Croupy cough- Barking noises, nighttime surprises

Croup seems to be on the rise early this season. I have seen many children brought into the Emergency Department with this scary ailment. Most commonly seems to awaken kids at night with this horrible sounding seal like barking noise. If you have ever heard a croupy cough or stridor coming out of a small child's mouth you will remember it well.
If your child wakes up barking loudly do you need to bring them to the Emergency Room? Well, that's a very good question. Not all children need to be rushed to the ER for a croupy cough. You can try a couple of things at home first.
Ask yourself these things first 

• Does my child have a high fever? ( check it rectally if they can not hold the thermometer in their mouth well, of course you are the parent and you know when your child has a temp. Go ahead and medicate them for fever, it will help with discomfort also. 
• Does my child have any breathing trouble, like retractions (look at them with no shirt on, does it seem like they are sucking in hard to breath?
• Does my child have stridor-- a high pitched noise when they breath, not just the barky cough?
• Are you freaking out and just don't know what to do (its ok if you are, better to bring them in to be checked out than not)

OK-- If your child is limp, lethargic and turning blue around the lips, call 911!! 

IF your child is happy, playful, and looks normal, but still has that terrible sounding cough- take a deep breath and calm down, its gonna be just fine.

Try these methods at home if your child seems ok at home first:

• Turn on the shower water to hot--get the bathroom nice and steamy (of course don't put your child in the hot water) take your child in the bathroom and stay with them, help them to breath in the nice steamy air in the bathroom for around 5-10 min or so.
• Take them immediately outside into the cool nighttime air (its ok, you are not gonna make them sicker doing this--no matter what your grandma told you) 
• The alternating of the steam and the cool air will most of the time help stop the bronchospasm-like coughing  and help them calm down and settle back to sleep.
• Don't medicate your child with any sedating cough syrups, alcohols or home remedies. Cool mist vaporizers or humidifiers in their room is fine. I use the old Vicks vapor rub on their chest and feet remedy myself (unless they are infants)
• Call your peds doctor or advice line if you want more advice before traveling to the ER, they are a wealth of good information.

So What is Croup?? 

Croup is a condition that causes an inflammation of the upper airways — the voice box (larynx) and windpipe (trachea). It often leads to a barking cough or hoarseness, especially when a child cries.

Most cases of croup are caused by viruses, usually parainfluenza virus and sometimes adenovirus or respiratory syncytial virus (RSV).Viral croup is most common — and symptoms are most severe — in children 6 months to 3 years old, but can affect older kids too. Some children are more prone to developing croup when they get a viral upper respiratory infection.

Most cases of viral croup are mild and can be treated at home. Rarely, croup can be severe and even life threatening.

The term spasmodic croup refers to a type of croup that develops quickly and may happen in a child with a mild cold. The barking cough usually begins at night and is not accompanied by fever. Spasmodic croup has a tendency to come back again (recur).

Treatment of symptoms is the same for either form of croup.

Signs and Symptoms

At first, a child may have cold symptoms, like a stuffy or runny nose and a fever. As the upper airway (the lining of the windpipe and the voice box) becomes more inflamed and swollen, the child may become hoarse, with a harsh, barking cough. This loud cough, which is characteristic of croup, often sounds like the barking of a seal.

If the upper airway continues to swell, it becomes even more difficult for a child to breathe, and you may hear a high-pitched or squeaking noise during inhalation (called stridor). A child also might breathe very fast or have retractions (when the skin between the ribs pulls in during breathing). In the most serious cases, a child may appear pale or have a bluish color around the mouth due to a lack of oxygen.

Symptoms of croup are often worse at night and when children are upset or crying. Besides the effects on the upper airway, the viruses that cause croup can cause inflammation farther down the airway and affect the bronchi (large breathing tubes that connect to the windpipe).

Hope this helps you understand Croup a little better, have questions? Feel free to post in the comments.

A New Drug On The Block: Zohydro - another addictive substance

Frank Lewis

PDT Staff Writer

Anti-prescription drug abuse activist Lisa Roberts, RN, of the Portsmouth Health Department, says the Food and Drug Administration ignored it own panel and approved a new Hydrocodone drug called Zohydro which she says is 10 times more potent than Vicodin.

