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COMMUNITY SZ ALTH CTL
47/1, (First Fleor) St. Marks Road
Md-28 Bandatore - 580 091,
INSTRUCTIONS AND PRECAUTIONS
9) FOR INJECTIONS
This is a reprint from
Where There Is No Doctor
(Indian adaptation)
published by the
Voluntary Health Association of India
C-14 Community Centre
Safdarjung Development Area
New Delhi 110016
COMMUSt ry WEA TH CELL | 77
CHAPTER
INSTRUCTIONS AND PRECAUTIONS
FOR INJECTIONS
WHEN TO INJECT AND WHEN NOT TO.
Injections are not needed fied. Most sicknesses that require medical treatment
can be treated as well or better with medicines taken by pent. As a general rule:
It is more dangerous to inject
medicine than to take it by mouth.
Injections should be used only when absolutely necessary, Except in
emergencies, they should be given only by health workers or persons trained in
their use. |
The only times medicines should be injected are:
1. When the recommended medicine does not come in a form that can be taken
by mouth.
2. When the person vomits often, cannot swallow, or is unconscious.
3. In certain unusual emergencies and special cases (see the next page).
WHAT TO DO WHEN THE DOCTOR PRESCRIBES INJECTIONS
Doctors and other health workers sometimes prescribe injections when they are
not needed. After all, they can charge more money for injections. They forget
the problems and dangers of giving them in rural areas.
1, If a health worker or healer wants to give you an injection, be sure the
medicine is appropriate and that he takes all the necessary precautions,
2. |\f a doctor prescribes injections, explain that you live where no one is well
trained to give injections and ask if it would be possible to prescribe a medicine to
take by mouth.
3. If a doctor wants to prescribe injections of vitamins, liver extract, or vitamin
B72, but has not had your blood tested, tell him you would prefer to see another
doctor.
78
EMERGENCIES WHEN IT IS IMPORTANT TO GIVE INJECTIONS
In case of the following sicknesses, get medical help as fast as you can. If there
will be any delay in getting help or in taking the sick person to a health center,
inject the appropriate medicine as soon as possible. For details of the doses,
consult the pages listed below. Before injecting, know the possible side effects and
take the needed precautions.
For these sicknesses | Inject these medicines
Severe pneumonia (p 208)
Infections after childbirth (p. 322) penicillin in high doses (p. 398'+99
Gangrene (p. 254)
Tetanus (p. 222) penicillin (p. 397=98)
and tetanus antitoxin (p.421 )
and phenobarbital (p.422)
or diazepam (p.423)
Appendicitis (p.108) penicillin or ampicillin
Peritonitis (p,108) and bullet wound in strong doses (p. 399)
or other puncture wound in the
belly
Poisonous snakebite (p.121) snake antivenin (p. 421)
Scorpion sting (p.123) scorpion antivenin (p. 421)
Meningitis (p. 225) penicillin (p. 398) in very high doses
when you do not suspect or ampicillin (p.399 400)
tuberculosis
Meningitis (p.226) ampicillin or penicillin together
when you suspect tuberculosis with streptomycin (p.399~ 400)”
} and other ‘anti- tuberculosis
drugs (p. 403)
Vomiting (p.192) when it antihistamines, for example,
cannot be controlled promethazine (p.419,420)
Severe allergic reaction
allergic shock, (p. 83) Adrenalin (p. 419)
and severe asthma, (p. 204)
The following chronic illnesses generally require injections. but they are
rarely emergencies. It is best to consult a health worker for treatment.
Tuberculosis (9.219 220) streptomycin (p.403.404) together
with INH tablets and PAS tablets
(p. 404)
syphilis (p.281) procaine penicillin in very high
Gonorrhea (p.280) doses (p. 399)
79
WHEN NOT TO INJECT:
Never give injections if you can get medical help quickly.
Never give an injection for a sickness that is not serious.
Never give injections for a cold or the flu.
Never inject a medicine that is not recommended for the illness you
want to treat.
Never inject a medicine unless you know and take all the recommended
precautions.
Avoid giving injections especially to smail children when
there is an epidemic of polio in your village.
MEDICINES NOT TO INJECT
In general, it is better never to inject the following:
1. Vitamins. Rarely are injected vitamins any better than vitamins taken by
mouth. Injections.are more expensive and more dangerous. Use vitamin pills
or syrups rather than iniections. Better still, eat foods rich in vitamins (see
0.130).
2. Liver extract and vitamin B12. Do not inject them! Ferrous sulfate pills will
do more good for almost all cases of anemia (see p. 424)
3. Calcium. Injected into a vein calcium is extremely dangerous, if not given
very slowly. An injection in the buttock may Cause a large abscess. Untrained
people should never inject calcium.
4. Penicillin, Nearly all infections that require penicillin can be effectively
treated with penicillin taken by mouth. Penicillin is more dangerous when
injected. Use injectable penicillin only for dangerous infections.
