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First aid & wound care

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First aid & wound care

 

 

Many members of the public have very little knowledge of first aid so will expect pharmacy staff to be able to help them should the need arise

Learning Objectives

After reading this feature you should be able to:

• Deal with common first aid situations

• Respond to an emergency, such as a heart attack or anaphylaxis

• Discuss the role of naloxone when a drug overdose occurs

 

First aid is an essential life skill, especially for healthcare professionals who have regular contact with people in the local community. “Pharmacists are faced with all sorts of health questions and the public will expect them to know the answers, whether that’s dealing with a splinter or a heart attack,” says Clive James, training officer at St John Ambulance.

Tim Harrison, director at Stockwood Consulting, agrees that pharmacists should know how to respond in an emergency. “A first aid certificate is valid for three years, but ideally skills should be refreshed with an annual course. Our syllabus is similar to those run by other organisations but has a pharmacy focus, including professional and ethical considerations and additional skills associated with giving medicines advice.” The following guide will help pharmacists advise customers on how to deal with some specific first aid and emergency situations.

How should I wash wounds?

Wash minor cuts and grazes to remove any dirt by rinsing them under gently running water or using alcohol-free wipes. Pat the wound dry with a gauze swab or clean non-fluffy cloth, then cover with an adhesive plaster or dressing. If there is a risk that the wound could be infected, the patient should see his/her GP or practice nurse.

The Red Cross advises that wounds that are bleeding heavily shouldn’t be washed, as this will wash away all the clotting agents and make the bleeding worse. Put pressure on the wound (e.g. with a hand, t-shirt or tea towel) to stop or stem the flow of blood until help arrives. If there is something embedded in the wound, don’t remove it, as it is helping to plug the hole and stop the blood flow. Instead, apply pressure around the object until help arrives.

Call for an ambulance as soon as possible. In all cases of moderate to severe bleeding, St John Ambulance advises raising and supporting the part of the body that’s injured. If it is a hand or arm, raise it above the head. If it is a lower limb, lay the patient down and raise the cut area above the level of the heart. This will help stop the bleeding.

Wounds that are bleeding heavily shouldn’t be washed, as this will wash away all the clotting agents

How do I know if someone goes into shock?

If someone looks pale, cold or dizzy, or has a fast, weak pulse rate or breathing rate after an injury, accident or heart attack this means they are probably going into shock. Shock needs to be treated immediately, as it is a life-threatening situation.

Lay the patient down with their head and feet higher than the rest of their body. This position helps to increase blood flow to the brain and heart. Call for an ambulance, stating ‘shock’ and a possible cause (if known). Loosen any tight clothing around the neck, chest and waist. Wrap the patient in a blanket to keep them warm, comfortable and calm.

Keep checking their breathing, pulse and level of response while waiting for the ambulance to arrive. If they lose consciousness, open their airway, check their breathing, put them in the recovery position and be prepared to perform cardiopulmonary resuscitation (CPR) if they stop breathing.

What is the best way to stop a nosebleed?

Most nosebleeds are minor, lasting only a few minutes, and stop without the need for medical attention. However, they can be dangerous if someone loses a significant amount of blood. To stop a nosebleed, first ask the patient to sit down (not lie down), as keeping the nose above the heart will reduce bleeding.

They should also lean forward (not backwards), to make sure the blood drains out through their nose, rather than down the back of their throat (which could block their airways or cause them to vomit). Ask them to breathe through their mouth and pinch the soft part of the nasal cavity, just above the nostrils, as this helps blood clot. Maintain the pressure for 30 minutes, taking a brief pause every 10 minutes, or until the bleeding stops.

Encourage them not to speak, swallow, cough, spit or sniff, as this could break blood clots that may have started to form. It can also help to place a covered ice pack on the bridge of the nose. The patient should avoid blowing their nose, bending down or taking part in strenuous activity for at least 12 hours after a nosebleed. If the bleeding hasn’t stopped after 30 minutes, or is severe, seek medical help.

 

Key facts

• First aid skills should be refreshed every year

• Never wash heavily bleeding wounds

• Always call an ambulance for anaphylaxis even if an auto-injector has been used

 

How should I deal with sprains and strains?

Strains and sprains are common injuries, particularly during sporting activities. They usually cause pain, swelling and/or bruising around a joint or muscle. Most strains and sprains can be managed at home by following the RICE procedure:

• Rest the injured area for the first 48-72 hours

• Apply Ice – either ice wrapped in a damp towel or an ice pack – to reduce pain and swelling. Apply for no longer than 20 minutes, every two to three hours for the first 48-72 hours after the injury

• Apply Compression. Compress or bandage the injured area to limit any swelling or movement. Use a simple elastic bandage or an elastic tubular bandage. The bandage should be snug, but not so tight that it restricts the blood flow, and should be removed at night

• Elevate the affected area on a pillow to reduce swelling.

For the first 72 hours after an injury, heat, alcohol, running (or other forms of exercise) and massage should be avoided. Paracetamol is the most suitable painkiller after an injury; non-steroidal anti-inflammatories, such as ibuprofen, should be avoided for the first 48 hours. If there is a risk that a bone is broken, or there are other injuries, or if the injury doesn’t improve, the patient should go to hospital.

What about a fracture after a fall?

Fractures are not easy to diagnose without an x-ray but a patient with a fracture may have bruising, pain and swelling or be lying in an unnatural position. In severe cases, the limb may be misshapen or have an open wound. With all fractures, it is important to keep the injured part secure with soft padding, to stop it from moving, ease pain and prevent further damage.

