Download July 2016

Vol. VIII Issue I
PROVEN VALUES. POWERFUL VISION.
July 2016
LIGNITE LIFE LINE
NLC GH hosts State Level Seminar for Nurses
Inaugural Function
A state level seminar for Continuing Nursing Education (CNE) was organized by NLC GH at Neyveli on
6th and 7th April 2016, for the benefit of the nurses of NLC GH to keep abreast of latest development. The event was
held in the Industrial Medical Center Hall of NLC GH on the topic Malignancy : Chemotherapy, Radiotherapy and
Palliative care. Prof. Dr. Mrs. Annie Grace Kalaimathi, Registrar, Tamil Nadu Nurses and Midwives Council, Chennai
was the Chief Guest of the inaugural session. Dr. K. Janardhan, CGS, Dr. P. Ravi, GS, Dr. Jeyamohandhas, RMO,
Dr. M. Malarvizhi, CMO & Incharge of Nursing Dept., NLC GH participated and addressed the participants.
Shri D. Krishnamoorthy, Asst. Professor, ES College of Nursing, Villupuram participated as the CNE Observer.
Nurses from NLC GH attended the programme and actively participated in the deliberations.
Dr.Annie Grace addressing the nurses of NLC GH
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3
10 Things to Avoid in Asthma
Gout
Chemical injury to the Eye
4
5
Shri D. Krishnamoorthy, addressing the participants
INSIDE
OPV (Oral Polio Vaccine) What is New?
Asthma Treatment in Children
Foreign Bodies in Ear
Heat Stroke
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7
Heat Stroke (contd.)
World Asthma Day
Asthma Awareness Programme
8
8
National Polio Switch Day
Events……
10 Things to Avoid in Asthma
Dr. S. Aruna
Department of Chest Medicine
1. Dust
6. Drugs
Dust, due to its allergy-inducing property, causes havoc
Certain prescription and over-the-counter drugs like
for asthmatics. Therefore it's absolutely essential that
aspirin and non-steroidal anti-inflammatory drugs
very high level of hygiene is maintained and that rooms
(ibuprofen) and beta blockers may trigger asthma attacks.
are kept dust-free. This can be achieved by thoroughly
If you are taking any medications, inform your doctor about
vacuuming the every nook and corner of the room.
the condition.
2. Pollens
7. Exercise
Pollen from flowers is a well-known trigger for asthma
Yes! Even exercising can trigger an asthmatic attack.
attacks and hence, it goes without saying that one will do
Exercise-induced asthma is a type of asthma triggered by
well by avoiding them. Moreover, growing plants indoors
vigorous or prolonged exercise or physical exertion.
can be dangerous too, since they can be a source of mold
Narrowing of airway begins five to 20 minutes after
– which acts as a trigger for asthma. To avoid the formation
exercise begins, making it difficult to catch your breath.
of molds, make sure not to overwater plants, keep them in
Whenever we breathe, the air is first warmed and
a sunny place and remove dead parts as soon as they
moistened by the nasal passages. However, during
appear.
exercise people tend to breathe through their mouths thus
3. Pets
inhaling colder and drier air. In exercise-induced asthma,
If you are an animal lover, you might have a difficult time
the muscle bands around the airways are sensitive to
to deal with asthma. Research suggests that contact with
these changes in temperature and humidity. They react by
cats or dogs is extremely dangerous for asthmatics. Not
contracting, which narrows the airway triggering
to mention the fact that small pieces of fur, particles of
symptoms of exercise-induced asthma.
hair, saliva and even skin are all known asthma triggers.
