant parts (chest, cranium, and limbs) with limited fetal exposure is permissible.

What is PLAB 1 Exam?- Eligibility, Requirements, Fees, Total Cost, Process, Syllabus, Results and Passing Marks

Dr.Varun Tyagi
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2
What is PLAB 1 Exam?- Eligibility, Requirements, Fees, Total Cost, Process, Syllabus, Results and Passing Marks

If you are dreaming to join NHS in the UK via the GMC route, then you have already figured out that PLAB is your route. If you are starting from scratch and wish to explore everything about PLAB 1 exam- What is it, its Eligibility, Requirements, Total Cost and Fees, Process, Study Material, Syllabus, Results and Dates, then you have landed at the right spot.

In this blog, we will walk you through the basics and explain to you in brief how things are in 2023.

What is PLAB 1 Exam?

PLAB exam stands for “Professional and Linguistic Assessments Board where part 1 is the first step towards acquiring a full GMC registration and ultimately, a license to practice in the UK. It comprises two parts- Part 1 and Part 2.

It is an essential exam required by IMG (International Medical Graduates) to work in the UK as a doctor. The exam tests your skills based on clinical understanding, knowledge and practice in real life. GMC sets the standards so that the IMG meet the sufficient set of skills required by any newly qualified doctors in the UK itself.

PLAB test is a theory-based paper where a total of 180 questions are given and the student has to attempt them in 3 hours. The exam is MCQ based and you are required to mark answers on an answer sheet the examiners provide. Please note, this exam is not Computer-based as many believe otherwise.

As of today, the exam is held four times a year. However, GMC has already announced this exam is going to be replaced by UKMLA in 2024. This is not a new PLAB 1 exam, the name has been changed with some minor adjustments.

DetailsPLAB 1 Exam
TypeTheory-based
FormatMCQ-based
Number of MCQs180
Time3 hours
Pattern5 Multiple Choice Answers with one correct answer
Answered onPaper-based and answered on booklet and not computer-based
General Details of th PLAB test

Most questions comprise clinical stems where you will be given the history of a patient and you will be asked to answer the best for the patient. It is important to note that many will have dilemmas answering ethical questions or differ with answers based on the guidelines in their own country.

Since you are sitting in an exam for the UK, you are required to answer accordingly. It is strongly advised not to mix up your clinical practice with the questions. Follow the guidelines set up by GMC and the rest becomes easy.

Eligibility

To appear in the PLAB test, you need to have a PMQ (Primary Medical Qualification) that is recognized by the GMC. This is usually the MBBS degree that is equivalent to the degree awarded to a doctor in the UK Medical School.

Your first step towards PLAB exam eligibility would be to check if the college or medical school you graduated from is actually listed in the World Directory of Medical School. A complete walkthrough is as follows:

PLAB 1 Exam College Sponsor Notes

How to Check Eligibility for College

3 minutes 3 minutes

Visit WDOMS

PLAB 1 College Eligibility Criteria

Visit the World Directory of Medical Schools. Enter your country and college name.

Select your College Name

PLAB 1 Eligibility Criteria WDOMS

Confirm your college name exists in the WDOMS directory. If it does not, you are not eligible to sit in the exam. If it is not listed, you can contact the administration department of your college can apply for this procedure.

Usually, it takes 1-2 months and requires a substantial amount of effort from the candidates to put pressure on the college to follow up the complete process.

Confirm Your College

PLAB 1 Exam Eligibility Criteria for College

Navigate through your college and confirm the name and location. Your next step would involve clicking on “Sponsor Notes” to view if the PMQ is sponsored.

Confirm Sponsor Notes

PLAB 1 Exam College Sponsor Notes

GMC notes will not be present in this section. Don’t bother looking for them. Instead, check if the ECFMG is present because EPIC verification is part of GMC registration. If these details are not present, you need to contact your college to move the process as soon as possible.

Additionally, this must include 5.5 years of studies- 4.5 years of your MBBS along with 1 year of rotational internship. Bear in mind, you must check the internship criteria before applying to the GMC. This is as follows:

Internship Criteria

To sit in PLAB 1 test, you must prove that you underwent a rotational clinical internship which should meet the following requirements:

  • Minimum 12 months
  • Absents no more than 20 days
  • Must include at least three months in Medicine and three in surgery

If you have had an internship in a hospital other than your college, then you need to prove:

  • Institution/Hospital is recognized
  • You can justify why it was not possible to do an internship at your college

Requirements

To appear in the PLAB test, you need to meet the prerequisites before you can even book a seat. These are as follows:

  1. Educational– PMQ (Primary Medical Qualifications) which is usually an MBBS degree.
  2. College Eligibility– The name of your college must be present in the World Directory of Medical Schools.
  3. Passport– You will need to have it to give English Exam and also open up your GMC account.
  4. English Proficiency Exam– This can be IELTS or OET. You can follow the complete guide here for IELTS.

IELTS or OET Requirements

We have prepared a table that will help you better grasp the contents of this section. The minimum English proficiency requirements for the PLAB test are as follows:

IELTSOET
Academic versionMedicine version
Overall 7.0Overall B Grade
Minimum 7 in each (Writing, Speaking, Listening and Reading)Minimum B Grade in each (Writing, Speaking, Listening and Reading)
Most recent examMost recent exam
Original form with stampCandidate number
IELTS and OET requirements for the PLAB exam

How long is the IELTS valid?

It is valid for 2 years from the date of qualifying for the test. The same applies to OET as well.

What if I get passing marks but in different exams?

It won’t be considered valid. To appear in the exam, you must get an overall 7.0 and a minimum of 7.0 in a single sitting. Two cumulative test results don’t count. If you have not qualified for the proficiency test, you can simply give it again.

Which one is better?

Ideally, OET is far better than IELTS as it is based on medical scenarios which is a booster for doctors planning to sit in this exam. However, it is costly and usually takes time for booking as well as results.

On the other hand, IELTS is relatively cheaper and you can sit in a Computer-based exam for as short as 10 days. On the contrary, the questions are somewhat general and most students end up failing in writing (6.5 is a curse). You can read a complete guide here.

The pros and cons are compared in the following table:

IELTSOET
Cost- 15,500 INR455 USD (approximately 37,000 INR)
Can be booked within 10 days for computer-basedTakes time to book and dates are far
Writing is the most difficult for non-medicosEasier for medicos as the medical scenarios are provided
Results declared within 5-7 daysResults take time as long as one month
IELTS vs OET for PLAB Test

Dates

Recent dates were announced on 10th December 2022 for 10th August and 2nd November. These were picked immediately and there are currently no available slots for the PLAB exam in 2023. GMC will release their plans for releasing further seats soon. The best way to get updated will be to follow their Twitter handle.

Importantly, the exam is held four times a year. You can give the exam in your country or in the UK itself. Currently, the following are the overseas countries with available exam venues for PLAB 1:

  1. Australia
  2. Bangladesh
  3. Canada
  4. Egypt
  5. Ghana
  6. India
  7. Kenya
  8. Nigeria
  9. Pakistan
  10. Saudi Arabia
  11. South Africa
  12. Spain
  13. Sri Lanka
  14. Sudan
  15. UAE

If you are taking the exam in the UK, the following venues are available:

  1. Belfast
  2. Cardiff
  3. Edinburgh
  4. London
  5. Manchester
  6. Newcastle
  7. Sheffield

Fees

Although not frequently, the cost of PLAB 1 keeps changing. The latest fees for the PLAB 1 exam in India are as follows:

Booked made before 31st March 2023Booked after 1st April 2023
£247£255
24,927 INR25735 INR
Fees in India as on 28/01/2023

Refund Policy

For bookings made before 31st March 2023, the following amount will be deducted from the initial payment you made if you are planning to cancel the PLAB exam seat:

Cancellation PeriodAmount Deducted
More than 42 days before the exam£24.70 (10% deducted, 90% refunded)
Less than 42 days before the exam£247 (no refund)
If you booked the exam before 31st March 2023, these are the refund policies

However, if you are booking after 31st March, then the following will be the deductions:

Cancellation PeriodAmount Deducted
More than 42 days before the exam£25.50 (10% deducted, 90% refunded)
Less than 42 days before the exam£255 (no refund)
If you booked the exam from 1st April 2023, these are the refund policies

Cost

Many doctors around the globe don’t even try for the exam because of a traditional belief- “It is too costly”. Actually, PLAB 1 exam costs much less as compared to USMLE. In case you are wondering how much does PLAB 1 costs, for just appearing in part 1, you require almost 40,000-50,000 INR.

The following is a rough estimate you will be spending in 2023 if you are planning to appear in PLAB 1:

AssetCost
IELTS/OET15,500 INR or 37,000 INR
PLAB 1 Bookingapproximate 25,000 INR
Total40,500 INR or 52,000 INR depending on whether you give IELTS or OET
Total PLAB exam Cost

How to Book PLAB Seat?

As of today, it is very difficult to even get a seat. The GMC last announced the release of PLAB 1 dates on 10th December 2022 for slots in 2023. These included 10th August and 2nd November slots. You can find all the latest dates here.

As previously mentioned, the seats are difficult to get. If you are wondering how other students are getting slots despite GMC not announcing any, the answer is fairly simple- They are booking the cancelled seats. This task requires sheer dedication, patience and time and despite the efforts, the results could not be promising.

To book a slot, you will first need to open a GMC account. You must have a valid passport to open an account. To book a seat, you must have your English Proficiency Exam (IELTS or OET) verified by GMC. Once both these steps are done, you can proceed to the “Book Exam” section and find the available slots.

There is a complete guide we wrote on “9 Hacks on How to Book PLAB 1 Effectively“. You might find some advanced tricks worth noting as well as a complete process on how to book it through the GMC portal.

Study Material

Most students opt for online platforms which provide sufficient study material to pass PLAB Part 1 test. The renowned platforms include:

  1. PLABable
  2. PLABkeys
  3. Medrevisions

There are in fact books that are often recommended. These include:

  1. Oxford Handbook of Clinical Medicine and Specialties
  2. Khalid 1700 Question Bank

If you want a complete review of all these and anything, you can read our guide on “PLAB 1 Study Material: Free and Paid“

Don't forget to test yourself with GMC Sample Questions. These are a must-do and can be found at GMC Website!

Additionally, you must do as many as PLAb 1 Mock Exam to test your limits and your fallbacks.

Syllabus

There are a number of topics covered in the PLAB 1 exam, however, you are required to focus on the ones which frequently come in the exam. You will require roughly 4-6 hours of study for at least 3-4 months to complete the entire syllabus. Broadly, PLAB 1 exam syllabus consists of 29 subjects which are listed as follows:

  1. Gastromedicine
  2. General Surgery
  3. Vascular Surgery
  4. Anatomy
  5. Orthopaedics
  6. ENT
  7. Ophthalmology
  8. Palliative
  9. Geriatrics
  10. Ethics
  11. Psychiatry
  12. Neurology
  13. Chest Medicine
  14. Emergency Medicine
  15. Critical Care
  16. Rheumatology
  17. Pharmacology
  18. Dermatology
  19. Epidemiology
  20. Nephrology
  21. Urology
  22. Genitourinary
  23. Obstetrics and Gynaecology
  24. Paediatrics
  25. Genetics
  26. Haematology
  27. Infectious Diseases
  28. Endocrine
  29. Cardiology
You can find the complete syllabus at GMC but the blueprint is difficult to understand. We will soon release the syllabus along with the marking scheme for the recent exams.

