cm First Aid for Bites and Stings Not all bites or stings are the same. A person bitten by an insect, spider or a snake, have to take different steps to apply the right first aid and seek proper medical assistance. INSECTS Nearly everyone has had an insect bite or sting at one time. Most bites or sting, whether from mosquitoes, flies, bees or wasps, results in a mild reaction to the venom or other protein that the insect injects into one. This can result in redness, minor swelling, pain and itching at the site of the bite or sting. Some people develop a severe allergic reaction to an insect sting, often from a bee or wasp. A severe reaction may result in: Abdominal cramps Nausea and vomiting Swelling of the face, lips or throat Hives Breathing problems Shock. Ifsomeone begins experiencing these symptoms shortly after an insect bite or sting, call 103 and get to an emergency room as soon as possible. A severe, whole body allergic reaction is called anaphylaxis. This can be life-threatening, if not treated promptly. "If one has ever had a severe reaction to an insect sting, should fequest a medication called epinephrine from your doctor. Epinephrine is injected into the muscle through an ‘autoinjector: It on the body to raise the blood pressure, stimulate heart, e - swelling. and breathing. It should be carried at all times, ‘when outdoors,Chapter 3: First Aid for Bites and Stings 37 redness and intense pain occurs, followed by the development of a blister. When the blister breaks down, a deep ulcer is left in the skin. One also may have a fever, rash and/or nausea as well as the potential for an infection in the ulcerated skin area. If it is recognized a bite is that of a black widow or a brown recluse spider, seek immediate medical attention. First Aid Measures 1. First aid care for most spider bites is similar to that of insect bites and stings. 2. Wash the area with soap and water. 3. Place a cold compress or an ice pack (wrapped in a cloth to protect the skin) on the sting or bite for about 10 minutes to reduce pain and swelling. 4. Apply calamine lotion, an antihistamine cream, or a paste of baking soda and water to the area several times a day until itching and pain are resolved. First Aid Care for a Brown Recluse or Black Widow Spider Bite 1. Clean the skin with soap and water. 2. Help the person remain calm to reduce the spread of venom; do not apply a tourniquet. 3. Apply a cold compress or ice pack wrapped in a cloth to protect the skin. 4. Get the victim to medical care as soon as possible. If possible, catch the spider or take a picture to help medical personnel ee: NAKES While many snakes are harmless, there are a few common species in the United States, such as the copperhead, coral, cottonmouth and rattlesnake that can be poisonous and even deadly. Snake Bites Snake bites are punctured wounds caused by the fangs of snakes. As far as the treatment of the wound is concerned, it is dealt with as a Minor wound, However, in India, there are several poisonous snakesChapter 3: First Aid for Bites and Stings 39 the treatment once in 4 hourly for six times. This will nullify the snake venom complications, First Aid Measures Summon medical help immediately. In addition, you can call the National Poison Control Center hotline (1-800-222-1222, US) for instruction. Help the person to remain calm and lie quietly. Movement can spread the venom more rapidly, so try to keep the body still, especially in the bitten area. Do not raise the bitten area above the level of the heart. Remove constricting jewelry or clothing around the bitten area, as swelling may occur. If there are symptoms of shock, such as dizziness, weakness, pale and clammy skin, shortness of breath and increased heart rate, have the person lie quietly with his/her feet elevated about 12 inches. Cover him/her with a blanket to maintain body warmth. Aims + Reassure the casualty + Prevent absorption of venom « Arrange urgent transportation to hospital. First aid measures for snakebite 1. Tieapiece of cloth (atleast within 1 hour) ora tourniquet, tightly above the bite to prevent the venous blood return, i.e. it should "be tight enough to prevent the blood flow through the veins, but "not tight enough to prevent the blood flow in the arteries. oosen the tourniquet for 1 minute in every 20 minutes. eep the bitten limb hanging down. sat for shock reassure and keep the patient at rest and warm. e the wound. If there are no fang marks the snake was sonous, If there are fang marks, try to get the patient to ‘immediately, an antivenom injection given in time ve his/her life. re is doubt and cannot get the patient to hospital quickly: e wound with lukewarm water, with potassium nate added, if available. or blade in a flame and make a cut 1 cm deep ‘a cross over the bite, liquid (poison), using a piece of plastic over to protect yourself or suck out of the wound andChapter 3: First Aid for Bites and Stings 41 4, Transverse shields extend completely across from side-to-side occupying entire belly surface to the tail. 5. Top of head is arrow shaped. Broader than rest of the body, which it joins by a constricted neck. Head covered with small scales, common to all vipers, except pit viper. 6. Top ofheadis oval, smaller than rest of the body and streamlined without demarcation of neck covered with a big shield. If neck passes into expanded hood, then it is cobra; common cobra has spectacles, king cobra without spectacles. . Same as 5 only on expanded hood. Examination of side or face. . Shield on side of face. Tip-tilted nose with well-marked ‘pit’ between eye and nostril is ‘pit’ viper. 