Snake Bites - PBworks



First Aid for Snake Bites, Ticks, Burns, and Insect Bites

Short condensed version on first 3 pages! For detailed info see the articles starting on page 4.!

Snake Bite:

"The main thing is to get to a hospital and don't delay,"

According to the American Red Cross, these steps should be taken:

* Wash the bite with soap and water.

* Immobilize the bitten area and keep it lower than the heart.

* Get medical help.

Some medical professionals, along with the American Red Cross, cautiously recommend two other measures:

* If a victim is unable to reach medical care within 30 minutes, a bandage, wrapped two to four inches above the bite, may help slow venom. The bandage should not cut off blood flow from a vein or artery. A good rule of thumb is to make the band loose enough that a finger can slip under it.

* A suction device may be placed over the bite to help draw venom out of the wound without making cuts. Suction instruments often are included in commercial snakebite kits.

How NOT to Treat a Snakebite

Though US medical professionals may not agree on every aspect of what to do for snakebite first aid, they are nearly unanimous in their views of what not to do. Among their recommendations:

* No ice or any other type of cooling on the bite. Research has shown this to be potentially harmful.

* No tourniquets. This cuts blood flow completely and may result in loss of the affected limb.

* No electric shock. This method is under study and has yet to be proven effective. It could harm the victim.

• No incisions in the wound. Such measures have not been proven useful and may cause further injury.

Ticks

* Remove the tick promptly and carefully. Use tweezers to grasp the tick near its head or mouth and pull gently to remove the whole tick without crushing it.

* If possible, seal the tick in a jar. Your doctor may want to see the tick if you develop signs or symptoms of illness after a tick bite. (tape tick to paper)

* Use soap and water to wash your hands and the area around the tick bite after handling the tick.

* Call your doctor if you aren't able to completely remove the tick.

Burns

For minor burns, including first-degree burns and second-degree burns limited to an area no larger than 3 inches (7.5 centimeters) in diameter, take the following action:

* Cool the burn. Hold the burned area under cold running water for at least five minutes, or until the pain subsides. If this is impractical, immerse the burn in cold water or cool it with cold compresses. Cooling the burn reduces swelling by conducting heat away from the skin. Don't put ice on the burn.

* Cover the burn with a sterile gauze bandage. Don't use fluffy cotton, which may irritate the skin. Wrap the gauze loosely to avoid putting pressure on burned skin. Bandaging keeps air off the burned skin, reduces pain and protects blistered skin.

* Take an over-the-counter pain reliever. These include aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) or acetaminophen (Tylenol, others). Never give aspirin to children or teenagers.

Burns Caution

* Don't use ice. Putting ice directly on a burn can cause frostbite, further damaging your skin.

* Don't apply butter or ointments to the burn. This could prevent proper healing.

* Don't break blisters. Broken blisters are vulnerable to infection.

Insect Bites

Bites from bees, wasps, hornets, yellow jackets and fire ants are typically the most troublesome.

* Move to a safe area to avoid more stings.

* Scrape or brush off the stinger with a straight-edged object, such as a credit card or the back of a knife. Wash the affected area with soap and water. Don't try to pull out the stinger. Doing so may release more venom.

* Apply a cold pack or cloth filled with ice to reduce pain and swelling.

* Apply hydrocortisone cream (0.5 percent or 1 percent), calamine lotion or a baking soda paste — with a ratio of 3 teaspoons baking soda to 1 teaspoon water — to the bite or sting several times a day until your symptoms subside.

* Take an antihistamine containing diphenhydramine (Benadryl, Tylenol Severe Allergy) or chlorpheniramine maleate (Chlor-Trimeton, Actifed).

Any apparent allergic reaction, take to hospital immediately. If person caries Epi Pen for insect allergy, apply Epi Pen.

CPR mini basics

Kids ages 1 to 8 same as adults except use one hand for compressions.

Check for heart beat – No need for compressions if heart is beating.

30 compressions and 2 breaths = 1 Cycle

2 compressions per second (compress chest approximately 2 inches)

ABC’s = Airway, Breathing, and Circulation

Clear the Airway

Give 2 Breaths

Give 30 compressions to circulate blood.

If you are untrained in CPR or “rusty” just give compressions.

Shock

If you suspect shock, even if the person seems normal after an injury:

* Dial 911 or call your local emergency number.

* Have the person lie down on his or her back with feet higher than the head. If raising the legs will cause pain or further injury, keep him or her flat. Keep the person still.

* Check for signs of circulation (breathing, coughing or movement). If absent, begin CPR.

* Keep the person warm and comfortable. Loosen belt(s) and tight clothing and cover the person with a blanket. Even if the person complains of thirst, give nothing by mouth.

* Turn the person on his or her side to prevent choking if the person vomits or bleeds from the mouth.

* Seek treatment for injuries, such as bleeding or broken bones.

Snake Bites



For Goodness Snakes!

Treating and Preventing Venomous Bites

By John Henkel

They fascinate. They repel.

Some pose a danger. Most are harmless.

And whether they are seen as slimy creatures or colorful curiosities, snakes play important environmental roles in the fragile ecosystems of the nation's wildlife areas.

People who frequent these wilderness spots, as well as those who camp, hike, picnic, or live in snake-inhabited areas, should be aware of potential dangers posed by venomous snakes. A bite from one of these, in which the snake may inject varying degrees of toxic venom, should always be considered a medical emergency, says the American Red Cross.