You can have a taste of the topics covered in these subjects by reviewing the notes we prepared exclusively for PLAB 1:

If you love them, please leave feedback in the comments section so we will drop the complete set directly to your mail.

Results

The PLAB 1 result is typically announced 42 days after the exam has been conducted. Otherwise, in the examination hall itself, the invigilators will tell you the exact date when the result will be declared. You can jot it down, although it is difficult to forget one date that is special to you.

You will be given the time when the results will be announced. Upon entering the portal at the given time, you will be allotted a random queue number. Once your queue timer ends and your queue number comes, you will be redirected to the GMC portal where you can see the results as well book the PLAB 2 exam if you pass.

Your result card will include:

  1. Your Score
  2. A Minimum Score to Pass
  3. The Average Score for the test
  4. The percentage of questions you passed in each skill area, compared to all other candidates who took the exam:
    • Assessment
    • Management
    • Knowledge and Experience

The most recent result dates for 2022 are as follows:

ExamResults
17th February 202231st March 2022- 9.30 AM onwards
26th May 20229th July 2022- 10 AM onwards
11th August 202222nd September 2022- 8 PM onwards
3rd November 202215th December 2022- 8 PM onwards
The time is in GMT. Don’t forget to convert to your country’s time to not miss the queue.

Passing Marks

The PLAB 1 passing score is usually between 115-120. However, these criteria can vary depending on the difficulty level of the exam and how doctors who sat in the exam performed on average. Therefore, for the most recent exams held in 2022, the passing scores have been between 63.8% to 66.6%.

Interestingly, the GMC sets passing marks based on the Angoff method. So what is the Angoff method (in case you are wondering)? Based on a discussion of the difficulties involved in credentialing and their judgement of the examination, the Angoff method permits experienced judges to decide on an acceptable pass grade for an examination.

Additionally, as per GMC, a standard error of measurement is included.

Following are the year-wise pass rates for PLAB 1 exam:

YearPass Rate
201869.3% (5,239 out of 7,559)
201963.1% (7,014 out of 11,118)
202069.7% (7,384 out of 10,601)
202174.1% (7,728 out of 10,431)
202270.9% (10,259 out of 14,470)
The pass rate has been influenced by various factors which include gender too. You can find the full research report on the GMC portal.

Additional Resources

Tips for passing the PLAB Part 1:

Credits: Dr Nauman Balghari

FAQs

Is the PLAB 1 exam difficult?

Many students who have fresh internship knowledge and have recently passed the exam find the questions relatively easier. This is because the exam tests your clinical knowledge and skills. The exam covers topics which are often seen by trainees entering the FY2 (Foundation Year 2).

On the other hand, this is relatively tough for doctors who have either not been in practice (clinical gaps) or IMG who have difficulty adjusting to how the medical system works in the UK.

How do I register for PLAB Part 1?

PLAB 1 Exam Dates- Test Booking Step 2

You can register for PLAB 1 once you have proved your English proficiency exam. You can then register to take the exam at the GMC portal under the “Test Bookings” section. This is where you will be able to see all the available slots for the exam.

Can I book PLAB 1 without IELTS?

Yes, you can take PLAB 1 without IELTS or OET too given you are a citizen of a country with English as their native language and your Primary Medical Qualification was awarded in the same country. There are over 40 countries recognized by GMC and accepted as “English as First Language” where you will not be required to pass IELTS or OET.

How many attempts does PLAB 1 have?

PLAB 1 Attempts Requesting an additional attempt

You can take the exam four times at max. However, you can take a final attempt given you prove to GMC that you meet three requirements. These include:

1. At least 12 months gap from your last attempt to request of additional attempt
2. 12 months of Clinical Practice or a Post-graduation qualification
3. Re-submission of English Proficiency Exam in case it has expired

For the last attempt (5th), you will have to download the Structured Report Form which will be fulfilled by your employee. However, if you have done PG, then you will be required to fill out the Application Form. Either of these must be sent to plab@gmc-uk.org.

How can I apply for PLAB in India?

PLAB 1 Exam Dates- Booking Step 1

The requirements to register for the exam are the same as for any other IMG (International Medical Graduate). To sit in the exam, you should have possession of an MBBS degree, a passport and a passing certificate of English Proficiency Exam (IELTS/OET).

Once you have these three, simply head over to GMC and register an account and get your IELTS/OET verified. Upon verification, you can book PLAB 1 which is the first part of GMC registration.

Can I give PLAB during the Internship?

YES, you can sit for PLAB 1 exam before graduation also without requiring an internship. However, to receive the full registration from GMC, that is, a complete license to practice in the UK, you must have completed your internship.

ICC or Internship Completion Certificate is required and a mandatory document during final GMC registration. You only receive this document after MBBS.

Ideally, students should make up their minds during the internship itself and start preparing for the PLAB exam as the freshness of the clinical exposure as well as the application of the knowledge is useful in both parts of the PLAB exam.

How long is the PLAB 1 valid?

PLAB 1 results are valid for up to three years from the date of passing On passing the exam, you can either choose to book the second part of the exam straight away or you can book it later. Please note, the longer you delay, the quicker the slots for part 2 are filled. It is strictly advised to take a seat immediately after the results. Alternatively, you can book it within a month, but more than that is not recommended.

Is PLAB 1 a Pass or Fail type exam?

YES, the scores of the exam do not matter at all. Your main goal is to pass the exam, even with the lowest passing marks if possible. If you successfully get marks above the passing criteria which is usually 115-120, you pass. Below that, even with 1 mark, you are considered as fail.

Can I get my PLAB 1 marks rechecked?

NO, such an option does not exist. GMC clearly states that remarking or rechecking is not done and students should not even approach them for the same. If you are feeling bad about your results, your next step should be to find another slot immediately without wasting a second.

Understanding Rashes in Children: Approaching Clinical Diagnosis- Table and Algorithm

Dr.Varun Tyagi
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Understanding Rashes in Children: Approaching Clinical Diagnosis- Table and Algorithm

While there are a number of reasons for rashes in children, it is extremely important to spot severe threats and identify the signs and symptoms to make the correct diagnosis. If such hazards are recognized at the right span, they can directly impact the management and prognosis.

From common rashes like measles and chickenpox to more serious rashes like Kawasaki disease, Scarlet fever, and Meningitis, it is crucial for parents to know when to seek medical help.

In this article, we will explore different types of rashes and organize them in a table so that it is relatively easier to understand. Additionally, we will discuss the associated signs and symptoms, peculiarities of these rashes, the management and an approach to these rashes by providing some clinchers.

What are Rashes?

A rash is described as a noticeable change in the skin’s colour or texture. Rashes in children might present as an itchy or painful red patch, a cluster of raised bumps, or a rough, scaly region.

They can be caused by a number of things, such as viral or bacterial infections, allergies, or skin irritations. Some rashes are minor and resolve on their own, however, others may necessitate medical treatment.

Parents must learn the many types of rashes and their symptoms in order to detect them and seek suitable therapy. It is particularly vital to distinguish between viral, bacterial, and fungal rashes in children since treatment options vary.

Why It is Important to Understand these Rashes in Children?

Understanding childhood rashes is critical for various reasons. Following are the reasons why it is important to know the types of rashes:

  1. Determine what therapy to receive: For starters, it enables parents to recognise the rash and seek therapy. A small rash produced by a skin irritant, for example, can be treated with over-the-counter lotions, but a more serious rash caused by a bacterial infection may necessitate antibiotics.
  2. Helps in Prevention: Second, understanding the causes of rashes in children is crucial because it can help prevent them from repeating. If a rash is caused by an allergic reaction to a specific food or product, avoiding that allergen may help to prevent repeat outbreaks.
  3. Identify when to seek immediate medical help: Third, knowing rashes in children can help parents detect when a rash is dangerous and requires quick medical intervention. Certain rashes, such as sepsis or meningitis, can be fatal if left untreated. Recognizing symptoms and seeking medical assistance as soon as possible can make a significant difference in the result.
  4. Provide the best care: Finally, knowing about rashes in children may help parents manage their child’s health and give the best care possible. This might involve relieving itching and pain caused by inflammations and providing preventive actions to help avoid rashes in the future.

Table of Types of Rashes in Children

We have made a table for 7 types of rashes based on NICE CKS guidelines. It is as follows:

DiseaseMeasles (Rubeola)Rubella (German Measles)Roseola (Roseola Infantum)Parvovirus B19 (Erythema Infectiosum/ Fifth disease)Hand, Foot and Mouth Disease (Coxsackie virus)Kawasaki Disease (Febrile systemic vasculitis)Scarlet Fever (Scarlatina)(Streptococcal Pyogenes)
CauseParamyxovirusRubella virusHHV 6Parvovirus B19Coxsackie virusVasculitisStreptococcus pyogenes
Features
Sudden HIGH temperatureSlapped Cheek appearance (bright red rash on both cheeks, may spread to the body, maybe itchy if involves the feet soles)Painful ulcers on tongue/ mouth + Grey blisters on hands and feet
RashRed-brown blotchy rash> Itchy on the Face/Neck which spreads to the bodyItchy rash BEHIND EAR/ on Face/Neck which spreads to the bodyFollowed by Fever> Non-itchy rash on Chest or Legs then spread to the bodyBright red rash on the face which then spreads to the body can be itchyRASHES ON PALMS AND SOLESPolymorphous rash-Pinhead- Sandpaper-like rash- starts on trunk 12-48 hours after fever and spreads to the body
Notifiable diseaseYes–––––Yes
LNP (Lymphadenopathy)NoYes–––Yes Painless Cervical LNPYes
Investigations–––––Screening for Coronary Artery Aneurysm Echocardiogram–
TreatmentSupportive and ReassuranceSupportive and ReassuranceSupportive and Reassurance
  • Supportive and Reassurance
  • Once the rash appears, the child becomes NON-INFECTIOUS
    • No need to exclude from school
    Tables of Rashes in Children and Approach with Differential Diagnosis (Crafted from NICE CKS Guidelines)

    This table was crafted from NICE CKS guidelines while prepping for PLAB 1 exam for the UK.

    Types of Rashes in Children

    While there are a number of reasons why a child may develop a rash, these can be divided based on occurrence for simplicity.

    Common Rashes

    Some of the common rashes that appear in children are as follows:

    1. Eczema
    2. Chickenpox
    3. Measles

    1. Eczema

    Eczema, also known as atopic dermatitis, is a skin ailment that causes red, itchy, and scaly areas of the skin. It is a common childhood ailment that typically runs in families.

    Eczema can be treated with both over-the-counter and prescription lotions and ointments.

