CHAPTER 5: FIRST AID
 
 
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Objectives

After studying this chapter, you should be able to:

1. Tell when a person:

  • is unconscious,
  • is not breathing,
  • has no heartbeat.

2. Decide what to do and give first aid in each case.

3. Give first aid when a person:

  • has fits (convulsions),
  • has chemical in the eyes,
  • has chemical on the skin,
  • has been bitten or stung by a poisonous or venomous animal.

First aid is the help a person gives straight away in a medical emergency.

This chapter can help you learn first aid, but you also need someone to teach you first aid, and check that you are doing it correctly. It is important to have someone show you the right way to do mouth-to-mouth respiration and heart massage. You should practise on a special training manikin (a life-size model). Never practise heart massage on another person, only on a manikin.

It is dangerous to use heart massage if you have not had proper training.

People who are poisoned may:

  • be unconscious,
  • stop breathing,
  • have no heartbeat,
  • have fits (convulsions).

They need immediate first aid to help them to breathe and to start the heart beating.

When people get chemical in the eyes or on the skin, it may cause burns. These people need immediate first aid to wash the chemicals out of the eyes and off the skin. The chemical may also get into the body and cause poisoning.

People who have been bitten or stung by a poisonous or venomous animal need first aid:

  • to remove stings, spines or tentacles,
  • to clean the wound and stop infection,
  • to slow the spread of poison through the body.

Give first aid at once

Immediate first aid may stop serious poisoning and may save life. If breathing and the heart stop, the person will die within a few minutes unless you give first aid at once.

First aid for poisoning

Here is an action list. Each step is explained in more detail below the list. Start with the first step and follow each step in the order given. Act as quickly as you can, but stay calm.

  1. Check if the patient is conscious.
  2. Open the airway and make sure the tongue is not blocking the throat.
  3. Check if the patient is breathing.
  4. Clean out the mouth and clear the throat.
  5. Give mouth-to-mouth respiration.
  6. Check if the heart is beating.
  7. If the heart is beating, but the patient is still not breathing, carry on with mouth-to-mouth respiration.
  8. If the heart is not beating, give heart massage.
  10. Give first aid for fits if necessary.
  11. Wash any chemical out of the eyes.
  12. Remove contaminated clothing and wash any chemical off the skin and hair.
  13. Give first aid for poisonous bites and stings.

Check if the patient is conscious

Try to make the patient wake up. Shout "Are you all right?" and gently shake the shoulders, but take care not to make any injuries worse (Fig. 15). Pinch the skin on the neck and watch the face. A patient who is just sleeping will wake up, but an unconscious patient will not.

Fig. 15. Check that the patient is unconscious.

Open the airway

The airway is the tube through which air passes from the mouth and nose to the lungs. If it is blocked the patient cannot breathe and air cannot get into or out of the lungs. A patient who cannot breathe will die within four minutes.

In an unconscious patient the tongue may block the throat and the airway. Make sure the airway is open and air can get down the throat (Fig. 16):

Fig. 16. In an unconscious patient, the tongue may fall back,
blocking the throat and stopping breathing.

Fig. 17. Open up the airway by pressing the forehead back
and lifting the clin with the thumb and fingers.

Check whether the patient is breathing

After opening the airway, quickly check whether the patient is breathing (Fig. 18):

  • Look for the belly or the chest moving up and down.
  • Feel the chest moving up and down.
  • Feel the patient's breath on your cheek.
  • Listen for breath sounds. Put your ear close to the patient's mouth.

Fig. 18. Check whether the pacient is breathing by looking and
feeling for movement of the chest or belly, listening for breathing
sounds and feeling for the pacient's breath on your check.

Use all four checks. Remember that the chest may move up and down even when the throat is completely blocked and air cannot get to the lungs.

A person may stop breathing because:

  • Something is stuck in the throat.
  • The throat is blocked by the tongue, or by blood, spit, vomit, food, or false teeth. (If you have tilted the head back, the tongue will not block the throat.)
  • The throat is blocked because the patient has swallowed poison which has burnt the throat and made it swell.
  • The patient has been poisoned.
  • The patient has been hit on the head or chest.
  • The patient has had a heart attack.
  • The patient has nearly drowned.

Clean out the mouth and clear the throat

If the patient is not breathing after you have tilted the head back, something may be blocking the throat.