8. Extreme weather
Even if the pet is not physically around you, their fur/hair
Hot and humid weather or extremely cold weather causes
might be in your environment and may pose a high risk.
asthma symptoms to flare-up. Even though the weather
So stay away from pets to lower the severity of asthma.
changes cannot be controlled, asthmatic patients should
4. Smoke and aromas in the kitchen
ensure that they do not expose themselves to varying
The smoke and aromas given off when cooking can be a
temperatures in a short time. As the severity of the
major irritant to asthma sufferers, so take steps to reduce
symptoms increases during winters.
such problems. Make sure that your kitchen has proper
9. Extreme emotional arousal
ventilation. If a proper exhaust fan or chimney is not
Extreme emotions such as anxiety, anger and fear might
available, then ensure there is an open window in the
induce stress which in turn changes heart-rate and
kitchen to help the cooking smells to escape outside.
breathing patterns. The rapid, shallow breathing causes
5. Smoking
constriction of airways and can consequently lead to an
asthmatic attack.
Cigarette smoke contains different chemicals and gases
that can irritate the lungs. Smoking not only increases your
10. Food allergies
chance of getting asthma but also worsens the symptoms
Some of the most common foods associated with allergic
such as coughing and wheezing. Also, smoking during
symptoms are egg, cow milk, peanut, soy, wheat, fish,
pregnancy is known to increase the risk of decreased lung
shrimp etc. Food preservatives like sodium bisulfite,
function and wheezing in infants.
potassium bisulfite, sodium metabisulfite, potassium
metabisulfite and sodium sulfite can also trigger asthma.
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Gout
Dr. V. Subramanian
Industrial Medical Centre
A common form of arthritis
characterized by sudden, severe
attacks of pain, redness and
tenderness in joints, often the joint at
the base of toe
n
It can affect any one.
n
Men are more likely to get gout,
but women become increasingly
susceptible to gout after
menopause.
Gout attack location:
Common – knee joint, ankle joint,
Elbow joint.
Less common – shoulder and
wrist joint.
Most common – Big (1st) Toe which is affected in more
than 90% of individuals with gout.
DO's & DON'Ts:
Manage high uric acid with
nutrition.
1. High Fibre Food : Intake of foods
high in dietary fibre may help
lower uric acid in your blood.
2. Cold pressed olive oil : Helps you
avoid production of excess uric
acid.
3. Taking a health dose of Vitamin C :
Regular intake of Vitamin C 500
mg. will decrease your uric acid
levels in a month or two.
4. Avoid use of saturated fat,
transfat, sugar & alcohol.
5. Antioxidant rich foods : Fruits & vegetables such as tomatoes,
blueberries, pepper, broccoli, grapes are rich source of
antioxidant vitamins which helps to lower uric acid level.
Chemical injury to the Eye
Dr. A. Senthilkumar
Ophthal Department
Chemical injury can produce
extensive damage to the Eye
leading to permanent impairment
of vision. It is one of ocular
emergencies.
Incidence : Industrial,
occupational hazard – 80%,
Domestic, Assault - Common in
males, Alkali injury is very
common. Chunna Injury is very common in India.
Etiology: Acids, Alkalis, Solvent, Adhesives, Detergents &
Oxidizing agents etc.
Alkali: e.g. Ammonia – Fertilizer, cleaning agents, Lye
(NaOH) – drain cleaners, Caustic Potash (KOH), Magnesium
Hydroxide (MgOH) – sparklers, Lime (Ca(OH)2) – plaster,
whitewash, cement.
Acids: e.g. Sulphuric Acid – Battery, industrial cleaners,
Sulphurous acid – bleach,
Hydrofluoric acid – glass polishing.
Hydrofluoric acid is more
dangerous. Acetic acid – Vinegar.
Hydrochloric acid.
Damage to tissue is due to Direct
injury and Inflammation.
Clinical features are Pain,
Irritation, Redness, Tearing,
Photophobia, Swelling of lids and Blurred vision.
On Examination – Look for Lid burns, Conjunctival
congestion, chemosis, ischaemia, corneal epithelial defect,
corneal stromal haze, Limbal ischemia, Foreign bodies in the
fornices, Anterior Chamber-iritis, sec glaucoma, hypotony,
cataract & Fluorescein staining.
