11-11 First Aid : INSECT AND ANIMAL BITESInsects and animals are part of our lives in villages. As healthworkers we will often come across people who will seek our helpfor insect and animal bites. While people could even die fromsome bites, most cause only pain and irritation, but are seriousenough to need our help. Here, we will learn to deal with some common bites: 1. Bee bites/insect/wasp bites 2. Snake bites 3. Scorpion bites 4. Dog bites 5. Poisonous plants/mushrooms
11-12 Insect BitesLet us start with insect bites. Mosquitoes are the most common insectsthat bite humans. But these bites can be said to be of low importancesince the bites usually cause no more than pain at the time of bitingand later on, some itching. We need not treat the bite itself as it is notdangerous though it can cause troublesome diseases like malaria &filaria later. But bites of some insects will need looking into. 1. Bee Bites Bees are usually not What to do when bees bite? known to bite on their own unless their hive is dis- Bees usually leave behind their stingturbed. When they bite, they tend along with the poison gland. Do not try to pullto cause severe swelling locally, a the sting out as it may squeeze the poison outsense of tightness in the bitten part into the person. Instead, get the sting out byand considerable pain that lasts scraping the area with the blunt end of a knife orfrom a few hours to a few days! any other flat metal.Some people who are allergic to beebites may even develop severe Apply Baking soda (also called sodium orreactions like massive swelling of soda bicarbonate) used for cooking purposes at thethe face and neck, difficulty in Bee bite. If Soda is not easily available, washing thebreathing and even area with soda water may also help. This helps tounconsciousness. Such allergy may quickly reduce the swelling and the pain. Repeatlead to death. after a few hours if necessary. Wasps Wasps are known to bite even when not troubled, but this is rare. Yellow or black in colour, wasps move much slowly. They make nests with caked mud in shaded corners of houses, roofs, letterboxes, etc. Their sting also may be removed with the blunt side of a knife or key. A wasp bite may also lead to local pain and swelling. Unlike a bee bite, pain and swelling from a wasp bite comes down rapidly when vinegar or acetic acid is applied at the site of bite. Remember: B(icarbonate) for Bee and V(inegar) for V(W)asp bite! Other Insect BitesInsects like mosquitoes and flies and mites, ticks, etc., may also bite andcause swelling and itching. When we scratch it could cause infection.Try not to scratch with bare nails. Applying some coconut oil or wet mudmay help reduce itching. CHLORPHENIRAMINE helps in rare cases wherethe itching and swelling are beyond tolerance.
11-13 Snake bitesOnly one out of twenty snakebites belong to poisonous snakes. There are only fourvarieties of snakes that are poisonous. Of all poisonous snakebites, only half of the biteshave enough poison injected that may be dangerous to life. So, never get scared ofsnake bites - there are more chances of surviving than of dying by snakebites.Poisonous Or Non-Poisonous Snake Bite? 1. Check the Teeth Marks : One can make out a poisonous snake from a non-poisonous snake from the “teeth” (called fangs) ) marks where the snake has bitten. A poisonous snake’s fang marks have only one or two puncture sites while the other shows many teeth punctures in the shape of its jaw. 2. Checking the Skin of the Snake : In case the snake has been killed, there is another way to make out whether the snake is poisonous or not. You will have to carefully turn the dead snake on its belly, but make sure it is dead – snakes’ jaws may bite up to half an hour after they are dead. Poisonous snakes have a broad band running across the width of its belly. NOTE : Nowadays, we do have good injections that can take away the poison of a poisonous snakebite. However, they may be costly. Also, they may lead to serious reactions. So, unless we are sure that the bite is poisonous one should not just give the injections.Learn To Make Out The Signs Of ABite Types Of Poisonous SnakesA person can die immediately if the snake hasbitten directly into the vein. But such occa-sions are rare. Usually there is pain in the areabitten and this pain increases and spreads toother areas. But it is not only poison but alsofear which creates problems. Viper BandedWe see many people who even without poi-son may have problems. They show breath- Kraitlessness, tight feeling in chest, palpitation andflushing of face. Nausea and vomiting arevery common signs of bites from poisonoussnakes. Apart from these, just by the signs Cobrashown we can make out the variety of snakethat has bitten the person. These are explainedbelow.1. Cobra group (including Kraits) 2. Viper group (snakes that give birth toLocal swelling, pain young ones and do not give eggs).Initial Signs : Vomiting, heaviness of eye- Swelling of bitten part; pain increasing in arealids, blurred sight, tingling around mouth. and intensity; bleeding under skin.Later Signs : Closing of eyelids, inability to Later bleeding from fang site, gums, nose andspeak and to swallow, inability to move chest and ears, with vomiting and shitting. Last, inabilitybreathe. to sit up, giddiness and weak pulse and low BP.The first symptoms of cobra group’s bite like If no swelling within two hours, probably nodrooping eyes, etc. usually start within 15 min- poison has entered. Bleeding and other problemsutes of bite – latest by 10 hours. may take 3 to 5 days to start.3. Sea snakes (found only in sea water) 4. River snakesHeadache, feeling of “thick tongue,” thirst, They are non-poisonous. But poisonous snakessweating and vomiting are immediate. Later, may be washed out in floods and heavy rainswithin half to three hours muscle stiffness, pain and their bites can be dangerous.in muscles and later bleeding with urine, no urineas kidney fails.