Every state but Maine, Alaska and Hawaii is home to at least one of 20 domestic poisonous snake species, according to a study in the August 1, 2002, issue of The New England Journal of Medicine. The article's authors estimate that between 7,000 and 8,000 people a year receive venomous bites in the United States, and about five of those people die. Some experts say that because people who are bitten can't always positively identify a snake, they should seek prompt care for any bite, though they may think the snake is nonpoisonous. Even a bite from a so-called "harmless" snake can cause an infection or allergic reaction in some individuals.

Medical professionals sometimes disagree about the best way to treat poisonous snakebites. Some physicians hold off on immediate treatment, opting for observation of the patient to gauge a bite's seriousness. Procedures such as fasciotomy, a surgical treatment of tissue around the bite, have some supporters. But most often, doctors turn to the antidote to snake venom--antivenin--as a reliable treatment for serious snakebites.

There are two types of antivenin (sometimes called "antivenom") in use today. They are derived from antibodies created in the blood of a horse or sheep when the animal is injected with snake venom. In humans, antivenin is injected either through the veins or into muscle, and it works by neutralizing snake venom that has entered the body. The first antivenin, derived from horse blood, was introduced in the United States in 1954. Because this antivenin is obtained from horses, snakebite victims who are sensitive to horse proteins must be carefully managed. The danger is that they could develop an adverse reaction or even a potentially fatal allergic condition called anaphylactic shock.

Newer kinds of antivenins derived from sheep have been studied, and one (CroFab) is now licensed for use in the United States. This sheep antibody preparation has been digested with an enzyme to reduce the risk of allergic reactions. The enzyme treatment also allows the antivenin to be cleared from the body more rapidly, so that additional treatments may need to be given.

The Food and Drug Administration regulates antivenins as part of its oversight of biological products. The agency requires certain criteria to be met before these materials are sold, including standards for purification, packaging and potency. The FDA also regulates antivenin labeling, ensuring that data on potential side effects and other pertinent information are available. The agency also periodically inspects antivenin production facilities to ensure compliance with regulations.

Types of Poisonous Snakes

Two families of venomous snakes are native to the United States. The vast majority are pit vipers, of the family Crotalidae, which include rattlesnakes, copperheads and cottonmouths (water moccasins). Pit vipers get their common name from a small "pit" between the eye and nostril that detects heat and allows the snake to sense prey at night. These snakes deliver venom through two fangs that the snake can retract at rest, but which spring into biting position rapidly. Virtually all of the venomous bites in this country are from pit vipers. Some--Mojave rattlesnakes or canebrake rattlesnakes, for example--carry a neurotoxic venom that can affect the brain or spinal cord. Copperheads, on the other hand, have a milder and less dangerous venom that sometimes may not require antivenin treatment.

The amount of venom actually delivered by a pit viper bite varies. "Some 20 to 30 percent of patients we see who have been bitten by a snake, who actually have fang marks, have not received any venom at all," says Edward L. Hall, M.D., a Thomasville, Ga., trauma surgeon who treats snakebites." He says one reason for this may be poor timing by the snake. "Pit vipers have a very sophisticated mechanism that allows them to deliver venom at the exact instant the teeth are sunk into the flesh. So it has to be precise timing. But what we often see is that the [snake's timing is off and] venom is squirted on the pants leg or released prematurely."

The other family of domestic poisonous snakes is Elapidae, which includes two species of coral snakes found chiefly in the Southern states. Related to the much more dangerous Asian cobras and kraits, coral snakes have small mouths and short teeth, which give them a less efficient venom delivery than pit vipers. People bitten by coral snakes lack the characteristic fang marks of pit vipers, sometimes making the bite hard to detect.

Though coral snakebites are rare in the United States--only about 25 a year by some estimates--the snake's neurotoxic venom can be dangerous. A 1987 study in the Journal of the American Medical Association examined 39 victims of coral snakebites. There were no deaths, but several victims experienced respiratory paralysis, one of the hazards of neurotoxic venom.

Some nonpoisonous snakes, such as the scarlet king snake, mimic the bright red, yellow and black coloration of the coral snake. This potential for confusion underscores the importance of seeking care for any snakebite (unless positive identification of a nonpoisonous snake can be made).

The bites of both pit vipers and coral snakes can be effectively treated with antivenin. But other factors, such as time elapsed since being bitten and care taken before arriving at the hospital, also are critical.

First Aid for Snakebites

Over the years, snakebite victims have been exposed to all kinds of slicing, freezing and squeezing as stopgap measures before receiving medical care. Some of these approaches, like cutting into a bite and attempting to suck out the venom, have largely fallen out of favor.

"In the past five or 10 years, there's been a backing off in first aid from really invasive things like making incisions," says Arizona physician David Hardy, M.D., who studies snakebite epidemiology. "This is because we now know these things can do harm and we don't know if they really change the outcome."

Many health-care professionals embrace just a few basic first-aid techniques. According to the American Red Cross, these steps should be taken:

* Wash the bite with soap and water.

* Immobilize the bitten area and keep it lower than the heart.

* Get medical help.