    Summary of Eczema in Children (NICE CKS Guidelines)
    • Occurrence
      • Infants- Face and trunk
      • Younger Children- Extensor surfaces
      • Older Children- Flexor surfaces
    • Treatment
      • Apply Emollient first, then wait for 20 minutes, then apply the Topical Steroids
        • i.e. the First line is ALWAYS EMOLLIENT
    • Hydrocort> Betamethasone 0.025%/Clobetasone> Betamethasone 0.1%/ Mometasone> Clobetasol
    • Mild
      • Mild Eczema or New case that is not responding to emollients alone
      • Hydrocortisone
    • Moderate
      • Wide Areas
      • Betamethasone 0.025% or Clobetasone
    • Severe
      • Bleeding, Intense itching that prevents sleeping, and Not responding to hydrocortisone
      • Betamethasone 0.1% or Mometasone
    • Very potent- Clobetasol
    Notes on Eczema in Children
    • 10-15% of children
    • typically presents before age of 6 months but clears in around 50% of children by 5 years of age and in 75% of children by 10 years of age
    • Features
      • Infants- Face and trunk
      • Younger Children- Extensor surfaces
      • Older Children- Flexor surfaces and creases of face and neck
    • Management
      • 1st line- Emollients (at least BID) + washing, bathing (moisturising)
      • 2nd line- Topical Steroids (for eczema itself)
    • Summary of Steroids
      • Mild- Hydrocortisone acetate 0.5%
      • Moderate- Betamethasone valerate (0.025%) or Clobetasone butyrate (0.05%)
      • Severe (Potent)- Betamethasone valerate (0.1%), Mometasone Furoate (0.1%) or Hydrocortisone Butyrate
      • Very potent strength- Clobetasol
    • In Short
      • Mild- Emollients + Mild Potency Topical Steroid (Hydrocortisone)
      • Moderate- Emollients + Moderate Potency Topical Steroid (Betamethasone 0.025% or Clobetasone)
      • Severe- Emollients + Potent Topical Steroid (Betamethasone 0.1% or Mometasone)
      • Very potent- Clobetasol
    • Mild Strength for Mild Eczema
      • Hydrocortisone acetate
        • 0.5% or 1% or 2.5%
        • Mild Eczema or New case that is not responding to emollients alone
        • If still not responding, try a more potent option
    • Moderate Strength for Moderate Eczema
      • Betamethasone valerate (0.025%)
      • Clobetasone butyrate (0.05%)
        • For Moderate Eczema: WIDE area of dryness, crackling, and redness
    • Potent Strength for Severe Eczema
      • Betamethasone Valerate (0.1%)
      • Mometasone Furoate (0.1%)
        • For Severe Eczema that causes bleeding, intense itching that prevents sleeping, and not responding to hydrocortisone
      • Hydrocortisone Butyrate
    • Very Potent Strength
      • Clobetasol Propionate
    • Important: if emollients and topical steroids are to be given together
    • Apply Emollient first, then wait for 20 minutes, then apply the Topical Steroids
    • “Creams soak into the skin faster than ointments”
    • Other lines
      • Avoid irritants and stress
      • Treat bacterial infection if present with Oral Flucloxacillin (1st line) “Rarely the answer”
      • If eczema awakens the patient at night- consider a sedative antihistamine (eg. Chlorpheniramine)

    2. Chickenpox

    The varicella-zoster virus causes chickenpox, a highly infectious infection marked by an itchy, blister-like rash. Chickenpox is a common paediatric infection that is typically minor, but in some circumstances can lead to significant problems.

    Vaccination is the most effective method of preventing chickenpox.

    Summary of Chickenpox in Infants and Neonates
    • Respiratory>Direct
    • 2 days before Rash and 5 days after rash (7 days before delivery and 7 days after delivery for Neonates)
    • Return to School- After Rash and Vesicles are dried and Crusted (usually 5th day from the onset of rash)
    • Rx- Reassurance + Supportive, If superimposed infection- Oral Antibiotics
    • Shingles- Reactivation of VZ
    • Rx Modalities
      1. Immunocompromised- 2 Days before Rash and 5 days after Rash > Exposed to Chickenpox- Check Immunity by Serology
        • Negative (Not Immune) + Serology not back within 7 days of initial contact- Oral Acyclovir to be started 7 days after exposure (previously VZIG)
        • Positive
          • VZ antibody not detected- Oral Acyclovir to be started 7 days after exposure
          • VZ antibody detected- Reassure
      2. Mother- 2 Days before Rash and 5 days after Rash > Exposed to Chickenpox- Check Immunity
        • Not Immunised/ Already developed Rash- Aciclovir
        • Immunised- Reassurance
      3. Neonate- 7 days before and 7 days after Delivery (Peri-Partum)
        • Rx- VZ Ig

    3. Measles

    Measles is a highly contagious respiratory ailment caused by the measles virus that is marked by a red, blotchy rash.

    Measles can cause significant consequences such as pneumonia and encephalitis, and in rare circumstances, it can be deadly. Vaccination is the most effective method of preventing measles.

    Some features of Measles:

    • Also known as Rubeola
    • Features
      • Fever, Irritability
      • Rash on 4th Day “often itchy”, begins on Face/ Neck and then spreads to the body
      • Koplik’s spots “red with white centre spots -grain of salt- on the buccal mucosa
      • URTI (runny nose and sore throat)
      • No cervical Lymphadenopathy
    • Management
      • Mainly supportive (e.g. PCM/Ibuprofen for pain and fever)
      • A Notifiable disease
      • Reassurance (as no antibiotics or steroids are required, it usually resolves spontaneously in a week or so)
    • Measles
      • 4K on 4 D
        • 4K: Koplik spots, Cough, Conjunctivitis, Coryza (fever, runny nose, sore throat)
        • 4D- 4th Day

    Serious Rashes

    While common rashes are usually not concerning, the serious threats can come from others like Meningitis, Kawasaki Disease, Scarlet fever and Sepsis.

    1. Meningitis

    Meningitis is a bacterial infection of the membranes that enclose the brain and spinal cord.

    A bacterial or viral infection can cause it, and symptoms include fever, headache, stiff neck, and a rash that appears as little red or purple patches that do not vanish when touched.

    Meningitis is a dangerous infection that, if not treated promptly, can cause brain damage, hearing loss, and even death.

    Common signs and Symptoms of Meningitis in Babies and Toddlers
    Common signs and Symptoms of Meningitis in Children and Adults
    Kernig’s and Brudzinski Signs

    2. Kawasaki Disease

    Kawasaki disease is an uncommon but potentially fatal juvenile condition that affects blood vessels and can cause inflammation in the heart’s coronary arteries.

    Symptoms include high fever, rash, enlarged lymph nodes, redness and irritation in the eyes, red and cracked lips, and redness and swelling of the hands and feet.

    It primarily affects children under the age of five, and it affects boys more than girls. The precise aetiology of Kawasaki disease is uncertain.

    Kawasaki disease is a dangerous condition that can develop into major consequences such as coronary artery aneurysms if left untreated. Early detection and treatment are critical.

    To minimise inflammation and avoid coronary artery aneurysms, a high dose of aspirin and IVIG (intravenous immunoglobulin) are used in treatment.

    Parents must be aware of the signs of Kawasaki illness and seek medical assistance if they fear their kid has the disease. The prognosis for Kawasaki sickness is typically favourable with immediate treatment, and most children recover completely without problems.

    Kawasaki Disease Mnemonic and Features
    • Child <5 YO + High Grade Fever (>_39 C) resistant to antipyretics
    • + At least 4 of the following:
      • CRASH Burn Lipstick
        • Conjunctivitis (non-exudative)
        • Rash (Polymorphous)
        • Adenopathy (Painless cervical Lymphadenopathy)
        • Strawberry tongue
        • Hand foot erythema (that later peel -desquamate-)
        • Burning high fever (>_39 C)
        • Lip– bright red and cracked
      • Investigations
        • None
      • Complications
        • Coronary Artery Aneurysm
      • Screen for Coronary Artery Aneurysm
        • High dose Aspirin
        • Iv Ig (Intravenous Immunoglobulins)
        • Echocardiogram

    3. Scarlet Fever

    Scarlet fever, often known as scarlatina, is a streptococcus bacterial illness. It is distinguished by a red, sandpaper-like rash that occurs first on the chest and belly before spreading to other regions of the body.

    A high fever, scratchy throat, enlarged lymph nodes, and a strawberry-coloured tongue are further symptoms. Scarlet fever is most frequent in children aged 5 to 15, and it is extremely infectious.

    If a child exhibits signs of scarlet fever, it is critical to get medical assistance since the disease can develop into more serious consequences such as rheumatic fever, kidney inflammation, and skin infections.

    The good news is that it can be cured with medicines and is less infectious once treated.

    Features of Scarlet Fever
    • Cause
      • Streptococcus pyogenes
    • Signs and Symptoms
      • Fever for 24-48 hours
      • Sore throat
      • Rash- pinhead- Sandpaper-like rash- starts on trunk 12-48 hours after fever and spreads to the body
      • Strawberry tongue
      • Cervical LNP
      • Forchheimer spots
      • Tonsils covered with pale exudates with red macules
    • Investigations
      • Oral Penicillin V for 10 days
      • Penicillin resistant- Azithromycin
      • Children return to school 24 hours after starting antibiotics
      • Notifiable disease
    • Complications
      • Otitis Media- most common
      • Rheumatic fever- 20 days after infection

    4. Sepsis

    Sepsis is a serious infection caused by bacteria that enter the circulation and spreads throughout the body. It can produce a variety of symptoms such as fever, chills, fast heart rate, low blood pressure, and a rash that can be red, purple, or bronze in colour.

    It is frequently accompanied by other symptoms such as fever, low blood pressure, and disorientation. If not treated promptly, sepsis can be fatal, necessitating rapid medical intervention.

    How to Differentiate between Mild and Severe Rashes?

    It might be difficult to tell the difference between moderate and severe rashes in children, but there are several traits that can assist.

    Mild rashes are often distinguished by:

    1. Redness or inflammation in small, localised locations.
    2. Other symptoms, like fever or enlarged lymph nodes, are rare.
    3. A proclivity towards self-resolution or treatment using over-the-counter lotions or ointments.
    4. Heat rash, which is characterised by little, red pimples that form when sweat ducts become clogged, is an example of a moderate rash.
    5. Insect bites that are red, swollen, and irritating.

    Severe rashes, on the other hand, are often distinguished by:

    1. Widespread redness or inflammation.
    2. Other symptoms like as high fever, swelling lymph nodes, or trouble breathing may accompany it.
    3. Medical care is required, and antibiotics or other treatments may be prescribed.
    4. Scarlet fever, which is characterised by a red, sandpapery rash that often occurs on the chest and abdomen and is followed by high fever, sore throat, and enlarged lymph nodes, is one example of a severe rash.
    5. Meningitis is characterised by a red or purple rash that does not fade when pushed, as well as fever, headache, stiff neck, and nausea.