Roberts, speaking with the Daily Times from Michigan where she was serving this week as a presenter at their state Prescription Drug Summit, said, “They (FDA) continue to approve more blockbuster painkillers. Yesterday (Monday) they ignored their own panels recommendations and approved a new pure Hydrocodone product called Zohydro which has no built in abuse deterrent and is 10 times more potent than Vicodin.”

According to a watchdog report in the Milwaukee-Wisconsin Journal Sentinel, against the recommendation of its own advisers, the U.S. Food and Drug Administration has approved a new high-dose narcotic painkiller without an abuse-limiting formula and tested using a method critics describe as stacking the deck in favor of the drug.

Zohydro ER will be the first Hydrocodone-only opioid, and it will come in doses packing five to 10 times more heroin-like narcotic than traditional Hydrocodone products such as Vicodin, which combine Hydrocodone with over-the-counter pain relievers such as Acetaminophen or Ibuprofen.

Though the narcotic in Zohydro ER is designed to be released slowly over 12 hours, pleasure-seekers will be able to crush it, chew it or mix it with alcohol to unleash its full punch at once.”

The story said the November 2012 memo from the FDA’s own staff warned that the drug will be abused more than traditional Hydrocodone products. The memo compares what likely will occur with Zohydro to what happened with extended-release, Oxycodone-containing opioids.

“The FDA is too influenced by the Pharmaceutical Industry, and it is reflected in their decisions such as the recent discovery of the ‘Enriched Enrollment’ process to approve painkillers whereas, basically, people who experienced problems with opioid pain medication are removed from the clinical trials process insuring that these outcomes are favorable for the pain medication and those that manufacture them,” Roberts said. “The FDA charged the Pharma Companies $25,000 per meeting to be on this panel to help them enact Enriched Enrollment. If that’s not a fox in the hen house situation I don’t know what is.”

The Daily Times asked Roberts about an effort to combat “misuse and abuse” by the Food and Drug Administration in proposing new restrictions that would change regulations for some of the most commonly prescribed narcotic painkillers on the market.

The FDA’s latest proposal would specifically affect Hydrocodone combination pills, also known as opioids, which combine Hydrocodone with less potent painkillers such as Acetaminophen. One example is Vicodin.

Currently labeled as Schedule III drugs, these opioids would, if the reclassification proposal is accepted, be labeled as Schedule II.

This means patients would have to have a written prescription from a doctor, instead of a prescription submitted orally over the phone or via an internet-based delivery system, to access the drugs. And refills would be prohibited. Patients would have to check in with the doctor to get another prescription.

A Schedule II classification would also put manufacturing quotas in place for these Hydrocodone products. Pure Hydrocodone is already a Schedule II substance.

Drugs are categorized into one of five “schedules” by the Drug Enforcement Administration based on “whether they have a currently accepted medical use in treatment in the United States, their relative abuse potential and their likelihood of causing dependence when abused.” Other drugs, such as Adderall and Morphine, are also labeled as Schedule II.

“When you wonder why your dentist gives you 40 hydrocodone for a toothache, or your knee doctor prescribes far more than he should, that’s because they’re under the impression that it’s not as addictive as Percocet,” Dr. Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing, told CNN in January when an FDA advisory panel first urged the administration to recommend tighter restrictions.

“That’s completely false,” he said.

In an online statement posted Thursday, the FDA said it “has become increasingly concerned about the abuse and misuse of opioid products, which have sadly reached epidemic proportions in certain parts of the United States.”

“I agree with Dr. Dr. Andrew Kolodny,” Roberts said. “In fact, many of us locally signed the Petition that PROP sponsored calling for the reclassification of Hydrocodone products. Although the FDA is finally doing something, it is inadequate and long overdue.”

Frank Lewis may be reached at 740-353-3101, ext. 252, or at flewis@civitasmedia.com. For breaking news, follow Frank on Twitter @FrankLewisPDT.

Just another addictive substance, needs to be classified as a Schedule II

No Butts About It....Colonoscopy Saves Lives #justdoit

Holy Crap............thats about all I can say about my colonoscopy adventure last week. Nurses are the worst kind of patient, yes tis true. I recently turned another year older and had been putting off this most anxiety producing procedure for several years now. Due to the fact that my family history includes a father who had colon cancer and died with liver cancer, it was a "no brainer" per my internal medicine doctor. I should have had a first screening at age 40...............well just 9 years late, I put my mind to it and got it done.
Yes, I survived and it was not as bad as I had imagined at all.