Turn the head to one side. With one or two fingers (and preferably wearing gloves) scoop deeply round the mouth and throat to clear any blockage such as vomit (see Fig. 19). Take out the patient's false teeth.

Fig. 19. Explore el interior de la boca del paciente
para eliminar cualquier causa de obstrucción.

If the patient starts breathing turn him or her onto one side, into the recovery position. Check breathing and pulse frequently.

Whatever the cause, if the patient does not start breathing you must act immediately to help the patient to breathe.

Give mouth-to-mouth respiration

You can help the patient to breathe by blowing air from your lungs into his or her lungs through the patient's mouth (mouth to mouth) or nose (mouth to nose). This is called mouth-to-mouth (or mouth-to-nose) respiration.

If there is poison on the patient's lips, or if corrosive chemicals have burnt the lips and chin, wipe the chemical off, cover the mouth with a cloth to protect yourself from getting poison on your lips or hands, and give mouth-to-nose respiration. Breathe into the patient's nose (see Fig. 20).

Fig. 20. Mouth-to-nose respiration.

How to give mouth-to-mouth respiration or mouth-to-nose respiration to an adult

  1. With the patient lying flat on his or her back, clear any blockage from the mouth. Kneel beside the patient's head.
  2. Tilt the head back.
  3. Pinch the nose with one hand. With the other hand pull the mouth open (Fig. 21). Do not press on the neck. For mouth-to-nose respiration, close the patient's mouth with your thumb.

    Fig. 21. Mouth-to-nose respiration: tilt the head back, pinch
    the nose and pull the mouth open.

  4. Breathe in deeply. Cover the patient's mouth completely with your own mouth and breathe out steadily and smoothly so that all your breath goes into the patient's mouth. Breathe out strongly to fill the chest (see Fig. 22). Look for the patient's chest rising. For mouth-to-nose respiration put your mouth around the patient's nose.

    Fig. 22. Mouth-to-nose respiration: breather steadily and smoothly
    into the patient's mouth, filling his or her chest with air    .

  5. Lift your mouth away so that the patient can breathe out and you can take another breath of air. Turn your head, look for the chest falling, feel the breathed-out air on your cheek, and listen for the sound of the patient breathing out (see Fig. 23). For mouth-to-nose respiration you may have to open the patient's mouth to let air out.

    Fig. 23. Mouth-to-nose respiration: lift your mouth away so that the patient
    can breathe out; watch for the chest falling, feel for the patient's
    breath on your cheek, and listen for the sound of breathing.

  6. Take another breath of air. Once the chest has fallen, blow into the patient's mouth (or nose) again. Watch the patient breathe out again. Then check that the heart is beating.

If the chest does not rise with each breath, and you cannot feel or hear the patient breathing out, then either the airway is blocked or some of your breath is not going into the patient's chest. Check that the head is held well back and clear the airway again. Make sure there is no air escaping when you breathe into the patient's mouth (or nose).

How to give mouth-to-mouth respiration to a child or a baby

Open the airway in a child or baby in the same way as for an adult, but do not tilt the head too far back or the soft airway may kink.

If you can see something blocking the throat carefully remove it, but do not sweep your finger inside a baby's mouth if you cannot see anything there. If the throat is swollen because of an infection, you might make the swelling worse.

Do not pinch the nose. Put your lips over both the nose and the mouth (Fig. 24). Breathe gently, just enough to move the chest. For a very small baby only small puffs are needed. Do not blow hard or you may harm the baby's chest. Blow into the chest every 3 seconds.

Fig. 24. If giving mouth-to-mouth respiration to a child, blow
very gently to avoid damaging the child's lungs.

Check if the heart is beating

Feel for the pulse in the neck, in the hollow between the voice box and the muscle. Place two fingers on the voice box (Adam's apple) and slide your fingers into the groove under the jaw (Fig. 25). Keep your fingers there for at least five seconds to feel if there is a pulse.

Fig. 25. Feel for a pulse in the groove under the jaw.

If you cannot feel a pulse, the heart has stopped. This is called cardiac arrest. The patient will be unconscious and will probably have large pupils. If the patient has white skin it will probably have a blue-grey colour. If the patient has black or brown skin look for a blue colour to the nails, lips and the inside of the lower eyelids. If the heart stops, breathing will also stop and the patient will need both heart massage and mouth-to-mouth respiration.