"The main thing is to get to a hospital and don't delay," says Hardy. "Most bites don't occur in real isolated situations, so it is feasible to get prompt [medical care]." He describes cases in Arizona where people have caught rattlesnakes for sport and gotten bitten. "They waited until they couldn't stand the pain anymore and finally went to the hospital after the venom had been in there a few hours. But by then, they'd lost an opportunity for [effective treatment]," which increased the odds of long-term complications. Some medical professionals, along with the American Red Cross, cautiously recommend two other measures:

* If a victim is unable to reach medical care within 30 minutes, a bandage, wrapped two to four inches above the bite, may help slow venom. The bandage should not cut off blood flow from a vein or artery. A good rule of thumb is to make the band loose enough that a finger can slip under it.

* A suction device may be placed over the bite to help draw venom out of the wound without making cuts. Suction instruments often are included in commercial snakebite kits.

Treatment Drawbacks

Antivenins have been in use for decades and are the only effective treatment for some bites. "Antivenins have a fairly good safety record," according to Don Tankersley, former deputy director of the FDA's Division of Hematology. "There are sometimes reactions to them, even life-threatening reactions, but then you're treating a life-threatening situation. It's clearly a case of weighing the risks versus the benefits."

People previously treated with horse-derived antivenin for snakebites probably will develop a lifelong sensitivity to horse products. To identify these and other sensitive patients, hospitals typically obtain a record of the victim's experience with snakebites or horse products. But some people with no history of such exposures may have become sensitive through contact with horses, or possibly through exposure to horse dander, and be unaware that they are sensitive. Others may be sensitive without any known or remembered contact with horses. So hospitals also perform a skin test that may quickly show any sensitivity. However, the test also can give a false-positive or false-negative skin reaction. Some hypersensitive patients may even have severe reactions to the small amount of antivenin used in the skin test. Hospitals usually treat patients with serious allergic reactions by administering epinephrine. Some victims with positive skin tests can be desensitized by gradually administering small amounts of antivenin.

Certain venomous snakebites may be treated without using antivenin. This is usually a judgment call the doctor makes based on the snake's size and other factors, which normally involves close monitoring of patients in a medical facility.

"In some areas, such as desert areas, most rattlesnakes are small and don't have as potent a venom," says Hall. "You might get by with those patients in not using antivenin." But with other snakes, Hall says, antivenin can be a lifesaver. For example, the Eastern diamondback rattlesnake--found in large numbers in the region of Georgia where Hall practices medicine and in other Southern states from the Carolinas to Louisiana--can reach six feet in length and deliver a potent payload of venom. "It's an enormously dangerous bite that requires very aggressive treatment [with antivenin] or the patient will die," Hall says.

Treatment Dilemmas

Because not all snakebites, including those from the same species, are equally dangerous, doctors sometimes face a dilemma over whether or not to administer antivenin. Venomous snakes, even dangerous ones like the Eastern diamondback, don't always release venom when they bite. Other snakes may release too small an amount to pose a hazard.

Another complicating factor is the diverse potency of venom. "Venom can vary within species and even within litter mates--brothers and sisters," says Arizona physician Hardy. For example, he says, a common pit viper in the Southwest, the Mojave rattlesnake, may carry a powerful neurotoxic venom in some areas and a less toxic one in others.

Hall's work in Georgia and Florida shows that factors such as genetic differences among snakes, their age, nutritional status, and the time of year also can affect venom potency. All these variables make it nearly impossible for doctors to characterize a "typical" venomous snakebite. That's why there exists what Hall calls "so much controversy" about snakebite treatment.

The solution, Hall says, lies with the patient. "Truly the only way to look at snakebites is on an individual basis and on the patient's actual reaction to the venom." Basic signs like pain, swelling and bleeding, along with more complicated reactions such as ecchymosis (purple discoloration), necrosis (tissue dies and turns black), low blood pressure, and tingling of lips and tongue give medical professionals clues to the seriousness of bites and what treatment route they should take.

Some experts emphasize that, although antivenin can effectively reverse the effects of venom and save life and limb, there is no guarantee that it can reverse damage already done, such as tissue necrosis. Some patients may later require skin grafts or other treatment. Arizona physician Hardy says the potential for limiting complications is one compelling reason to seek medical treatment as soon as possible after a snakebite.

Avoiding Snakebites

Some bites, such as those inflicted when snakes are accidentally stepped on or encountered in wilderness settings, are nearly impossible to prevent. But experts say a few precautions can lower the risk of being bitten:

* Leave snakes alone. Many people are bitten because they try to kill a snake or get a closer look at it.

* Stay out of tall grass unless you wear thick leather boots, and remain on hiking paths as much as possible.

* Keep hands and feet out of areas you can't see. Don't pick up rocks or firewood unless you are out of a snake's striking distance. (A snake can strike half its length, Hardy says.)

* Be cautious and alert when climbing rocks.

What do you do if you encounter a snake when hiking or picnicking? Says Hardy: "Just walk around the snake, giving it a little berth--six feet is plenty. But leave it alone and don't try to catch it."

Though poisonous snakes can be dangerous, snake venom may have a positive side. Clinical trials reported in the February 2002 issue of the Journal of Evaluation in Clinical Practice indicate that a venom-derived product called ancrod could provide significant benefits in treating stroke. Earlier proposals using snake venom to treat neuromuscular disorders such as multiple sclerosis never reached the clinical trial stage.