If you have been putting off having this life saving test done, don't. Besides the prep the night before, it is not all that bad. It is the best test to detect precancerous and cancerous polyps or lesions in your large bowel or colon.
The prep that I endured was called "Suprep" and it was more like a ticking time bomb that went off several hours after I drank the 2nd bottle at 9pm the night before. It did take a couple of Zofran ODT(nausea medication) to get thru the prep, it made me sick on my stomach. It sure does work well though....sheesh. I highly suggest that you plan ahead to stay home and rest while doing your prep. You will go to the bathroom, have some abdominal discomfort and watery diarrhea that can be hard to control until it finally stops. Have a path to the bathroom and place a towel or protective barrier on your bed that night....just in case. I had several uh oh moments when the bathroom was just not close enough..... I told you this stuff worked well.....lol

I arrived at the Endoscopy center at 8am, got my IV started (took 2 sticks as usual, I am a difficult pt I told you) , hooked up to a bunch of monitors, rolled back to the procedure room and the anesthesia staff gave me some happy milk of anesthesia (propofol--Michael Jackson death juice) to sedate me. I don't remember any of the actual procedure and woke up as they rolled me into the recovery area. My hubby was waiting for me there. I felt safe and never embarrassed while I was there. The staff was great and made my experience much calmer and less stressful.

How is the procedure done? 

A colonoscopy is an exam that views the inside of the colon (large intestine) and rectum, using a tool called a colonoscope.

The colonoscope has a small camera attached to a flexible tube that can reach the length of the colon.

How the Test is Performed

You will usually be given medicine into a vein to help you relax. You should not feel any discomfort. You will be awake during the test and may even be able to speak, but you probably will not remember anything.

You will lie on your left side with your knees drawn up toward your chest. The colonoscope is inserted through the anus. It is gently moved into the beginning of the large bowel and slowly advanced as far as the lowest part of the small intestine.

Air will be inserted through the scope to provide a better view. Suction may be used to remove fluid or stool.

The health care provider gets a better view as the colonoscope is moved back out. Therefore, a more careful exam is done while the scope is being pulled back. The doctor may take tissue samples with tiny biopsy forceps inserted through the scope. Polyps may be removed with snares, and images may be taken.

Specialized procedures, such as laser therapy, may also be done.

More information can be found HERE 

Gas is what you will have post-procedure--lots of it, be prepared to toot toot toot it out as instructed by the staff, this is the only time when it is perfectly acceptable to let it all out...lol. You want to expell the gas so you don't have problems later as it rises up and causes pain & nausea. 

I feel very blessed that my colonoscopy results only showed a couple of diverticula areas and no cancerous areas. Now I only have to have this test every 5 years ( due to my family history). Normally it is every 10 years after age 50. 

Having A Safe Thanksgiving Dinner: Turkey Cooking Safety Tips

We all want a safe and a Happy Thanksgiving, so a case of food poisoning that involves the entire family would not be very "happy" , so make sure you are aware of a few basic tips to cooking your bird ,gobble, gobble....

Thawing your Bird: 

Turkeys must be kept at a safe temperature during "the big thaw." While frozen, a turkey is safe indefinitely. However, as soon as it begins to thaw, any bacteria that may have been present before freezing can begin to grow again.

A package of frozen meat or poultry left thawing on the counter more than 2 hours is not at a safe temperature. Even though the center of the package may still be frozen, the outer layer of the food is in the "Danger Zone" between 40 and 140 °F — at a temperature where foodborne bacteria multiply rapidly.

There are three safe ways to thaw food: in the refrigerator, in cold water, and in the microwave oven.

Cooking your Bird: 

 A food thermometer should be used to ensure a safe minimum internal temperature of 165 °F has been reached to destroy bacteria and prevent foodborne illness.

Many variables can affect the roasting time of a whole turkey:

• A partially frozen turkey requires longer cooking.
• A stuffed turkey takes longer to cook.
• The oven may heat food unevenly.
• Temperature of the oven may be inaccurate.
• Dark roasting pans cook faster than shiny metals.
• The depth and size of the pan can reduce heat circulation to all areas of the turkey.
• The use of a foil tent for the entire time can slow cooking.
• Use of the roasting pan's lid speeds cooking.
• An oven cooking bag can accelerate cooking time.
• The rack position can have an affect on even cooking and heat circulation.
• A turkey or its pan may be too large for the oven, thus blocking heat circulation.

