Common causes of fecal incontinence may include constipation, diarrhea or nerve or muscle damage. Muscle or nerve damage is typically associated with giving birth or aging.

Despite the cause, fecal incontinence is an embarrassing condition. However, it is important that you see your doctor for appropriate treatment.

Signs and symptoms

Most people have fecal incontinence occasionally during diarrhea. However, some people experience recurrent fecal incontinence because:

• They are not able to control the release of gas or feces, be it liquid or solid form
• Are not able to use the toilet all the time

For some adults and children, fecal incontinence is a minor problem only causing occasional soiling of underwear. However, the condition becomes an emergency problem if you lose complete bowel control.

Fecal incontinence may occur along with other bowel issues like:

• Diarrhea
• Constipation
• Bloating and gas

When to seek medical attention

See your doctor if you or your child have fecal incontinence. Usually new mothers and some adults may shy away from disclosing their problem to their doctors, however, treatment is available can relieve symptoms better upon early evaluation.

Treatment

Medications for fecal incontinence depend on the cause and can include:

• Anti-diarrheal drugs for diarrhea
• Laxatives if constipation is the cause
• Medication that reduce spontaneous bowel movements

Other treatment options include:

• Dietary changes. Your diet can affect your stool consistency. Therefore, you may be advised by your doctor to drink plenty of fluids and consume foods rich in fiber, if constipation is the cause. If fecal incontinence occurs due to diarrhea, high fiber foods can be helpful in reducing the watery consistency of your stools
• Exercise. If fecal incontinence occurs as a result of muscle damage, you may be directed to follow an exercise program along with other therapies to restore your muscle strength. Such therapies and exercises aim at enhancing anal sphincter control so that you can improve your urge to defecate. Therapy includes biofeedback which involve simple exercise that enhance anal muscle strength, bowel training to establish a timing to use the toilet, such as after eating and sacral nerve stimulation, which involves implanting a device to stimulate nerves to strengthen bowel muscles. Sacral nerve stimulation is usually administered if other treatments are ineffective.
• Surgery. Surgery may be required if the underlying condition can only be treated by it. For example rectal prolapse or sphincter damage while giving birth, can only be rectified with surgery.

The team physician must have an unrestricted medical license and be an MD or DO who is responsible for treating and coordinating the medical care of athletic team members. The principal responsibility of the team physician is to provide for the well-being of individual athletes – enabling each to realize his/her full potential. The team physician should possess special proficiency in the care of musculoskeletal injuries and medical conditions encountered in sports. The team physician also must actively integrate medical expertise with other healthcare providers, including medical specialists, athletic trainers, and allied health professionals. The team physician must ultimately assume responsibility within the team structure for making medical decisions that affect the athlete’s safe participation.

The primary concern of the team physician is to provide the best medical care for athletes at all levels of participation. These are the qualifications necessary for all team physicians. First, he should have an MD or DO in good standing, with an unrestricted license to practice medicine. He should possess a fundamental knowledge of emergency care regarding sporting events and be trained in CPR. He must have a working knowledge of trauma, musculoskeletal injuries, and medical conditions affecting the athlete. In addition, it is preferable for him to have clinical training/experience and administrative skills in some or all of the following: Specialty Board certification; continuing medical education in sports medicine; formal training in sports medicine; fifty percent or more of practice involving sports medicine; membership and participation in a sports medicine society; involvement in teaching, research and publications relating to sports medicine; training in advanced cardiac life support; knowledge of medical/legal, disability, and workers’ compensation issues; and media skills training.

As for the duties, the team physician must be willing to commit the ample time and effort to provide care to the athlete and team. In addition, the team physician must develop and maintain a current, appropriate knowledge base of the sport(s) for which he/she is accepting responsibility. The duties for which the team physician has ultimate responsibility are divided into two. First is the medical management of the athlete and this includes the following: coordinates pre-participation screening, examination, and evaluation; manages injuries on the field; provides for medical management of injury and illness; coordinates rehabilitation and return to participation; provides for proper preparation for safe return to participation after an illness or injury; integrates medical expertise with other health care providers, including medical specialists, athletic trainers and allied health professionals; provides for appropriate education and counseling regarding nutrition, strength and conditioning, ergogenic aids, substance abuse and other medical problems that could affect the athlete, and provide for proper documentation and medical record keeping. The second classification is administrative and logistical and these are the following duties: establishes and defines the relationships of all involved parties; educates athletes, parents, administrators, coaches, and other necessary parties of concerns regarding the athletes; develops a chain of command; plans and train for emergencies during competition and practice; addresses equipment and supply issues; provides for proper event coverage; and assesses environmental concerns and playing conditions.