    Here is a table of differences to make things easier when differentiating mild rashes from severe ones:

    Features of RashesMildSevere
    SizeSmallLarge
    Inflammation/ RednessLocalized areas of redness or inflammationWidespread areas of redness or inflammation
    FeverUsually MildHigh-grade
    LymphadenopathyMay be presentPresent with other accompanying features like difficulty in breathing
    PrognosisMostly resolves on its ownRequires urgent medical care
    Mild vs Severe Rashes: How to Identify

    It is crucial to remember that certain rashes may look moderate at first and then progress to more serious symptoms; therefore, it is critical to monitor symptoms and get medical assistance if they worsen.

    Parents should be on the lookout for any unexpected changes in their child’s health and seek medical assistance if they detect a major rash.

    Identifying the Signs of Rashes in Children

    Recognizing the symptoms of a rash in children can be difficult since rashes vary in appearance, size, and location. However, there are several traits that might assist you in identifying a rash. These traits include:

    1. Appearance
    2. Location
    3. Size
    4. Symptoms
    5. Change

    1. Appearance

    Rashes can show on the skin as red, pink, or purple patches or lumps. They might be flat, elevated, or blister-like in appearance. They can also be dry, scaly, wet, or weepy in appearance.

    2. Location

    They can arise everywhere on the body, however, some rashes are more prevalent in particular areas. A rash generated by an allergic response, for example, may occur on the face or hands. A fungal infection can cause a rash to emerge in the skin folds or in the diaper area.

    3. Size

    They range in size from small, isolated patches to big, spreading patches. A rash that covers a broad portion of the body is potentially more severe than a localised rash.

    4. Symptoms

    Rashes may be accompanied by itching, discomfort, or burning. Fever, swelling lymph nodes, or trouble breathing may accompany certain rashes.

    5. Change

    Finally, they can alter over time, worsen or improve, occur in various regions, spread, and be accompanied by new symptoms.

    Associations: Itchiness and Discomfort

    Itching and pain produced by rashes are frequent symptoms that can be caused by a variety of circumstances.

    • As a result of skin inflammation or irritation, the rash itself might cause itching or pain.
    • An allergic response may accompany the rash, causing irritation and pain.
    • An infection can produce a rash, which can cause itching and pain while the body’s immune system battles the illness.
    • A skin disease, such as eczema, can produce a rash, which can be persistent and cause itching and pain.

    Itching and pain may cause a great deal of misery in children, affecting their sleep, attitude, and overall well-being. Scratching the rash can aggravate it by producing additional discomfort and raising the risk of infection.

    To treat the irritation and pain caused by rashes, parents can use over-the-counter lotions or ointments containing calamine or hydrocortisone, which can soothe the skin and reduce itching. Itching and discomfort can be reduced by keeping the afflicted region cold and dry.

    Rashes and School

    • Chickenpox
      • Until vesicles have crusted over AND at least 5 days have passed from the onset of rash
      • Keep away from pregnant women
    • Impetigo
      • Until lesions are crusted and healed OR 48 hours after starting antibiotics
    • Pertussis (Whooping Cough)
      • 48 hours after commencing antibiotics or 21 days from onset of symptoms if no antibiotics are given
    • Scarlet fever
      • Until 24 hours from starting antibiotics
    • DO NOT EXCLUDE
      • Hand, Foot and mouth disease
      • Cold sores (Herpes simplex)
      • Molluscum Contagiosum
      • Roseola
      • Parvovirus B19 (once the rash has developed)
    • Keep away for 4 Days from the Onset of the Rash
      • Measles
      • Rubella

    Causes of Rashes in Children

    While there are different classifications for reasons for rashes, we will broadly categorize them into three parts:

    1. Allergies
    2. Skin Irritation
    3. Infections

    Here is an amazing video from PedsCases explaining the rashes in children:

    Credits: PedsCases

    1. Allergies

    Rashes in children are frequently caused by allergic responses. They arise when the body’s immune system overreacts to a typically innocuous item, such as a meal, drug, or allergy in the environment. Allergic responses can result in a variety of symptoms, including rashes.

    There are several forms of allergic responses that can produce rashes, the most frequent of which are:

    1. Eczema
    2. Hives
    3. Angioedema

    1. Eczema

    Eczema (atopic dermatitis): Eczema is a persistent, irritating skin disorder that causes red, dry, and itchy skin. It is frequently linked to other allergy disorders including asthma and hay fever.

    2. Hives

    Hives (urticaria) are raised, red, and itchy welts that can occur anywhere on the skin. They are frequently triggered by an allergic response to food, medicine, or an allergen in the environment.

    Summary of Urticaria from NICE CKS Guidelines
    • Wheal = Central itchy white papules or plaque surrounded by erythema
    • Eruption of itchy rash after URTI or after stress (eg. playing football), exercise-induced urticaria, or after taking aspirin or opiates, or soon after an insect bite
    • Acute<6 weeks (usually minutes to hours and less than 24 hours- Here Today and Gone Tomorrow)
    • Chronic>6 weeks
    • Management
      • Treat aggravating factors- Stop Aspirin, Opiates, Overheating, Stress, Alcohol, Caffeine
      • Non-sedating H1 Anti-Histamines e.g. Cetirizine, Loratadine
      • Calamine lotion

    3. Angiogedema

    Angioedema is a disorder that causes swelling of the skin’s deeper layers, most commonly around the eyes, lips, and hands. It might be the result of an allergic response or another medical problem hereditary angioedema).

    Symptoms of allergic responses might emerge minutes or hours after contact with the allergen. In certain circumstances, symptoms may not develop for many days.

    Take note of any symptoms and the date of probable allergen exposure, and seek medical assistance if your kid has severe symptoms or if the symptoms are intensifying.

    An allergist or dermatologist can assist in identifying the allergen and providing appropriate medication such as antihistamines, steroids, and immunotherapy.

    2. Skin Irritation

    One of the most typical causes of childhood rashes is skin irritation. The majority of instances are recorded when the skin is in touch with specific elements or compounds that hurt or irritate the skin. A couple of these have already been mentioned:

    1. Detergents: Cleaning agents, fabric softeners, and laundry detergents can irritate the skin. They have the ability to deplete the skin’s natural oils, resulting in dryness, irritation, and redness.
    2. Shampoos, soaps, and cosmetics: A few of these products might irritate the skin. They could include strong substances or scents that make people itch, get red, or get allergic responses.
    3. Clothing: Certain materials, such as wool or synthetic textiles, might irritate the skin. Particularly in locations where perspiration is more likely to occur, including the armpits and groyne, they might produce itching and redness.
    4. Weather: Skin irritation can be brought on by hot and humid conditions as well as UV radiation. Common manifestations of weather-related skin irritation include sunburn, chapped skin, and heat rash.
    5. Bites and stings from insects: Mosquitoes, bees, wasps, and other insects can irritate the skin when they bite or sting. They are able to produce swelling, itching, and redness.

    Depending on the reason, skin irritation symptoms might change. Itching, redness, dryness, peeling, and even blistering might be among them. Once the culprit has been removed, symptoms could become better. Calamine or hydrocortisone-based over-the-counter lotions and ointments can assist to calm the skin and lessen the irritation.

    3. Infections

    Children’s rashes frequently result from bacterial, viral, and fungal illnesses. Rashes are one of the many symptoms that these illnesses may produce.

    1. Viral infection: Chicken pox, measles, rubella, and roseola are among typical viral infections that can result in rashes in children. These infections frequently result in a distinctive rash along with other symptoms including fever, headaches, and muscular pains.
    2. Bacterial infection: Impetigo, scarlet fever, and Lyme disease are a few typical bacterial illnesses that can result in rashes in kids. These infections frequently result in a rash that is red, puffy, and painful, along with accompanying symptoms including fever, enlarged lymph nodes, and headaches.
    3. Fungal infection: Ringworm, jock itch, and athlete’s foot are examples of common fungal diseases that can cause rashes in youngsters. These infections often result in a red, scaly, and itchy rash, which is frequently accompanied by additional symptoms such as itching, burning, and, in rare cases, peeling skin.

    Take note of any symptoms and the timing of the rash, and seek medical assistance if the rash is accompanied by other symptoms, spreads or worsens, or the symptoms are severe and interfering with the child’s normal activities.

    A doctor can assist in determining the origin of the rash and administering appropriate therapy, which may include antibiotics, antifungal medicine, or antiviral medication.

    Diet and Allergies

    Youngsters tend to develop food allergies more often than others. This is especially true because new onset is often identified during this period mostly.

    Therefore, it becomes essential to identify the dietary contents that may be causing these allergies. Once identified, they can easily be stopped and prevent any further episodes.

    It is equally important to distinguish between allergies and intolerance which can be understood as:

    1. Food allergies: These are a prevalent cause of rashes in children. They develop when the body’s immune system responds to a specific food, resulting in symptoms such as itching, hives, redness, and swelling. Milk, eggs, peanuts, tree nuts, fish, shellfish, soy, and wheat are among the most frequent food allergies.
    2. Food intolerances: These vary from food allergies in that they do not involve the immune system. Instead, they are caused by the body’s inability to effectively digest or assimilate a certain meal. Lactose intolerance, gluten intolerance, and histamine sensitivity are examples of common dietary intolerances.

    Home Remedies for Treating Mild Rashes in Children

    Once you have identified the rashes are not a threat, you can move to conservative management for the same. There are some home remedies which can be used to ease up the symptoms. These include:

    1. Oatmeal Bath: Taking an oatmeal bath can help soothe sensitive skin because oatmeal has anti-inflammatory effects. To help with itching relief and to lessen redness, add 1 cup of oatmeal to a warm bath and soak for 15 to 20 minutes.
    2. Aloe vera: This plant is relaxing and moisturising. Itching, redness, and inflammation in the affected area can be lessened by applying aloe vera gel.
    3. Cold compresses: Cold compresses might assist to lessen inflammation and itching. Apply a clean, damp cloth to the afflicted region for 15 to 20 minutes at a time after soaking it in cold water. Iterate as necessary.
    4. A cream containing hydrocortisone: Hydrocortisone cream can help lessen inflammation and irritation. It is over-the-counter and can be used as directed on the affected region.
    5. Calamine lotion: Calamine lotion can aid in relieving itching and speeding the healing of blisters brought on by rashes like chickenpox.
    6. Avoiding irritants: This will help stop rashes from returning. Harsh soaps, detergents, and specific materials are just a few examples of irritants to keep away from.
    7. Maintain skin moisture: Maintaining skin moisture might help stop irritation and dryness. Several times per day, or after taking a bath, massage a moisturiser or lotion into the affected region.

