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Many pharmacists find themselves
having to recall their first aid knowledge when customers consult them
so preventing a potentially unnecessary visit to their doctor. Pharmacists
seem so much more easily accessible — no appointment is needed, and
they are available to dispense medicines and advice throughout the day.
Add to that the fact that many pharmacies are open for long hours, and
it is easy to see why the public takes advantage of such convenient access
to health advice.
Some of the more common complaints that a pharmacist
might be faced with are outlined below, with the correct first aid procedure
given for each complaint, as recommended by St John Ambulance. Clearly,
this guide is not a substitute for attending a first aid course but it
should serve as an informative taster for those who are considering first
aid training, or as a useful memory jogger for qualified first aiders.
Step-by-step instructions are included below, which
go through what should be done if asked about the following:
- Animal bites
- Asthma attack
- Bone, joint and muscle injuries
- Foreign bodies in the eye
- Head injuries
- Insect stings
- Burns and scalds
- Splinters
Animal bites
Any bite that breaks the skin can cause a wound
that is vulnerable to infection. Therefore, it will need prompt first
aid and medical attention. For serious wounds, control bleeding by applying
direct pressure and raising the injured part. Cover the wound with a sterile
dressing, bandaged in place, and arrange for the casualty to go to hospital.
For superficial bites, wash the wound thoroughly
with soap and warm water. Pat the wound dry with clean gauze swabs and
cover with a sterile dressing. Advise the casualty to see a doctor in
case he or she needs primary immunisation against tetanus, or a booster.
Asthma attack
If you see someone having difficulty in breathing,
remember to keep calm and reassure him or her while they take a dose from
their bronchodilating inhaler.
Allow the casualty to choose the most comfortable
position for them, which is often sitting down, and encourage them to
breathe slowly and deeply. If the attack is mild and eases within five
to 10 minutes, the casualty should take another dose from the same inhaler
and inform their general practitioner of the attack. However, if it is
the first attack, or if it is severe and the inhaler has no effect after
five to 10 minutes, dial 999 for an ambulance. While waiting, help him
or her to use their inhaler every five to 10 minutes and monitor and record
breathing and pulse every 10 minutes. A preventative inhaler should not
be used. Do not let the casualty lie down because they will be able to
breathe more effectively when sitting up.
Bone, joint and muscle injuries
If you have any doubt about which type of injury
you are dealing with, it is best to opt for the most serious, which is
generally a fracture.
In an open, or compound fracture, the overlying
skin is broken and the bone is exposed to the air. When the skin around
a broken bone is intact, the injury is known as a closed fracture, often
with bruising and/or swelling. Some injuries, such as an open fracture,
or a dislocated thumb, are obvious. Others are only revealed by an x-ray.
Compare the shape and appearance of the affected limb with the uninjured
side and if there is any doubt as to the severity of an injury, then treat
it as a fracture.
Open fractures For open fractures,
cover the wound with a clean pad or sterile dressing, and apply pressure
to control the bleeding. Without touching the open wound with your fingers,
carefully place some clean padding over and around the dressing. Secure
the dressing and padding, and bandage firmly (but not so tightly as to
impede circulation). Immobilise the injured part as for a closed fracture,
dial 999 for an ambulance and treat the casualty for shock, checking the
circulation distal to the bandage every 10 minutes.
Do not let the casualty eat, drink or smoke and
do not move him or her until the injured part is secured and supported.
Closed fractures and dislocations
For closed fractures and dislocations, tell the casualty to keep still,
and steady the injured part with your hands until it is immobilised. For
firmer support, secure the injured limb to a sound part of the body, bandaging
from the uninjured side. Dial 999 for an ambulance and treat the casualty
for shock, if necessary. Check the circulation distal to any bandages
every 10 minutes, and loosen if necessary. Do not try to replace a dislocated
bone into its socket. As with open fractures, do not let the casualty
eat, drink or smoke and do not move the casualty until the injured part
is secured and supported.
Sprains and strains For sprains and
strains, support the injured part in the most comfortable position. If
the injury has just happened, cool the area by applying an ice pack or
cold compress to reduce swelling, bruising and pain. Apply gentle, even
pressure by surrounding the area with a thick layer of soft padding, such
as cotton wool or plastic foam, secured with a bandage. Raise and support
the injured limb to reduce blood flow to the injury and to minimise bruising.
Advise the casualty to go to hospital unless the injury seems very minor,
in which case advise him or her to rest the injured part and to see their
doctor.