10. Absence of ‘pit; probably krait. 11. Central row of large shields occupy midline of back, with foregoing features, can be regarded as a krait. een Examination of the Belly Ifthe arrangement of scales conforms to either, then the snake can be pronounced non-poisonous straight way and further investigation can cease, and anxiety is at an end. If the attention is at once directed to the poisonous varieties, then before proceeding to examination of the top of head, it is well to remember that the important poisonous land snakes of India are six in all, divided into two main families: 1. Viperine. 2. Colubrine. For practical purposes we are concerned with three in each family. In the viperine group there are two vipers (Russell’s viper and the pit viper) and a snake called Echis carinatus, while in the Colubrine group, there are two cobras (common cobra and king cobra) anda snake called krait. Examination of the Top of Head Examination of the top of head gives the distinguishing characteristic ‘ofthe two main families: 1. Annexed description applies to all three vipers except the pit § egies further confirmation. description identifies the two cobras, while raises a g suspicion that the snake is a krait.a Captaris Fest Ald tr Bitesanustings 43 Poisonous Land Snakes Met Within India 1, Vipers are usually short in length. All are poisonous and have tubular fangs: a. Russell’s viper (Daboia): It is found all over India. It is the longest and most poisonous viper. It varies from 1 to 5 feet in length. Reddish brown in color, it has three parallel chain along back and sides, and body is of diamond-shaped blotches edged with white. b. Echis carinatus (phoorsa): It is met within Northern India, but is not very common, It seldom exceeds 2 feet in length and is less dangerous than ‘Russell’s viper: It has a dark white blotches on the top of its arrow-shaped head, outlined in black. c. Pit viper (ancestrodon): It is named on account of the pit between eye and nostril, is a tree viper found in Ceylon and the hilly districts of Southern India. It may be 3 feet in length, is not very formidable and seldom causes death. 2. Colubrines are usually large and very poisonous with grooved, not bored fangs: a. Common cobra (naga): It is found all over India and the Himalayas. Long, cylindrical bodies up to 6 feet in length, hooded and with spectacle markings on the hood. b. King cobra (hamadryad): It is found in lower Bengal, Assam and Burma. May be 15 feet in length and with common cobra __ isthe most poisonous of all Indian snakes. ¢. Krait (Bungarus): It is found in Northern India and Sind. ‘There are two varieties, both very poisonous. The common krait ‘may measure 4 feet in length and has a series of white arches over the back, well-marked towards the tail. The banded krait sometimes measures 6 feet. It is a yellow snake with black rings or bands encircling the body. Sea snakes are all poisonous, but seldom attack ‘man. ‘are specialized for their habitat. Head is small, nostrils on the and the tail is flattened from side to side. of Snake Venom er venom is quite different from that of the colubrinae ». Viper venom aets chiefly on the blood and blood vessels, when44. Section Il: First Aid in Emergency Situations ; i Jocal reaction of marke injected into the tissues, therefore, ae is aries. Mipevents ie discoloration and hemorrhage rue es teete poisoning a te ee SRE dilated pupils. If: Tecovery takes a eal sloughing and e round the bite. Paralysis, is lace, n : Fare. Colubrinae venom is a very rapidly, See eet Severe pain follows the bite, with nausea, an idly t the ie e onset of paralysis of the legs is rapid. This ascends: en eee zal ‘with paralysis of the face muscles and dripping fro Reon c. pupils are contracted. Respiration is rap) dly sag F; e heart may continue beating for a mu cl Hee period. If recovery takes place, it is complete. Reco y dey on the amount of venom injected in both cases, whil doses, or may be purely due to fea SCORPION STING scorpion stings child who is es, complains weak it may produce serious results, cramps, sweating and possibly com What to do when a patient who has a rule, itis told that the sting is by a scoy some relative has actually not seen thi 1. Examine the site of the sting, 2, Look for signs of shock, partic Treatment 1, Apply a cold compress to the bicarbonate paste (cooking sox 2. Treat for shock, ve 3, Give hot drink and keep the p; Note «+ Ifby any chance the poison is «Ifthe signs of shock are severe, (or hospital for medical aid), ! 7 | !___thaperssFitid frites and tings 45 BEE, WASP AND HORNET STINGS Bee, wasp and hornet stings occur frequent in rural areas, especially if their nests are disturbed. The insects have a sting, which is left at the site of puncture and has to be removed. If a person is prone to allergies, a bee, wasp or hornet sting may be a serious condition because of the shock produced. Signs ‘The site of the sting looks red, swollen and painful. First Aid Measures 1, Remove the sting with a pair of forceps. 2. Apply cold compresses to the site. 3. A paste with sodium bicarbonate (cooking soda) or washing soda can be applied or if available antihistamine ointment. 