Prognosis depend on: Chemical, pH>11 or <2.5,
Concentration, Amount of exposure & Time of exposure,
Associated with thermal, mechanical injury.
Complications: Dry eyes, Persistent epithelial defect,
Corneal opacity/perforation, Sec. glaucoma, Uveitis,
Cataract, Sympblepharon, Trichiasis and Entropion /
Ectropion.
Immediate Management: Immediate washing of the eyes is
the main – prognostic factor – treat first ask later.
Use copious amount of clean tap water to wash the eyes and
face at the worksite itself.
At emergency clinic, put a drop of local anesthetic and an eye
speculum and use normal saline or RL attached to iv drip set to
irrigate the eye for at least 15 to 30 minutes or the pH of tears is
neutral.
Get specialist opinion immediately. Good prognosis in most of
the cases.
Prevention is better, use protective goggles, warning signs on
chemicals at worksite, safe storage and handling of common
household chemicals.
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OPV (Oral Polio Vaccine)
What is New?
Dr.Bharathi
Paediatric Department
1 . What is Trivalent (t)OPV?
In addition to Bivalent (b)OPV our government is also trying to
provide IPV (inactivated poliovirus vaccine) two doses at
6 weeks and 10 weeks to provide with extra immunity to the
child.
Trivalent Oral polio vaccine - it contains 3 strains of live polio
virus namely type 1, 2 & 3.
2 . What is Bivalent (b)OPV?
Bivalent oral polio vaccine - it contains only 2 strains of live
polio vaccine namely type 1& 3.
3 . What is switch?
From now we are going to switch from Trivalent (t)OPV to
Bivalent (b)OPV, for regular immunization schedule and pulse
polio immunization.
4 . Why are we switching over to Bivalent (b)OPV?
As type 2 strain of polio is eradicated from our country and
tOPV which was already used carries a small risk of vaccine
associated polio due to type 2 strain. We are going to switch
over from Trivalent (t)OPV to Bivalent (b)OPV
5 . When we are going to switch over?
April 25, 2016 has been announced as national switch day.
Asthma Treatment in Children
Dr. V. Prakash
Paediatric Department
Successful treatment of asthma involves three components:
MONITORING ASTHMA SYMPTOMS AND LUNG FUNCTION
● Controlling and avoiding asthma triggers
● Understanding how and when to use medications to treat
asthma
Successful management of asthma requires the parent and/or
child to monitor their asthma symptoms regularly. This is primarily
done by recording the frequency and severity of asthma
symptoms (coughing, shortness of breath and wheezing).
CONTROLLING ASTHMA TRIGGERS
Following methods are used
● Regularly monitoring asthma symptoms and lung function
1. Asthma questionnaires can be used to know the frequency and
severity of symptoms. Parents may be asked to maintain a diary.
The factors that worsen asthma symptoms are called triggers.
Identifying and avoiding asthma triggers, when possible, is
essential in preventing asthma flare-ups.
2. Lung function assessment using a test
known as Peak Expiratory Flow Rate
(PEFR).
Common asthma triggers generally fall
into several categories:
● Respiratory infections
3. Review of asthma treatment.
● Allergens (including dust, pollens, and
furred animals)
UNDERSTANDING HOW AND WHEN TO
USE MEDICATIONS TO TREAT ASTHMA
● Irritants (such as tobacco smoke, aerosol
sprays, some cleaning products)
There are some medications which need to
be used only during symptoms
(Eg:Salbutamol). Some medications need to
be taken on regular basis (Eg:Steroids).
Some medicines need to be taken orally.
Some are to be administered by MDI (Metered dose inhaler).
Parents should be proactive in learning these things from doctors,
and carry out properly at home.
● Exercise
● Cold air
Exercise is an exception to the general rule about trigger
avoidance. Exercise is encouraged for all children, including
those with asthma, but with little caution to treat symptoms.
