UNIT 2 BITES & STINGS modified version DNE 1.pdf

At the end of the unit, the student will be able to:  Define the terms bites and stings  Identifythe types of bites and stings and effects on the body  Outline principles of first aid management for common bites, scratches and stings  Give effective first aid management to casu...

At the end of the unit, the student will be able to:  Define the terms bites and stings  Identifythe types of bites and stings and effects on the body  Outline principles of first aid management for common bites, scratches and stings  Give effective first aid management to casualties with bites and stings  Bites - lacerations or puncture wounds caused by teeth of an animal or human.  Human bites - third most common type of mammalian bite after dog and cat bites, accounting for ~ 3% of all reported bites (Buckley, Cabrera, & Pravikoff, 2014).  Bites from sharp pointed teeth cause deep puncture wounds that can damage/crush the tissue and introduce germs.  Any bite that breaks the skin needs prompt first aid as there is a risk of infection.  Animal bites can cause rabies and tetanus.  There is a small risk of hepatitis virus/HIV from a human bite  assess whether the bite has broken the skin Document:  Who was bitten & by whom  Timing and nature of the bite  Known immunosuppression  Known antibacterial allergies. A casualty’s reaction to bites and stings depends on:  The type and location of the bite or sting.  The amount of poison injected.  The time elapsed since the poisoning.  The victim’s age, size, weight and medical condition  Dog  Bees  Human  Wasp  Mosquito  Scorpion  Snake  Jelly fish  Sea eggs Sunday, September 222, 2019. http://www.jamaicaobserver.com/news/pit-bull- attack-on-teacher-saddens- jta_175392?profile=1373  Domestic animal bites usually cause an infected wound.  Medical care is recommended, and antibiotics and a prophylactic tetanus injection given. A dog’s bite may cause puncture (front teeth) and laceration (irregular / jagged) by the other teeth. Abrasion close to site from paws. Common Dog Bite sites  Children: Face and neck area, (especially the lips, nose and cheek).  Adults: hands, arms, legs and feet Effects of dog bites:  Blood poisoning (sepsis)  Meningitis (infection of the outer layers of the brain)  Endocarditis (infection of the inner lining of the heart).  Rabies & tetanus  Disfigurement.  The dog bite injury should be documented with photographs and diagrams when appropriate.  Signs of a serious secondary infection include hyperthermia of or above 38°C (100.4°F) or feeling unwell. Human saliva has been found to contain at least 42 different kinds of species of bacteria. streptococcus pyogenes is often discovered in human bites  Human bites that break the skin, must be treated like all puncture wounds.  If wound is deep, control bleeding  Carries high risk of infection.  Possible risk of injury to tendons and joints.  Casualty may need admission, antibiotics intravenously and some cases surgery. Management:  Control any bleeding  If the wound is bleeding apply a firm pad.  Clean minor wound thoroughly with soap and warm water or a saline solution.  Raise and support wound  Apply a protective dressing and  seek medical care. Complications of human bite wounds includes:  Haemorrhage  Infections  Osteomyelitis and tenosynovitis  Disfigurement  Associated risk of amputation  Psychological trauma.  Mosquito bites (increases during rainfall, summer). Female mosquitoes proboscis ( mouth part) pierce skin and siphon off blood.  Mosquitoes can act as reservoirs of diseases such as Chikungunya, Zika virus, West Nile virus, Malaria, Yellow fever and Dengue fever. Reactions includes:  local skin inflammation - rash (red, raised and very itchy).  Pain - headache, joint pain, muscle pain  Fever, or conjunctivitis (red eyes). Most mosquito bites usually -  Stop itching and heal on their own without medical treatment.  Topical treatments - hydrocortisone cream or calamine lotion. A cold pack.  Seekmedical care if: there is fever, headache and or body ache.  Thepopularity of owning exotic snake species has increased the number of snakebites by non-native species.  