Fractures on the arm, for example, can be secured with a sling, while a fractured leg can be tied to the uninjured leg. Call for an ambulance while continuing to support the injured area. For an open fracture (when part of the bone punctures through the skin), St John Ambulance advises covering the wound with a sterile dressing and securing it with a bandage. Then apply pressure around the wound to control any bleeding.

How do I treat anaphylaxis?

Symptoms of anaphylaxis include narrowing of the airways (causing wheezing and breathing difficulties), difficulty swallowing, alterations in heart rate, a drop in blood pressure, feeling lightheaded or faint, swollen eyes, lips, hands and feet and collapse/unconsciousness. If an adrenaline auto-injector is available, it should be given straightaway. Auto-injectors release adrenaline when jabbed or pressed against the outer thigh. It is important to call an ambulance immediately, and state ‘anaphylaxis’, even if an autoinjector has been given and the patient’s symptoms appear to be improving.

A second auto-injector should be injected into the other leg if there is no improvement after five minutes. Anaphylaxis UK advises that, if the person is conscious but feels faint, they should lie flat with their legs elevated, if possible. If they are conscious but experiencing breathing difficulties, they should sit up to make breathing easier. In the case of an unconscious patient, check that their airways are open and clear and check their breathing before putting them in the recovery position to ensure they don’t choke on their vomit.

Knowing how to perform CPR can save lives 

 

What should I do if someone is suspected of having a heart attack?

A heart attack is life-threatening. Symptoms include discomfort, tightness, heaviness or pain in the chest, possibly spreading down the arms, neck, jaw, back or stomach. The patient may also feel sweaty, light-headed or dizzy or become short of breath. If a heart attack is suspected, call for an ambulance immediately. If an aspirin is available, and the patient is not allergic to it, they can slowly chew one adult aspirin tablet (300mg) while waiting for the ambulance to arrive.

If the patient is conscious, check whether they have any underlying conditions that could increase the risk of a heart attack (e.g. angina) and whether they are carrying any medication; if they have tablets or a spray, they should take these if possible. It is important that the patient sits and rests during this time; a good position is on the floor leaning against a wall with their knees bent and head and shoulders supported. Keep checking their breathing, pulse and level of response. If they lose consciousness at any point, open their airways and check their breathing. Be prepared to do CPR if necessary.

How do I treat poisoning?

Signs of serious poisoning include being sick, dizziness, palpitations, breathing difficulties, seizures, drowsiness or loss of consciousness. If someone has swallowed a poisonous substance, they need medical help immediately. If they are conscious, encourage them to spit out anything left in their mouth. Wipe any vomit away from their mouth and keep their head pointing downwards to allow any vomit to escape without them breathing it in or swallowing it.

Don’t give them anything to eat or drink, put anything in their mouth or try to make them sick. If the harmful substance has splashed onto their skin or clothes, remove any contaminated items (without contaminating yourself). While waiting for medical help, put the patient in the recovery position. If the patient is not breathing or their heart has stopped, begin CPR. When the paramedics arrive, or the patient arrives in A&E, provide as much information as possible about the suspected poisonous substance.

 

Take-home naloxone programmes

According to the Office for National Statistics, there are nearly 3,000 drug-related deaths each year in England and Wales, with more than half involving opioids (mainly heroin and/or morphine). New World Health Organization guidelines recommend that countries expand naloxone access to people likely to witness an overdose, such as friends, family members and partners of people who use drugs, and social workers.

The National Records of Scotland show that there were 526 drug-related deaths in 2013, with heroin and/or morphine implicated in 42 per cent of these. Scotland’s national naloxone programme, which was introduced in November 2010, enables prescription-only naloxone to be distributed through a patient group direction (PGD), with recipients and carers trained in how to administer the drug.

Naloxone is safe and effective with no dependence-forming potential and, when given following an overdose, provides extra time for emergency services to arrive. In October 2014, Scotland published the programme’s results from its first three years; the proportion of deaths from opioid overdose among people just released from prison was down from 9.8 per cent in 2006-2010 to 6.3 per cent in 2011-2013. An independent evaluation of the Scottish service in June 2014 recommended a greater involvement of community pharmacists.

“Only a few areas are using pharmacists at present, mainly because they need funding for the PGD,” says Kirsten Horsburgh, national naloxone co-ordinator at the Scottish Drugs Forum. “However, patients often feel more comfortable going to a pharmacist for their naloxone supply, rather than a GP, and this is particularly useful for people who are not usually part of the addiction services.”

A national naloxone programme was launched in Wales in 2011 but, to date, there has been no similar national programme in England. According to an editorial in the British Medical Journal in November 2014, naloxone should be available in England without a prescription. The Birmingham and Solihull addiction service, which provides take-home naloxone to its clients, was established in 2013. So far, the NHS foundation trust has issued over 1,500 kits city-wide (well over 2,000 kits now that other service providers are on board).

According to Kevin Ratcliffe, consultant pharmacist at Birmingham and Solihull mental health NHS foundation trust, community pharmacists are vital in the distribution of takehome naloxone. “They see a lot of people through the needle syringe programme that are unknown to treatment services,” he says. “Community pharmacists, and their staff, should be trained to recognise opioid overdose and administer naloxone, so that they can respond in an emergency.

“Research has shown that the majority of heroin overdoses are witnessed. The more people who know how to recognise the signs of overdose, know how to respond appropriately and have access to take-home naloxone, the greater the chance that the overdose will not be fatal. Anyone can administer naloxone for the purpose of saving a life.”

 

Useful contacts

First aid training for pharmacists is available from various companies and organisations.

St John Ambulance: 0844 770 4800

British Red Cross: 0845 527 7743

Stockwood Consulting: 01858 898070

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