If the heart is beating, but the patient is still not breathing, carry on with mouth-to-mouth respiration

Take a deep breath and blow once every 5 seconds, until the patient starts to breathe without help. You may have to do this for more than one hour.

If the patient has breathed in an irritant gas, the mouth and throat may be full of froth. You cannot remove this froth by wiping, so do not waste time trying to remove it. As this froth is air bubbles, all you have to do to move air in and out of the lungs is to blow the froth into the lungs. So blow as usual.

When the patient starts to breathe, turn him or her onto one side into the recovery position. The patient may vomit when breathing starts again but the vomit will not block the throat if the patient is lying on one side. Let the vomit come out and clear it out of the mouth with your finger.

Watch carefully in case the patient stops breathing again. If breathing stops turn the patient onto his or her back and start mouth- to-mouth respiration again.

If the heart is not beating give heart massage

If you cannot feel a pulse in the neck, you should try to start the heart beating again by giving heart massage (see below).

Heart massage (or chest compression) means pressing down on the heart to push blood out of it and round the body. This may start the heart beating again. It will only be effective if the patient is lying on a hard surface.

If there is no heartbeat, the patient will have stopped breathing. Always start mouth-to-mouth respiration before heart massage.

Do not give heart massage if the heart is beating, even faintly. Stop as soon as you feel a pulse in the neck, but carry on with mouth- to-mouth respiration if the patient is still not breathing.

How to give heart massage to an adult

  1. Check that there is no heartbeat.
  2. Lay the patient on his or her back on a firm surface. Kneel beside the patient's chest.
  3. Find the right place to put your hands. Find the lower edge of the ribs. Follow the edge of the ribs to where they meet the breastbone. Place your middle finger on the base of the breastbone, and the index finger next to it (Fig. 26), then place the heel of your other hand next to these two fingers, on the breastbone in the midline of the chest (Fig. 27).

    Fig. 26. Heart massage: place your middle finger on the base
    of the breastbone and your index finger nexto to it.

    Fig. 27. Heart massage: place the heel of your free
    hand next to the two fingers on the breastbone    .

  4. Now cover this hand with the heel of your other hand, lock your fingers together, keeping them off the chest (Fig. 28). Put your shoulders above the patient's chest and keep your arms straight.

    Fig. 28. Heart massage: interlock the fingers of both hands
    and, with the arms     straight, press down 4-5 cm.

  5. Press down on the lower half of the breastbone 4-5 centimetres, keeping your arms straight. Then stop pushing. While counting "one and two and three and...", press 15 times, in time with the numbers (80 presses a minute). Presses should be regular and smooth, not jerky and jabbing.
  6. Remember that both mouth-to-mouth respiration and heart massage are needed. After 15 presses tilt the head back again so that air can get down the throat, put your mouth round the patient's mouth and give two breaths.
  7. Continue with 15 presses followed by two full breaths. After one minute check the heartbeat, then after 3 minutes or every 12 cycles check the heartbeat again. As soon as the heartbeat returns stop heart massage immediately. You may see the patient's colour become more normal and the pupils return to normal size.
  8. Continue mouth-to-mouth respiration at 12 breaths a minute, until the patient breathes without help. It may be some time before breathing starts again, even after the heart has started beating. When breathing starts again put the patient onto his or her side in the recovery position.

If another person is with you, get him or her to do the breathing while you do the heart massage (Fig. 29). The other person should kneel by the patient's head while you kneel by the middle of the chest. The other person should give two breaths and check the heartbeat. If there is no heartbeat you should give five presses on the chest. Continue with the other person giving one breath and you giving five presses on the chest. Check the heartbeat after one minute then after every three minutes or 12 cycles.

Fig. 29. If there are two of you, work together so that one person gives
heart massage while the other gives mouth-to-mouth respiration.

How to give heart massage to a child or a baby

The best place to feel the pulse in a small child or a baby is on the inside of the upper arm. With your thumb on the outside of the arm press your first and middle fingers into the groove below the muscle.

When giving heart massage to a child or baby, press with less force but slightly faster than you would for an adult.

For a child use one hand only and press lightly on the chest (Fig. 30). Press down 2.5-3.5 cm.

Fig. 30. To give heart massage to a child, use one hand
only and press lightly on the chest.