Online References:

http://en.wikipedia.org/wiki/Sports_medicine&ei=TL2NUc70HcPWrQeIyYHgBg&usg=AFQjCNHTGX53tY03KSX0Yd4grQIqwfE19A&sig2=DnJk3dyzvI_ztzPCeUrqmQ&bvm=bv.46340616,d.bmk

http://www.aaos.org/about/papers/advistmt/1021.asp

When rescuers approach an emergency situation, it is vital to perform a quick scene size-up to verify if there is no longer an existing danger that might injure the rescuers. A quick assessment of the area such as the existing situation, general type of problem (whether it is an injury, accident or attack), severity of the problem (minor or severe) and the number of victims that need rescue all accounts for the  initial first aid assessment. Majority of First Aid Training teaches rescuers to do a quick survey of the environment since it is the most important and sensible thing to do before approaching a victim. Moreover, most First Aid Courses usually include basic and intermediate proficiencies in quick response assessment before actual first aid skills.

Learn more about Initial First Aid Care with this YouTube video.

When sizing-up an area for emergency disasters always check if the area is safe. It is critical that rescuers don’t rush into an unsafe scene. It may be necessary to call emergency services such as the fire department or paramedics if the area is dangerous such as the presence of broken power lines, heavy smoke and fire.

Upon reaching the victim, immediately check to see what is wrong and correct any urgent life-threatening conditions first. If there are two or more victims that are present in the scene, go to the quiet and motionless ones first and secure the victim to a safe place. If there are no immediate threats to life, do a quick physical check and gather as much information and history about the victim and his complaints.

Primary Inspection for First Aid Care

Based on recent surveys, the majority of individuals who take lessons in first aid fail in their first practical exam for a First Aid Certification mainly because they fall short in their assessment skills in first aid. It is important for a rescuer to do a primary check to determine whether there are life-threatening problems that requires quick intervention. Ideally it will only require a few seconds to complete a primary check, unless immediate care should be done at any point during the primary check. The steps involve during a primary inspection should involve the following:

1. Checking for responsiveness and breathing

If the victim is alert and responsive upon first contact immediately ask his/her name and what happened. If the victim responds to his/her name and is aware of the situation then the victim is alert. If the victim is motionless, the rescuer must first determine if the unconscious victim is responsive and breathing. By gently tapping the shoulders and asking “Are you okay?”will let the rescuer know if the victim is conscious. If there is no response, the victim is considered unresponsive. When checking for responsiveness, make sure to also assess the victim’s breathing and ask if he/she has difficulty in every breath. Finally, for victims who are unresponsive and have absent breathing, immediately perform CPR.    

2. Check for any signs of active and severe bleeding

Perform a quick assessment for any active bleeding or external wounds by doing a head to toe inspection as well as checking for blood-soaked clothing or pooling of blood on the ground where the victim is lying. If there is bleeding, apply pressure to the wound to prevent further blood loss.

3. Positioning the victim correctly

Properly position the victim is an important step in providing immediate first aid care. For an unresponsive victim lying face down, position the person onto his/her back so that CPR can be initiated if needed. After performing cycles of CPR, have the victim turn his/her body to one side (recovery position) in order to clear the airway and prevent the tongue from falling back into the throat. This position is also permitted for suspected spinal and neck injuries.   

Reference:

Alton, T. et al (2012). First Aid, CPR and AED Standard 6^th Ed. Jones & Bartlett Learning

Cellulitis may only affect the skin, but it can also occur in the underlying tissues of your skin and can radiate to the bloodstream and lymph nodes as well.

If the condition is not treated, it may spread and become life-threatening. Therefore, it is important that you see your doctor as soon as symptoms begin to occur.

Signs and symptoms

Signs and symptoms of cellulitis include:

• Redness
• Swelling
• Pain
• Tenderness
• Warmth
• Fever

Changes in skin condition may accompany a fever as well. With time, the affected area may expand and small red spots may begin to appear on the affected regions of the skin. Rarely, small blisters may also occur as rupture overtime.