5. Penicillin with streptomycin. Avoid this combined medicine. Never use it
for colds or the flu (p.200).
6. Chloramphenicol or tetracycline. These medicines do as much or more good
when taken by mouth. Use capsules or syrups rather than injections (p.401).
7. Intravenous (1.V.) solutions. These should be used only for severe
dehydration and given only by someone who is well trained. When not given
correctly they can cause dangerous infections or death (p. 64).
8. Intravenous medicines. There is so much danger in injecting any medicine in
the vein that only well-trained health workers should do it. However, never
inject into a muscle (the buttock) medicine that says ‘for intravenous use
only’. Also, never inject in the vein medicine that says for intramuscular use
only’.
sO
RISKS AND PRECAUTIONS
The risks of injecting any medicines are (1) infection caused by germs entering
with the needle and (2) allergic or poisonous reactions caused by the medicine.
1. To lower the chance of infection
when injecting, take great care that
everything is completely clean. It is
very important to boil the needle and
syringe before injecting. After boiling,
do not touch the tip of the needle with your
fingers or with anything else.
Always boil the needle before each injection,
especially if you are using the same needle
for many persons. Carefully follow all of
the instructions for injections (see following
pages) cs
|
An abscess like this one comes from
injecting with a needle that has not
been well boiled and is not sterile
(completely clean and germ-free).
2. This child was injected with a needle
that was not sterile.
The dirty needle caused an infection that
produced a large painful abscess (pocket
of pus)and ‘gave the child a fever.
Finally, the abscess burst as shown in
the picture below.
The child was injected for a cold. It
would have been far better to give him no?
medicine at all. Rather than doing him .
good, the injection caused the child
suffering and harm.
81
3. To avoid problems like this:
Inject only when absolutely necessary.
* Boil the syringe and needle just before
giving the injection and be very careful
to keep them completely clean.
* Use only the medicine recommended for
the disease and be sure that it is still
in good condition and not spoiled:
* Inject in the correct place. (Notice
that this child was injected too low on the
‘buttock, where it is possible to damage
the nerve.
4. It is very important to know what
reactions medicine can produce and to
take the recommended precautions before |
injecting. -
DANGEROUS REACTIONS FROM INJECTING
CERTAIN MEDICINES
Certain drugs like penicillin, ampicillin, and antitoxins are likely
to give severe allergic reactions. Before injecting the full dose of
any of these medicines, ALWAYS DO A SENSITIVITY TEST * to find
Out. if the person is sensitive to the medicine.
Always keep adrenalinready before and after doing a sensitivity
test.
How to do a sensitivity test.
¢ Prepare the syringe for injection as shown in page 85
¢ Use avery small needle
e Clean the skin of the inner side of the forearm with soap and water
or alcohol
* Be sure the skin is dry before injecting
LL TT RT ISN RE Ae SO ETP A RN TEI
- * 7 e.¢ ‘ * { ) Af 4 “\f Tt \V rc | -
David Werner has not included the ‘sensitivity test’ in his original book, as he tee thay subi Atesl dbas Ty iB
not prove that a person is not sensitive to the medicine G//1, (First Floor) St. Marke 5. 4
——_ tr - “s m4 ¥ af nN S Noa -_
82
® Hold the syringe flat against the skin
@ Inject Q)1 ml. of the medicine just into the skin so that a raised area, J
the size of a pea, is formed,. Do not injoct under the skin.
@ Remove the needle and wait for 30 minutes. ; a 4
4
PZ
Watch for the following signs: Sf-————
site of the injection becomes red, painful, or swells up
hives or a rash with itching
swelling anywhere
difficult breathing
signs of shock (see p. 83)
dizzy spells with nausea
(wanting to vomit)
problems with vision
ringing in the ears or deafness
severe back pain
difficulty urinating
lf any of the signs appear, DO NOT INJECT THE REST OF THE
MEDICINE. DO NOT EVER GIVE THE MEDICINE TO THE SAME
PERSON AGAIN.Inject 2 mi. of adrenalin for adults and % ml. for
children.
lf none of these signs appear within 30 minutes, then inject the
rest of the medicine in the muscle of the buttocks as shown in
page. 86
Sometimes a person who shows no signs of allergic reaction after a sensitivity test
may show the signs after a full dose. Always keep adrenalin ready even after doing
a sensitivity test.
lf a person complains of hives or rash a few days after getting a full dose of the
injection, he is probably allergic to the medicine. Do not give him the same medicine
again.
Sometimes, hives or arash with itching can appear a few hours or several days after
getting an injection.
83
The following groups of medicines sometimes produce a dangerous reaction
called ALLERGIC SHOCK a short time after injection:
® penicillins (including ampicillin)
snake antivenin
scorpion antivenin
s antitoxins that are made from horse serum
tetanus antitoxin
The risk of Allergic snock is greater in a person who has previously oN
injected with one of these medicines or with another medicine of the same group.