For a small child or a baby press on the chest with just two fingers. Press down 1.5-2.5 cm (Fig. 31).

Keep your hand or fingers below the level of the nipples.

Press down at a rate of 100 presses a minute giving 15 compressions followed by two breaths.

Fig. 31. To give heart massage to a baby, press lightly
on the chest with two fingers.

If the patient is breathing but is unconscious, turn him or her onto one side, into the recovery position

An unconscious patient should be turned to lie on one side to stop the tongue blocking the throat and to allow fluid to come out of the mouth. This is called the recovery position.

Before you turn the patient over:

  • If breathing is noisy, sweep your finger round the mouth to remove anything blocking the airway, and take out the patient's false teeth if they are loose.
  • Empty the patient's pockets of anything that would be uncomfortable to lie on.
  • Take off the patient's spectacles in case they injure the eyes.
  • Look for injury to the head or neck, and feel with your fingers to see whether the back of the neck or the backbone is bent or swollen.
  • Get help if the patient has an injury to the head or neck. Three people should roll the patient keeping the head, neck and body in a straight line. Do not let the patient sit up when he or she wakes up.

The patient should be turned onto one side with:

  • the head, neck and body in a straight line,
  • the head placed so that the tongue will not block the throat, and vomit or saliva can come out of the mouth;
  • the arms and legs placed so that the patient stays in the same position.

One way of turning a patient

  1. Kneel beside the patient, turn the patient's face towards you, and tilt it back, with the jaw jutting forward so the airway stays open. Place the arm nearest you above the head. Place the patient's other arm across the chest. Raise the patient's far leg under the knee, to bend it (Fig. 32).

    Fig. 32. Putting a patient into the recovery position: place the arm
    nearest you above the patient's head, bring the other arm across
    the chest, and bend the leg further from you.

  2. Protect the patient's face with one hand. With your other hand, grasp the patient's clothes at the hip and pull the patient towards you until he or she is resting on one side, against your knees (Fig. 33). The patient's head should be resting on the lower arm. Check that the airway is still open.

    Fig. 33. Putting a patient into the recovery position: pull the
    patient towards you until he or she is lying on one side
    with the head resting on the arm    .

  3. Take the patient's upper arm and place the hand under the face (Fig. 34). This will help to keep the head tilted back and the airway open. Now position the upper leg so that the bent knee rests on the ground and supports the patient's body.

    If the patient is too heavy for you, get help. Someone else can support the patient's head while you do the turning, or can push the patient towards you as you pull.

    Fig. 34. The recovery position: make sure that
    the patient's head is tilted back so that
    the airway stays open.

Give first aid for fits (convulsions) if necessary

 
  1. If the patient has a fit, make him or her lie down in a safe place. Make sure there are no hard or sharp objects nearby and protect the patient from injury.
  2. Turn the patient to lie on one side so that the tongue comes to the front of the mouth and froth can come out of the mouth easily.
  3. Put a folded cloth under the patient's head, or hold the head so that it does not bang on hard things.
  4. Do not try to stop the shaking movements.
  5. Loosen any tight clothing.
  6. Do not put anything in the patient's mouth or try to open it.
  7. After the fit, let the patient rest in the recovery position.

Wash any chemical out of the eyes

Wash chemicals out of the eyes at once, with plenty of cool, clean water, before you wash the skin. Even a delay of a few seconds can make the injury worse.

  		1.

    Fig. 35. Wash any chemical out of the eye
    for 15-20 minutes.

  2. While you are rinsing the eyes check that the inside of the eyelids has been well washed. Check that there are no solid pieces of chemical in the folds of skin round the eyes, or on the eyelashes or eyebrows. If you are not sure whether all the chemical has been removed, wash out the eyes for 10 more minutes.
  3. Do not let the patient rub the eyes.
  4. The patient's eyes should be examined by a doctor even if there is no pain, because damage may be delayed.
  5. If light hurts the patient's eyes, cover them with a sterile eye pad, a dry gauze pad, or a pad of clean cloth. Bandage the pad in place securely, but not too tightly. This will protect the eyes and help them to heal.
  6. If the patient is in pain, give aspirin or paracetamol every four hours.

Medical treatment of chemical contamination of the eye

Remove contaminated clothing and wash any chemical off the skin and hair

  1. Take the patient immediately to the nearest shower or source of clean water. If there is no water nearby dab or gently wipe the skin and hair with cloths or paper. Do not rub or scrub the skin.