When to seek medical attention

It is important that you treat the condition during the early staged because the infection may worsen and spread rapidly around the body.

See your doctor if:

• You have a swollen, tender and red rash or a rash that appears to change rapidly
• The rash is accompanied with a fever

And especially if the rash is:

• Red, swollen, warm, tender and expanding, without a fever

Causes

Cellulitis usually occurs when bacteria enters through broken regions or cracks in the skin. Commonly, streptococcus and staphylococcus cause this infection. Bacteria can enter through cuts, areas where you have had surgery recently, puncture wounds, athlete’s foot, ulcers or dermatitis.

Certain insect bites such as spider bites can also transfer bacteria to the body that may bring rise to this infection.

Treatment

See your doctor as soon as symptoms begin to appear. Your doctor will most likely prescribe an oral antibiotic, which you will have to take for about two weeks. If you do not respond to treatment or if you have a high fever, see your doctor as you may require to be hospitalized so that antibiotics are given intravenously.

It is important that you take the prescribed drugs and antibiotics as directed by your health care provider and avoid skipping doses as this may make medication ineffective. Even if you begin to feel better, finish the entire medication course so ensure recovery. Your doctor may also advise elevating the affected area.

Prevention

To prevent infections such as cellulitis, follow these self-care tips:

• Wash your wound with soap and water daily as a part of everyday bathing
• Apply a topical antibiotic ointment on the wounds to prevent infection
• Make sure you look out for signs of infection such as pus, drainage, red streaks or fever
• Check your feet regularly to ensure that you are not injured
• Keep your skin moisturized using a moisturizer to prevent scaling and peeling, which may make skin susceptible to infection
• Trim your toenails and fingernails making sure you do not cause a wound
• Treat superficial skin infections quickly as these tend to be contagious

Wear appropriate gloves and footwear to keep your hands and feet protected.

A person with genital sores may experience symptoms depending on the underlying cause. Symptom that occur with genital sores include ulcers or skin lumps on the genital,  genital pain, penile ulcer, penile discharge, penile pain, swollen glands in the groin and genital tenderness.

Treatment for genital sores depends on the underlying cause of the condition. Treatment may include oral antibiotics, oral antiviral medication. Topical antibiotics, topical antiviral medication, cold compresses, warm compresses, topical corticosteroids and nonsteroidal anti-inflammatory medication to treat pain.

Signs and symptoms

Signs and symptoms of genital sores include:

• Skin ulcers on the scrotum or penis that do not go away
• Skin lumps on the scrotum or penis
• Genital pain or penile pain
• Genital tenderness
• Swollen glands in the groin
• Penile discharge

Causes

Causes of genital sores in males include:

• Chancroid
• Bowen’s disease
• Genital warts
• Herpes genitalis
• Molluscum contagiosum
• Penile cancer
• Syphilis
• Skin injury
• Skin abscess

Treatment

Treatment for genital sores depends on the underlying cause of the condition. Treatment may include oral antibiotics, oral antiviral medication. Topical antibiotics, topical antiviral medication, cold compresses, warm compresses, topical corticosteroids and nonsteroidal anti-inflammatory medication to treat pain.

Treatment for genital sores in males includes:

• Oral antibiotics for genital infections
• Oral antiviral medication for genital infections
• Topical corticosteroids to reduce inflammation
• Cold and warm compresses
• Nonsteroidal anti-inflammatory medication for pain, narcotic pain medication for moderate to severe pain for short-term use only

Homecare treatment

Homecare treatment for genital sores may include:

• Avoid having sexual intercourse with your partner until therapy has been fully completely
• Use topical corticosteroids for itching
• Avoid sexual intercourse with partners having abnormal vaginal discharge
• Avoid having sex with anyone with oral or genital sores
• Practice sex with protection – use condoms and avoid sex with multiple partners or with a person who has sex with multiple sexual partners
• Acetaminophen for pain
• Nonsteroidal anti-inflammatory medication for pain
• Take medication as directed by your health care provider

When to seek medical attention

See your doctor if any of the following problems occur along with genital sores:

• Fever of 103 degreed F or above or shaking chills
• Drainage of mucus from the pens
• Pain while urinating
• Worsening sores on the genitals
• Swollen glands in the groin

