Bites and its types

Bites

The act of cutting, tearing, holding or gripping with the teeth or sting is called bite.

Types of Bite

• Insect bite
• Snake bite
• Dog bite

Insect Bite

When an insect pierces its sting into the tissue and releases venom, it is known as insect bite. The venom contains chemical compounds which produce allergy. The type of reaction which occurs after an insect bite depends upon the species of insects, the age of person and whether or not the person has been exposed to the insect before.

Common Insect Bites

• Bees and wasps
• Scorpions
• Hornets
• Spider
• Leech bite
• Ticks and mites bites

Bees and Wasps Bite

The most harmful among the insects are bees and wasps and other insects of the same type. Their sting causes local pain, itching and severe swelling because their stings have one type of poison which is little in quantity. Some people are very sensitive to this poison and therefore certain reactions like histamine, local pain and swelling, respiratory inhibition because of throat swelling and low blood pressure because of contraction of the air pipe occur. The patient becomes unconscious and if the first aid is not given in time then death can occur due to anaphylactic shock.

First aid Management

• If the sting is present then instead of pulling it by force it should be taken out slightly scrubbing the skin, so that a hole is formed from which the poison can come out easily.
• If the swelling and pain is severe then keep wet bandage in the area.
• Keep the place cool by applying alcohol, spirit or ice.
• After this, apply antibiotic cream and do the dressing.
• If the victim's condition is serious or he is in a condition of shock then send him immediately to the hospital.

Ticks and Mites Bites

Tick is a small insect-like bed bug. It is about ½ or 1 cm long. It has a terrible capacity to stick to the body. It sticks itself to the body and keeps sucking the blood. During this period it spreads germs of certain diseases in the body. As these are generally found in animals, wood, camps in open grounds, etc., care should be taken while going to these places.

Mites are generally found in wood and stored grains. Their bite can cause typhoid fever.

First Aid Management

• If a tick or mite has bitten and it is stuck, than it should be immediately removed.
• It should not be pulled forcefully; otherwise some part of their body will be left in the wound and if it gets crushed then the disease causing germs will enter the body.
• It should be taken out either by forceps or they will fall themselves by applying burning cigarette on their dorsal surface.
• It can also be removed by applying some oil or kerosene.
• The wound should be washed with soap and water. * An antibiotic cream should be applied and bandaged.

Spider Bite

Spiders are generally found in the gaps of wood, hollow places, corners of the house and dark places.

Sign and Symptoms

• Redness, severe pain and local swelling.
• After the absorption of the poison from bitten area, the affected person suffers from stomach cramps and muscle become hard.
• Face, hands and legs look swollen.
• Breathlessness and condition of shock can arise.
• Small localized blisters arise due to their poison.

First Aid Management

• The victim should be made to lie in a comfortable position and should be covered with blanket or bed sheet.
• A cloth or rope should be tied at a distance from the bitten area so that blood is not absorbed in other parts of the body.
• If the victim is conscious then he should be given tea or coffee to drink.
• The bitten area should be cleaned and bandaged.
• If the victim is serious then send him to the hospital immediately.

Leech Bite

Leech is generally found in tanks, rivers, moist and muddy places. Though a serious condition does not arise with their bite, these suck quite a large amount of blood. Do not take them out by pulling because these are delicate and flexible and therefore can break. On applying a burning stick or cigarette on their dorsal surface they come out easily. After taking them out, the wound should be washed and bandaged.

Scorpion Bite

Generally, a scorpion can be seen in the moist dark places and in rainy season. Scorpion bite rarely leads to a serious condition but there is severe burning, intolerable increasing pain in the bitten area. Sometimes a person complains of vomiting and can become unconscious.

If the symptoms are not severe and are restricted to the bitten area, the victim should be made to lie comfortably and soothing cream should be applied. Sometimes a big blister is seen after 6 to 12 hours and it bursts by itself. In such condition do the dressing with antibiotic cream.

Common Signs and Symptoms of Insect Bite

• Severe burning pain
• Swelling
• Dizziness
• Children especially may have sign of shock, sweating, nausea, vomiting and difficulty in breathing.
• Painful muscle cramps all over the body, and extreme pain in the stomach muscle which become rigid especially in spider bites.

Common First Aid Treatment of Insect Bite

• Examine the sting closely; look for the stinger that may be in the skin.
• If the stinger is visible and accessible, attempt to remove it with the help of forceps, tweezers or flame cooled needles.
• To reduce irritation at the site of the skin, apply spirit or weak solution of bicarbonate of soda. Ice can also be used. Never use alcohol near the eyes.
• Apply antihistamine ointment if available.
• If sting is in the mouth, give mouth wash immediately with salt solution.
• If the victim develops difficulty in breathing, place the victim in sitting position.
• Seek medical aid immediately if the patient's condition becomes critical.

Snake Bite

Snake bites occur when a snake bites on the skin. They are medical emergencies if the snake is poisonous. Snake bites can be deadly if not treated quickly. Children are at higher risk for death or serious complications due to snake bites because of their smaller body size.

There are about 2500 to 3000 species of snakes. But amongst these, approximately 250-300 only are poisonous, therefore in the cases of snake bite if the snake can be seen in nearby place it should be confirmed whether it is poisonous or not. There are 3 million bites and 1,50,000 deaths/year from venomous snake worldwide. 97% of all snake bites are on the extremities.

