Malaise

Overview
Malaise is a feeling of general discomfort or uneasiness, an "out of sorts" feeling, often the first indication of an infection or other disease. Often defined in medicinal research as a "general feeling of being unwell".

Colloquially, malaise has been referred to as "the creeping crud" (especially in reference to the malaise caused by communicable diseases such as influenza and the common cold). This usage may have originated in folk medicine, but it is adopted from the French word meaning "discomfort," "feeling faint," "feeling sick."

The term is also often used figuratively in such contexts as "economic malaise."

Cause
There can be various causes to a malaise, from the slightest like an emotion (causing vagal response) or hunger (light hypoglycemia) to the most serious (cancer, cerebrovascular accident, internal bleeding etc.).

Generally speaking, the malaise expresses that "something is wrong," like a general warning light, but only a medical examination can determine the cause.

First aid response
As stated above, it is not possible to easily determine the cause of the malaise, and thus whether it is slight or not, and whether it is an emergency or not (for example, a cancer is very serious, possibly deadly, but it is usually not an absolute emergency as the life is not likely to be threatened in the next hours).

The first response is:
 * to keep the person safe, protected from the external dangers and weather (cover with a jacket or a blanket in cold conditions);
 * to place the person to rest, possibly in a calm place: to propose the recumbent position, but to let the person adopt the most comfortable position; the aim is to prevent from falling down, and to make the blood circulation easier;
 * to ask questions:
 * How does the person feel,
 * when did it start,
 * if it is the first time it has happened,
 * if the person has a known disease, known health problems,
 * if the person had a recent accident,
 * if the person is under medical treatment,
 * if the person was already hospitalised;
 * talk to the person to calm him or her down.

Some signs and symptoms have a particular importance for the assessment of the situation and indicate a possible medical emergency:
 * unusual and violent headache (see, e.g. hemorrhagic stroke);
 * a chest pain, like a vise pressing;
 * intense stomach pain, that lasts or comes again and again;
 * the person has abundant sweat whereas it is not a hot ambiance and he or she did not make any physical effort (this can be related to a problem of carbon dioxide elimination);
 * the person is very pallid (this can be related to problem of blood circulation) or blue (possibly respiratory problem); on a person with darker skin, this can be seen on the internal face of the lips or the nails;
 * the person has problems breathing (makes efforts to breathe, or sounds can be heard at inhalation and/or exhalation);
 * the person has difficulties speaking (e.g. too weak to be heard, words without sense, mouth distorted);
 * the person has partial paralysis in an arm or a leg, even if it does not last;
 * agitation (violent behaviour, or uncontrolled movements).

The following step depends on the organization of the emergency medical assistance. Some countries provide free medical advice by phone (e.g., SAMU in France): it is then useful to call this service to know what to do. Otherwise, it is useful to contact the usual general practitioner of the person, to get his or her advice, or any medical or paramedical professional at least. The bystander who calls must mention all the elements collected so far. When it is not possible to contact the individual's primary-care physician, it is then necessary to assess the situation in order to decide whether it is necessary to call an ambulance.

Some specific situations require specific actions:
 * the person is a casualty of an accident: the malaise is likely to be related to a physical trauma, the person should only be touched by professionals, except immediate danger (e.g. fire hazard, bleeding that must be stopped…); this is a life threatening situation (even if the casualty is conscious), which requires an immediate call for help;
 * in case of chest pain or respiration difficulties, the most comfortable position is usually seated or half seated (back at 45°), because the weight pulls the viscera down, allowing the lungs to develop downwards (pushing the diaphragm), and it reduces the blood pressure inside the chest (pulmonary hypertension);
 * in case of stomach pain, the most comfortable position is often with the thighs perpendicular to the body (this relaxes the abdominal muscles); this can be done with a lying person by lifting the legs and placing them on a chair, the bystander can also kneel besides the person and support his or her legs;
 * when the person has a medical treatment for this situation, it is necessary to help this person taking the medication; this includes sugar for some diseases; otherwise, a non medical bystander should never propose food, drink or any medication;
 * a pregnant woman should be laid on her left side, in order to release the pressure on the inferior vena cava);
 * the person falls unconscious: this is a life threatening situation which requires immediate action (recovery position if the person breathes, cardiopulmonary resuscitation otherwise);

An important point is to watch the person until he or she recovers or the arrival of the ambulance, for the situation is likely to worsen.

See also First aid and Emergency action principles.

First responder response
The first responder response is not very different from the first aid response. The assessment is completed by (according to the education and the available equipment):
 * measurement of the respiration frequency; mechanical ventilation should be performed if the person has 6 spontaneous breathings per minute or less;
 * checking the pulse: on a resting adult in good health, a pulse above 120 bpm or below 40 bpm is a severe warning; it is also important to check whether the radial pulse can be detected on both arms;
 * measurement of the blood pressure;
 * measurement of the blood oxygenation (with a pulse oximeter);
 * measurement of the glycemia (portable glucometer);
 * asking the bystanders or relatives for any details; at home, looking for empty medication packing (besides the patient, in the trash, in the toilets, in the bathroom).

Oxygen first aid is recommended for any sign of severity, or in any doubt. Although oxygen is considered as a medication in some countries, it is harmless (humans do breathe 21% of oxygen). There is controversy about patients suffering chronic respiratory insufficiency, and the so-called "paradoxical effect" of oxygen: the patient's body is used with oxygen lack and a massive saturation can lead alter the spontaneous breathing. However: Even when it is not necessary, the oxygen breathing can have a placebo effect; on the contrary, the mask can cause a stress and be detrimental, it is thus necessary to explain the acts that are performed and to accept if the patient refuses.
 * this situation is not likely to happen until a few hours of pure oxygen breathing, which is far beyond the intervention time of first responders;
 * it is the lack of oxygen that kills, especially in case of respiratory insufficiency;
 * in case of doubt, the first should contact a medical authority to have instructions; in the meanwhile (few minutes), the patient can be put under oxygen inhalation without risk.

Any other action should be performed only after a contact (by radio or by phone) with a medical authority (medical regulation).