Prevention

• Avoid sex with multiple sexual partners
• Avoid sex with a person with multiple sexual partners
• Avoid sex with a person with oral or genital sores
• Avoid sexual contact with a person with vaginal or penile discharge
• Practice sex with protection

Related Video

Other Related Articles

• First Aid For Childbirth (read here)
• Managing Peptic Ulcers (read here)

Alzheimer’s disease or dementia is both defined as both loss of memory and brain disorder. This disease is most common to older people aged 65 years old and older. This condition causes individuals to  loss interest in each and everything they do. Eventually the disease causes individuals to not even understand, think or remember things. People with this problem become apathetic or uninterested and they may even begin to hallucinate.

Important Disclaimer: this blog is post is designed to help first aiders understand common issues that may arise during scene assessment and secondary survey. Treating patient s) with alzheimers can make the emergency situation much more difficult. Enrol in first aid training (sign up here) and ask your instructor on how to manage these situations.

WHAT CAUSES ALZHIEMER’S DISEASE

This disease is common among older individuals. This disease is a hereditary disease, which means it is strongly tied to genetics.  If you have brother, sister or a parent that has Alzheimer’s disease then you are at high risk to get this disease. However, nobody is immune to this disease as 1 in 10 people over the age of 65 will suffer from this disease.

Additional factors include a history of head trauma and having a high blood pressure for a long time. This disease is also very common to women. If your family member is experiencing this disease do not be afraid to ask for medical help. The Alzhiemers society is a great guide if you are concerned that a loved one is portraying symptoms (more information here).

UNDERSTANDING THE SYMPTOMS OF ALZHIEMER’S DISEASE

A key point to remember is that typically the first symptoms of Dementia or Alzheimer’s disease is forgetfulness followed by a change in the person’s emotional behaviour  This behaviour includes how the person talk, think and pays attention. The symptom of this disease will unfortunately slowly get worse.

There are two types of Alzheimer’s disease

• Early Onset:  This is less common than late onset since this disease start before 60 years of age but this disease will get worse more quickly.
• Late Onset: This is the most common to people aged 65 and over. The symptom will start slowly until it gets worse.

TREATMENT

A person with this disease needs a lot of support and help from family members. Although this disease doesn’t have a cure, understanding the person with this problem and supporting them will help minimize the symptoms from getting worse.

There are medicines that a doctor could recommend to slow down the Alzheimer’s disease and there are some psychological test that could help the person to control the symptoms but still this people who suffered from this disease needs tender loving care from their loved one and family member.

Some Popular Medications Associated with Treating Alzheimer’s include:

• Razadyne®
• Exelon®
• Aricept®
• Namenda®

Related Information

Many individuals that work in care homes must attend Red Cross first aid courses (register here) which teach individuals how to help recognize and manage first aid emergencies. However, when treating individuals with Alzheimers completing a secondary survey or scene assessment can be difficult. It is important to factor in known diseases such as Alzheimers to any scene assessment.

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This is not typically referred to a serious emergency, however, if the cause of the congestion is an allergy or affects the child’s ability to breathe training in first aid can be extremely beneficial.

Causes

Common causes of nasal congestion in toddles, babies and young children include flu, colds and allergies. It is important to note that colds are often caused by viruses, thus making antibiotics ineffective. Due to new strains of viruses, colds cannot be prevented however; some of the symptoms can be relieved.

Symptoms

Common signs and symptoms of nasal congestion in children include:

• Nasal discharge
• Runny nose or stuffy nose
• Posterior nasal drip
• Pain in the sinuses
• Facial pain
• Cough
• Sore throat
• Reddened eyes
• Fever
• Breathing difficulty

When to seek medical attention

See your doctor if:

• Your child is three months or younger
• Symptoms of the congestion last for more than two weeks
• Your child is suffering from a severe cough or is coughing in a barking sound
• Your child is suffering from ear pain
• Your child is suffering from fever along with cough
• Your child’s breathing patterns seems altered or too fast

How will the doctor treat nasal congestion in your child?

The treatment method implemented by your doctor will solely depend on the underlying cause of the nasal or sinus congestion in your child. Your doctor will prescribe oral fluids, humidifiers, saltwater nasal spray, cough suppressants, antihistamines, decongestants and acetaminophen. People with sinusitis may be advised to take antibiotics for treatment.

