Practice matters

 

Content of an emergency first aid kit

None of us ever want to see a complication in our patients, but we do know that complications occur. Accordingly, there is some kit that you should always have available should the need arise, and more importantly you should be very familiar with how to use it. Let’s now have a look at the kit that we keep at the clinic and review the contents of each kit.

 

We do know that many patients suffer from life-threatening allergies. This can happen in the clinical setting due to a number of products we use, for instance, latex gloves. It’s important to have an anaphylaxis kit in case of serious allergy, and I’m going to show you the products in this one. The first thing we have is a written protocol that the staff can use in case of an emergency. Clearly, we need an adrenaline pen, this is a generic product that can be used in the initial stage of anaphylaxis. In addition, we have both corticosteroid injection and also antihistamine for injection, as per the anaphylaxis protocol. We also keep oral tablets of antihistamine for milder cases of allergy. Finally, we have some additional items. We have some extra adrenaline that can be used intramuscularly, because sometimes the protocols will require additional adrenaline after the epipen has been used. We also have a variety of syringes and needles alongside the medications so that we can administer the products, and finally we have some water for injection to reconstitute the various items.

 

Next, it’s important to have some basic resuscitation kit. This is a simple face mask and bag in case you have a patient with breathing difficulties. This particular one also has an oxygen reservoir. It is important to undergo the basic training to learn how to use this equipment. I think it is good clinical practice to have a defibrillator in the clinic, and this is one that we use in our clinic. Ensure that all the team are trained in basic life support and also how to use the defibrillator.

 

Finally, we have a dermal filler complications kit. A little bit like the anaphylaxis kit, this contains all of the various things that we need in the case of a potential complication, alongside some written instructions. Let’s review the various components of this. First and foremost, it’s vital to have some hyaluronidase, or Hyalase. If you look at the protocol surrounding the use of hyaluronidase, and some of these will be found in videos on this website, you will understand that when a patient has a potential vascular occlusion, the protocols do require additional repeat doses of the hyalase. Accordingly, do make sure you have adequate supply to treat a patient who may need up to four vials for one episode. In addition, we have some 300 mg aspirin tablets. Next, we have some GTN in the form of an ointment. Please ignore the fact that it is a rectal ointment, it is clearly just proprietary GTN 4 mg/g ointment, and this can be useful in the later stages of managing a vascular occlusion. We also have some sublingual glyceryl trinitrate tablets, and these very useful commercial hot packs. Some of these are activated by crushing the pack while others require a microwave to activate them. Finally, we have saline and syringes, and needles of different sizes which are useful to reconstitute hyalase if it is required. In addition to all of these items, it is important that every clinic knows the location of its nearest hospital eye unit, and you should have this clearly printed on a laminated sheet on a grab pack.