  2. Immediately wash the affected part of the body under cold or lukewarm running water, using soap if you have some. If there is no running water use buckets of water. Do it quickly and use a lot of water (Fig. 36). Wear gloves and an apron if needed, to protect yourself from splashes of chemical. Some chemicals give off vapour: be careful not to breathe it in.

    Fig. 36. If running water is not available, use buckets
    of water to rinse chemicals off skin.

  3. At the same time quickly remove any of the patient's clothes contaminated with chemical or vomit, as well as shoes and wrist watch if necessary. Speed is important - cut the clothes off if the chemicals are very poisonous or corrosive.

  4. If large areas of the body are contaminated with chemical, wash the patient under a shower or a hose. Remember to clean the hair and under the fingernails, in the groin and behind the ears, if necessary.

  5. Continue to pour water over the patient for 10 minutes, or longer if you can still see chemicals on the skin. If the skin feels sticky or soapy, wash it until the feeling disappears. This may take an hour or more.

  6. Make sure the water drains away freely and safely as it will have chemical in it.

  7. Dry the skin gently with a clean, soft towel. If clothing stays stuck to the skin even after water has been poured over it, do not remove it.

  8. Remember that many chemicals can pass through the skin very quickly. Look for signs of poisoning (see Chapter 7).

  9. Put contaminated clothes in a separate sealed container and do not use them again until they have been washed. Throw away shoes contaminated with chemical. If you have used cloths or paper to wipe the skin, put these in a container and burn them.

If the patient has burns, and there is no doctor:

  1. Do not break open blisters or remove skin. Where the skin is red and painful or raw, cover it and the skin round it with a sterile, dry dressing and bandage. Keep the bandage loose. This will protect the burn and speed up healing.

  2. Dress the patient in clean clothes or cover with a sheet.

  3. Replace fluid loss: if a large area is burnt give the patient half a cup of water every 10 minutes until the patient reaches hospital.

  4. Treat pain: give aspirin every four hours until the pain is better.

  5. Get the patient to a doctor or hospital as soon as possible.

Give first aid for poisonous bites and stings

This section gives general advice first, followed by specific advice for dealing with:

  • snake bites,
  • stings or bites by bees, wasps, hornets, fire ants, scorpions, spiders or ticks,
  • stings by jellyfish,
  • stings by venomous fish.

General advice

  1. People often panic if they have been bitten or stung. You should tell the patient that many snakes, spiders, insects and sea creatures are harmless and that even the bites and stings of dangerous animals often do not cause poisoning.

  2. Keep the patient calm and still. Moving the bitten or stung limb speeds up the spread of venom to the rest of the body. Fear and excitement also make the patient worse. The patient should be told not to use the limb and to keep it still and below the level of the heart. The limb may swell after a while, so take off the patient's rings, watch, bracelets, anklets and shoes as soon as possible. A splint and a sling may help to keep the limb still.

  3. The following measures should not be used. They may cause infection, or make the effects of the venom worse.

    Time spent giving traditional remedies and herbal medicines would be better spent getting the patient quickly to hospital. Such "remedies" are often of no use and may be dangerous or even life- threatening.

  4. The patient should lie on one side in the recovery position so that the airway is clear, in case or vomiting or fainting.

  5. Do not give the patient anything by mouth - no food, alcohol, medicines or drinks. However, if it is likely to be a long time before the patient gets medical care, give the patient water to drink to stop dehydration.

  6. Try to identify the animal, but do not try to catch it or keep it if this will put you, the patient or others at risk. If the animal is dead take it to hospital with the patient, but handle it very carefully, because even dead animals can sometimes inject venom.

  7. As soon as possible, take the patient to a hospital, medical dispensary, or clinic where medical care can be given. The patient should not walk but should keep as still as possible. If there is no ambulance or car, carry the patient on a stretcher or trestle, or on the crossbar of a bicycle.

  8. Antivenom should only be given in a hospital or medical centre where resuscitation can be given, because the patient may have an allergic reaction. If available, antivenom should be used if there is evidence of severe poisoning. It should not be used when there are no signs of poisoning.