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Foreign Bodies in Ear
Dr.Varadharaje
ENT Department
The common foreign bodies in ear
-Cotton bud
-Insects
-Seeds
Using cotton bud to clean the ear after taking
bath is not a good habit. Ear has self cleaning
mechanism, so it is not needed to clean the ear
using ear buds. Ear buds may damage the
external auditory canal causing bleeding, it may also perforate
the ear drum. After using ear bud sometime the cotton stays
inside and may cause blocking sensation. In such cases, it is
not advisable to remove by self. It has to be removed by doctor
after viewing it.
Insects enter the ear usually at night. Children are
commonly affected. In such cases pouring of
clean coconut oil or salt water may kill the insect
and then patient should be brought to hospital to
remove the insect.
Children playfully insert Seeds, Beads, Rubber, Chalk piece
in to ear which has to be removed only in hospital.
Heat Stroke
Dr.Kirankumar Goud
Industrial Medical Centre
Heat stroke can kill or cause damage to the brain and other
n
Lack of sweating despite the heat
internal organs. Although heat stroke mainly affects people
n
Red, hot and dry skin
n
Muscle weakness or cramps
n
Nausea and vomiting
n
Rapid heartbeat, which may be either strong or weak
n
Rapid, shallow breathing
n
Behavioral changes such as confusion, disorientation, or
over age 50, it can also take a toll on healthy young athletes.
Heat stroke often occurs as a progression from milder heatrelated illnesses such as heat cramps, heat syncope (fainting),
and heat exhaustion.
Heat stroke results from prolonged exposure to high
temperatures usually in combination with dehydration, which
staggering
leads to failure of the body's temperature control system. The
medical definition of heat stroke is a core body temperature
greater than 105 degrees Fahrenheit, with complications
involving the central nervous system that occur after exposure
n
Seizures
n
Unconsciousness
First Aid for Heat Stroke (Neutline)
to high temperatures.
If you suspect that someone has a heat stroke, immediately
Symptoms of Heat Stroke
call emergency or transport the person to a hospital. Any delay
The hallmark of heat stroke is a core body temperature above
in seeking medical help can be fatal.
105 degrees Fahrenheit. But fainting may be the first
While waiting for the paramedics to arrive, initiate first aid.
symptom.
Move the person to an air-conditioned environment or at least
Other symptoms may include:
a cool, shady area and remove any unnecessary clothing.
n
Throbbing headache
If possible, measure the person's core body temperature and
n
Dizziness and light-headedness
initiate first aid to cool it to 101 to 102 degrees Fahrenheit.
5
(If no thermometers are available, don't hesitate to
close to the skin, cooling them may reduce body
initiate first aid.)
temperature.
Try these cooling strategies:
n
n
n
Immerse the patient in a shower or tub of cool water, or an
ice bath.
Fan air over the patient while wetting his or her skin with
water from a sponge or garden hose.
If emergency response is delayed, call the hospital emergency
Apply ice packs to the patient's armpits, groin, neck, and
room for additional instructions.
back. Because these areas are rich with blood vessels
HEAT STROKE
Sunstroke - First Aid
* Anxiety - Confusion
* Skin Hot & Dry *Na* and K* Depletion
* Impaired Sweating
* Na+ and + Depletion
* Listlessness
* Body Temperature 40.6° C
or 105° F
Cerebral
Edema:
* Seizures
* Pulse & Resp Rate
* Delirium
* Hypotension
* Coma
(
(Management - Cooling, Rest,
Fluid & Electrolyte Support.)