11-14 First aid for snakebite Bandaging A Snake Bite 1. Reassure patient that most snakebites are non poisonous and many non poi- sonous snakes also look like poisonous snakes. 2. RUSH TO A DOCTOR IN A HOSPITAL quickly, comfortably and passively — the leg or hand with the bite should not exercise. Preferably splint it or put it in a sling. 3. DO NOT cut the area – usually it does more harm than good most often. 4. DO NOT tie a string or tourniquet – usu- ally it gets too tight and damages the leg or arm permanently. 5. DO NOT go after the snake to kill it. If killed already, try to carry it to the hos- pital but do not handle it – dead heads of snakes also cause bites! 6. For pain, give PARACETAMOL and not Wrap a firm (but not tight) bandage. It Aspirin. should start from the bite area and then wrap around the leg (or arm) above the next joint to cover the leg or arm. ThisAnti-Venin Serum (against snake poison) in- helps in delaying the poison from gettingjections are costly. Each injection that can into the body altogether and helps thedestroy the poison of most Indian snakes costs liver in destroying the poison safely. Ifabout Rs 200 and 10 such injections may be this is not done within the first hour orrequired to start treatment. Collect enough so, there is no need to try it, as the poison must have already spread in the body.money with the patient.Scorpion BitesUsually, most scorpions do no more than cause severe pain in the area of bite. Reassuranceand PARACETAMOL are about all that is required. If sleep isaffected for more than a night, a doctor may be contacted togive an injection in the area of bite that can remove the sensa-tion from the area.Only one species of scorpion in India is known to be poisonousenough to cause death, but it is rare and found only in someareas. This usually kills by affecting the heart. After any scor-pion bite, it may be good idea to feel the pulse every hour or soto avoid chances of poisoning. If too slow (below 55 per minute)or too fast (above 90 per minute or so), such a person having scorpion bite may be rushed toa doctor in hospital.
11-15 Dog bitesDog bites are considered dangerous. Though uncommon, they can leadto Rabies, a disease that has almost no chance of surviving anywhere inthe world. We have no treatment for it. This makes people fear dog bites.If a dog has Rabies or gets Rabies within 10 days of a bite, it must betaken seriously. Management and first aid as below should be followed.If one is not sure about the dog whether it is immunised against Rabies ornot, it must be presumed to be having Rabies unless proved otherwise.If the dog can be watched for 10 days and if the dog does not developRabies, there is no need for Anti Rabies injections. First Aid in such cases is enough treatment. How To Know If The Dog Has Rabies? What Happens ToOut of all dogs having rabies, only 1 out of A Person With Rabies ?4 will actually behave “madly” – run Starting within 3 weeks to 3 months, the per-around, bark, bite etc. son getting Rabies after a dogbite feels itch- ing, pain and tingling at the site of the dogA rabid dog has difficulty in swallowing, bite. Later, the person may get headache, ir-barking, eating and its eyelids may droop. ritability and inability to look at light. StillA bark different from their normal bark and later, the person may not be able to drinkparalysis of the jaw, neck and back legs are water or to tolerate cold wind. Even thehow we can spot a dog with Rabies. Lots of thought of drinking water may produce fitssaliva, red eyes, itching, shivering, trembling, or convulsions.snapping at imaginary objects and alteredtaste of the dog, and extreme restlessness In some people, “Dumb” Rabies may de-(causing the animal to wander miles from velop. Such persons may get fever, headachehome ) all are signs of Rabies in dogs. Dogs and tingling. Later a ‘limp’ paralysis may bewith furious rabies attack lifeless objects, of- seen gradually increasing in affected areaten seriously injuring their mouths in the until the patient dies.process. What To Do For Rabies? Once Rabies starts, we have NO treatment. To perevent the virus from en- tering the brain and developing rabies, we must group the bites differently as each has to be dealt with differently. As first aid, wash wound at the earliest with soap /detergent and water under a tap or stream of water for at least five minutes. Leave the bite wound open. DO NOT COVER IT. Type Type of bite Old vaccine New vaccine (Rs.300/- per injection) Type I Licks on skin that may For 10 days On 0, 3, 7, 14, 30 and 90 days be scratched Type II Less than five bites – not For 14 days As above on face or hands Type III More than five bites For 14 days* For six days as above* anywhere; even a single bite on face * Add Rabies I-globulin for this type of bites. Treat at hospital. NOTE: 1. The old vaccine MUST be available at each Block PHC. It may be more trouble in taking but the poor can afford it. 2. If the dog remains alive, later treatment against Rabies may be stopped.