    Medications

    Depending on the underlying cause of the rash, different medical treatments may be available for children’s rashes. A paediatrician may advise one or more of the following therapies if a rash doesn’t go away on its own in particular circumstances:

    1. Topical drugs: Topical drugs are applied directly to the skin to lessen itching, inflammation, and infection. Examples include creams, ointments, and gels. Calamine lotion, hydrocortisone cream, and antifungal creams are a few examples.
    2. Oral drugs: Oral drugs are given by mouth to treat the underlying cause of the rash and lessen symptoms, such as antibiotics, antihistamines, or antiviral drugs. These drugs can be used to treat allergies as well as bacterial and viral infections.
    3. Light therapy: Light therapy, sometimes called phototherapy, is a medical procedure that uses UV light to lessen inflammation and encourage healing. Eczema, psoriasis, and vitiligo are among the ailments it can be used to treat.
    4. Immunomodulator therapy: It is a medical procedure that aids in immune system regulation. Eczema, psoriasis, and vitiligo are among the ailments it can be used to treat.
    5. Biological Therapy: Proteins created in a lab are used in biological therapy, a sort of medical intervention, to assist with immune system regulation. Eczema, psoriasis, and vitiligo are among the ailments it can be used to treat.
    6. Allergen immunotherapy: It involves exposing a patient to progressively higher concentrations of an allergen, such as pollen or mould, over time. This can lessen the signs of an allergic reaction and assist the body in developing immunity to the allergen.

    It is important to note that most mild rashes do not even require treatment and can be managed conservatively.

    Tips for Parents dealing with Rashes in Children

    There are certain things you can do to ease your child’s symptoms and encourage healing, even though parenting can be difficult while they have a rash. Managing child rashes can be difficult. Here are some parenting suggestions:

    • Keep your child at ease: Because rashes can be irritating and upsetting, it’s crucial to keep your child at ease by giving them soft, breathable clothing and bedding. Maintain the affected region clean and dry, and avoid using harsh soaps and detergents.
    • Ensure that your youngster drinks enough water to be hydrated: This will assist to lessen irritation and keep the skin soft. Encourage your youngster to ingest liquids throughout the day, whether it be water or other drinks.
    • Observe your child’s signs: Keep a record of your child’s symptoms, including when they happen. When speaking with your paediatrician, you may find this information helpful.
    • Follow the plan: You should strictly adhere to your paediatrician’s recommended course of therapy if they give you one. The symptoms will be lessened, and recovery will be aided.
    • Teach your kid: teach your child about their rash and what they can do to aid with symptoms by providing them with information. Remind them to keep their nails short and tidy and to refrain from scratching the region that is hurt.
    • Be patient: Remind your youngster to exercise patience as well. Rash healing might take some time.
    • Seek help when required: Never be afraid to seek assistance if you’re struggling; you can always turn to friends, family, or a support group.
    • Care for yourself too: Self-care is essential for parents, therefore practise self-care. Don’t forget to take care of your own physical and emotional needs and to set aside time for yourself.

    Conclusion

    Parents frequently worry when their children get rashes, but knowing the origins, symptoms, and warning signs can help you decide whether to get treatment.

    It’s critical to distinguish between moderate and severe rash situations and to recognise the symptoms of a rash. Eczema, chickenpox, and measles are examples of common rashes. Sepsis and meningitis are examples of dangerous rashes.

    Rashes, along with allergic responses, skin irritation, and viral, bacterial, and fungal infections, are characterised by itching and pain. Rashes can also be influenced by nutrition and allergies.

    FAQs

    When should I worry about a rash on my child?

    If the child shows any symptoms such as high-grade fever, difficulty in breathing, pus discharge from the rashes, vomiting or diarrhoea, rashes on eyes or tongue, fatigue and weakness, enlarged lymph nodes or whenever there is a concern, the parents should seek medical help.

    What are the five childhood rashes?

    The most common childhood rashes include Chickenpox, Measles, Rubeola, Roseola, Rubella and Parvovirus B19 (also known as Erythema Infectiosum/ Fifth disease).

    Resources

    1. “Rashes in Children: Causes and Treatments.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 5 Oct. 2020, www.mayoclinic.org/diseases-conditions/rashes-in-children/symptoms-causes/syc-20376232.
    2. “Eczema (Atopic Dermatitis).” American Academy of Dermatology, www.aad.org/public/diseases/eczema/atopic-dermatitis.
    3. “Chickenpox.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 18 Mar. 2020, www.cdc.gov/chickenpox/index.html.
    4. “Measles.” World Health Organization, World Health Organization, www.who.int/news-room/fact-sheets/detail/measles.
    5. “Sepsis and Septic Shock.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 11 Sept. 2020, www.mayoclinic.org/diseases-conditions/sepsis/symptoms-causes/syc-20351214.
    6. “Meningitis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 30 Sept. 2020, www.mayoclinic.org/diseases-conditions/meningitis/symptoms-causes/syc-20350508.
    7. “Kawasaki Disease.” American Heart Association, www.heart.org/en/health-topics/kawasaki-disease/what-is-kawasaki-disease.
    8. “Scarlet Fever.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 14 Sept. 2020, www.mayoclinic.org/diseases-conditions/scarlet-fever/symptoms-causes/syc-20351291.
    9. “Skin Irritation.” American Academy of Dermatology, www.aad.org/public/diseases/skin-irritation.
    10. “Rashes in babies and children.” National Health Service, www.nhs.uk/conditions/rashes-babies-and-children

    Vishram Singh Anatomy PDF Download | Latest Edition Textbook

    Admin
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    Vishram Singh Anatomy PDF Download | Latest Edition Textbook

    The Vishram Singh General Anatomy PDF is one of the books that a first-year medical student would choose to read and look for insights as he reads BD Chaurasia sideways.

    Although not the bible of anatomy, this has a position in the learning process during the first semesters of MBBS. This page contains a link to a copy of the Textbook of Anatomy Second Edition. Simply scroll down to find free Google Drive links to the PDF version.

    Please find all links below to the individual Head and Neck, Lower Limb, Abdomen, Upper Limb, and Thorax.

    Updated: New links for 2023 latest editions have been regenerated! (Third edition is yet to come, kindly have patience)

    Vishram Singh General Anatomy PDF Book

    This book is divided into three sections- Upper Limb and Thorax, Abdomen, and Lower Limb, and Head, Neck, and Brain. The following are the contents of Vishram Singh Anatomy PDF:

    Upper Limb and Thorax

    Vishram Singh General Anatomy PDF Volume 1- Upper limb and Thorax book are 375 pages long with contents as follows:

    • Chapter 1 Introduction to the Upper Limb
    • Chapter 2 Bones of the Upper Limb
    • Chapter 3 Pectoral Region
    • Chapter 4 Axilla (Armpit)
    • Chapter 5 Back of the Body and Scapular Region
    • Chapter 6 Shoulder Joint Complex (Joints of Shoulder Girdle)
    • Chapter 7 Cutaneous Innervation, Venous Drainage, and Lymphatic Drainage of the Upper Limb
    • Chapter 8 Arm
    • Chapter 9 Forearm
    • Chapter 10 Elbow and Radio-ulnar Joints
    • Chapter 11 Hand
    • Chapter 12 Joints and Movements of the Hand
    • Chapter 13 Major Nerves of the Upper Limb
    • Chapter 14 Introduction to Thorax and Thoracic Cage
    • Chapter 15 Bones and Joints of the Thorax
    • Chapter 16 Thoracic Wall and Mechanism of Respiration
    • Chapter 17 Pleural Cavities
    • Chapter 18 Lungs (pulmones)
    • Chapter 19 Mediastinum
    • Chapter 20 Pericardium and Heart
    • Chapter 21 Superior Vena Cava, Aorta, Pulmonary Trunk, and Thymus
    • Chapter 22 Trachea and Esophagus
    • Chapter 23 Thoracic Duct, Azygos and hemiazygos Veins, and Thoracic Sympathetic Trunks

    Abdomen and Lower Limb

    Vishram Singh General Anatomy PDF Volume 2- Lower Limb and Abdomen book is 521 pages long with the following contents:

    • Chapter 1 Introduction and Overview of the Abdomen
    • Chapter 2 Osteology of the Abdomen
    • Chapter 3 Anterior Abdominal Wall
    • Chapter 4 Inguinal Region/Groin
    • Chapter 5 Male External Genital Organs
    • Chapter 6 Abdominal Cavity and Peritoneum
    • Chapter 7 Abdominal Part of Esophagus, Stomach, and Spleen
    • Chapter 8 Liver and Extrahepatic Biliary Apparatus
    • Chapter 9 Duodenum, Pancreas, and Portal Vein
    • Chapter 10 Small and Large Intestines
    • Chapter 11 Kidneys, Ureters, and Suprarenal Glands
    • Chapter 12 Posterior Abdominal Wall and Associated Structures
    • Chapter 13 Pelvis
    • Chapter 14 Pelvic Walls and Associated Soft Tissue Structures
    • Chapter 15 Perineum
    • Chapter 16 Urinary Bladder and Urethra
    • Chapter 17 Male Genital Organs
    • Chapter 18 Female Genital Organs
    • Chapter 19 Rectum and Anal Canal
    • Chapter 20 Introduction to the Lower Limb
    • Chapter 21 Bones of the Lower Limb
    • Chapter 22 Front of the Thigh
    • Chapter 23 Medial Side of the Thigh
    • Chapter 24 Gluteal Region
    • Chapter 25 Back of the Thigh and Popliteal Fossa
    • Chapter 26 Hip Joint
    • Chapter 27 Front of the Leg and Dorsum of the Foot
    • Chapter 28 Lateral and Medial Sides of the Leg
    • Chapter 29 Back of the Leg
    • Chapter 30 Sole
    • Chapter 31 Arches of the Foot
    • Chapter 32 Joints of the Lower Limb
    • Chapter 33 Venous and Lymphatic Drainage of the Lower Limb
    • Chapter 34 Innervation of the Lower Limb

    Head, Neck, and Brain

    Vishram Singh General Anatomy PDF Volume 3- Head and Neck book has over 460 pages and contents of:

    • Chapter 1 Living Anatomy of the Head and Neck
    • Chapter 2 Osteology of the Head and Neck
    • Chapter 3 Scalp, Temple, and Face
    • Chapter 4 Skin, Superficial Fascia, and Deep Fascia of the Neck
    • Chapter 5 Side of the Neck
    • Chapter 6 Anterior Region of the Neck
    • Chapter 7 Back of the Neck and Cervical Spinal Column
    • Chapter 8 Parotid Region
    • Chapter 9 Submandibular Region
    • Chapter 10 Infratemporal Fossa, Temporomandibular Joint, and Pterygopalatine Fossa
    • Chapter 11 Thyroid and Parathyroid Glands, Trachea, and Esophagus
    • Chapter 12 Pre- and Paravertebral Regions and Root of the Neck
    • Chapter 13 Oral Cavity
    • Chapter 14 Pharynx and Palate
    • Chapter 15 Larynx
    • Chapter 16 Blood Supply and Lymphatic Drainage of the Head and Neck
    • Chapter 17 Nose and Paranasal Air Sinuses
    • Chapter 18 Ear
    • Chapter 19 Orbit and Eyeball
    • Chapter 20 Vertebral Canal and Its Contents
    • Chapter 21 Cranial Cavity
    • Chapter 22 Cranial Nerves
    • Chapter 23 General Plan and Membranes of the Brain
    • Chapter 24 Brainstem
    • Chapter 25 Cerebellum and Fourth Ventricle
    • Chapter 26 Diencephalon and Third Ventricle
    • Chapter 27 Cerebrum
    • Chapter 28 Basal Nuclei and Limbic System
    • Chapter 29 Blood Supply of the Brain

    Overview

    Vishram Singh General Anatomy PDF Book gives the First year students another option apart from the traditional BD Chaurasia book. The book has super illustrations and also holds special as it has MCQ-based questions along with it.

