Community pharmacy Topic 8 First aids Burns

1. Community pharmacyTopic 8First aidsBurns

2. First aid is the provision of immediate care to a victim with an injury of illness, usually effected by a lay person, and performed within a limited skill range. • First aid is normally performed until the injury is stopped (such as in the case of small cuts, minor bruises, and blisters) or until the next level of care, such as an ambulance or doctor, arrives

3. Emergency treatment in shock • Shock: is a life-threatening medical condition of low blood perfusion to tissues .The basic cause is a inadequate cardiac out put with compensator vasoconstriction, renal and cerebral hypo perfusion which resulting in cellular injury and inadequate tissue function.

5. Classification of different types of shock and their etiological factors 1. Hypovolumic shock: decreased blood volume. Loss of blood to hemorrhage Loss of plasma due to burns Loss of fluid due to diarrhea, vomiting, DM, over use of diuretics. 2. Cardiogenic shock: inadequate pumping of the heart. MI HF with low cardiac out put Arrhythmia

6. 3. Septic shock: Gram – septicemia Gram + septicemia 4. Obstruction shock: Pulmonary embolism 5. Neurogenic shock: nervous system injury leading to vasodilation in the periphery causing inadequate perfusion to the vital organs.

7. Drugs include: • Directly toxic drugs: daunorbicin • Over dose: BB, CCB, salicylates, TCAs, spinal anesthesia. • Spinal cord injure 7. Others: • Anaphylactic shock: severe allergic reaction that leads to vasodilation and bronchoconstriction. • Hypoglycemia

8. General Signs and symptoms of shock • A person in shock has extremely low blood pressure. Depending on the specific cause and type of shock, symptoms will include one or more of the following: • Anxiety or agitation/restlessness • Bluish lips and fingernails • Chest pain • Dizziness, lightheadedness • Pale, cool, clammy skin • Excessive sweating, moist skin • Shallow breathing and Unconsciousness

9. The typical signs of shock are low blood pressure, rapid heart rate, and signs of poor end-organ perfusion (ex: low urine output, confusion, or loss of consciousness). • The systolic blood pressure is usually low, often less than 100 mmHg. • Oliguria may progress to tubular necrosis.

10. Consciousness may be preserved but frequently there is confusion and irritability • Onset of shock may be sudden or general. The skin is cold, pale, sweaty and in advance cases there may be peripheral cyanosis or gangrene. • A rising plasma K concentration and progressive acidosis both from renal failure and ischemic necrosis of skeletal muscles may cause cardiac arrhythmia.

11. Management • Call 911 for immediate medical help. • Check the person's airway, breathing, and circulation. If necessary, begin rescue breathing and CPR. • Even if the person is able to breathe on his or her own, continue to check rate of breathing at least every 5 minutes until help arrives.

12. If the person is conscious and does NOT have an injury to the head, leg, neck, or spine, place the person in the shock position. • Lay the person on the back and elevate the legs about 12 inches. Do NOT elevate the head. If raising the legs will cause pain or potential harm, leave the person lying flat. • Give appropriate first aid for any wounds, injuries, or illnesses. Keep the person warm and comfortable. Loosen tight clothing.

13. IF THE PERSON VOMITS OR DROOLS • Turn the head to one side to prevent choking. Do this as long as you do not suspect an injury to the spine. • If a spinal injury is suspected, "log roll" the person instead. To do this, keep the person's head, neck, and back in line, and roll the body and head as a unit.

14. DO NOT • Do NOT give the person anything by mouth, including anything to eat or drink. • Do NOT move the person with a known or suspected spinal injury. • Do NOT wait for milder shock symptoms to worsen before calling for emergency medical help.

15. The immediate objective of the emergency treatment is shock is to restore and maintain cardiac output at a satisfactory level until the cause of circularity failure can be identified the specifically treatment or allowed to resolve. a. Fluid representation: it is the primary therapeutic consideration in the patient of Hypovolumic shock because early complete correction of Hypovolumic prevents the latter complication of shock

16. This can be achieved by intravenous administration of crystalloids, or colloids and is followed by whole blood transfusion to restore the hematocrit to at least 30 %. b. drugs: in case of Cardiogenic shock vasodilation and intropic agents are used for the control of shocked state depending on the other vital parameters of vasodilation therapy is to decrease pulmonary venous congestion and to improve cardiac out put.