Sevennon-venomous species of snakes - indigenous to Jamaica.  Six species are endemic species.  The Jamaican Boa (Epicrates subflavus) (a.k.a. Yellow Snake/ Nanka) is the largest of the seven species(6 ½ feet in length).  nonvenomous snake bites can cause infection or allergic reactions.  Sea snakes, cobras, and kraits are among the most venomous (i.e., poisonous) snakes in the world. Aim  To prevent venom spreading  To arrange urgent removal to hospital.  Medical personnel are not in general agreement about care for snakebites.  Most deaths from snakebites occur because—  The victim has an allergic reaction.  The victim is in poor health.  Too much time passes before the victim receives medical care.  Signals that indicate a poisonous snakebite include  One or two distinct puncture wounds.  Severe pain and burning at the wound site.  Swelling and discoloration (redness) at the wound site.  Labored breathing  “Do it R.I.G.H.T.” R. Reassure the patient I. Immobilize in the same way as a fractured limb. Use bandages or cloth to hold the splints in place, do not to block the blood supply or apply pressure. II. Do not apply tourniquets. G.H. Get to Hospital Immediately. T. Give history of any systemic symptoms (ptosis).  Follow DRSABCD  Rest and reassure the patient.  Apply a broad pressure bandage.  Preferably crepe over the bite site as soon as possible.  Apply tightly without stopping blood supply to the limb.  Splint the bandaged limb.  Ensure the patient does not move.  Write down the time of the bite and when the bandage was applied  Stay with the patient  Check circulation in fingers or toes. AVOID!  Applying ice or  Tourniquets  Using incision/cut area to remove venom  Or suction (these interventions often lead to increased tissue injury and the need for surgical intervention).  Hymenoptera is an order of insects - includes bees, vespids (e.g., wasps, yellow jackets, hornets), and ants.  have hollow stingers - use to inject venom.  Each species’ venom has its own neurotoxin.  Hymenopterans sting repeatedly, exception of the domestic honeybee.  Bees have only one stinging barb that is left in the skin following the incident.  The venom sac is attached to the barb and continues to inject venom until it is empty.  For this reason the barb should be removed as soon as possible  Casualties with h/o allergic reaction to bee venom may collapse within 2 or 3 minutes after a sting, requiring resuscitation and urgent medical treatment. Removing the barb/ sting  Remove the barb by brushing or scrape with card or finger nail (No tweezers – do not want to squeeze the sting or inject more poison).  Raise the affected area  Apply a wrapped ice pack/cold compress and leave it in place for up to 10 minutes.  To minimize swelling  Reapply the ice pack at frequent intervals or whenever pain relief is needed.  Elevate the injured area.  For Pruritus: give antihistamine eg DPH. Monitor casualty for warning signs these include: ↓ level of response  breathing (wheezing or coughing)  fine rash over the trunk, allergic reaction  Oedema around the face, eyes and neck. NB! If present, get medical aid/care.  Scorpions are arachnids, a class of arthropod.  Inject venom with their bites or stings and some carry disease. Venom can invade tissues or cause an allergic reaction  venomis stored in vesicles, a pair of bulb- shaped glands located at the end of its tail  In Jamaica scorpions are found in areas such as cane pieces, old derelict buildings stone heaps, etc.  It is hard to distinguish poisonous scorpions from the non-poisonous scorpions.  All scorpion stings should be treated as medical emergencies. Signs and symptoms  Pain, redness and edema at site of sting.  Nausea and vomiting  Headache. NB! Worse case – Anaphylactic shock Aims  To relieve pain and swelling  To arrange removal to hospital if necessary Management  Reassure the casualty and help him to sit or lie down.  Raise the affected area  Wash the affected area with cool water and a mild soap  Place cold compress on affected area (at least 10mins).  Monitor level of response, breathing ( wheezing) and pulse.  Sea creatures can cause various injuries.  Jellyfish, Portuguese man-of-war, corals and sea anemones can cause stings.  