    The drawings are so fine and clear with different colors to explain the details. The book also depicts clinical pictures of the same as the reader gets deep into the book. It’s a good book if you are preparing for NEET PG exams as well.

    Suggestions to those studying from Vishram Singh General Anatomy PDF in First Year MBBS are as follows:

    1. Consider creating more diagrams and 3D visuals to help you remember everything. The more you conceive and sketch, the easier it will be to recollect them.
    2. There are many YouTube videos available, and there are also several animations that aid in understanding the most crucial concepts. You will need these throughout your whole medical career, so just don’t miss them.
    3. Please study this book if you are prepared for the PG Exams. It will open the door for improved education. BD Chaurasia is still regarded as the definitive work on anatomy in India.
    4. It is an excellent approach to recall anatomy to clinically correlate it with cadavers during dissection hall posting.
    5. If you need help, the following are some posts that can greatly help you in clinical anatomy. They have been made short but explained to the level of a medical student. You can check out our Clinical Skills Section to learn more.

    Vishram Singh General Anatomy PDF Download

    BookTextbook of Anatomy
    SubjectGeneral Anatomy
    AuthorVishram Singh
    BindingPaperback
    Edition2nd
    LanguageEnglish
    Total Volumes3
    File Size129MB
    File TypePDF
    Link TypeGoogle Drive
    Number of Pages1326
    Last Updated24/12/2022

    You can download the 2nd Edition of this book through the Google Drive links given below. Please note, the Latest Edition- 3rd edition of the book has already been released.

    Check out other Anatomy books:

    Volume 1: Upper Limb and Thorax

    Volume 1

    Volume 2: Abdomen and Lower Limb

    Volume 2

    Volume 3: Head, Neck, and Brain

    Volume 3

    Acupressure Points for Back Pain Relief- A Comprehensive Guide on Techniques and Tips

    Dr.Varun Tyagi
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    Acupressure Points for Back Pain Relief- A Comprehensive Guide on Techniques and Tips

    You probably have heard people exaggerating the amazing effects they experienced after pressing some Acupressure points for back pain. Well, it is somewhat true given how perfectly you execute it.

    In this article, we will take a closer look at the causes of back pain, identify the specific points, explain how to perform it on yourself, and provide tips for maximizing the effectiveness of the treatment.

    What is Acupressure?

    Acupressure is a type of traditional Chinese medicine in which pressure is applied to particular places on the body to relieve pain and other ailments.

    It is similar to acupuncture, except instead of using needles, it applies pressure to specific spots with fingers, palms, or even a gadget.

    It’s like giving yourself a massage, but for a good cause!

    It is based on the premise that our bodies contain energy routes known as meridians. Pain and other symptoms can occur when these routes get blocked.

    It can assist to unblock energy and restore balance to the body by applying pressure to certain locations along these routes.

    How does Acupressure help with Back Pain?

    Now, let’s look at how it can especially aid with back pain relief. Back discomfort is a frequent issue that can be caused by reasons such as poor posture, injury, and stress.

    You may assist relieve discomfort and enhance your general well-being by targeting certain acupressure points connected with the lower, middle, and upper back.

    It’s the equivalent of pressing the “reset” button on your back!

    So, it is a terrific method to give your back some much-needed TLC and relieve discomfort without having to travel anywhere. Give it a go and see how it goes!
    How does Acupressure help with Back Pain?

    What are the Causes of Back Pain?

    There are a number of reasons why you could be having back pain, but some of them are worth mentioning. We have given the top 5 causes of the back which are as follows:

    1. Poor Posture
    2. Injury
    3. Stress
    4. Arthritis
    5. Recent C-Section
    What are the Causes of Back Pain

    1. Poor posture

    Long durations of sitting, slouching, and hunching over can all lead to bad posture, which can strain your back muscles. Your back is a superhero, but it must have a good stance to combat the bad guys (the pains and aches).

    2. Injury

    Back pain can be caused by a sudden injury, such as a fall or a vehicle accident. Your back has been the victim of a crime, and the agony is the proof.

    3. Stress

    Stress, believe it or not, can also contribute to back discomfort. When we are anxious, our muscles stiffen up, which can cause pain and discomfort. All of your tension is hitting you in the back.

    4. Arthritis

    This is a joint ailment that can cause discomfort and stiffness in the back. Your back is becoming old, and it’s not as supple as it once was.

    Arthritis Back Pain Acupressure Points
    These are only a handful of the numerous potential causes of back pain. Herniated discs, osteoporosis, and even kidney stones can be causes.

Back discomfort can be caused by a variety of causes, including poor posture, injury, stress, and even underlying medical issues.

    What are the Acupressure Points for Back Pain?

    Certain areas on the body may be addressed when utilizing acupressure to relieve back pain. These places are frequently found along the body’s energy routes or “meridians“.

    Let’s look at some of the most effective back pain acupressure points:

    Lower Back Pain

    Acupressure Points for Lower Back Pain
    • The point known as “Bladder 23” is located on the lower back, just above the buttocks.
    • “Bladder 40” is located on the outer edge of the foot, near the little toe. A magic spot on your foot that can help alleviate lower back pain.

    Middle Back Pain

    Acupressure Points for Middle Back Pain
    • “Gallbladder 21” is located on the shoulder blade, near the spine. Shhh.. this is a secret button located in a hard-to-reach spot, but it’s worth it!
    • “Gallbladder 34” is located on the thigh, about four fingers width below the knee. Press this button on your thigh to alleviate middle back pain.

    Upper Back Pain

    Acupressure Points for Upper Back Pain
    • “Large Intestine 14” is located on the upper back, just below the base of the neck. A magic button that can help alleviate upper back pain!
    • “Triple Warmer 5” is located on the back of the wrist, in the webbing between the thumb and index finger. Somewhat similar to a button on your wrist that can help alleviate upper back pain.
    It's worth noting that these are only a handful of the numerous spots that may be utilised to relieve back pain. To identify the optimal points for your unique requirements, speak with a qualified acupressure practitioner or a healthcare expert.

    Proper Technique for Applying Pressure to Acupressure Points

    How to perform acupressure on yourself

    When it comes to applying pressure to these points, proper technique is key. Here’s a step-by-step guide for how to perform acupressure on yourself:

    10 Minutes 10 minutes

    1. Locate the point

      Step 1- Locate the Point for Acupressure

      Use the images or diagrams provided in the previous section to locate the specific acupressure point you want to work on.

    2. Apply pressure

      Step 2- Apply Pressure for Acupressure

      Use your finger, thumb, or a device to apply firm, steady pressure to the point. You should feel a dull ache or sensation of pressure. You don’t want to overdo it, it should not be too painful.

    3. Hold the pressure

      Step 3- Hold the pressure during Acupressure

      Keep the pressure applied for 2-3 minutes, or as long as is comfortable.

    4. Release the pressure

      Step 4- Release the pressure during Acupressure

      Slowly release the pressure and take a few deep breaths. You can repeat this process 2-3 times per session, or as needed.

    It's critical to remember that this procedure shouldn't hurt. If you feel any intense pain or discomfort, remove the pressure immediately.

Always get the advice of a skilled practitioner or a healthcare professional before doing it yourself.

In brief, the right way to apply pressure to the above mentioned sites is to use firm, consistent pressure, hold it for 2-3 minutes, and then gently release it.

    Getting the Most of Acupressure for Back Pain

    There are a few things to keep in mind when it comes to enhancing the effectiveness of acupressure treatment.

    By following these guidelines, you can guarantee that you get the most out of your targeted sessions and achieve the greatest outcomes possible:

    1. Relax: Before commencing your session, make sure you’re in a comfortable and relaxed position. This will assist to relieve muscular tension and allow energy to flow more easily.
    2. Apply the proper amount of pressure: As previously said, this technique should not be uncomfortable. Apply firm, consistent pressure that is comfortable for you.
    3. Repeat and Repeat: Repeat the procedure in the same location 2-3 times every session, or as needed. It’s similar to completing a series of exercises; the more you do it, the greater the outcomes.
    4. Moisten it up: If your skin is dry, add a tiny quantity of oil or lotion to moisten it before applying pressure to the acupressure points. This reduces friction and makes the procedure more pleasant.
    5. Try Breathing: Deep breathing methods should be incorporated into your workouts. Focus on the sense of pressure on the spot as you breathe in and out. This will assist to improve the treatment’s efficacy and encourage relaxation.
    6. Maintain consistency: Acupressure is most effective when used on a regular basis. So, make it a part of your daily routine and be consistent with your workouts.
    Breathing along with Acupressure

    Don’t Stop!

    Acupressure is an excellent remedy for back pain, but it is not the only option. Other therapies, in addition to this, can be utilized to relieve back pain and enhance general well-being.

    Acupressure for back pain can be combined with other techniques which include:

    1. Stretching
    2. Exercise
    3. Massage

    1. Stretching

    Stretching exercises can aid in the release of muscular tension and the improvement of flexibility. This can assist to relieve discomfort and lessen the likelihood of harm.

    There are certain stretches meant to target the back muscles, so it’s critical to execute the stretches that are suited for you.

    2. Exercise

    Exercising regularly basis can assist to develop muscles and enhance general fitness. This can aid with pain relief, injury prevention, and overall well-being.

    There are specialized exercises meant to target the back muscles, so it’s critical to do the proper ones for your requirements.

    3. Massage

    Massage treatment can assist to relieve muscular tension and enhance circulation. This can aid with pain relief, injury prevention, and overall well-being.

    There are particular massage techniques meant to target the back muscles, so choosing the proper treatment for your requirements is critical.

    Conclusion

    Acupressure is a powerful tool for treating back pain. It is a non-invasive, natural therapy that can help to alleviate pain and improve overall well-being. It’s like a natural painkiller that you can do yourself.

    Some of the benefits of using acupressure for back pain include:

    • Relief from pain
    • Improved circulation
    • Reduced muscle tension
    • Increased flexibility
    • Improved overall well-being

    It can also be used in conjunction with other therapies, such as stretching, exercise, and massage, to achieve the best possible results. It can also be used as a preventative measure to reduce the risk of injury and improve overall well-being.

    It's important to note that this should not be used as a substitute for medical care. If you're dealing with chronic pain or other serious health issues, it's best to consult with a healthcare professional before trying acupressure.

    FAQs

    Is Acupressure safe?

    It is generally considered safe and has minimal side effects. However, it’s best to consult with a healthcare professional before trying it, especially if you have a chronic condition or are pregnant.

    Can I use Acupressure to treat chronic back pain?

    It can be effective in treating chronic back pain, but it’s important to note that it should not be used as a substitute for medical care.

    If you have chronic back pain, it’s best to consult with a healthcare professional before trying it. They can help you determine if it is appropriate for your condition, and they can also help you develop a treatment plan that includes acupressure as well as other therapies, such as stretching, exercise, and massage, to achieve the best possible results.