17. Glyceryltrinitrate has been successfully used I.V for producing effective vasodilation and dopamine, dobutamine, and isoproteranol have been used as intropic agents. • Even after the recovery, permanent cerebral damage or loss of peripheral tissues may be inevitable. • While this is being done, the patient must be protected from fuss, unnecessary disturbance and hypothermia.

18. The anxiety and pain should be controlled using small I.V dose of morphine if necessary. • Oxygen should be administered by face mask. A catheter should be inserted to monitor urine out put and great should be taken to protect the ischemic skin from damage.

19. Septic shock • Septic shock is a serious condition that occurs when a body-wide infection leads to dangerously low blood pressure. • Occurs when invasion by M.O causes circularity and inadequate tissue perfusion. Although gram (-) account for majority of the cause of the septic shock, (+) cocci, viruses, rickettsia, and fungi account for most cases • Toxins released by the bacteria or fungi may cause tissue damage. This may lead to low blood pressure and poor organ function. Some researchers think that blood clots in small arteries cause the lack of blood flow and poor organ function.

20. Risk factors for septic shock include • Diabetes • Diseases of the genitourinary system, or GI • Diseases that weaken the immune system, such as AIDS • Indwelling catheters (those that remain in place for extended periods, especially intravenous lines and urinary catheters and plastic and metal stents used for drainage) • Leukemia and Lymphoma • Long-term use of antibiotics • Recent infection • Recent surgery or medical procedure • Recent use of steroid medications • Solid organ or bone marrow transplantation

21. Symptoms • Septic shock can affect any part of the body, including the heart, brain, kidneys, liver, and intestines. Symptoms may include: • Cool, pale arms and legs, Skin rash or discoloration • High or very low temperature, chills, Shortness of breath • Light-headedness • Little or no urine • Low blood pressure, especially when standing • Palpitations • Rapid heart rate • Restlessness, agitation, lethargy, or confusion

22. The emergency treatment of septic shock will depend on the presenting symptoms and homodynamic profile. • In many cases volume replacement and maintenance of high cardiac output is essential to prevent further worsening of shock. Along side, chemotherapeutic measure using appropriate antibiotics are taken to care the septicemia which is the main cause.

23. Treatment may include: • Breathing machine (mechanical ventilation) • Dialysis • Drugs to treat low blood pressure, infection, or blood clotting • Fluids given directly into a vein (intravenously) • Oxygen • Sedatives • Monitoring pressure in the heart and lungs

24. Anaphylactic shock • Anaphylaxis is a life-threatening type of allergic reaction • Systemic anaphylaxis consist of a group of very severe reaction which occurs rapidly following an injection of the antigen, as in the case of a drug like penicillin or the sting on insect.

26. The features of anaphylactic shock include bronchospasm, laryngeal oedema with extreme dyspnea and cyanosis and marked fall in blood pressure.

27. Management • Check the person's airway, breathing, and circulation (the ABC's of Basic Life Support). A warning sign of dangerous throat swelling is a very hoarse or whispered voice, or coarse sounds when the person is breathing in air. If necessary, begin rescue breathing and CPR. • Call 911. • Calm and reassure the person.

28. If the allergic reaction is from a bee sting, scrape the stinger off the skin with something firm (such as a fingernail or plastic credit card). Do not use tweezers -- squeezing the stinger will release more venom. • If the person has emergency allergy medicine on hand, help the person take or inject the medication. Avoid oral medication if the person is having difficulty breathing.

29. Take steps to prevent shock. Have the person lie flat, raise the person's feet about 12 inches, and cover him or her with a coat or blanket. Do not place the person in this position if a head, neck, back, or leg injury is suspected, or if it causes discomfort. • There may also be nausea, vomiting if not treated promptly with adrenaline I.M . An antihistamine ( ex: chlorpheniramine ), followed in severely ill patient by I.V corticosteroids ( ex: hydrocortisone)

30. Burns • The mortality due to extensive burns remain high despite the greater understanding of the Pathophysiology of burns and improved measures to cope with burn shock. • Control of infection in the burn by topical application of mafende, sliver nitrate sulphadiazine leads to further decline in mortality of patient with 30-60%body burn.