John Henkel is a member of the FDA's Website Management Staff.

How NOT to Treat a Snakebite

Though US medical professionals may not agree on every aspect of what to do for snakebite first aid, they are nearly unanimous in their views of what not to do. Among their recommendations:

* No ice or any other type of cooling on the bite. Research has shown this to be potentially harmful.

* No tourniquets. This cuts blood flow completely and may result in loss of the affected limb.

* No electric shock. This method is under study and has yet to be proven effective. It could harm the victim.

* No incisions in the wound. Such measures have not been proven useful and may cause further injury.

--J.H.

Ticks



Tick bites: First aid

Some ticks transmit bacteria that cause illnesses such as Lyme disease or Rocky Mountain spotted fever. Your risk of contracting one of these diseases depends on what part of the United States you live in, how much time you spend in wooded areas and how well you protect yourself.

If you've received a tick bite:

* Remove the tick promptly and carefully. Use tweezers to grasp the tick near its head or mouth and pull gently to remove the whole tick without crushing it.

* If possible, seal the tick in a jar. Your doctor may want to see the tick if you develop signs or symptoms of illness after a tick bite.

* Use soap and water to wash your hands and the area around the tick bite after handling the tick.

* Call your doctor if you aren't able to completely remove the tick.

See your doctor if you develop:

* A rash

* A fever

* A stiff neck

* Muscle aches

* Joint pain and inflammation

* Swollen lymph nodes

* Flu-like symptoms

If possible, bring the tick with you to your doctor's appointment.

Call 911 or your local emergency number if you develop:

* A severe headache

* Difficulty breathing

* Paralysis

* Chest pain or heart palpitations



Ticks

Ticks Overview

Ticks are the leading carriers of diseases to humans in the United States, second only to mosquitoes worldwide. It is not the tick bite but the toxins or organisms in the tick's saliva transmitted through the bite that cause disease.

Ticks are arthropods, like spiders. There are more than 800 species of ticks throughout the world. They are responsible for carrying such diseases as Rocky Mountain spotted fever, Lyme disease , babesiosis (Texas fever), ehrlichiosis, and tularemia (also transmitted via rabbits), as well as Colorado tick fever and Powassan (a form of encephalitis).

In addition to disease transmission, ticks can also cause tick paralysis. This condition occurs when neurotoxins in the tick saliva make you ill; cause paralysis of the body; and in extreme cases, can stop you from breathing in extreme cases.

Two groups of ticks are important to humans because of the diseases they can transmit:

* Hard ticks have a tough back plate or scutum that defines their appearance. The hard ticks tend to attach and feed for hours to days. Disease transmission usually occurs near the end of a meal, as the tick becomes full of blood. Some of the more common hard ticks are these:

o American dog tick

o Wood tick

o Deer tick (they carry Lyme disease)

o Lone star tick

* Soft ticks have more rounded bodies and do not have the hard scutum found in hard ticks. These ticks usually feed for less than 1 hour. Disease transmission can occur in less than a minute. The bite of some of these ticks produces intensely painful reactions. Two common soft ticks found in the United States are the Pajaroello tick and spinose ear tick.

* Outbreaks of tick-related illnesses follow seasonal patterns as ticks evolve from larvae to adults. They hide in low brush to hitch a ride on a potential host. Ticks require a "blood meal" to grow and survive, and they are not very particular upon whom or what they feed. If these freeloaders don't find a host, they may die.

o Once a tick finds a host—such as you, your pet, a deer, a rabbit—and finds a suitable site for attachment, the tick begins to burrow with its mouthparts into exposed skin. Tick mouthparts are barbed, which helps to secure them to the host.

o Often the tick secrets "cementum" to more firmly anchor its mouthparts and head to the host. Ticks may secrete or regurgitate small amounts of saliva that contain neurotoxins. These nerve poisons cleverly prevent you from feeling the pain and irritation of the bite. You may never notice the tick feeding on you. The saliva may contain a blood thinner to make it easier for the tick to get its blood meal.

Ticks Symptoms

Tick bites are generally painless. You may not even notice the bite. And you may never find the tick if it falls off. Small ticks, like the deer tick that transmits Lyme disease, are so tiny they may be nearly undetectable. Some ticks are about as small as the period at the end of this sentence.

The actual bite may cause symptoms only after the tick drops off. You may notice local redness, itching, and burning—and, rarely, localized intense pain. The results of the illnesses transmitted by ticks often begin days to weeks after the tick is gone. That's why doctors may not suspect a tick-related illness.

You may have any of these symptoms:

* Feel as if you have the flu

* Fever

* Numbness

* Rash

* Confusion

* Weakness

* Pain and swelling in joints

* Palpitations

* Shortness of breath

* Nausea and vomiting

When to Seek Medical Care

* Call or see your doctor if any of these conditions exist:

o The person or child bitten exhibits any weakness, lethargy, confusion, fever, numbness, headache, or rashes.

o You are unable to remove the tick, or if significant amounts of the head and mouthparts remain after removal.

o You observe any worsening of symptoms.

o You are pregnant, and particularly before you take any medications.

* You should go immediately to a hospital's emergency department if a tick bite causes any of the following:

o Fever

o Headache

o Confusion

o Weakness

o Numbness

o Vomiting

o Difficulty breathing

o Palpitations

Exams and Tests

Doctors cannot test for the tick bite itself. But they can conduct a careful examination of your entire body looking for ticks that are still attached, rashes, or signs of a tick-caused disease.