    In addition, it’s important to maintain consistency and regularity in sessions for chronic conditions.

    What are the Acupressure points for back Pain by Baba Ramdev?

    Baba Ramdev is a well-known yoga guru and Ayurvedic practitioner from India who has popularized the use of acupressure for various health conditions, including back pain.

    He suggests specific points for back pain relief that can be performed by individuals at home. Some of these points include “Bladder 23” located on the back, just below the waistline, and “Bladder 40” located on the back of the legs, just below the knee.

    He also recommends “Gallbladder 21” located on the upper back, between the shoulder blades, and “Gallbladder 34” located on the back of the legs, just below the knee.

    What are the Acupressure points for back pain due to gas?

    Some of the most effective acupressure points for gas-related back pain include “Large Intestine 4” located on the back of the hand, between the thumb and index finger, “Stomach 36” located on the lower leg, four finger widths below the kneecap, and “Spleen 6” located on the inner ankle, just above the ankle bone.

    These points are believed to help relieve gas and improve digestion which can in turn help in relieving back pain caused by gas. It’s important to note that this remedy should be used in conjunction with other therapies recommended by a healthcare professional for best results.

    Resources

    1. “Acupressure for Back Pain” by Michael Reed Gach, Ph.D.
    2. “Acupressure’s Potent Points: A Guide to Self-Care for Common Ailments” by Michael Reed Gach
    3. “Acupressure: A Step-by-Step Guide” by Chris Jarmey
    4. “Acupressure for Emotional Healing: A Self-Care Guide for Trauma, Stress, and Common Emotional Imbalances” by Michael Reed Gach
    5. “Acupressure for Lovers: Secrets of Touch for Increasing Intimacy” by Michael Reed Gach
    6. “Acupressure for Athletes” by Michael Reed Gach
    7. “Acupressure for Common Ailments: An Illustrated Guide” by Nigel Dawes
    8. “Acupressure: A Simple Guide to Healing Common Ailments” by Jacqueline Young
    9. “Acupressure: Healing Techniques for Every Body” by Deborah Bleecker
    10. “Acupressure for Dummies” by Jacqueline Young

    Back Pain after C-Section: Why It Occurs and How to Manage It

    Dr.Varun Tyagi
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    Back Pain after C-Section: Why It Occurs and How to Manage It

    Some women can develop back pain immediately or a few days after delivering the baby through a Cesarean section. In this article, we will highlight the reasons behind back pain after C Section and what are the appropriate ailments that should be approached to get relief.

    Introduction

    It is not common for mothers to develop back pain after a C-Section. Before we dive deep into the topic, let us start with the basics first:

    What is a C-Section?

    A Cesarean section, also known as a C-section, is a surgical procedure in which a baby is delivered through an incision in the mother’s abdomen and uterus. This procedure is usually performed when a vaginal delivery would pose a risk to the mother or baby.

    Why C-Section is performed?

    There are several reasons why a C-section may be necessary. One of the most common reasons is when a baby is in a breech position, meaning that they are not facing head-first toward the birth canal.

    Other reasons for a C-section include placenta previa, a condition in which the placenta covers the cervix, or if the mother has a health condition such as hypertension or diabetes that makes a vaginal delivery risky.

    How is the procedure done?

    A C-section is usually performed under spinal or epidural anesthesia, which numbs the lower half of the body so that the mother is awake but cannot feel pain during the procedure.

    The procedure typically takes around 30 to 60 minutes. Recovery time for a C-section is generally longer than for a vaginal delivery, and the mother may experience discomfort and pain in the abdominal area.

    Is it safe?

    C-section is a safe procedure and it has a high success rate, but as with any surgery, it does come with some risks. These risks include bleeding, infection, and injury to the bladder or bowel. Additionally, there is a risk of blood clots for the mother and breathing problems for the baby.

    It is important for expectant mothers to discuss the pros and cons of a C-section with their healthcare provider. In most cases, a vaginal delivery is the preferred method, but in certain situations, a C-section may be the safest option for both mother and baby.

    What are the Chances of having Back Pain After C Section?

    Back discomfort is a typical complication following a Cesarean section. Back discomfort can arise as a result of the physical pressure on the lower back after surgery, as well as hormonal changes and muscle relaxation during pregnancy.

    Additionally, changes in posture and carrying excess weight can put a strain on the spinal cord, resulting in back discomfort. This pain can range from modest discomfort to severe and incapacitating pain, and it can linger for weeks or even months following birth.

    New moms must take precautions to control and alleviate their back discomforts, such as appropriate posture, light exercise, and adequate sleep.

    Over-the-counter pain relievers and physical therapy may be required in some circumstances to control discomfort. It is vital to remember that if the discomfort persists or worsens, obtaining medical assistance is strongly advised.

    Causes of Back Pain after C Section

    There are a number of reasons why a woman can suffer from back pain following a cesarean section. These include:

    1. Physical strain on the lower back during surgery
    2. Hormonal changes and muscle relaxation during pregnancy
    3. Posture changes and carrying extra weight
    4. Stress on the spinal cord

    1. Physical Strain on the Lower Back During Surgery

    Physical strain on the lower back during a C section surgery can be a significant contributor to the development of back pain after the delivery.

    The procedure involves making an incision in the mother’s abdomen and uterus, which can put a lot of stress on the lower back muscles. This can result in muscle soreness, stiffness, and pain that can last for several weeks or even months after the delivery.

    Furthermore, the positioning required during a C-section can also put a lot of strain on the lower back. The mother may have to lie on her back for an extended period of time, which can lead to muscle strain and pain.

    The pressure on the lower back during the surgery also causes compression of the nerves which can lead to pain.

    It’s important to note that the intensity of back pain may vary from person to person, but it is a common occurrence after a c-section. It’s crucial for new mothers to take steps to manage and alleviate their back pain, such as through proper posture, gentle exercise, and proper sleep.

    In some cases, over-the-counter pain medications and physical therapy may be necessary to manage the pain. However, it is always recommended to consult with the healthcare provider for personalized advice on managing the pain.

    In conclusion, physical strain on the lower back during a Cesarean section surgery can be a significant contributor to the development of back pain after delivery.

    The procedure and positioning required during a C-section can lead to muscle soreness, stiffness, and pain. It is essential for new mothers to take steps to manage and alleviate their back pain, and seeking medical attention if the pain persists or becomes severe is highly recommended.

    2. Hormonal changes and muscle relaxation during pregnancy

    Back discomfort after a Cesarean section might be exacerbated by hormonal changes and muscular relaxation during pregnancy.

    Pregnancy causes hormonal changes that allow the ligaments that support the spine to relax and stretch, increasing the likelihood of injury. This can cause lower back pain and discomfort, especially as the pregnancy advances and the baby becomes larger.

    The body also creates a hormone called relaxin during pregnancy, which causes the joints and ligaments to relax and loosen in preparation for birthing.

    This can cause spine instability, resulting in pain and discomfort. Furthermore, the weight gain that happens during pregnancy can place additional strain on the lower back, resulting in discomfort.

    Furthermore, as the pregnancy proceeds, the abdominal muscles might weaken, causing the back to bear more of the weight. This might strain the lower back muscles, causing pain and discomfort.

    It is vital to highlight that these changes occur not just during pregnancy but also after birth. Hormonal shifts and muscle relaxation continue to impact the body after birth, which can cause back discomfort to last longer.

    Maintaining excellent posture, engaging in mild exercise, and engaging in activities that strengthen the core muscles are all helpful ways to manage back discomfort induced by hormonal changes and muscular relaxation during pregnancy.

    Pregnant women should also be cautious of their weight gain and seek tailored pain management guidance from their healthcare professionals.

    3. Posture changes and carrying extra weight

    Changes in posture and bearing extra weight might also contribute to the development of back discomfort following a Cesarean section.

    As the pregnancy continues, the body’s center of gravity slips forward, causing a woman to lean back and arch her lower back in an attempt to maintain balance. This might put tension on the lower back muscles, causing pain and discomfort.

    Additionally, carrying extra weight during pregnancy can place additional tension on the lower back, resulting in strain and pain.

    As the baby grows, the abdominal muscles may weaken, causing the back to bear more of the pregnancy’s weight. This might strain the lower back muscles, causing pain and discomfort.

    Furthermore, new moms may have lower back discomfort after delivery when they lift and carry their babies. Carrying the infant in the improper position or raising them incorrectly can strain the lower back muscles.

    Maintaining proper posture, engaging in mild exercise, and engaging in activities that strengthen the core muscles are all helpful ways to treat back discomfort caused by changes in posture and carrying excess weight.

    When raising and holding their newborn, new moms should be cautious of their posture and technique. Pregnant women should also be cautious of their weight gain and seek tailored pain management guidance from their healthcare professionals.

    4. Stress on the spinal cord

    Back discomfort after a Cesarean section can also be caused by stress on the spinal cord. The surgical technique and the physical rehabilitation process can exert significant pressure on the spinal cord, resulting in pain and discomfort.

    The spinal cord is crushed and twisted during the procedure, which might injure the nerves and muscles that surround the spinal cord. This can cause pain and discomfort in the lower back, particularly as the rehabilitation process progresses.

    Furthermore, the physical healing process following a C-section can place a lot of strain on the spinal cord. It takes time for the incision site to heal, and the mother may endure discomfort and anguish as the region heals.

    The mother may also need to adjust to the rehabilitation process, which may entail lying down, sitting, and walking, all of which can place stress on the spinal cord and create discomfort.

    Maintaining excellent posture, engaging in modest exercise, and engaging in activities that strengthen the core muscles are all effective ways to alleviate back discomfort caused by spinal cord tension.

    During the recuperation phase, it’s also critical to get enough of rest and avoid heavy lifting or vigorous exercise. Physical therapy may be required in some circumstances to assist manage discomfort.

    Symptoms of Back Pain After a Cesarean Section

    The symptoms can vary from mild to severe. There are symptoms that are relatively common as compared to infrequent ones. These are:

    Common Symptoms

    The following are the frequent symptoms for women following a Cesarean section:

    1. Lower Back Pain
    2. Muscle Stiffness
    3. Discomfort

    Lower back pain can range from minor discomfort to severe pain in the lower back that can extend down the legs.

    The physical strain on the lower back muscles after surgery, as well as the hormonal changes and muscular relaxation that occur during pregnancy, can all contribute to this pain.

    Muscle stiffness is another typical side effect after a C-section. The incision site may be painful, and the mother’s muscles surrounding the wound may be tight.

    The physical recuperation process, as well as the strain on the muscles after surgery, can all contribute to this stiffness.

    Another typical sensation observed following a C-section is discomfort. This might include general soreness in the location of the incision, as well as discomfort in the lower back, hips, and legs.

    This soreness can be caused by both the physical healing process and the strain placed on the muscles during surgery.

    It is important to remember that the strength and length of these symptoms can vary from person to person and may last for several weeks or even months following the delivery.