)
Use a fan
to lower
temperature
Elevate feet
* Move the person to shade
* Give cold water to drink
* Pour water over the skin
Apply cold
compresses
(mainly head & neck)
* Place ice packs on :
Give fluids
Neck Armpit & Groin
@2007 Nursing Education Consultants, Inc
Preventing Heat Stroke
n
Reschedule or cancel outdoor activity. If possible, shift your
time outdoors to the coolest times of the day, either early
When the heat index is high, it's best to stay in an
morning or after sunset.
air-conditioned environment. If you must go outdoors, you can
prevent heat stroke by taking these steps:
Other strategies for preventing heat stroke include:
n
Wear lightweight, light-colored, loose-fitting clothing, and a
wide-brimmed hat.
dehydration. Be sure to drink enough fluids to maintain very
n
Use a sunscreen with a sun protection factor (SPF) of 30 or
light-colored urine.
n
more.
n
n
Measuring your weight before and after physical activity.
Drink extra fluids. To prevent dehydration, it's generally
Monitoring lost water weight can help you determine how
recommended to drink at least eight glasses of water, fruit
much fluid you need to drink.
juice, or vegetable juice per day. Because heat-related
n
Avoid fluids containing caffeine or alcohol, because both
substances can make you lose more fluids and worsen
illness also can result from salt depletion, it may be
n
Monitoring the color of your urine. Darker urine is a sign of
advisable to substitute an electrolyte-rich sports drink for
heat-related illness. The easiest and safest way to replace
water during periods of extreme heat and humidity.
salt and other electrolytes during heat waves is to drink
Take additional precautions when exercising or working
sports beverages or fruit juice.
outdoors. The general recommendation is to drink 250ml.
Outlook for Heat Stroke
to 750ml. of fluid and another 250ml. of fluid two hours
After you've recovered from heat stroke, you'll probably be
before exercise, and consider adding another 250ml. of
more sensitive to high temperatures during the following
water or sports drink right before exercise. During exercise,
week. So it's best to avoid hot weather and heavy exercise
you should consume another 250ml. of water every
until your doctor tells you that it's safe to resume your normal
20 minutes, even if you don't feel thirsty.
activities.
6
World Asthma Day
As a part of world asthma week celebrations, an in-house symposium on Asthma in children took place on 6th May 2016 in
NLC General Hospital at IMC Hall. The program was organised by Department of Paediatrics. Various aspects of asthma in children
were discussed by Paediatricians from the department. The program was attended by doctors from NLC GH.
Asthma Awareness Programme
Asthma awareness programme was conducted in Genl. Hospital New Conference Hall on 10.05.2016, between 11.30 a.m. &
12.30 p.m. Dr. P. Ravi, GS / Medical, Dr.V. Nagaraju, GS / Medical and Dr. M. Rajani, DGS / Medical conducted Quiz, Pre-test & Post
test for the Nursing students of OPR Memorial College. Prizes distributed to the 10 winners.
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National Polio Switch Day
National Polio switch day was celebrated on 25th April 2016, at NLC GH - Industrial Medical Centre Conference Hall. The
function was presided and felicitated by our beloved CGS medical, Dr.K.Janardhan. All doctors, nurses, health officer and
health workers were invited for the event to create awareness. CME on polio vaccines, followed by a quiz was conducted as a
part of the program, by doctors of our Paediatric department.
Continuing to learn...
Tele CME
On 25.05.2016 By Dr. Ganapathy, Sr. Consultant,
Neuro Surgeon, Apollo Hospital, Chennai
Topic “Recognising dangerous headache”.
Tele CNE
1. On 22.04.2016 By Ms. Jeevitha Reddy,
Nurse Educator, Apollo Hospital, Chennai
Topic: Chromosomal Abnormalities
2. On 25.04.2016 By Ms. J. Benita, Nurse Educator,
Sree Ramachandra Hospital, Chennai
Topic: “Appendicitis”
10.06.2016 - Topic: “Minimal Invasive
Cardiac Surgery – A way forward”
Dr.G. Chandrashekar, Sr. Consultant in
Cardiac Surgery, Sri Sathya Sai Institute of
Higher Medical Sciences, Bangalore
LIGNITE LIFE LINE
News Letter of NLC General Hospital
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Neyveli 607 801, Tamil Nadu. Website : www.nlcindia.com