Recently, it was reported that an elderly person prescribed medicine in a large hospital and went to the community clinic for injections that were rejected. The news was on the hot search.
Image from the web
Many friends have also expressed their own views on this, and there are two different views that collide very fiercely -
One view is that the elderly are older and have limited mobility, and that it is against human feelings for community clinics to refuse injections because they do not prescribe drugs themselves, and there is also a lack of service attitudes.
Another view is that community clinics have certain limitations in terms of facilities and capabilities to prevent injection risks, and in order to ensure the safety of injections in the elderly, serious adverse reactions can be treated in time, and it is excusable to refuse injections.
So, in daily life, is it really feasible to prescribe injectable drugs in large hospitals and go to community clinics for injections?
01
Whether the needle can be hit or not is not simple to answer
For the two views just mentioned, we cannot completely say who is right or who is wrong, because in fact, this is derived from different positions and different thinking angles, and can only be analyzed on a case-by-case basis, rather than simply choosing one or the other. This is a matter of health, even life, but it is not sloppy at all.
Whether to inject or not, due to the patient's physical condition, condition, and medication, it is difficult to generalize. If the community clinic has a relatively good understanding of the specific situation of the patient, and has the relevant qualifications and conditions for injection, the drugs injected are also relatively safe and low-risk drugs, of course, they can also be injected. However, if the patient's physical condition is not understood, or it lacks the relevant injection capacity, or does not have the ability to treat adverse reactions that may occur after injection, then a cautious attitude should also be understood.
It may be safer to have an informed doctor get the injection | Figureworm creative
Some friends may still be a little confused, isn't it just a matter of pricking a needle? How can it be so exquisite?
02
Injectable administration is at higher risk
When it comes to "needles", we are not strangers. A lot of times when we get sick, we all need an injection. However, with regard to injectable administration, whether subcutaneous, intramuscular, intravenous or some other injectable administration, it is more risky than oral administration.
So what's the difference between the two?
Oral administration is a basic mode of administration and is relatively safer. Because after the drug enters the human body by oral administration, most of them will be initially metabolized through the liver, and then enter the bloodstream, and exert related effects through blood circulation. This "first-pass effect" of the liver avoids the risk of some adverse reactions caused by the direct absorption of the drug, and is also a completely noninvasive mode of administration. Moreover, if there is an adverse reaction after oral administration of the drug, it can also quickly prevent the absorption of the drug by means of gastring and other means.
"Drippling" is actually a kind of injection and administration | Figureworm creative
Injection is different. First, injection administration is an invasive way of administration; second, injection administration also absorbs drugs more quickly and directly. Although this may be more rapid and effective in terms of drug action, it may also increase the risk of adverse reactions, and once an adverse reaction occurs, it is difficult to remove the drug that has entered the blood vessels, which requires attention.
Therefore, there is a principle of medication: it can be taken orally without injection, whether it is intramuscular or intravenous (including "drip"), should not be abused.
03
What are the risks of injectable administration?
Taking our most common intravenous injection as an example, the main risks it may bring are as follows:
Intravenous injection is an invasive mode of administration, which can cause wounds in venous vessels, trigger an inflammatory reaction to the lining of blood vessels, and may also cause inflammation of superficial veins.
Intravenous injection requires high aseptic operation requirements, and if the sterile operation is not standardized, it is possible to cause the risk of wound infection by injecting needles or other instruments.
Doctors wear sterile gloves, a common aseptic procedure | Figureworm creative
u Intravenous injection needs to combine the patient's physical condition and the type of drug used, control the instillation speed, if the infusion speed is too fast, it will cause rapid increase in blood volume, increase the workload of the heart, on the other hand, a large number of drugs quickly enter the body, beyond the body's tolerance, may bring serious adverse reaction risk.
Although the quality control of drugs is becoming more and more stringent, it is not possible to completely remove insoluble tiny particles from intravenous solutions. If a large amount of fluid is often infused, more particles will enter the human body with the injection, they are usually difficult to degrade, and they remain in the human body for a long time, which may cause local circulation disorders and bring chronic health hazards.
In rare cases, intravenous fluids may cause serious adverse infusion reactions such as hyperthermia and convulsions, although they do occur rarely, but such risks should also be noted.
For injectable dosing, children and the elderly are two risk groups that should be paid more attention to.
Children's bodies are still in the developmental stage, some tissues and organs are not yet mature in their ability to metabolize drugs, and intravenous infusion of drugs into the body, the probability of risk is also higher.
The body of the elderly for the drug metabolism and absorption capacity will decline, for the drug directly into the human body capacity will also decline, therefore, for children and the elderly, in the choice of drug delivery, should also be combined with the situation, carefully choose the mode of administration of intravenous fluids.
The elderly need to pay more attention to physical condition | injections Figureworm creative
In addition, intramuscular injection administration will often bring local redness and pain, and in a few cases, it may also lead to adverse reactions such as induration or purpura, so it is often used for immunization, and usually administered has been relatively rare.
04
Injectable administration is used only in these cases
Under what circumstances should injectable administration be used? In the following three cases, it may be advisable to consider administering the drug by injection.
First of all, if there is a critical condition and oral administration cannot achieve timely treatment, the way of injection of drugs can often take effect faster and achieve the role of emergency treatment.
Secondly, if the patient cannot be administered by oral means (such as severe vomiting and diarrhea), without drug therapy, and can not effectively control the disease, injection can be considered.
Finally, some drugs, oral administration, because of the influence of the digestive system, will make the drug ineffective, and it needs to be administered by injection. Drugs such as insulin can only be administered as injections.
05
These 2 misunderstandings, do not be tricked
After talking about the drug risks and principles of injection administration, let me tell you about the two common misunderstandings of injection administration.
If the condition is not critical, it is advisable for children to take oral medication as much as possible | Figureworm creative
Myth 1: The injection after the child is sick is "good fast"
This idea of "getting better fast" has led to many cases of infusion abuse. Especially when children are sick, whether it is a cold or a cough, some people will always propose to get the injection quickly, thinking that the injection will get better quickly. Injection and infusion will indeed make the drug absorbed faster, but this does not mean that the condition will improve faster, and it may also bring the above multi-faceted injection drug safety risks, which is completely unnecessary and an excessive medical behavior. If the condition is not critical, you can control the condition through oral medication, or try to choose oral medication, do not let our acute child harm the child.
Myth 2: The elderly can pass through the blood vessels by infusing fluids once or twice a year
The idea of this infusion through the blood vessels seems to make sense, but in fact, the plaques on the blood vessels are lipid "garbage" formed under the lining of the blood vessel wall, and it is impossible to "wash them away" through infusion. The fluid circulatory system itself is also a closed pathway, and the goal of dredging blood vessels by infusion of glucose or normal saline irrigation is unlikely to be achieved. Moreover, additional infusions can also bring multiple risks such as infection and increased heart load, which is really not worth the loss.
As a commonly used mode of administration, injection administration has its risks and scope of application, and should be reasonably applied. Finally, it should be emphasized that it can be taken orally without injection, and when injecting, it is necessary to choose a qualified medical unit to better ensure the safety of medication.
Author | Li Jin is the deputy chief pharmacist and the deputy leader of the youth group of the Medical Committee of the China Association for Science Popularization
Audit | Liu Zhanyang, chief pharmacist of the Fourth Medical Center of the PLA General Hospital
Edit | Jiang Fan
Editor-in-charge | Ding Song
This article is produced by the "Scientific Rumor Dispelling Platform" (ID: Science_Facts), please indicate the source when reprinting.
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