* Blood tests for diseases such as Lyme disease, Rocky Mountain spotted fever, ehrlichiosis, and tularemia are generally not positive for weeks after the exposure—even though symptoms may be present.

* Examination of blood under a microscope is necessary to diagnose babesiosis.

Ticks Treatment

Self-Care at Home

Everyone has a favorite way to remove ticks. Some are better than others. The greatest concern in removing a tick is the possible transmission of disease. Methods of removal that stimulate the tick to spit out even small amounts of their blood meal, or to pass infected saliva back into the host, may increase the likelihood of disease transmission.

Two cautions

* Commonly used methods such as a hot matchhead touched to the hindparts of the tick, to covering or "painting" the tick with paint, nail polish, petroleum jelly, or gasoline may cause additional injury to the host (that's you or your pet) as well as stimulate the tick to spew out disease-causing germs.

* You should be concerned about removing the head and mouthparts. Because the tick is attached firmly to most hosts, rough or improper handling may result in portions of the head and mouthparts remaining embedded in the skin. This can be a site of infection and inflammation and might increase the likelihood of transmitting disease.

How to remove a tick

* Use a small pair of curved forceps or tweezers. If possible, wear some sort of hand protection such as gloves so you don't spread bacteria from the tick to your hands.

* Using the tweezers, carefully flip the tick over onto its back. Grasp the tick firmly with the tweezers as close to the skin as possible. Apply gentle pulling until the tick comes free. Twisting or turning the tick does not make removal easier because the mouthparts are barbed, not spiraled.

* Once removed, don't crush the tick because you may transmit disease. Rinse it down a sink or flush it down a toilet. Consider keeping it in a tightly closed jar or taped to a piece of paper. You may need to show the tick to the doctor if you become ill from the tick bite.

* The area of the bite should leave a small crater or indentation where the head and mouthparts were embedded. If significant portions of the head or mouthparts remain, they may need to be removed by a doctor.

* Thoroughly cleanse the bite area with soap and water or a mild disinfectant. Observe the area for several days for development of a reaction to the bite, such as a rash or signs of infection. Apply antibiotic cream to the area. Application of an antibiotic to the area may help prevent a local infection but does not affect the diseases transmitted by the tick.

* Remember to wash your hands thoroughly after handling any tick or instruments that touched a tick. Clean and disinfect any instruments that were used.

Medical Treatment

The treatment of a given tick exposure will depend on the length of attachment, the type of tick, the diseases that are seen in the community, and your symptoms.

* Local cleansing and antibiotic cream may be applied.

* For itching, the doctor may recommend preparations containing diphenhydramine (Benadryl). You can apply these directly to the skin for itching, or you may take tablets by mouth.

* Blood tests for Rocky Mountain spotted fever or Lyme disease may be done if there are significant symptoms. These tests are generally not recommended to screen people who do not have symptoms.

* Oral antibiotics may be prescribed for some diseases. With more significant symptoms, you may need antibiotics given through an IV and may need to be hospitalized.

* Other treatments may involve more detailed blood tests, fluids and medications given by IV, and admission to the hospital.

Next Steps

Prevention

* Avoid grassy areas and shrubs where ticks may be lying in wait to tag a ride on a potential "meal."

* Avoid tick season completely by staying away from outdoor areas where ticks thrive, usually during the months of May through September.

* Wear light-colored clothing so you can spot ticks easily and brush them off.

* Tuck your pants into your boots or socks.

* Apply insect repellant, specifically the brands designed to repel ticks. Follow label instructions. Avoid use of DEET-containing repellants on children. You may apply some repellants directly to your skin and others to clothing.

o DEET-containing repellants with concentrations of 15% or less may be suitable for children. These should be carefully applied strictly following label directions.

o Repellants containing permethrins may be applied to clothing but never to skin.

o In high tick areas, DEET-containing repellants may need to be reapplied more frequently than for repelling mosquitoes. Follow the package label.

* Promptly check yourself, others, and your pets if exposed to tick areas.

* Make sure to treat your pets with flea and tick repellants. If you remove ticks from your pets, try to manage them the same way you would remove a tick on a person. Protect yourself from the potential exposures with gloves.

* If you live in a tick-infested area, and if you've had a fever within the last 2 months, you should not donate blood.

* Taking antibiotics for the prevention of Lyme disease is very controversial and probably only useful in areas of the country where exposure to deer ticks would be high.

* An immunization shot against Lyme disease, LYMErix, is not currently widely recommended by the Centers for Disease Control and Prevention.

Outlook

Most tick bites are probably harmless and may cause no problems. Ticks that have never fed, if handled properly, will not cause any harm. The earlier a tick is removed, the less the likelihood that the tick transmitted any disease.

Synonyms and Keywords

ticks, tick removal, removing a tick, tick paralysis, Rocky Mountain spotted fever, Lyme disease, lime disease, babesiosis, Texas fever, ehrlichiosis, tularemia, Colorado tick fever, Powassan, American dog tick, wood tick, deer tick, Lone star tick, tick-related illness, tick bite

Authors and Editors

Author: Joseph A Salomone III, MD, Associate Professor, Department of Emergency Medicine, Truman Medical Center, University of Missouri at Kansas City School of Medicine.