Treatment

1. Call 911 immediately if:

• Your child is suffering from breathing difficulties
• Your child seems to be out of breath
• Your child starts coughing suddenly after eating or being fed
• The congestion is accompanied with cough and bluish skin discolouration or any other forms of skin changes
• Your child is not able to perform daily activities, eat or even talk

2. Clear the mucus from the nose

• You can use an aspirator or an infant nasal bulb to suck out the mucus from the child’s nose
• Ask your child to blow his or her nose frequently, if your child is able to do so
• Do NOT give your child cough or cold medicine if he or she is under 6 years of age, unless your child’s paediatrician advises it

3. Give your child plenty of fluids

• For children over 3 months old, apple juice can be given
• For older children, other drinks such as warm soups such as chicken soup can be given

4. Humidify the air

• If the air is dry, a cool-mist humidifier should be used
• You can moisten your child’s nasal passages with saline nose drops
• You may sit near a shower with hot water running and have your child sit on your lap. Do not sit too close to the shower as the water may burn your child’s skin

5. Treat other symptoms of the condition

• For children older than 1 year, ½ to 1 teaspoon of honey can be given to treat cough. Avoid giving cough medication
• Keep your child away from cigarette smoke and other irritants
• Petroleum jelly can be rubbed under the nose in order to reduce chapping
• In case of allergies, consult your paediatrician about the necessary treatment

Learn More

To learn more about serious breathing emergencies and allergic reactions enrol in a first aid course with a credible provider (more information).

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Treatment includes taking antibiotic drugs to combat the infection and acid-suppressing drugs.

Causes of stomach ulcers

Many factors contribute to stomach ulcers, some of the common ones include:

• Helicobacter pylori. This bacterium affects more than 60% of the population causing stomach ulcers and more than 90% with duodenal ulcers.
• Medications. These include clopidogrel—taken to prevent heart problems, aspirin and drugs used to treat arthritis. Additionally, anti-inflammatory drugs, NSAIDS also have been known to cause stomach ulcers.
• Cancer.  Stomach cancers may result in stomach ulcers—usually in older people.

Symptoms

• Indigestion
• Abdominal pain—below the rib cage
• Loss of appetite
• Nausea and vomiting
• Bloating
• Significant weight loss
• Light-headedness
• Unusual or bright blood in the vomit or stool (usually dark or black)
• Shock as a result of excessive blood loss

Risk factors

The following factors may make you susceptible to developing a stomach ulcer:

• Infection due to H. pylori bacterium
• Family history with stomach ulcers
• Usage of NSAIDs such as ibuprofen, aspirin or naproxen
• Regular consumption of alcohol
• Other already-present illnesses such as lung, liver or kidney disease
• An age of 50 years or above

Treatment

It is important to note that stomach ulcers may turn into medical emergencies—when shock occurs—therefore, it is important that you get your condition diagnosed and get medical treatment from your doctor.

The following are some treatment options that can be considered to alleviate some of the symptoms:

• Take antibiotic medications. These should be taken after diagnosis and under the consent of your doctor. Antibiotic medications are taken to kill the H.pylori bacterium. Additionally, you can take drugs to speed up the healing process. You may have to take different medications in combination to treat certain symptoms such as rashes and diarrhea. Moreover, antibiotic resistance may also be a factor causing you to take more drugs.
• You will have to take regular breath tests in order to confirm if the treatment medications are working effectively.
• You will have to change your existing medication doses, particularly those that treat heart disease and arthritis to reduce the harmful effects due to stomach ulcers.
• Take drugs to reduce the acidic content of the gastric juices in your stomach to reduce the severity of stomach ulcers.
• Consider some lifestyle changes such as quitting smoking. Smoking greatly impairs the body’s immune system and thus, slows down the healing process.

Prevention

• Quit smoking
• Avoid alcohol
• Avoid overuse of NSAIDs and aspirin

Learn More

To learn about more serious medical emergencies such as internal bleeding and circulatory emergencies enrol in Red Cross first aid training with one of our training partners. Unfortunately, stomach ulcers are not covered in any Red Cross program.

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Inhaled injuries occur when a person has inhaled heated gases such as by-products of burned materials. Smoke inhalation is the leading cause of mortality related to fires rather than burns. It is estimated that 2 out of 10 people who suffer from burns will have some degree of inhalation injuries. Inhalation injuries can lead to the impairment of the body’s normal gas exchange and even respiratory failure thus are potentially life threatening.