Using traditional medicines to treat poisonous bites and stings

No home remedy or traditional cure for poisonous bites or stings (from snakes, scorpions, spiders or other poisonous animals) has any effect beyond that of the healing power of belief.

Anyone who says that a traditional medicine kept a snake's venom from harming him or her was probably bitten by a snake that did not inject poison.

Some traditional medicines may do some good. If a person believes in them he or she will feel less afraid, the pulse will slow down, the person will move and tremble less, and as a result, the poison will spread through the body more slowly. So there is less danger.

But the benefit of these traditional medicines is very limited. Even when they are given traditional medicines, many people still become very ill or die from snake bite. Using traditional medicine may delay more effective treatment. It is better to use hospital treatment.

Do not use traditional remedies that contain animal or human waste or that involve eating animals not usually used as food. They do not help at all. They are often dangerous and can cause serious infections.

Medical treatment of poisonous bites and stings

  1. Antivenom should only be given in a hospital or medical centre where resuscitation can be given, because the patient may develop an allergic reaction. If available, antivenom should be used if there are signs of severe systemic envenoming. It should not be used when there are no signs of systemic envenoming.

  2. To decide whether venom has been injected, and how serious the poisoning is, look for these signs:

    • swelling and local tissue injury at the site of the bite;
    • blood that does not clot, causing bleeding from gums, nose, wounds and injection sites;
    • shock caused by circulatory failure;
    • neurotoxic paralysis (ptosis, ophthalmoplegia, dysarthria, peripheral muscle weakness, respiratory distress);
    • generalized muscle pain and local tissue damage;
    • kidney failure, red or black urine;
    • tender swollen lymph nodes near the bite site.

    To test clotting time of whole blood: Place 2-3 ml of whole venous blood in a clean, dry, glass test-tube and leave undisturbed for 20 minutes at room temperature. Normal blood should have clotted by this time. Tip the tube to see if the blood is still liquid.

  3. If the wound becomes infected, treat as for any other local infection. Use antibiotics if needed.

  4. If there is local tissue injury, do not cover the wound but leave it open.

What to do if someone is bitten by a snake

Venomous snakes often bite without injecting venom. In other words, the bites are "dry". Many people survive being bitten by venomous snakes, even the most dangerous species, without being poisoned.

  1. Keep the patient lying on one side, in the recovery position, to lessen the risk of vomit blocking the throat. Check breathing and heartbeat.

  2. Do not use any of the harmful measures listed on chapter 5.

  3. Clean the wound gently so that there is no venom left on the skin. Use clean water and soap, or wipe the wound gently with a clean cloth.

  4. Give first aid as follows for the bites of elapid snakes that do not cause local tissue injury or swelling (coral snakes, kraits, mambas, some cobras, but not African and some Asian cobras or vipers). Apply a broad, firm bandage over the bite site, then bandage as much of the bitten limb as possible over the patient's clothing. The bandage should be firm but not so tight that it acts as a tourniquet. You should still be able to feel the pulse in the lower part of the limb. Severe pain in the bandaged limb may mean that the bandage is too tight. It is important to use a splint so that the patient cannot move the limb. Once the patient is in a hospital or medical centre the bandage should be taken off. It should not be taken off before then because, once the bandage is removed, venom may spread rapidly through the body.

  5. Some snake bites cause severe pain, although most do not. Paracetamol can be given for the pain, but aspirin should not be given, as it may make the patient bleed.

  6. If the snake has been killed, take it to the hospital with the patient so that it can be identified. Handle the dead snake very carefully, because it can still inject venom, even after the head has been cut off.

Medical treatment of snake bites

Snake bites may cause tetanus (lockjaw). The patient should be given an injection of tetanus antitoxin if possible.

Do not give unnecessary injections because of the risk of bleeding if the blood does not clot.

A patient with respiratory paralysis may need artificial ventilation for hours, days or even weeks.

If the patient has kidney failure, make sure the patient is given the right amount of fluids and carefully monitor fluid balance. Dialysis may be needed, preferably haemodialysis or, if this is not possible, peritoneal dialysis.

Shock and low blood pressure may be caused by fluid moving out of the blood vessels that have been damaged by the snake venom. This happens especially with viper bites. Intravenous fluids may be life- saving.

Usually there is no need for surgery, and unnecessary surgery could cause complications or permanent damage to the bitten limb.