Editors: Scott H Plantz, MD, FAAEM, Research Director, Assistant Professor, Department of Emergency Medicine, Mount Sinai School of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; James Ungar, MD, Medical Director, Chair Department of Emergency Medicine Santa Rosa Memorial Hospital.

Last Editorial Review: 8/10/2005

© 2008 WebMD, LLC.

All rights reserved.

eMedicineHealth does not provide medical advice, diagnosis or treatment. See Additional Information.

Burns



Burns: First aid

To distinguish a minor burn from a serious burn, the first step is to determine the degree and the extent of damage to body tissues. The three classifications of first-degree burn, second-degree burn and third-degree burn will help you determine emergency care:

First-degree burn

The least serious burns are those in which only the outer layer of skin is burned. The skin is usually red, with swelling and pain sometimes present. The outer layer of skin hasn't been burned through. Treat a first-degree burn as a minor burn unless it involves substantial portions of the hands, feet, face, groin or buttocks, or a major joint.

Second-degree burn

When the first layer of skin has been burned through and the second layer of skin (dermis) also is burned, the injury is called a second-degree burn. Blisters develop and the skin takes on an intensely reddened, splotchy appearance. Second-degree burns produce severe pain and swelling.

If the second-degree burn is no larger than 3 inches (7.5 centimeters) in diameter, treat it as a minor burn. If the burned area is larger or if the burn is on the hands, feet, face, groin or buttocks, or over a major joint, treat it as a major burn and get medical help immediately.

For minor burns, including first-degree burns and second-degree burns limited to an area no larger than 3 inches (7.5 centimeters) in diameter, take the following action:

* Cool the burn. Hold the burned area under cold running water for at least five minutes, or until the pain subsides. If this is impractical, immerse the burn in cold water or cool it with cold compresses. Cooling the burn reduces swelling by conducting heat away from the skin. Don't put ice on the burn.

* Cover the burn with a sterile gauze bandage. Don't use fluffy cotton, which may irritate the skin. Wrap the gauze loosely to avoid putting pressure on burned skin. Bandaging keeps air off the burned skin, reduces pain and protects blistered skin.

* Take an over-the-counter pain reliever. These include aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) or acetaminophen (Tylenol, others). Never give aspirin to children or teenagers.

Minor burns usually heal without further treatment. They may heal with pigment changes, meaning the healed area may be a different color from the surrounding skin. Watch for signs of infection, such as increased pain, redness, fever, swelling or oozing. If infection develops, seek medical help. Avoid re-injuring or tanning if the burns are less than a year old — doing so may cause more extensive pigmentation changes. Use sunscreen on the area for at least a year.

Caution

* Don't use ice. Putting ice directly on a burn can cause frostbite, further damaging your skin.

* Don't apply butter or ointments to the burn. This could prevent proper healing.

* Don't break blisters. Broken blisters are vulnerable to infection.

Third-degree burn

The most serious burns are painless, involve all layers of the skin and cause permanent tissue damage. Fat, muscle and even bone may be affected. Areas may be charred black or appear dry and white. Difficulty inhaling and exhaling, carbon monoxide poisoning, or other toxic effects may occur if smoke inhalation accompanies the burn.

For major burns, dial 911 or call for emergency medical assistance. Until an emergency unit arrives, follow these steps:

1. Don't remove burnt clothing. However, do make sure the victim is no longer in contact with smoldering materials or exposed to smoke or heat.

2. Don't immerse large severe burns in cold water. Doing so could cause shock.

3. Check for signs of circulation (breathing, coughing or movement). If there is no breathing or other sign of circulation, begin cardiopulmonary resuscitation (CPR).

4. Elevate the burned body part or parts. Raise above heart level, when possible.

5. Cover the area of the burn. Use a cool, moist, sterile bandage; clean, moist cloth; or moist towels.

Insect Bites and Stings



Insect bites and stings: First aid

Signs and symptoms of an insect bite result from the injection of venom or other substances into your skin. The venom triggers an allergic reaction. The severity of your reaction depends on your sensitivity to the insect venom or substance.

Most reactions to insect bites are mild, causing little more than an annoying itching or stinging sensation and mild swelling that disappear within a day or so. A delayed reaction may cause fever, hives, painful joints and swollen glands. You might experience both the immediate and the delayed reactions from the same insect bite or sting. Only a small percentage of people develop severe reactions (anaphylaxis) to insect venom. Signs and symptoms of a severe reaction include:

* Facial swelling

* Difficulty breathing

* Abdominal pain

* Shock

Bites from bees, wasps, hornets, yellow jackets and fire ants are typically the most troublesome. Bites from mosquitoes, ticks, biting flies and some spiders also can cause reactions, but these are generally milder.

For mild reactions

* Move to a safe area to avoid more stings.

* Scrape or brush off the stinger with a straight-edged object, such as a credit card or the back of a knife. Wash the affected area with soap and water. Don't try to pull out the stinger. Doing so may release more venom.

* Apply a cold pack or cloth filled with ice to reduce pain and swelling.

* Apply hydrocortisone cream (0.5 percent or 1 percent), calamine lotion or a baking soda paste — with a ratio of 3 teaspoons baking soda to 1 teaspoon water — to the bite or sting several times a day until your symptoms subside.