11-16 Plants with poisonsMushroomMushroom is the commonest plant leading to poisoning. Although usually people know whichmushrooms to eat or not to eat, the same mushroom may become poisonous at a different placeor in a different season. The commonly cultivated mushroom also rarely may lead to poisoningespecially if it is old, damaged, raw or not cooked properly.What Happens If We Eat Poisonous Mushrooms?Cases of mushroom poisoning can be grouped into those:1. Develop signs of poisoning within 2 hours(a)mainly nausea, vomiting, diarrhoea and pain in abdomen.(b)sweating, giddiness(c)irrelevant talk in half – sleep.(d)deep sleep(d)fearful imagination(e)as if person has taken lots of alcohol.2. Develop signs of poisoning after 6 hours or up to several days(a)severe vomiting and diarrhoea(b)less or no urine.(c)abdominal discomfort, severe headacheThe common thing to happen is that our digestion gets upset. Within 2 hours, we may getvomiting and diarrhoea. This may remove most of the poison so that most patients require littleor no treatment.But at times, serious conditions (especially liver and kidney failure) follow apparent recoveryfrom gastrointestinal symptoms. They start 6 to 24 hours after eating the mushroom or may occurafter a problem free period of several days’ duration. In case such serious signs are present after aperson has eaten mushrooms, rush the person to a doctor.Rarely, allergic reactions may also develop. After taking a mushroom for years, a person may getsevere allergy in which the body reacts to the mushroom abnormally and causes the blood tobreak down. Also, blisters and rash on the skin may appear after taking mushrooms due to al-lergy.First Aid for Mushroom Poisoning Poisonous Plants Commonly, giving warm water with a lot of salt may help in getting the per- Poison ivy and some other leaves son to vomit out the poisonous mush- when touched may cause redness, rooms. itching and pain in the area around the place of contact. Applying a paste If the person has diarrhoea, of mud on the affected part helps to help in cleaning the system by soothe. giving lots of water and fluids. If allergy of skin is seen, give CHLORPHENIRAMINE along CHLORPHENIRAMINE. with IBUPROFEN or PARACETAMOL may If symptoms of poisoning as given be given to decrease pain above appear, send for a doctor. and swelling.
11-18 FIRST AID : UNCONSCIOUSNESSFalling unconscious is a very scary thing for most of us. It remains on our minds for a long time.As health workers, we will often be called to do something when someone falls unconscious.Worse, unconsciousness may be due to such a cause that can soon lead to death. So, we may beable to save a life simply by knowing more and being able to give first aid. Steps In Helping A Why A Person Person Gain Could Fall Unconscious ? Consciousness · Drunkenness: If drunk, one can await for the effect of drinks to finish. If thereFIRST STEP: Lay the person flat is no attendant, place the person in RE-on the ground or a hard bed if pos- COVERY position.sible. Do take the person to a · Fainting from fright, weakness, badshaded place. Raise the legs by news, etc: Person would normally re-putting a folded blanket or a pil- cover if the steps ONE and TWO havelow (if person has head injury, DO been taken.NOT raise legs). DO NOT try to · Shock: If the skin is moist and pale withlift up the patient’s head. DO NOT a weak fast pulse , this is shock. Lookkeep a pillow under the head. En- for the cause – like excessive vomiting /sure that there is no hard or sharp diarrhoea/ burns/bleeding or diabetes,thing near the patient’s body so etc and treat accordingly.that she may not get injured in · Poisoning: If any history of poisoning,case of fits/convulsions. send to the hospital. · Excessive heat – heat stroke: If noSECOND STEP: Loosen any tight sweat, high fever and red skin, the per-clothes, pant belt/buckle or py- son has heat stroke. Put into the shade,jama string. DO NOT allow any pour cold water and fan the person.crowd to gather around the pa- · Brain stroke: If the person was knowntients and let fresh air to circulate. to have high blood pressure, or is oldIf possible, fan the patient. DO aged and suddenly lost consciousness,NOT ALLOW ANYTHING BY it is likely to be a brain stroke. RUSHMOUTH UNTIL PERSON RE- TO A HOSPITAL after ensuring thatGAINS CONSCIOUSNESS. the person is lying down. · Heart Attack: A middle aged or eld-THIRD STEP: Check the person’s erly person who complains ofpulse. If no pulse is felt at the Checking - heaviness or pain in the chestwrist, try to feel in the neck. If stillnot found, start HEART MAS- the Pulse that may go down the left arm, - has cold sweat and a feeling ofSAGE as described in box. uneasiness These are the signs of a heart attack. IfFOURTH STEP: Check if the per- the person falls unconscious followingson is breathing on her own. If not, a heart attack, it should be tackled urstart ARTIFICIAL BREATHING gentlyby a heart specialist. But evenas described in next page. before sending to the doctor, check the heart beat orpulse. If needed, carryFIFTH STEP: If the person has a out a heart massage as given later.pulse and is breathing but is stillunconscious, look for the causes · Fits/epilepsy: Fits are common. A per-and treat accordingly. son may become unconscious after an attack of fits. There is little to do butSIXTH STEP: If person does not allow the person to gradually wake outcome back to consciousness of this ‘sleep’ that follows fits. If the per-within five or ten minutes of car- son is still having fits, try to keep therying out the above steps, SEND person away from injury and place theFOR A DOCTOR or ask the rela- person on the ground to avoid a fall. Iftives to get ready to take the per- an Injection of DIAZEPAM is around,son to a hospital. use it.