4, Treat for shock. JELLYFISH STING ‘The effects of Jellyfish sting vary from minor local reactions to large wheals, severe pain and sometimes death. First Aid Measures ‘the first aid measures are as follows: + Apply paste of sodium bicarbonate in water « Seek medical aid urgently, if symptoms are severe. PORTUGUESE MAN-OF-WAR ‘The effects vary from slight stinging to cramps, nausea and difficulty in breathing.o_o Biot Alf Bites anistings 47 « Blustering may occur ~ Casualty may complain of ‘pins and needles’ and intense pain, ‘put the part gradually becomes numb and pain disappears as the freezing bites deeper « ‘Theskin feels hard and stiff. Aims Warm the affected area slowly and naturally to prevent further tissue destruction Arrange transportation to hospital. Treatment Note ‘If there are signs of accompanying hypothermia, treat it before frostbite. Do not attempt to thaw out a part if the casualty will Jater be exposed to cold or a journey, as to freeze-thaw-refreeze is disastrous for tissues. Simply cover the affected part in dry gauze, \d loose bandaging, or enclose it in a plastic bag. { first signs of whiteness, pain or tingling, handle damaged gently. Remove frozen covering carefully, together with Or ‘watches. Warm the part with own hands. Alternatively, eris frost bitten place the casualty’s affected hand in his/ pposite armpit until normal color returns. s/her to warm surroundings as soon as possible. He/ walk on frost bitten feet before thawing out, but never carry his/her on a stretcher. If color does not return place the affected part in warm water (tested first with thaws out, the color will improve and pain will ae ee the thawed area with dry gauze or wool eects swelling. y a doctor, give the casualty two paracetamolirst Aid for Bites and Stings 49 Chapter temperature of the body must retain heat when the environmental temperature is cold and lose heat when it becomes hot. Body heat is under the control of a temperature control center (thermostat) situated at the base of the brain, which automatically adjust the mechanism that keep the balance between Joss and heat gain. Heat is lost by radiation as the small arteries and capillaries in theskin dilate, thereby increasing circulation and diverting heat from the vital organs. Heat is also lost by the cooling effect of sweating and in the vapor breathed out from the lungs. Conversely, heat is retained by shutting down these processes. Therefore when it is hot the skin is flushed and moist; when cold, it is pale and dry. Moreover, the rate of breathing is more rapid in hot environment than in cold. Temperature regulation may sometimes be inadequate for the circumstances and it tends to be less effective in the very young or very old. ZSRBIES AND ANTIRABIC TREATMENT IN INDIA Rabies is an acute infective fetal disease of dogs, jackals, wolves, horses, monkeys and other animals communicated to man by bites and scratches from these infected animals, or by licks on preexisting abraded surface, e.g. rag, nails, cuts, etc. The poison or virus is probably an ultramicroscopic organism, contained in the saliva of these infected animals, which gains entrance to the system through the abraded skin surfaces of the victim. Pasteur, about 1885, proved that rabies was essentially an infection of the central nervous system and that the pathway from skin to spinal cord was via terminal nerve endings and up along the parentnerve trunks. Pasteur explained the added risk ofabrasions on the face or head, by the fact that these short nerves trunks provided the shortest possible route, by which the poison could reach the brain. In man the effects of injection produced vary according to the region bitten, the extent of laceration and the virulence of the person absorbed, The amount of poison applied is modified in the case of bites through clothing. PRE af 9 af Symptoms in Victim ‘ jays an interval between the date of the bite and the first of symptoms known as the incubation period and thisinst Aid for Bites and Stings 51 e outstanding feature of rabies in a dog takes place within 10 days. ey which ends fatally with some of jethe unexpected onset of a disease, these symptoms in 2-5 days. t prevention is everything in dealing with rabies, as the disease is always fatal. First Prevention of Biting nlarge majority of cases, the biting animal is a dog and a pet one at Cae dog should never be kept in a household in India with young "children. They have natural instinct to pet and fondle a pet dog they court the disaster of bites about the face, which are by ‘the most dangerous. n in districts where infected jackals roam about, it is not ble to keep a dog at all. e dog has a hot nose, is off color and refuses its food, in India, id always be claimed up and the following precautions id be taken at this stage. giving the dog medicine, thick leather gloves to protect ands should be used. The dog's food plate or drinking vl, should be pushed within its reach with a stick and the dog handled as little as possible. @ procedures will prevent the dog from biting the owner or and the rabies from subsequently developing. 's appetite and normal condition return, then, and should it be released. ‘hand, if suspicious symptoms develop, keep the ‘up and away out of harm, and send for a doctor or of doubt they will order the dog to remain ;, especially if it should have bitten anyone. ‘ loping rabies will survive 10 days (few will ‘80, even, if the dog should have bitten someone, | well after 10 days it can be pronounced non- of all concerned,mment of India has so provided that this treatment | available throughout the country. The protective antirabic se js now obtainable from a great many additional centers at d military hospitals and may be administered by general ners. Antirabic treatment for dogs is also now available with y doctors.