* Take an antihistamine containing diphenhydramine (Benadryl, Tylenol Severe Allergy) or chlorpheniramine maleate (Chlor-Trimeton, Actifed).

Allergic reactions may include mild nausea and intestinal cramps, diarrhea or swelling larger than 2 inches in diameter at the site. See your doctor promptly if you experience any of these signs and symptoms.

For severe reactions

Severe reactions may progress rapidly. Dial 911 or call for emergency medical assistance if the following signs or symptoms occur:

* Difficulty breathing

* Swelling of the lips or throat

* Faintness

* Dizziness

* Confusion

* Rapid heartbeat

* Hives

* Nausea, cramps and vomiting

Take these actions immediately while waiting with an affected person for medical help:

1. Check for special medications that the person might be carrying to treat an allergic attack, such as an auto-injector of epinephrine (for example, EpiPen). Administer the drug as directed — usually by pressing the auto-injector against the person's thigh and holding it in place for several seconds. Massage the injection site for 10 seconds to enhance absorption.

2. Have the person take an antihistamine pill if he or she is able to do so without choking, after administering epinephrine.

3. Have the person lie still on his or her back with feet higher than the head.

4. Loosen tight clothing and cover the person with a blanket. Don't give anything to drink.

5. Turn the person on his or her side to prevent choking, if there's vomiting or bleeding from the mouth.

6. Begin CPR, if there are no signs of circulation (breathing, coughing or movement).

If your doctor has prescribed an auto-injector of epinephrine, read the instructions before a problem develops and also have your household members read them.

Shock: First aid

Shock may result from trauma, heatstroke, allergic reactions, severe infection, poisoning or other causes. Various signs and symptoms appear in a person experiencing shock:

* The skin is cool and clammy. It may appear pale or gray.

* The pulse is weak and rapid. Breathing may be slow and shallow, or hyperventilation (rapid or deep breathing) may occur. Blood pressure is below normal.

* The eyes lack luster and may seem to stare. Sometimes the pupils are dilated.

* The person may be conscious or unconscious. If conscious, the person may feel faint or be very weak or confused. Shock sometimes causes a person to become overly excited and anxious.

If you suspect shock, even if the person seems normal after an injury:

* Dial 911 or call your local emergency number.

* Have the person lie down on his or her back with feet higher than the head. If raising the legs will cause pain or further injury, keep him or her flat. Keep the person still.

* Check for signs of circulation (breathing, coughing or movement). If absent, begin CPR.

* Keep the person warm and comfortable. Loosen belt(s) and tight clothing and cover the person with a blanket. Even if the person complains of thirst, give nothing by mouth.

* Turn the person on his or her side to prevent choking if the person vomits or bleeds from the mouth.

* Seek treatment for injuries, such as bleeding or broken bones.

Cardiopulmonary resuscitation (CPR): First aid

Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies, including heart attack or near drowning, in which someone's breathing or heartbeat has stopped.

Ideally, CPR involves two elements: chest compressions combined with mouth-to-mouth rescue breathing. (A complete description of how to do both follows farther down in this article.)

However, what you as a bystander actually should do in an emergency situation really depends on your knowledge and comfort level.

The bottom line is that it's far better to do something than to do nothing at all if you're fearful that your knowledge or abilities aren't 100 percent complete. Remember, the difference between your doing something and doing nothing could be someone's life.

Here's the latest advice from the American Heart Association:

* Untrained. If you're not trained in CPR, then provide hands-only CPR. That means uninterrupted chest presses of about two per second until paramedics arrive (described in more detail below). You don't need to try rescue breathing.

* Trained, and ready to go. If you're well trained, and confident in your ability, then you can opt for one of two approaches: 1. Alternate between 30 chest compressions and two rescue breaths, or 2. Just do chest compressions. (Details described below.)

* Trained, but rusty. If you've previously received CPR training, but you're not confident in your abilities, then it's fine to do just chest compressions.

The above advice applies only to adults needing CPR, not to children.

CPR can keep oxygenated blood flowing to the brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm.

When the heart stops, the absence of oxygenated blood can cause irreparable brain damage in only a few minutes. Death will occur within eight to 10 minutes. Time is critical when you're helping an unconscious person who isn't breathing.

To learn CPR properly, take an accredited first-aid training course, including CPR and how to use an automatic external defibrillator (AED).

Before you begin

Assess the situation before starting CPR:

* Is the person conscious or unconscious?

* If the person appears unconscious, tap or shake his or her shoulder and ask loudly, "Are you OK?"

* If the person doesn't respond and two people are available, one should call 911 or the local emergency number and one should begin CPR. If you are alone and have immediate access to a telephone, call 911 before beginning CPR — unless you think the person has become unresponsive because of suffocation (such as from drowning). In this special case, begin CPR for one minute and then call 911.

* If an AED is immediately available, deliver one shock if advised by the device, then begin CPR.

Remember the ABCs

Think ABC — Airway, Breathing and Circulation — to remember the steps explained below. Move quickly through Airway and Breathing to begin chest compressions to restore circulation.

AIRWAY: Clear the airway

1. Put the person on his or her back on a firm surface.

2. Kneel next to the person's neck and shoulders.

3. Open the person's airway using the head-tilt, chin-lift maneuver. Put your palm on the person's forehead and gently tilt the head back. Then with the other hand, gently lift the chin forward to open the airway.

