Vol. VIII Issue I July 2016

LIGNITE LIFE LINE

INSIDE2 6 8

85 7410 Things to Avoid in Asthma Heat Stroke (contd.)

World Asthma DayAsthma Awareness Programme3 Foreign Bodies in Ear

Heat Stroke

OPV (Oral Polio Vaccine) What is New?Asthma Treatment in Children

GoutChemical injury to the Eye

National Polio Switch Day

Events……

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 Shri D. Krishnamoorthy, addressing the participants

NLC GH hosts State Level Seminar for Nurses

Inaugural Function

PROVEN VALUES. POWERFUL VISION.

2

10 Things to Avoid in Asthma

Dr. S. Aruna Department of Chest Medicine

1. Dust

Dust, due to its allergy-inducing property, causes havoc

for asthmatics. Therefore it's absolutely essential that

very high level of hygiene is maintained and that rooms

are kept dust-free. This can be achieved by thoroughly

vacuuming the every nook and corner of the room.

2. Pollens

Pollen from flowers is a well-known trigger for asthma

attacks and hence, it goes without saying that one will do

well by avoiding them. Moreover, growing plants indoors

can be dangerous too, since they can be a source of mold

– which acts as a trigger for asthma. To avoid the formation

of molds, make sure not to overwater plants, keep them in

a sunny place and remove dead parts as soon as they

appear.

3. Pets

If you are an animal lover, you might have a difficult time

to deal with asthma. Research suggests that contact with

cats or dogs is extremely dangerous for asthmatics. Not

to mention the fact that small pieces of fur, particles of

hair, saliva and even skin are all known asthma triggers.

Even if the pet is not physically around you, their fur/hair

might be in your environment and may pose a high risk.

So stay away from pets to lower the severity of asthma.

4. Smoke and aromas in the kitchen

The smoke and aromas given off when cooking can be a

major irritant to asthma sufferers, so take steps to reduce

such problems. Make sure that your kitchen has proper

ventilation. If a proper exhaust fan or chimney is not

available, then ensure there is an open window in the

kitchen to help the cooking smells to escape outside.

5. Smoking

Cigarette smoke contains different chemicals and gases

that can irritate the lungs. Smoking not only increases your

chance of getting asthma but also worsens the symptoms

such as coughing and wheezing. Also, smoking during

pregnancy is known to increase the risk of decreased lung

function and wheezing in infants.

6. Drugs

Certain prescription and over-the-counter drugs like

aspirin and non-steroidal anti-inflammatory drugs

(ibuprofen) and beta blockers may trigger asthma attacks.

If you are taking any medications, inform your doctor about

the condition.

7. Exercise

Yes! Even exercising can trigger an asthmatic attack.

Exercise-induced asthma is a type of asthma triggered by

vigorous or prolonged exercise or physical exertion.

Narrowing of airway begins five to 20 minutes after

exercise begins, making it difficult to catch your breath.

Whenever we breathe, the air is first warmed and

moistened by the nasal passages. However, during

exercise people tend to breathe through their mouths thus

inhaling colder and drier air. In exercise-induced asthma,

the muscle bands around the airways are sensitive to

these changes in temperature and humidity. They react by

contracting, which narrows the airway triggering

symptoms of exercise-induced asthma.

8. Extreme weather

Hot and humid weather or extremely cold weather causes

asthma symptoms to flare-up. Even though the weather

changes cannot be controlled, asthmatic patients should

ensure that they do not expose themselves to varying

temperatures in a short time. As the severity of the

symptoms increases during winters.

9. Extreme emotional arousal

Extreme emotions such as anxiety, anger and fear might

induce stress which in turn changes heart-rate and

breathing patterns. The rapid, shallow breathing causes

constriction of airways and can consequently lead to an

asthmatic attack.

10. Food allergies

Some of the most common foods associated with allergic

symptoms are egg, cow milk, peanut, soy, wheat, fish,

shrimp etc. Food preservatives like sodium bisulfite,

potassium bisulfite, sodium metabisulfite, potassium

metabisulfite and sodium sulfite can also trigger asthma.

3

A c o m m o n f o r m o f a r t h r i t i s 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 suscep t i b l e t o gou t a f t e r 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 withnutrition.

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.

Gout

Dr. V. Subramanian Industrial Medical Centre

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.

I n c i d e n c e : I n d u s t r i a l , occupational hazard – 80%, Domestic, Assault - Common in males, Alkal i in jury 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, Su lphurous ac id – b leach, Hydrofluoric acid – glass polishing. H y d r o f l u o r i c a c i d i s m o r e dangerous. Acetic acid – Vinegar. Hydrochloric acid.

Damage to tissue is due to Direct injury and Inflammation.

Clinical features are Pain, Irr i tation, 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.

4

1 . What is Trivalent (t)OPV?

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:

● Controlling and avoiding asthma triggers

● Regularly monitoring asthma symptoms and lung function

● Understanding how and when to use medications to treat

asthma

CONTROLLING ASTHMA TRIGGERS

The factors that worsen asthma symptoms are called triggers.

Identifying and avoiding asthma triggers, when possible, is

essential in preventing asthma flare-ups.

Common asthma triggers generally fall

into several categories:

● Respiratory infections

● Allergens (including dust, pollens, and

furred animals)

● Irritants (such as tobacco smoke, aerosol

sprays, some cleaning products)

● 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.

MONITORING ASTHMA SYMPTOMS AND LUNG FUNCTION

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).