This risk is especially great if the medicine caused an allergic reaction (hives,
itching, swelling, or trouble breathing) a few hours or days after the injection was
given.
Rarely, ALLERGIC SHOCK may
result from the sting of a wasp or bee or
from medicine taken by mouth. ie
q
To prevent a serious reaction from an injection:
1. Use injections only when absolutely necessary.
2. Before injecting one of the medicines listed above, always have ready Z
ampules of Adrenalin (p. 419) and an ampule of an antihistamine like
promethazine (Phenergan, p.419) or diphenhydramine (Benadryl, p.420).
3. Before injecting, always ask if at any other time a similar injection caused
itching or other reactions. if the person says yes, do not use this medicine or any
other medicine of the same group, either injected or taken by mouth.
If he says no, do a sensitivity test before injecting the full dose of the medicine
4. In very serious cases, like tetanus or snakebite, if there is a good chance that
the antitoxin might produce an allergic reaction (if the person suffers from
allergies or asthma or has had horse serum before), inject promethazine or
diphenhydramine 15 minutes before giving the antitoxin: adults, 3 ml.; children
1 or 2 ml. depending on their size.
5. After injecting any medicine, always stay with the person for 30 minutes to
watch for any of the following signs of ALLERGIC SHOCK:
e cool, moist, pale, gray skin (cold sweat)
@ weak, rapid pulse or heartbeat
e difficulty breathing
e loss of consciousness
These signs can appear even if the sensitivity test was normal.
6. If these signs appear, immediately inject Adrenalin: adults, % ml.; children,
% mt. Treat the person for SHOCK (see p..89). Follow by giving an antihistamine
in double the normal dose.
84
How to Avoid Serious Reactions
to a Penicillin Injection &
1. For mild to moderate infections: 2. Before injecting ask the person:
give penicillin pills ao “Have you ever had
hives, itching, swelling, or
trouble breathing after
getting an injection of
penicillin?”
instead of injections.
If the answer is yes, do not use penicillin o
ampicillin. Use another antibiotic like
erythromycin (p. 400) or a sulfonamide (p.402).
If the answer is no, do a sensitivity test.
OSS etree
3. Before injecting penicillin: 4, After injecting:
always have ampules of
ADRENALIN ready.
i
ADRENALIN
\s
ADRENALIN
stay with the person for at least 30
minutes.
5. If the person becomes very pale, his heart beats very fast, he
has difficulty breathing, or he starts to faint, immediately inject
into a muscle half an ampule of ADRENALIN (a quarter of an
ampule in small children) and repeat in 10 minutes if necessary.
—
85
HOW TO PREPARE A SYRINGE FOR INJECTION
: ps
1. Take the syringe apart » gee
and boil it and the
5 aa ~)at
needle for 15 minutes. as
aa
prem di eg
catty)
3. Put the needle and the syringe
together, touching only the base of
the needle and the button of the
plunger. ee
—_—=
5. Fill the syringe. = 6. Rub the rubber of the 7. Inject the t \
(Be careful that / , bottle with clean cloth distilled water. ,
the needle does 7 f wet with alcohol into the bottle
not touch f- or boiled ~~“). with the
the outside water. ., Leonor’ f powdered
of the Zee medicine.
ampule.)
8. Shake until the
medicine dissolves. again.
9. Fill the syringe
2. Pour out the boiled
water without touching
the syringe or the needle.
4. Clean the ampule of distilled
water well, then break off the top.
10. Remove all air.
from the eee
syringe.
Be very careful not to touch the tip of the needle with anything not even the cotton
with alcohol. If by chance the tip of the needle touches your finger or something
else, boll it again.
86 .
WHERE TO GIVE AN INJECTION
It is preferable to inject in the muscle of the buttocks, always in the upper outer
quarter.
: Never inject children under 2 years of
ues age in the buttock. Inject them in the
ee upper outer part of the thigh.
HOW TO INJECT
1. Clean the skin with soap and water 2. Put the needle straight in, all the
(or alcohol—but to prevent severe pain, way. (If it is done with one quick
be sure the alcohol is dry before movement, it hurts less.)
injecting).
3. Before injecting, pull back 4. |f no blood enter
on the plunger. (If blood enters inject the medicine
the syringe, take the needle slowly.
out and put it in somewhere
else.)
5. Remove the needle
and clean the skin
again.
6. After injecting, rinse the syringe and needle at i
f once. Squirt water through the
peace and then take the syringe apart and wash it. Boil before using again.
The book Where There Ts No Doctor is available
F plus postage. Multiple copies of reprints
s chapters are also available, . 73a
Publications Officer . | : oo
/ Voluntary Health Association of India
_C-14 Community Centre
Safdarjung Development A rea
New Delhi 110016 cae.