4. Check for normal breathing, taking no more than five or 10 seconds: Look for chest motion, listen for breath sounds, and feel for the person's breath on your cheek and ear. Gasping is not considered to be normal breathing. If the person isn't breathing normally and you are trained in CPR, begin mouth-to-mouth breathing. If you believe the person is unconscious from a heart attack and you haven't been trained in emergency procedures, skip mouth-to-mouth rescue breathing and proceed directly to chest compressions to restore circulation.

BREATHING: Breathe for the person

Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the mouth is seriously injured or can't be opened.

1. With the airway open (using the head-tilt, chin-lift maneuver) pinch the nostrils shut for mouth-to-mouth breathing and cover the person's mouth with yours, making a seal.

2. Prepare to give two rescue breaths. Give the first rescue breath — lasting one second — and watch to see if the chest rises. If it does rise, give the second breath. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and then give the second breath.

3. Begin chest compressions to restore circulation.

CIRCULATION: Restore blood circulation with chest compressions

1. Place the heel of one hand over the center of the person's chest, between the nipples. Place your other hand on top of the first hand. Keep your elbows straight and position your shoulders directly above your hands.

2. Use your upper body weight (not just your arms) as you push straight down on (compress) the chest 2 inches (approximately 5 centimeters). Push hard and push fast — give two compressions per second, or about 120 compressions per minute.

3. After 30 compressions, tilt the head back and lift the chin up to open the airway. Prepare to give two rescue breaths. Pinch the nose shut and breathe into the mouth for one second. If the chest rises, give a second rescue breath. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and then give the second rescue breath. That's one cycle. If someone else is available, ask that person to give two breaths after you do 30 compressions.

4. If the person has not begun moving after five cycles (about two minutes) and an automatic external defibrillator (AED) is available, apply it and follow the prompts. The American Heart Association recommends administering one shock, then resuming CPR — starting with chest compressions — for two more minutes before administering a second shock. If you're not trained to use an AED, a 911 operator may be able to guide you in its use. Trained staff at many public places are also able to provide and use an AED. Use pediatric pads, if available, for children ages 1 to 8. Do not use an AED for infants younger than age 1. If an AED isn't available, go to No. 5 below.

5. Continue CPR until there are signs of movement or until emergency medical personnel take over.

To perform CPR on a child

The procedure for giving CPR to a child age 1 through 8 is essentially the same as that for an adult. The differences are as follows:

* If you're alone, perform five cycles of compressions and breaths on the child — this should take about two minutes — before calling 911 or your local emergency number or using an AED.

* Use only one hand to perform heart compressions.

* Breathe more gently.

* Use the same compression-breath rate as is used for adults: 30 compressions followed by two breaths. This is one cycle. Following the two breaths, immediately begin the next cycle of compressions and breaths.

* After five cycles (about two minutes) of CPR, if there is no response and an AED is available, apply it and follow the prompts. Use pediatric pads if available. If pediatric pads aren't available, use adult pads.

Continue until the child moves or help arrives.

To perform CPR on a baby

Most cardiac arrests in infants occur from lack of oxygen, such as from drowning or choking. If you know the infant has an airway obstruction, perform first aid for choking. If you don't know why the infant isn't breathing, perform CPR.

To begin, assess the situation. Stroke the baby and watch for a response, such as movement, but don't shake the child.

If there's no response, follow the ABC procedures below and time the call for help as follows:

* If you're the only rescuer and CPR is needed, do CPR for two minutes — about five cycles — before calling 911 or your local emergency number.

* If another person is available, have that person call for help immediately while you attend to the baby.

AIRWAY: Clear the airway

1. Place the baby on his or her back on a firm, flat surface, such as a table. The floor or ground also will do.

2. Gently tip the head back by lifting the chin with one hand and pushing down on the forehead with the other hand.

3. In no more than 10 seconds, put your ear near the baby's mouth and check for breathing: Look for chest motion, listen for breath sounds, and feel for breath on your cheek and ear.

If the infant isn't breathing, begin mouth-to-mouth breathing immediately.

BREATHING: Breathe for the infant

1. Cover the baby's mouth and nose with your mouth.

2. Prepare to give two rescue breaths. Use the strength of your cheeks to deliver gentle puffs of air (instead of deep breaths from your lungs) to slowly breathe into the baby's mouth one time, taking one second for the breath. Watch to see if the baby's chest rises. If it does, give a second rescue breath. If the chest does not rise, repeat the head-tilt, chin-lift maneuver and then give the second breath.

3. If the chest still doesn't rise, examine the mouth to make sure no foreign material is inside. If the object is seen, sweep it out with your finger. If the airway seems blocked, perform first aid for a choking infant.

4. Begin chest compressions to restore circulation.

CIRCULATION: Restore blood circulation

1. Imagine a horizontal line drawn between the baby's nipples. Place two fingers of one hand just below this line, in the center of the chest.

2. Gently compress the chest to about one-third to one-half the depth of the chest.

3. Count aloud as you pump in a fairly rapid rhythm. You should pump at a rate of about 100 to 120 pumps a minute.

4. Give two breaths after every 30 chest compressions.

5. Perform CPR for about two minutes before calling for help unless someone else can make the call while you attend to the baby.

6. Continue CPR until you see signs of life or until a professional relieves you.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download