What to do if someone is stung or bitten by bees, wasps, hornets, fire ants, scorpions, spiders or ticks

  1. Scorpion stings and insect stings or bites cause local pain and swelling. Spider bites may cause deep ulcers or blisters. The greater the number of stings or bites, the more severe is the effect. Some spiders (for example, the brown recluse or violin spider, widow spiders) and at least one scorpion (Hemiscorpion lepturus found in the Islamic Republic of Iran and Iraq) may cause local tissue injury and ulcers at the bite site, which may spread over the bitten limb.

  2. Some people are sensitive to insect venom. They may get a local or generalized rash, itching, and red skin. In serious cases the patient will feel sick and as if there is a tight band around the chest, the face may swell, the patient may not be able to breathe properly, may wheeze and gasp for air, and may become unconscious. If breathing becomes difficult, lie the patient on his or her side in the recovery position. If breathing and heartbeat stop, give mouth-to-mouth respiration and heart massage. Patients should be given an intramuscular injection of epinephrine (adrenaline).

  3. Bees leave their sting behind and can only sting once, but wasps and hornets do not leave their sting behind and can sting many times. If the sting has been left, remove it, but be careful not to squeeze the venom sac on the end. Either use tweezers to grasp the sting as near to the skin as possible and remove it (Fig. 37), or scrape the sting off the skin. Take off the patient's rings, bracelets and anklets in case the limb swells.

    		4.

    Fig. 37. Use tweezers to draw a sting out of the skin.

  4. A tick can sometimes be washed off with alcohol, or removed with the heat from a cigarette. If not, lever the tick off the skin using fine tweezers or forceps, but try not to squeeze its body.

  5. A cold compress, using cold water but not ice, may help lessen the swelling, itching and pain.

  6. Paracetamol may be given for pain, but aspirin should not be given.

Medical treatment for scorpion stings and insect stings or bites

  1. Antivenom is available in South America for some spiders: brown recluse spiders (Latrodectus spp.), widow spiders ( Loxosceles spp.), Phoneutria spp., and some scorpions (for example species of Centruroides, Tityus, Buthotus, and Leiurus).

  2. Antivenom may be useful in treating local tissue injury by Loxosceles spp., and Hemiscorpion lepturus, even when there are no signs of general poisoning. The wound should be treated open as for a burn.

  3. Pain can be treated with local analgesia (e.g. lidocaine, digital nerve block, peripheral nerve block), or with systemic analgesics. Morphine should not be used to treat pain because of the risk of respiratory depression. Antivenom may be useful in treating pain caused by bites from Latrodectus spp.

What to do if someone is stung by jellyfish

  1. Jellyfish tentacles cling to the skin and can be hard to get off. Keep the patient calm and still to avoid the tentacles causing more stings.

  2. There is no sure way to stop the tentacles stinging if they are moved, so it is best not to touch them until the first effect of the sting has worn off.

  3. To stop the cells from stinging, immediately flood the area with vinegar (5% acetic acid), unless the jellyfish is known to be a bluebottle (Portuguese man-of-war; Physalia species). If you do not have vinegar, use seawater. Do not use alcohol, methylated spirits, petrol or fresh water. Cold packs or crushed ice wrapped in a cloth may help to relieve pain caused by stings from Physalia and other jellyfish. Stings from box jellyfish and similar species (Chironex) often have very serious effects. Patients may need mouth-to-mouth respiration and heart massage.

  4. Gently scrape off the tentacles with a knife.

Medical treatment of jellyfish stings

Tetanus antitoxin should be given by intramuscular injection if available.

What to do if someone is stung by a venomous fish

Many venomous fishes, such as stonefish, lionfish, scorpion fish, and weever fish, have spines that puncture the skin. Venom is injected into the wound through the spines. The stingray may cause cuts that bleed a lot.

  1. If the patient is stung while in the water, rescue from the water.

  2. At once soak the wounded part of the body in a bowl or bath of water as hot as the patient can safely bear (not more than 45°C), until the pain goes, but for no longer than 30 minutes. The venom may be destroyed by heat and pain may disappear.

  3. Clean the wound and remove any broken spines.

Medical treatment of fish stings

Tetanus antitoxin should be given by intramuscular injection if available,.

Pain can be treated with local anaesthetics or pain killers such as paracetamol. It may be dangerous to give morphine because it may depress respiration.

 
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