11-19 RECOVERY POSITIONRecovery position is called by this name because it does not allow an unconscious person to drownin her own secretions / vomit. 1 Lay out the person RECOVERY POSITION straight on the head tilted ground and place the well back bent leg presses on the right arm at right an- body and stops person gles to her body, el- from rolling forward bow bent and with the palm uppermost. 2. Bring the left arm across the chest and hand hold the palm against supporting head the patient’s cheek. Now roll her body to- wards the right.3. Pull the knee of the left leg up to rest it on the ground so that the hip and the knee both arebent at right angles. Tilt the head back to make sure the airway is clear.4. This is the recovery position and is shown in the picture. It allows an unconscious person to besafe while being transported to safety or to a hospital without a trained attendant.ARTIFICAL BREATHING – MOUTH TO MOUTHA person could die in 4 minutes if she does not breatheIf the person is not breathing on her own and has turned bluewithout oxygen, you may use the following procedure. 1. Clean the inside of the mouth with your finger. Pull tongue forwards and clear anything in the throat. Open the buttons of the person’s shirt or blouse so that the move- ment can be seen clearly. Artificial Breathing 2. Tilt the person’s head back and pull the chin forward so that the mouth and the chest are in a straight line. 3. Pinch the patient’s nose and bring your mouth over the patient’s mouth. Breathe hard enough to see the chest of the patient expand. (Note : For a small baby, puff your cheeks and blow the cheekful of air into its lungs about twenty five times a minute. DO NOT blow from your chest as the baby’s small lungs might burst from too much air !) 4. Repeat twelve to sixteen times in a minute. Every few artificial puffs, wait to see if the person’s own breathing has returned. Stop if it has. 5. If the pulse is not felt in the neck, also add heart massage. For every four massages of the heart, there must be one artificial breath given to a patient. 6. Mouth to mouth breathing may need to be continued for an hour or more if the person’s heart s functioning, but she is not breathing on her own.
11-20 HEART MASSAGE1. Check for pulse at the neck. If it is absent, you may start a heart massage as below. If any relatives are around, explain that the LIFESAVING procedure that you are about to start may be difficult for them to bear and they may like to move out of the room.2. Heart thump : Close your fist and bring it down firmly from a height of two feet on the patient’s chest in the area of the heart (lower chest to the right side of the pa- tient.) This is called the ‘heart thump.’ Heart Massage put the heel of one palm ovre the chest and cover with the other hand3. Heart Massage : If the patient is on the ground, it may be better to kneel besides the patient (to her right if you are right handed). Place the heel of your right palm over the lower end of the breastbone in the midline of the chest. Place the heel of our other palm over this. Now press firmly without bending your elbows. The pressure should come from your body. This is what is called a heart massage. The chest must be pressed down one to two inches with each massage. Repeat the massage sixty times in a minute. (Note : For a small baby, pressing with the thumb of one hand will be enough!).4. Artificial Breathing : If there is a need to provide artificial breathing and you have no help, puff one breath for every four chest massage.5. At the end of five minutes of such a procedure, the person’s own pulse at the neck (and own breathing) must return. Check every 5 minutes if pulse & breathing have returned. Continue up to 30 minutes. If it still does not return, there is no need to go on and on. Without blood for three minutes, the brain cannot survive and the person is dead. Please explain this to the relatives.