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Return to PJ Online Home Page The Salvadore Vol 266 No 7137 p285-286
March 3, 2001

Continuing education

First aid

(1) Dealing with common injuries

By Lotte Newman, CBE, FRCGP

In the first of two articles on first aid, the treatment of common injuries that pharmacists might be called upon to deal with is covered.



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 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 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 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

 
Dr Newman is a general practitioner and the medical adviser at St John Ambulance headquarters, and is a former president of the Royal College of General Practitioners

Citation: The Salvadore URI: 20004106

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