Understanding Inhalation Injuries

The respiratory system is a crucial part of the human body that plays an essential role in maintaining proper oxygenation of the blood, without oxygen, a person can die in an instant.

The respiratory system starts with the upper airways, from the nose going down to the very fine blood vessels in the lungs where gas exchange occurs. When a person inhales heated gases, the mucosal barrier gets burned leading to inflammation, sloughing of tissues and obstruction of airway. Irritating gases and chemicals can also trigger bronchospasm or the uncontrolled contraction of lung tissues that makes exhalation difficult and noisy. These changes in the airways can cause to significant impairment in blood oxygenation and, if not treated, can progress to respiratory failure.

Signs and Symptoms

Recognizing inhalation injuries is primarily based on physical assessment. Victims of smoke inhalation often present symptoms that include:

• Coughing
• Hoarseness
• Shortness of breath
• Noisy breathing
• Bluish discoloration of lips or skin
• Black or grey spittle
• Fluid in the lungs

Some victims may show burns around and inside the mouth and nose, swollen throat and singed nasal hairs. In severe cases, the person may become unconscious and may even stop breathing. However, it is also possible for victims to show no signs of respiratory distress. Laboratory tests such as X-ray can help rule out inhalation injuries.

First Aid For Inhalation Injuries

As in any emergency situation, your top priority is to ensure your personal safety. Immediately survey the scene and check for any potential danger or risks. Call 911 or your local emergency services.

• Check airway, breathing and circulation (ABC’s). Open the airway and monitor breathing.
• Make sure the victim is breathing normally. Assist the casualty in a position of comfort – semi-sitting or upright position. Loosen clothing, including belt and tie.
• If breathing is ineffective or if it stops, provide rescue breathing.
• Check for pulse and be ready to provide CPR, in case pulse stops.
• Monitor for possible shock. Keep casualty warm.
• Provide reassurance while waiting for medical assistance to arrive.

To learn more about first aid for inhalations and other breathing emergencies enrol in Red Cross first aid training with a credible provider. A list of all of our providers is located on our “locations” page. In these classes you will learn, via “hands on training”, how to manage these and many other emergencies.

Related Video to Smoke Inhalation

A blow to any abdomen which does not cause any wounds is called a blunt trauma. A blunt trauma is primarily treated the same as a puncture trauma due to the signs of internal bleeding and shock, in extreme cases.

Signs and symptoms

The signs and symptoms of penetrating and blunt trauma include:

• Cool, pale, clammy skin
• Wounds
• Rapid yet shallow heartbeat—may be a sign of shock
• Rapid and shallow breathing
• Abdominal rigidity
• The casualty may take a fetal position, if lying down, holding his abdomen
• The casualty may be incontinent–inability to control bowel or bladder

Treatment

Once you have called 911, follow these steps:

• If you are able to administer first aid properly, control the bleeding and cover the wound with a sterile gauze and tape, for a minor wound.
• For a puncture wound, do not try to remove an embedded object and do not touch it, wait until help arrives.
• If practical, allow the casualty to lie down and elevate his legs.
• Reassure the patient that help is on its way and remain calm.

Evisceration

This is an injury which results in the exposure of the bodily organs to the outside air. This allows the organs to be visible and is, thus a serious emergency situation. Call 911 and seek medical assistance immediately. The casualty is less likely to feel severe pain in this sort of injury, however, if you are not trained, do not administer first aid. Many victims may also tell you that they are perfectly fine and they may even be able to walk around normally. However, you must make sure that their organs do not get in contact with foreign objects that may damage the sensitive membranes.

Symptoms

• Organs protrude out
• Pale, clammy, cool skin
• Rapid yet shallow heartbeat
• Rapid yet shallow breathing
• Nausea
• Anxiety
• If organs have been cut, you may smell fecal odor

Treatment

Until help arrives, follow these steps, only if you are properly trained to do so:

• Cover the exposed organs with sterile, non-adhesive gauze. Do NOT use adhesive bandages or tape.
• If practical, allow the casualty to lie on his back.
• Reassure the casualty and tell them that help is on its way.
• Do NOT try to touch, remove or replace the organs.

Additional Training – Video