    Less Common Symptoms

    Numbness or tingling in the legs is a less typical symptom that may occur following a Caesarean section. These symptoms can be produced by the procedure compressing or injuring the nerves around the spinal cord.

    Numbness or tingling in the legs might be described as a pins-and-needles sensation or lack of sensation in the legs. This might be an indication of something more serious and should be treated by a medical practitioner.

    Furthermore, numbness or tingling that is accompanied by weakness, or that continues or worsens, may be a symptom of nerve damage or compression and should be assessed by a healthcare practitioner as soon as possible.

    It’s crucial to emphasize that these symptoms are uncommon, and not all women may experience them following a C-section. If they do occur, it is critical to get medical assistance since they may signify a more serious problem.

    Coping with Back Pain After C Section

    Coping with back discomfort after a Cesarean section can be difficult, but there are numerous options for managing and relieving the pain. These include:

    1. Tips for Managing the Pain
    2. Medications
    3. Self-Care and Stress Management

    Tips for Managing the Pain

    These include:

    1. Proper Posture
    2. Gentle Exercises
    3. Proper Sleep

    1. Proper Posture

    Proper posture can assist to lessen tension in the lower back muscles and alleviate discomfort. When sitting, maintain the feet flat on the floor, the shoulders back, and the chest elevated.

    When standing, maintain the shoulders back and the chest high, and prevent slouching.

    2. Gentle Exercises

    Gentle exercise can also assist with pain management after a C-section. Walking, swimming or prenatal yoga can all assist to strengthen the core muscles and improve posture.

    These movements can aid in increasing blood flow, decreasing muscular stiffness, and relieving discomfort. During the healing phase, however, it is critical to avoid intense activity and heavy lifting.

    Exercises you can do for managing Post-Partum Back Pain

    3. Proper Sleep

    Proper sleep is also essential in coping with discomfort after a C-section. A certain amount of rest is required for the body to repair and recuperate.

    A supportive mattress and pillows can assist to relieve discomfort and lessen the strain on the lower back. It’s critical to maintain a comfortable sleeping position and avoid sleeping on your stomach, which can place extra strain on your lower back.

    Medications

    For more severe pain following a Caesarean section, over-the-counter pain medicines and physical therapy are available.

    To relieve pain and discomfort, over-the-counter pain relievers such as ibuprofen or acetaminophen can be utilized. However, it is critical to contact a healthcare expert before taking any prescription, as some drugs may be unsafe for new moms.

    Physical therapy can also assist with more severe pain following a C-section. Physical therapists can give exercises and stretches designed particularly to relieve pain and increase mobility.

    They can also advise on good posture, lifting and carrying techniques, and other pain management approaches. By strengthening muscular strength and flexibility, physical therapy can also assist to avoid future back discomfort.

    Self-Care and Stress Management

    Coping with discomfort after a Cesarean section requires self-care and stress management. Pain and discomfort can be exacerbated by stress, and self-care can assist to reduce stress and enhance general well-being.

    Self-care activities like taking a warm bath, reading a book, or participating in a hobby can help relieve stress and enhance general well-being. These exercises can also aid in relaxation and pain relief.

    Stress management practices such as meditation, yoga, or deep breathing exercises can also aid with stress reduction and pain control.

    These approaches can aid in the improvement of mental and emotional well-being as well as the promotion of relaxation, which can aid in the relief of pain and suffering.

    It’s also critical for new mothers to create reasonable goals for themselves throughout the healing time. It’s critical to remember that the rehabilitation process takes time, so be patient and allow the body to mend.

    Final Thoughts

    This article covered the most prevalent reasons for back discomfort following a Cesarean birth in this post.

    Physical pressure on the lower back following surgery, hormonal changes and muscular relaxation during pregnancy, postural alterations and carrying extra weight, and spinal cord tension are among the causes.

    Typical back pain symptoms include lower back pain, muscular stiffness, and discomfort, as well as less common symptoms like leg numbness or tingling.

    Pain-management recommendations comprise of keeping an appropriate posture, doing light exercise and getting enough sleep.

    For more severe pain, over-the-counter pain relievers and physical therapy may be required. There is a notble significance of self-care and stress management in dealing with back discomfort after a C-section.

    It is critical to underline that, while most women may suffer some pain and discomfort following a Caesarean section, the pain should gradually improve over time.

    However, if the discomfort persists or worsens, it is critical to seek medical treatment. Persistent or severe pain may indicate a more serious problem and should be checked by a healthcare practitioner.

    Furthermore, if the pain is accompanied by other symptoms such as leg numbness or tingling, weakness, fever, or if it gets severe, it is critical to seek medical assistance as soon as possible. These symptoms may signal a more serious disease and should be checked by a physician.

    Himalaya Face Wash Reviews: Benefits and Side Effects

    Dr.Varun Tyagi
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    Himalaya Face Wash Reviews: Benefits and Side Effects

    The Himalaya is a brand of skincare products that has been around for over 80 years. One of their most popular products is their Neem Face Wash. While many prefer this as the best in the market, the side effects make its usage debatable.

    In this post, we will uncover what are the two sides of the coin- The Good and Bad of Himalaya Face Wash.

    Key Ingredients

    Cleansing your face and getting rid of pollution, oil, and makeup is easy and effective with Himalaya Face Wash. It has organic components including aloe vera, neem, and turmeric. The advantages of every one of them are:

    1. Neem– Because of its antimicrobial characteristics, neem is recognized to help treat and prevent acne.
    2. Turmeric– Due to its inherent anti-inflammatory properties, turmeric can aid to calm the skin and lessen skin redness.
    3. Aloe Vera– Natural moisturizer aloe vera may aid in hydrating the skin and leaving it feeling supple and smooth.

    Additionally, the face wash has a unique combination of herbs that combined give your skin a revitalized appearance and feel.

    Licorice, which may help to lighten dark circles and diminish pigmentation, and winter cherry, which can aid to minimise the appearance of fine lines and wrinkles, are two of these herbs.

    Himalaya face cleanser is hypoallergenic and devoid of parabens, mineral oil, and artificial colours.

    It’s also cruelty-free and environmentally friendly. It is inexpensive and simple to use. It may be used to wash and remove makeup from your face in the morning and evening.

    How to use Himalaya Neem Face Wash?

    How to Wash Face the Right Way

    Learn how to use Himalaya Neem Face Wash effectively for best results:

    3 Minutes 3 minutes

    Wet Face and Massage

    To use Himalaya neem face wash, wet your face with warm water and massage a small amount of the face wash into your skin in a circular motion.

    Rinse and Clean

    Rinse your face with warm water and pat dry with a clean towel.

    Regular Usage

    Use the Himalaya neem face wash regularly to see the best results.

    Honestly speaking, Himalaya face wash is much better than any other product in the market. Additionally, it is an excellent alternative for individuals searching for a mild, effective, and natural face cleanser. Its natural components and herbs can help to cleanse and nourish your skin, leaving it looking and feeling rejuvenated.

    What are the Benefits of Himalaya Neem Face Wash?

    Himalaya face wash is a natural and effective solution for maintaining healthy and glowing skin. Made with a blend of herbs and minerals sourced from the Himalayan region, this face wash is packed with benefits for all skin types.

    1. Does not strips Natural Oils
    2. Moisturises Skin
    3. Good for Acne

    Let’s have an in-depth analysis of all of these:

    1. Does Not Strips Natural Oils

    There are products like Clean and Clear Facewash that completely removes oil from the skin, including natural oils. This renders skin prone to infections. Additionally, it accelerates the aging process.

    One of the biggest benefits of Himalaya face wash is its ability to cleanse the skin thoroughly without stripping it of its natural oils.

    Clean and Clear face wash bad reviews
    Why you should not use Clean and Clear: Authentic Review

    The face wash is formulated with ingredients such as neem and turmeric, which are known for their antibacterial and antifungal properties. These ingredients help to remove dirt, impurities, and excess oil from the skin, leaving it feeling refreshed and clean.

    2. Moisturises Skin

    Himalaya Neem Face wash also has the capacity to hydrate the skin. The face wash contains components recognized for their ability to moisturize and nourish the skin, such as aloe vera and licorice.

    Even after cleaning, these components assist to keep the skin smooth and supple.

    3. Good for Acne

    This facewash is also beneficial for those with acne-prone skin. The ingredients in the face wash help to reduce inflammation, and redness and prevent breakouts.

    4. Suitable for Sensitive Skin

    In addition to these benefits, it is also free from harmful chemicals and parabens. This makes it a safe and natural option for those with sensitive skin.

    Is Himalaya Face Wash Bad for Skin?

    Every coin has two faces. Although Himalaya face wash is a natural skincare product that uses minerals and plants from the Himalayas to produce results and has a lot of benefits, it is important to be aware of any possible drawbacks.

    The possible side effects include:

    1. Skin Irritation
    2. Dryness
    3. Redness
    4. Itching
    5. Burning Sensation

    Skin Irritation

    One potential side effect of Himalaya face wash is skin irritation. Some people may experience redness, itching, or a burning sensation on their skin after using the product.

    This is typically caused by an allergic reaction to one of the ingredients in the face wash. If you experience skin irritation after using Himalaya face wash, it is best to discontinue use and speak with a dermatologist.

    Dryness

    Another potential side effect of Himalaya face wash is dryness. While the face wash is formulated with ingredients that help to moisturize the skin, some people may find that it dries out their skin.

    This is more likely to occur in people with dry or sensitive skin. If you experience dryness after using Himalaya face wash, it is best to reduce the frequency of use or try using a moisturizer afterward.

    Allergic Reaction

    It is also important to note that Himalaya face wash contains natural ingredients like neem, turmeric, aloe vera, and licorice, which may cause skin irritation or allergic reactions in some individuals.

    If you have sensitive skin, it’s best to patch test before using the product regularly.

    It is also important to note that if you have a known allergy to any of the ingredients used in Himalaya face wash, you should avoid using it.

    A good idea is to know your skin type before using this product:

    Himalaya face wash is a natural and effective skincare treatment recognised for its numerous advantages. However, possible adverse effects such as skin irritation, dryness, or allergic responses should be avoided.

    If you encounter any of these negative effects, it is advised to stop using the product and consult with a dermatologist. Furthermore, if you have known allergies or sensitive skin, it is essential to patch test the product before using it on a daily basis.

    Conclusion

    In our opinion, we would give this product relatively better reviews as compared to others used widely. This face wash is definitely underestimated and is a potential competitor against renowned brands in the market.

    Not only Himalaya face wash is natural and effective but is also a safe solution for maintaining healthy and glowing skin. Its natural ingredients like neem, turmeric, aloe vera, and licorice help to cleanse, moisturize, and prevent breakouts, making it a perfect choice for all skin types.

    Most importantly, it is free from harmful chemicals and parabens, making it a safe option for sensitive skin. It is a splendid option for daily use for healthy and refreshed skin.

    However, it varies from skin to skin for its suitability. While some may benefit from it for conditions like acne, pimples, and dryness, others may develop them as a result of usage.

    The pros and cons of the famous face wash remain debatable, however, its safety concerns are nearly nil. This product can be used without worrying about any serious side effects.

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