Their venom is contained in stinging cells (nematocysts) that stick to the victim’s skin, and this is released when the cell ruptures.  BoxJellyfish, can be recognized by its somewhat cubic shape, rather than domed.  They also can move quite fast, as much as 5 mph, rather than just floating along as most jellies do. Common signs and symptoms include:  Immediate burning pain  Red, brown or purplish tracks on the skin.  Itching  Tingling and numbness  Throbbing pain that may radiate up a leg or arm to the torso. Signs and symptoms of severe jellyfish stings can include:  Nausea & Vomiting  Fever  Painful joints  Headache  Loss of consciousness  Muscle spasms  Difficulty breathing  Weakness  Irregular heartbeat  Trouble controlling  Sudden loss of heart muscle movement function (cardiac  Dizziness arrest) First aid management  To remove the tentacle, use gloves, thick clothing, tweezers, sticks, or the like to very gently detach it from the person being stung.  Discard after use to avoid accidentally stinging yourself later.  Forjellyfish stings—  Soak the injured part in vinegar or sea water to incapacitate the stinging cells  Do not rub the area.  Immobilize the injured part.  Take the patient to hospital.  Some tropical species can cause severe poisoning and death Complications  Hypersensitivity — an allergy-like reaction to the venom — that may produce blisters, rash or other skin irritations a week or more after the jellyfish sting. Rare complications jellyfish stings can cause:  Infection Scarring  Anaphylaxis (immediate cardiopulmonary resuscitation (CPR)).  Sea urchins belong to the group - echinoderms.  Usually live-in warm waters on the rocky bottom or close to the coral reefs.  The spines and the poisonous pedicellariaes, both need to be dealt with.  Spines: A sea urchin’s spines can inject painful venom.  Pedicellarines: (the poisonous clasping mechanisms hidden between some urchin’s spines) can be removed by shaving the area with shaving cream and a razor.  The spines of sea urchins may puncture the skin, if trodden on, and become embedded.  Symptoms of sea urchin injuries are the following: Common  Puncture  Bleeding  Swelling and redness surrounding the punctured wound  Severe pain  infection  Symptoms of sea urchin injuries are the following:  In severe cases (multiple deep puncture):  Fatigue  Weakness and tiredness  Severe muscle spasms or muscle aches  Faintness - Paralysis  Shock - Chest pain  Breathing difficulties - Respiratory failure, which may lead to death Treatment  Help the casualty immerse the injured part in water as hot as he can tolerate for about 30 minutes.  Take casualty to hospital to have the spines removed. Basaran, S., Ozkan, C., Coskun-Benlidayi, I., & Kozanoglu, E. (2009). Management of a case of human bite complicated by myonecrosis and compartment syndrome. Journal of the national medical association. 101,( 3), 266-269. Brook, I. (2005). Management of human and animal bite wounds: an overview. Advance Skin Wound Care. 18(4):197-203. Buckley, L., Cabrera, G., & Pravikoff, D, (2014). Bites: Human. CINAHL Nursing Guide. Caroline, N. L., MacDonald, R. D., Burgess, R. J., American Academy of Orthopaedic Surgeons., & Paramedic Association of Canada. (2010). Nancy Caroline's emergency care in the streets. Sudbury, Mass: Jones and Bartlett. First Aid CPR Ottawa. (2013). Treating and Managing Sea Urchin Injuries. http://firstaidcprottawa.ca/treating managing-sea- urchin-injuries/ First Aid Manual(2016) St. John’s Ambulance; St. Andrew’s First Aid; The British Red Cross Society 10th Edition. Darling Kindersley Ltd. Pinto, S., Schub, T., & Pravikoff, D. (2014). Snakebites. CINAHL Nursing Guide. Richards, S., Cabrera, G.,& Pravikoff, D. (2013). Stings: Hymenoptera (bees, vespids, and fire ants). CINAHL Nursing Guide. Roberts, J.R., & Hedges, J.R., (2004). Management of rectal foreign bodies. Clinical Procedures in Emergency Medicine. (4th ed.). Philadelphia, PA: WB Saunders Company. Rodríguez-Hermosa, J.I., Codina-Cazador, A., Ruiz, B., Sirvent, J.M., Roig, J., & Farrés, R. (2007). Management of foreign bodies in the rectum. Colorectal Dis. 9, (6):543-548