When to (and not to) panic

An article by Mr M

Not an hour passes at M-KEM without a panic stricken person either phoning or personally coming into the pharmacy for something as minor as a finding a worm at the rear-end and /or as serious as not being able to breath and having chest pains.

As a general guide, and NOT AS A DIRECTIVE, I have attempted to provide some advice as to when a situation is an emergency requiring immediate medical attention – often at a hospital.

“Accidental” ingestion of medication:

Firstly, allow me to emphasise the need to lock medicine cabinets and place them completely out of reach of children.  Too often children swallow medication not intended for them or their own medication in increased doses.  If discovered soon enough, and provided labelling gives the necessary information correctly, prompt action varying from doing absolutely nothing to having the stomach pumped could be required.  With isolated exceptions, all medicines taken in excessive doses are dangerous.

Always phone the poison information centre  of either Tygerberg (021 931 6129), Groote Schuur (021 404 911), Red Cross Children’s Hospital (021 689 5227) or the pharmacy and have as much information possible at hand relating to the product indicating recommended dosage and if possible, the amount of liquid or number of tablets swallowed and the time between swallowing and the discovery of the problem.

Fever:

Fevers in Children – For obvious reasons fevers in babies, especially infants under the age of 6 months should be handled differently to those in older children.  As a rule, the temperature of an infant 3 months old or younger should not exceed 38.1 degrees. At 3-6 months old, temperatures should not exceed 38.3 degrees and 6-12 months old, 39.4.  Except in the first instance of an infant lest than 3 months old, temperatures could be reduced by administering a few doses of effective paediatric pain treatment syrup over 24-48 hours but if the fever persists at a high level, medical opinion must be sought.  Children often develop a high fever for a variety of reasons most of which are not emergencies.  Spots often appear a few days later, indicating the probability of a viral infection i.e. measles.  The use of mercury containing glass thermometers to measure temperature is not advisable, neither are those placed on the skin surface.  I recommend the use of thermometers that scan the temperature via the ear.

Fever in adults / older children – A sudden spike of temperature in a child or adult is usually accompanied by other symptoms and could potentially be cause for alarm.  A gradual rise in temperature on the other hand, should be reason for a “wait and see” approach.  If a stiff neck accompanies the fever, medical advice must be sought.

Injuries:

Any injury to the head, especially in infants, would require assistance sooner rather than later especially if the injury is followed by vomiting, loss of consciousness or any other symptoms such as blurred vision.  Fractures should be diagnosed and treated soon after the event.  In my experience scratches which are considered minor are neglected, resulting in harmful bacterial infections, sometimes to the entire body.  ANY scratch to the skin surface should be handled appropriately, including the administration of anti-tetanus vaccine if the patient is not previously covered.

Vomiting:

Whereas vomiting once or twice can bring relief from discomfort, the dangers of dehydration due to persistent vomiting, especially in children and compromised adults should never be underestimated.  Should anti-nauseants By way of oral or rectal route not be immediately successful, the patient should be taken to a facility where a drip could be administered.  Occasional vomiting caused by shock, fright or pain can be disregarded, although the accompanying other symptoms could require prompt attention.  A medicine cabinet (KEPT OUT OF THE REACH OF CHILDREN) should always contain oral and rectal anti-nauseants, electrolytes and a digital or other accurate thermometer (especially the ‘ear type’).

Diarrhoea:

As in the above paragraph, excessive loss of fluid must be prevented or compensated for.  Medical opinions differ as to the treatment of diarrhoea, depending on severity and the course of treatment would depend on this.  Blood in the stool or diarrhoea which does not respond to the usual medication, especially if accompanied by temperature or other symptoms would be considered cause for concern.

High Blood Pressure:

Too often people arrive at the pharmacy, requesting headache medication, only to be found to be hypertensive – often severely so and this can be seen as a stroke waiting to happen.  Although not advocating a doctor’s visit for a headache, adults particularly, should consider an all-round check-up a priority.

Chest Pain:

Save to say, pains over the chest, with or without other symptoms should warrant immediate investigation by a doctor and NEVER be treated lightly however severe or otherwise the circumstances appear to be.

Shortness of Breath:

Choking or shallow breathing as a rule of thumb, shortness of breath for any reason except following physical exertion, should be considered a medical emergency to be treated in a medical facility – NOT AT A PHARMACY as is too often experienced - Asthma sufferers particularly, ‘self-treat’ for too long prior to seeking medical assistance.

Abdominal Pains:

We all have “tummy-ache” at some time and mostly this will clear up without treatment other than ant-acids and / or anti-spasmodic medicines.   When accompanied by fever (especially in children) intervention is required to eliminate the possibility of appendicitis, gall bladder problems etc.

Bee-Stings etc.:

When the body’s response is no more than a rash to a bee sting there is no need to panic.  However when it comes to nuts or any other products which has caused severe symptoms in the past, the time between the initial reaction and treatment is very important.  The patient should therefore be taken to a doctor speedily as oral is often inadequate.

Burns / Sunstroke:

Sunstroke, particularly in children where vomiting and / or fever results, should be treated with electrolytes and mild pain medication.  If there is no positive response to this treatment, the patient should be taken to a doctor.  Burns from a fire or in the kitchen limited to the surface layer of the skin and over a very limited area could be treated with over the counter products specifically for the treatment of minor burns.

Lameness:

Particularly in mature adults, but not completely excluding the younger population, sudden lameness or a loss of sensation, particularly in the facial area or limbs for no obvious reason could be cause for concern and therefore immediate medical assistance should be sought.

Conclusion:

I have attempted to cover a spectrum of symptoms relayed on a daily basis.  Most of the time a bit of reassurance is all that is required.  As M-KEM Pharmacists, Nursing Sisters and health professionals it is our privilege to be able to assist rather than ignore the public’s request for assistance.  We would rather err on the side of caution and advice on a course of action determined by the information provided.  My final word on the subject – Trust your gut feeling and do not hesitate to seek help when in doubt.

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