32. Individual with minor burn may not require hospitalization and may be treated as ambulatory patient but the care of seriously burnt patient is always conducted after admission to hospital. • upon arrival in the hospital the seriously burnt is first examined for evidence of pulmonary edema, manifestations of shock and serious concomitant injures a they require immediate care.

33. History: the following components of patient history are very helpful in treatment of burns. • Nature of burns: nature of agent causing burns and the environment in which burn indicate the possible extent of the tissue damage. Burns occurring in automobile accident are often accompanied by other injures. • There is more likelihood of upper respiratory injury if the patient has go burnt in a closed room

34. Hot air and mental produce deeper injury than those produced by hot water. • Hot air and flames caused dry burn whereas hot liquids produce moist burns. the area of electric burn is smaller but the actual extent of tissue damage is more. b. Duration: A patient seen within half an hour after an accident may not slow any sign of the shock or respiratory obstruction. Even blister formation of a second degree burn may not be apparent during the this period

35. c. Previous treatment: in actual cases history should be taken any previous treatment received by the patient as it may determine the future line in treatment. Also the presence of other diseases like hypertension or liver or kidney disease can after vital signs and values of blood and urine analysis. d. Tetanus immunization: in all patients history should be taken for the lost active or passive immunization against tetanus.

36. Physical examination: • The examination room should be warm and lighted. The patient should be completely undressed and laid on the sterile sheet if the burn is extensive so that entire area of the burn can be exposed. The examination of burn must be done under aseptic condition. • Location of burn and total area involved: • The total % of body surface involve can be estimated by the “ rule” of “nine”.

37. Management • First-degree or minor second-degree burns. • The pharmacist must caution the patient that a burn that worsens or fails to improve within 5 days of the injury should be seen by a physician to rule out • Children under the age of 2 years who suffer burns should be checked by a physician

38. OTC products currently on the market for self-treatment of wounds include topical antibiotics (eg, bacitracin, neomycin, and polymixin B sulfate), wound irrigants, wound antiseptics, various types of bandages including medicated bandages with topical antibiotics, and products that help reduce the appearance of scars. • Examples of first aid antiseptics include ethyl alcohol (48%-95%), isopropyl alcohol (50%-91.3%), iodine topical solution USP, iodine tincture USP, povidone-iodine complex (5%-10%), topical hydrogen peroxide solution (0.13%)

39. Topical AnestheticsTopical anesthetics, which can help relieve pain associated with minor burns, work by inhibiting the transmission of signals from pain receptors. These products are typically applied no more than 3 to 4 times a day as needed.The 2 most common topical anesthetics found in nonprescription products include benzocaine, in strengths of 5% to 20%, and lidocaine (0.5%-4%).

40. Protectants/lubricants include cocoa butter, glycerin, and petrolatum (Vaseline) • For pain relief, take an over-the-counter pain reliever like ibuprofen, acetaminophen or naproxen. • First and Second degree burn: should also cover the burn with a dry non-stick dressing.

41. Counseling notes • Patients with burns should be advised not to rupture blisters, and if the skin is broken • they should apply topical antibiotics to prevent infections. • It is also important for pharmacists to remind certain patient populations, such as patients with diabetes or those individuals currently taking medications that may impair the healing process. • Exposure to a source of heat is the most common cause of burns. If the burn is a minor one, you can soak it in cool water for 15 to 20 minutes. You should continue soaking it until it is free of pain when in and out of the water. • self-treatable burns are painful. If the burn looks dark red, yellowish-white, or pearly and is not painful, it may be the more severe second-degree or third-degree type that requires a physician. Lack of pain does not mean that the burn is minor. Instead, it does not hurt because the nerves have been burned away. Thus, you cannot use the absence of pain in your decision as to whether or not to seek immediate care. 

42. References • A text book of community pharmacy, chapter5, rakesh saini, 2012. • www. allergyuk.org. • U.S. National Library of Medicine, medline plus,2014 • First Aid for Minor Burns and Wounds, pharmacy times, 2011