Following methods are used

1. Asthma questionnaires can be used to know the frequency and

severity of symptoms. Parents may be asked to maintain a diary.

2. Lung function assessment using a test

known as Peak Expiratory Flow Rate

(PEFR).

3. Review of asthma treatment.

UNDERSTANDING HOW AND WHEN TO

USE MEDICATIONS TO TREAT ASTHMA

There are some medications which need to

b e u s e d o n l y d u r i n g s y m p t o m s

(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.

OPV (Oral Polio Vaccine) What is New?

Dr.Bharathi Paediatric Department

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.

Heat stroke can kill or cause damage to the brain and other

internal organs. Although heat stroke mainly affects people

over age 50, it can also take a toll on healthy young athletes.

Heat stroke often occurs as a progression from milder heat-

related 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

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

to high temperatures.

Symptoms of Heat Stroke

The hallmark of heat stroke is a core body temperature above

105 degrees Fahrenheit. But fainting may be the first

symptom.

Other symptoms may include:

n Throbbing headache

n Dizziness and light-headedness

n Lack of sweating despite the heat

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

staggering

n Seizures

n Unconsciousness

First Aid for Heat Stroke (Neutline)

If you suspect that someone has a heat stroke, immediately

call emergency or transport the person to a hospital. Any delay

in seeking medical help can be fatal.

While waiting for the paramedics to arrive, initiate first aid.

Move the person to an air-conditioned environment or at least

a cool, shady area and remove any unnecessary clothing.

If possible, measure the person's core body temperature and

initiate first aid to cool it to 101 to 102 degrees Fahrenheit.

5

Foreign Bodies in Ear

Dr.Varadharaje ENT Department

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.

The common foreign bodies in ear- Cotton bud- Insects- Seeds

Heat Stroke

Dr.Kirankumar Goud Industrial Medical Centre

6

Preventing Heat Stroke

When the heat index is high, it's best to stay in an

air-conditioned environment. If you must go outdoors, you can

prevent heat stroke by taking these steps:

n Wear lightweight, light-colored, loose-fitting clothing, and a

wide-brimmed hat.

n Use a sunscreen with a sun protection factor (SPF) of 30 or

more.

n Drink extra fluids. To prevent dehydration, it's generally

recommended to drink at least eight glasses of water, fruit

juice, or vegetable juice per day. Because heat-related

illness also can result from salt depletion, it may be

advisable to substitute an electrolyte-rich sports drink for

water during periods of extreme heat and humidity.

n Take additional precautions when exercising or working

outdoors. The general recommendation is to drink 250ml.

to 750ml. of fluid and another 250ml. of fluid two hours

before exercise, and consider adding another 250ml. of

water or sports drink right before exercise. During exercise,

you should consume another 250ml. of water every

20 minutes, even if you don't feel thirsty.

n Reschedule or cancel outdoor activity. If possible, shift your

time outdoors to the coolest times of the day, either early

morning or after sunset.

Other strategies for preventing heat stroke include:

n Monitoring the color of your urine. Darker urine is a sign of

dehydration. Be sure to drink enough fluids to maintain very

light-colored urine.

n Measuring your weight before and after physical activity.

Monitoring lost water weight can help you determine how

much fluid you need to drink.

n Avoid fluids containing caffeine or alcohol, because both

substances can make you lose more fluids and worsen

heat-related illness. The easiest and safest way to replace

salt and other electrolytes during heat waves is to drink

sports beverages or fruit juice.

Outlook for Heat Stroke

After you've recovered from heat stroke, you'll probably be

more sensitive to high temperatures during the following

week. So it's best to avoid hot weather and heavy exercise

until your doctor tells you that it's safe to resume your normal

activities.

@2007 Nursing Education Consultants, Inc

HEAT STROKE

* Anxiety - Confusion* Skin Hot & Dry *Na* and K* Depletion* Impaired Sweating* Listlessness

CerebralEdema:* Seizures* Delirium* Coma

* Body Temperature 40.6° Cor 105° F

* Na+ and + Depletion

* Pulse & Resp Rate* Hypotension

(Management - Cooling, Rest,Fluid & Electrolyte Support.)( )

Use a fan to lower

temperature

Apply cold compresses

Elevate feet

Give fluids

Sunstroke - First Aid

* Move the person to shade

* Give cold water to drink

* Pour water over the skin

(mainly head & neck)

* Place ice packs on :

Neck Armpit & Groin

(If no thermometers are available, don't hesitate to

initiate first aid.)

Try these cooling strategies:

n Fan air over the patient while wetting his or her skin with

water from a sponge or garden hose.

n Apply ice packs to the patient's armpits, groin, neck, and

back. Because these areas are rich with blood vessels

close to the skin, cooling them may reduce body

temperature.

n Immerse the patient in a shower or tub of cool water, or an

ice bath.

If emergency response is delayed, call the hospital emergency

room for additional instructions.

7

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 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.

Asthma Awareness Programme

LIGNITE LIFE LINENews Letter of NLC General Hospital

(for private circulation only)Published by Neyveli Lignite Corporation Limited, ‘Navratna’ - A Govt. of India Enterprise

Neyveli 607 801, Tamil Nadu. Website : www.nlcindia.com

Continuing to learn...

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Nurse Educator, Apollo Hospital, Chennai

Topic: Chromosomal Abnormalities

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Sree Ramachandra Hospital, Chennai

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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.

National Polio Switch Day