Let me parody “The Oxford Textbook of Medicine “. Intramuscular injection is dead. Long live injections. Ironic, isn’t it? To wish a dead thing long-life. Yes if I had my way, I would have phased out all intra-muscular(im) injections. I have both personal experience and research findings to back me up.
First my personal experience; In my early teens, I noticed that my father walked with a slight limp. I asked him, ‘why?’ he said it was a gun-shot wound he sustained during Burma war, in the early 40s of World War II. That the bullet was still lodged in his waist bone. When I qualified as a medical doctor, and before my father died, I revisited our discussion and told him I wanted to take him to my hospital for x-ray and MRI, so as to get a Consultant Surgeon to extract the bullet.
Then my father confessed that he was just pulling my legs then. That he started limping after an injection in the 40s in Port Harcourt by a white dispenser who claimed to be a doctor. The needle and syringe were then metals, and were usually re-boiled for sterilization. From then, I developed a pathological dislike for intramuscular injections.
As a precaution, in all my years of medical practice, I cannot remember ever prescribing an intramuscular injection for any of my patients. Usually I prescribe oral or parental that is intravenous – in which I will have to insert a canular-in-situ, and the patient must be on admission for observation and monitoring.
In the past, there used to be a madness with patient’s desire for intramuscular injections. Patients, especially the elderly fanatically believed, and quite erroneously, that only intramuscular injections could cure their ailments. A time was in my hospital that any elderly patient that did not receive an intramuscular injections, would automatically label you an incompetent doctor.
This was further compounded by some health workers, who are known to have strong preferences for injections, even when oral and other alternative routes are equally good and safer.
The second reason why I do not prescribe intramuscular injection is that several researches done in Ahmadu Bello University, University of Jos and several Indian Universities on – intramuscular injections during fever and poliomyelitis – discovered that ;
a) 70% of people especially children walking with a limp, was as a result of intramuscular injections given to them when they had fever.
b) 85% of paralyzed children due to poliomyelitis was aggravated by intramuscular injections, especially if the injections were administered during fever.
c) That most of the scars, scarifications and deformities in the gluteal(buttock) were caused by intramuscular injections, especially if administered by quack health workers, who had no knowledge of proper injection sites. Again most adults that walk with a limp sustained them through intramuscular injections given the as children.
Please let us define intramuscular injection.
Intramuscular also “im” injection is the injection of a substance directly into the muscle. In medicine it is one of several alternative methods for the administration of medication. Other routes include 2) Parental – intravenous. 3) subcutaneous injections and 4) intra – dermal injections.
There are 5 intramuscular injection sites.
1) Dorso-gluteal – upper outer quadrant of the buttock. This is usually reserved for high volume injections of 3 to 5mls eg analgesics, antibiotics, etc.
2) Ventro-gluteal – upper site of the hip. This is reserved mostly for self-administered drugs like insulin.
3) Deltoid – one or two inches below the shoulder region. This is reserved exclusively for vaccination.
4) Vastus laterals – located mid-thigh on the outer side of the leg, also used for self administered drugs like corticosteroids during adverse reactions.
5) Rectus femoris – located mid-thigh but on the anterior part of the leg reserved for emergency injections when other sites are saturated.
Now, from the above descriptions you would have noted that intramuscular injections and sites are very diverse, complicated and specialized. It should not be an all comers affair, where every person that can handle a needle goes on rampage inflicting incalculable and permanent deformities on innocent patients.
Side effects of intramuscular injections.
• Please call your doctor or health care provider right away if you experience the following
¤ Severe pain at the injection site.
¤ Tingling and numbness of limbs.
¤ Redness, swelling and warmth of the injection site.
¤ Drainage of fluid at the injection site.
¤ Prolonged bleeding at the injection site.
¤ Signs of allergic reaction such as difficulty in breathing or facial swelling.
What are the complications of intramuscular injections?
• Consistent and persistent pain at injection site.
• Abscess formation.
• Partial foot drop.
• Inability to walk properly.
• Complete foot drop
• Parasthesia and numbness of the injection area.
What is our take this week?
For your own good health, if any health worker – chemist, pharmacist, laboratory attendant, for exigency, prescribes any intramuscular injections for you. Ask him or her for an alternative which must be oral. If he or she insists make sure that the person to administer the injection learned about the proper injection sites at school, and not on-the-job-training. Lastly make sure the water-for-injection, the needle and syringe are new, sterile and sealed.
If you are in the medical line you would have noticed what massive deformities and disabilities intramuscular injections have wrecked on innocent patients, and your response would have been “God have mercy” pleas remain medically guided.
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