ROASTING INSTRUCTIONS

1. Set the oven temperature no lower than 325 °F. Preheating is not necessary.

2. Be sure the turkey is completely thawed. Times are based on fresh or thawed birds at a refrigerator temperature of 40 °F or below.

3. Place turkey breast-side up on a flat wire rack in a shallow roasting pan 2 to 2 1/2 inches deep.
Optional steps:

• Tuck wing tips back under shoulders of bird (called "akimbo").
• Add one-half cup water to the bottom of the pan.
• In the beginning, a tent of aluminum foil may be placed loosely over the breast of the turkey for the first 1 to 1 1/2 hours, then removed for browning. Or, a tent of foil may be placed over the turkey after the turkey has reached the desired golden brown color.

4. For optimum safety, cook stuffing in a casserole. If stuffing your turkey, mix ingredients just before stuffing it; stuff loosely. Additional time is required for the turkey and stuffing to reach a safe minimum internal temperature (see chart).

5. For safety and doneness, the internal temperature should be checked with a food thermometer. The temperature of the turkey and the center of the stuffing must reach a safe minimum internal temperature of 165 °F. Check the temperature in the innermost part of the thigh and wing and the thickest part of the breast.

6. Let the bird stand 20 minutes before removing stuffing and carving.

APPROXIMATE COOKING TIMES
(325 °F oven temperature) 

UNSTUFFED (time in hours)

• 4 to 6 lb. breast — 1 1/2 to 2 1/4
• 6 to 8 lb. breast — 2 1/4 to 3 1/4
• 8 to 12 lbs. — 2 3/4 to 3
• 12 to 14 lbs. — 3 to 3 3/4
• 14 to 18 lbs. — 3 3/4 to 4 1/4
• 18 to 20 lbs. — 4 1/4 to 4 1/2
• 20 to 24 lbs. — 4 1/2 to 5

STUFFED (time in hours)

• 8 to 12 lbs. — 3 to 3 1/2
• 12 to 14 lbs. — 3 1/2 to 4
• 14 to 18 lbs. — 4 to 4 1/4
• 18 to 20 lbs. — 4 1/4 to 4 3/4
• 20 to 24 lbs. — 4 3/4 to 5 1/4

More Ways to Cook a Turkey
For other cooking methods, read the publication "Turkey: Alternate Routes to the Table" atwww.fsis.usda.gov/Fact_Sheets/Turkey_Alt_Routes/index.asp.

SAFE HALLOWEEN : make it great!

 

Halloween is an exciting time of year for kids, and to help ensure they have a safe holiday, here are some tips from the American Academy of Pediatrics (AAP). Feel free to excerpt these tips or use them in their entirety for any print or broadcast story, with acknowledgment of source.

ALL DRESSED UP:

• Plan costumes that are bright and reflective. Make sure that shoes fit well and that costumes are short enough to prevent tripping, entanglement or contact with flame.
• Consider adding reflective tape or striping to costumes and trick-or-treat bags for greater visibility.
• Because masks can limit or block eyesight, consider non-toxic makeup and decorative hats as safer alternatives. Hats should fit properly to prevent them from sliding over eyes.
• When shopping for costumes, wigs and accessories look for and purchase those with a label clearly indicating they are flame resistant.
• If a sword, cane, or stick is a part of your child's costume, make sure it is not sharp or too long. A child may be easily hurt by these accessories if he stumbles or trips.
• Obtain flashlights with fresh batteries for all children and their escorts.
• Do not use decorative contact lenses without an eye examination and a prescription from an eye care professional. While the packaging on decorative lenses will often make claims such as “one size fits all,” or “no need to see an eye specialist,” obtaining decorative contact lenses without a prescription is both dangerous and illegal. This can cause pain, inflammation, and serious eye disorders and infections, which may lead to permanent vision loss.
• Teach children how to call 9-1-1 (or their local emergency number) if they have an emergency or become lost.

CARVING A NICHE:

• Small children should never carve pumpkins. Children can draw a face with markers. Then parents can do the cutting.

• Consider using a flashlight or glow stick instead of a candle to light your pumpkin. If you do use a candle, a votive candle is safest.
• Candlelit pumpkins should be placed on a sturdy table, away from curtains and other flammable objects, and should never be left unattended.