Foreign bodies in the eye
A speck of dust, a loose eyelash or even a contact
lens can literally float on the white of the eye and may cause great discomfort,
but it is usually easily removed. However, anything that sticks to the
eye, penetrates the eyeball, or rests on the coloured part of the eye
(the pupil and iris) should not be touched. Advise the casualty not to
rub the eye and sit them down facing the light. Gently separate the eyelids
with your finger and thumb. Examine every part of the eye, asking the
casualty to look right, left, up and down. If the foreign body is sticking
to or embedded in the eye, cover the affected eye with a bandage, then
take or send the casualty to hospital.
If you can see a foreign body on the white of the
eye, wash it out with water. If this is unsuccessful, and provided the
foreign body is not stuck in place, lift if off with a moist swab, or
the damp corner of a tissue or clean handkerchief. If the object is under
the upper eyelid, ask the casualty to grasp the eye lashes and pull the
lid over the lower lid. Blinking under water may also make the object
float clear.
Head injuries
Control any bleeding by replacing any displaced
skin flaps and placing a sterile dressing or clean pad over the wound
and applying firm, direct pressure. Secure the dressing over the wound
with a roller bandage. Lay the casualty down, making sure that the head
and shoulders are slightly raised. Make sure that he or she is comfortable.
Call an ambulance if the casualty cannot be transported in a horizontal
position.
Insect stings
If the casualty shows signs of anaphylactic shock
(ie, they become anxious, develop red, blotchy skin, the face and neck
start swelling, there is difficulty in breathing, or the pulse is rapid),
dial 999 for an ambulance. If the sting is in still in the wound, pluck
it out firmly with fine tweezers. Apply a cold compress to relieve pain
and minimise swelling, and advise the casualty to see a doctor if the
pain and swelling persist.
For a sting in the mouth, give the casualty ice
to suck or cold water to sip, to minimise the swelling. Dial 999 for an
ambulance and reassure the casualty.
Burns and scalds
Minor burns and scalds Small, superficial
burns involve only the outermost layer of skin and are characterised by
redness, swelling and blisters. These usually heal naturally, but if you
are unsure as to the severity of the injury, the casualty should be encouraged
to seek medical advice.
Flood the injured part with cold water for at least
10 minutes to stop the burning and relieve pain. If water is not available,
any cold, harmless liquid, such as milk or canned drinks, will do. Gently
remove any jewellery, watches, belts, or constricting clothing from the
injured area before it begins to swell. Cover the area with a sterile
dressing or any clean, non-fluffy material, and bandage loosely in place.
A plastic bag or some kitchen film makes a good temporary covering.
Never break a blister, as you may introduce infection
into the wound, and do not apply adhesive dressings to the skin, as the
burn may be more extensive than it first appears. Also, do not apply ointments
or fats to the injury.
Severe burns and scalds Great care
must be taken when treating burns that are deep or extend over a large
area. The longer the burning continues, the more severe the injury will
be. Dial 999 for an ambulance. Lay the casualty down, protecting the burned
area from contact with the ground. Douse the burn with plenty of cold
liquid for at least 10 minutes, but do not delay the casualty’s removal
to hospital.
While cooling the burn, watch for signs of difficulty
in breathing and be ready to resuscitate if necessary. Gently remove any
jewellery, shoes or smouldering clothing from the injured area before
it begins to swell. Carefully remove burned clothing, unless it is sticking
to the burn. Cover the injury with a sterile dressing, or some other suitable
material, to protect it from infection, unless the injury is to the face,
in which case keep cooling it with water until help arrives. Record details
of the casualty’s injuries and treat them for shock.
Do not touch or interfere with the injured area,
do not burst any blisters and do not apply lotions, ointment, fat or adhesive
tape to the injury.
Splinters
Gently clean the area around the splinter with soap
and warm water. If a portion of the object protrudes from the skin, attempt
to draw it out. However, if a foreign body is deeply embedded in a wound,
do not remove it, as you may cause further injury by doing so.
Sterilise a pair of tweezers by passing them through
a flame. Grasp the splinter with the tweezers as close to the skin as
possible and draw it out at the angle it went in. If the splinter does
not come out easily or breaks, seek medical advice. Squeeze the wound
to encourage a little bleeding. Clean the area and apply an adhesive dressing.
Check that the casualty’s tetanus immunisation is up to date.
Summary
All of these are examples of common problems, which
may bring patients to pharmacies. The above procedures are written from
a first aid perspective, rather than the long-term medical treatment of
a particular problem. If you are in any doubt about the severity of an
injury or illness, then you should advise the customer to consult a doctor,
or, in severe cases, call an ambulance to the pharmacy. If one of your
customers is taken to hospital from the pharmacy, try to get contact details
of a friend or relative so that you can let them know of the casualty’s
whereabouts.
The second article in the series
will appear on March 17
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