HOME SAFE HOME:

• To keep homes safe for visiting trick-or-treaters, parents should remove from the porch and front yard anything a child could trip over such as garden hoses, toys, bikes and lawn decorations.
• Parents should check outdoor lights and replace burned-out bulbs.
• Wet leaves or snow should be swept from sidewalks and steps.
• Restrain pets so they do not inadvertently jump on or bite a trick-or-treater.

ON THE TRICK-OR-TREAT TRAIL:

• A parent or responsible adult should always accompany young children on their neighborhood rounds.

• If your older children are going alone, plan and review the route that is acceptable to you. Agree on a specific time when they should return home.

• Only go to homes with a porch light on and never enter a home or car for a treat.

• Because pedestrian injuries are the most common injuries to children on Halloween, remind Trick-or-Treaters.
• Stay in a group and communicate where they will be going.

• Remember reflective tape for costumes and trick-or-treat bags.

• Carry a cellphone for quick communication.

• Remain on well-lit streets and always use the sidewalk.

• If no sidewalk is available, walk at the far edge of the roadway facing traffic.

• Never cut across yards or use alleys.

• Only cross the street as a group in established crosswalks (as recognized by local custom). Never cross between parked cars or out driveways.

• Don’t assume the right of way. Motorists may have trouble seeing Trick-or-Treaters. Just because one car stops, doesn't mean others will!

• Law enforcement authorities should be notified immediately of any suspicious or unlawful activity.

HEALTHY HALLOWEEN:

• A good meal prior to parties and trick-or-treating will discourage youngsters from filling up on Halloween treats.
• Consider purchasing non-food treats for those who visit your home, such as coloring books or pens and pencils.
• Wait until children are home to sort and check treats. Though tampering is rare, a responsible adult should closely examine all treats and throw away any spoiled, unwrapped or suspicious items.
• Try to ration treats for the days following Halloween.

©2013 American Academy of Pediatrics

- See more at: http://www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/pages/Halloween-Safety-Tips.aspx#sthash.Fdb2FMGW.dpuf

Be safe and have fun! Return home alive.

 

 

 

October is SIDS Awareness Month : Put Those Babies "Back" To Sleep #awareness

October is SIDS Awareness Month. Learn more about the problem and the risk factors and take action to reduce the risk. Start by always placing babies on their backs to sleep. 

Sudden Unexpected Infant Death (SUID): The death of an infant, less than 1 year of age that occurs suddenly and unexpectedly. After a case investigation, these deaths may be diagnosed as suffocation, asphyxia, entrapment, infection, ingestions, metabolic diseases, cardiac arrhythmias, trauma (accidental or non-accidental), or SIDS. In some cases where the evidence is not clear, or not enough information is available, the death is considered to be from an undetermined cause. 
Sudden Infant Death Syndrome (SIDS): The sudden death of an infant less than 1 year of age that cannot be explained after a thorough investigation is conducted, including a complete autopsy, examination of the death scene, and a review of the clinical history. SIDS is a type of SUID. 

Accidental Suffocation and Strangulation in Bed (ASSB) also is a type of sleep-related SUID. This includes infant deaths related to airway obstruction (asphyxia) in a sleeping environment caused by— 
Suffocation by soft bedding—such as a pillow or waterbed mattress. 
Overlay—another person overlaying or rolling on top of or against the infant. 
Wedging or entrapment—wedging between two objects such as a mattress and wall, bed frame, or furniture. 
Strangulation—such as when an infant’s head and neck become caught between crib railings. 

Understanding the Problem 
There are about 4,200 sudden unexpected infant deaths per year in the United States—half are caused by SIDS.1 The most frequently reported causes are— 
SIDS—the leading cause of infant death from 1–12 months old. 
Cause is unknown or undetermined. A thorough investigation was not conducted or after the investigation the cause could not be determined or remained unknown. 
Sleep-related suffocation—the leading cause of infant injury death. 
Black and American Indian/Alaskan Native infants are about two times more likely to die of SIDS and other sleep-related SUID than white infants. 

Reducing the Risk 
 
Health care providers and researchers don’t know the exact causes of SIDS, but they do know certain things you can do to help reduce the risk of SIDS other sleep-related SUID, such as— 

• Always place a baby on his or her back to sleep, for naps and at night, to reduce the risk of SIDS. 

• Use a firm sleep surface, covered by a fitted sheet, to reduce the risk of SIDS and other sleep-related causes of infant death. See crib safety information from the Consumer Product Safety Commission for more information http://www.cpsc.gov/info/cribs/index.html 

• Your baby should not sleep in an adult bed, on a couch, or on a chair alone, with you, or with anyone else. 

• Keep soft objects, toys, and loose bedding out of your baby’s sleep area. 

• To reduce the risk of SIDS, do not smoke during pregnancy, and do not smoke or allow smoking around your baby. 

• Breastfeed your baby to reduce the risk of SIDS. 

• Give your baby a dry pacifier that is not attached to a string for naps and at night to reduce the risk of SIDS. 

• Do not let your baby get too hot during sleep. 

Do not use bumper pads in cribs. Bumper pads can be a potential risk of suffocation or strangulation.

Make sure your baby receives all recommended immunizations. Studies have shown that immunization can reduce the risk of SIDS by 50%.

For more detailed information on reducing the risk of SIDS, visit the National Institute of Child Health and Human Development (NICHD) Web site http://www.nichd.nih.gov/health/topics/Sudden_Infant_Death_Syndrome.cfm

Another great resource for info http://kidshealth.org/parent/general/sleep/sids.html#

Speak Up, Speak Out! Stop This Problem! #worldwidechokinggameawareness

Today is a day, just like any other say yes? For some maybe for others no! If you have ever lost a child, no day is the same, you wake up with a piece of your heart ripped from you  that just can't be replaced.
No parent wants another parent to ever go thru the heartache of child loss, so today we urge you to wake up and educate yourself on something that 75% of kids already know about. Your kids!
The choking game has many names, it's all over YouTube, the internet, social media and your kids schools.
A high school trend...no, kids as young as 9 are dying everyday. So join us today on Worldwide Choking Game Awareness Day 2013 and Speak Up, Speak out, speak to Your kids today!

We don't want to add another statistic to our list......

World Suicide Prevention Day ~~ September 10th #stopsuicide #depression

World Suicide Prevention Day is held on September 10, 2013. It is an awareness day which is observed every year, in order to provide worldwide commitment and action to prevent suicides, with various activities around the world. The observance is endorsed by the International Association for Suicide Prevention (IASP) and the World Health Organization (WHO). The World Suicide Prevention Day was founded in 2003

From Kristin Brooks Hope Center 

Suicide is a permanent solution to a temporary problem. Suicidal behavior is complex, as some risk factors vary with age, gender, and ethnic group and may even change over time. The risk factors for suicide frequently occur in combination. Research has shown that more than 90% of people who commit suicide have depression or another diagnosable mental or substance abuse disorder.

The number one cause of suicide is untreated depression. A depressive disorder is an illness that involves the whole body, mood, and thoughts. It affects the way a person feels about oneself and the way one thinks about things. The taking of ones own life tragically demonstrates the terrible psychological pain experienced by a person who has lost all hope – a person who is no longer able to cope with day to day activities – a person who feels there is no solution to their problem – a person who wants to end the pain by ending their own life.

Much of this kind of suffering is unnecessary. Depression is treatable and as a result, suicide is preventable. Love yourself or a friend enough not to keep thoughts of suicide a secret. If you or a friend of yours is thinking of ending the pain by ending your own life, this is not a secret to keep. Talk to your family, friends or other special people in your life. They can help you find solutions to your problems and to see ways to cope with your pain without ending your life. Help is just a phone call away: 1.800.SUICIDE (784-2433)

Things to know about suicide:

•  90% of people who commit suicide have depression or another diagnosable  mental illness or substance abuse disorder

•  The number one cause of suicide is untreated depression

•  Suicide has ranked at the 3 rd leading cause of death for young people nationally

•  There are three female attempts for every male attempt at suicide. However, males are four times as likely to die from their attempts

What to do if a friend or loved one is suicidal:

•  Let that person know you are concerned about their well-being, and that you have observed certain clues that have made you think that they may want to hurt themselves. Ask them if they are depressed or suicidal.

•  Listen to your friend, and keep in mind that you must stay calm. Your friend will more than likely be relived that someone noticed their pain, and cared enough to confront them and talk about it.

•  Support your friend unconditionally. While you cannot make someone choose to live, and while you aren't responsible for their life, you can support them and show them that you care while giving them ideas about other choices.

•  Remind this friend that suicide is a permanent solution to a temporary problem.

•  Be honest with your friend and they will trust your input. Let them know you want to help them, even if it involves calling an adult or a hotline. Call them in front of your friend if necessary.

•  Call 9-1-1 if you feel their suicide threat is immediate.