When a poisonous snake bites, it releases its venom. The venom contains haemotoxin/ monrotoxin that destroy red blood cells or tissues. If the patient does not get prompt treatment, it may be fatal or cause death.

Types of Venom

There are a few categories of snake venom. Venomous snakes may have a mix of the following types of venom: 

Haemotoxic Venom: It affects the blood and circulation (viper). The prey dies from cardiovascular failure and bleeding. It often results in great pain, swelling and bruising, drop of M blood pressure, followed by bleeding from the gums, nose, eyes and in the brain. Death can result from untreated bites. It can cause severe tissue and organ damage.

Myotoxic: It affects muscle tissues (rattle snakes, sea snakes and sea kraits). In the prey the venom rapidly disables muscle contraction. It results in pain in legs, hips and shoulders, with paralysis and damage to the kidneys. About 25% of victims have severe muscle and kidney damage. Venom can cause muscle necrosis.

Cytotoxic: It destroys cell (Puff Adder). In humans, bites from this species can produce severe, local and systemic symptoms, bleeding, swelling and pain. They are responsible for more fatalities than any other African snakes.

Neurotoxic: It affects the nervous system (cobra). There is a progressive paralysis of the skeletal and peripheral muscles, followed by death from respiratory failure. It results in drooping of eyelids and a dazed sleeplike paralysis, sometimes followed by spasms, excess salivation and vomiting. Swelling and tissue damage can also occur. Without treatment, death can result from respiratory failure.

Poisonous Snake Bites Include Bites by Any of the Following 

• Cobra
• Copperhead
• Coral snake
• Cottonmouth (water moccasin)
• Rattlesnake

Common Poisonous Snakes in Nepal

• Viper (release neurotoxin)
• Cobra (release hemotoxin)

Sign and Symptoms of Poisonous Snake Bite

Cobra Snake Bite

• The poison of the cobra bite very quickly affects the nervous system.
• Severe pain on the bitten area.
• Uneasiness, giddiness, and sometimes vomiting.
• Weakness of hands and legs, loss of sensation.
• Watering of mouth.
• Slow respiration and weak pulse.
• Slow or moderate swelling.
• No discoloration.
• Paralysis of respiratory muscles.
• Asphyxiated.
• Death in case of delayed treatment.

Viper Snake Bite

• Blood vessel of bitten area gets affected.
• Blood clotting process is distributed.
• Excessive bleeding from bitten area.
• Immediate swelling of the part.
• Uneasiness, giddiness, vomiting, weakness, slow pulse rate.
• Discoloration.
• Slight bleeding from mouth and conjunctiva.
• May vomit blood.
• May have hematuria.
• Coma and death occurs within 24 hours.

Rattle Snakes

• Immediate pain and symptoms
• Drooping eyelids
• Low blood pressure
• Thirst
• Tiredness or muscle weakness

Copperheads and Water Moccasins

• Immediate pain and symptoms
• Change in skin color
• Shock
• Low blood pressure
• Weakness 

Coral Snakes

Coral snake bites may be painless at first. Major symptoms may not develop for hours. Do NOT make the mistake of thinking you will be fine if the bite area looks good and you are not in a lot of pain. Untreated coral snake bites can be deadly. Symptoms may include:

• Pain that is not immediate
• Symptoms that set in hours after the bite
• Convulsions
• Drooping eyelids
• Change in skin color
• Stomach pain
• Difficulty swallowing
• Headache
• Shock
• Paralysis

Common Sign and Symptoms of All Poisonous Snake Bites

• Two puncture wounds Bleeding from wound
• Pain, Burning of the skin
• Swelling
• Diarrhea
• Dizziness due to blood pressure dropping.
• Skin may become pale, cool
• Extreme weakness, sweating and faintness
• Rapid and weak pulse
• Numbness and tingling
• Fever
• Blurring of vision
• Nausea and vomiting
• Loss of muscle coordination
• Unconscious

First Aid Management of Snake Bite

• The confirmation of snake bite can be done by the presence of teeth prints on the affected o area.
• Keep the person calm, reassuring him that bites can be effectively treated. Restrict movement, and keep the affected area below heart level to reduce the flow of venom.
• Remove any rings or constricting items because the affected area may swell. Create a loose splint to help restrict movement of the area.
• If the area of the bite begins to swell and change color, the snake was probably poisonous.
• Monitor the person's vital signs - temperature, pulse, rate of breathing, and blood pressure if possible. If there are signs of shock (such as paleness), lay the person flat, raise the feet about a foot, and cover the person with a blanket.
• Cover the bite lightly, and then leave it alone. If you have a sterile bandage available, place it over the bite.
• Get medical help right away.
• Bring in the dead snake only if this can be done safely. Do not waste time hunting for the snake, and do not risk another bite if it is not easy to kill the snake. Be careful of the head when transporting it - a snake can actually bite for several hours after it is dead (from a reflex).

Special Precautions

• Not to allow the person to become over-exerted. If necessary, carry the person to safety.
• Not to apply a tourniquet.
• Not to apply cold compresses to a snake bite.
• Not to cut into a snake bite with a knife or razor.
• Not to try to suck out the venom by mouth.
• Not to give the person stimulants or pain medications unless a doctor tells you to do so.
• Not to give the person anything by mouth.
• Not to raise the site of the bite above the level of the person's heart.
• Not to try to capture the snake, but try to remember its color and shape so you can describe it, which will help in your treatment.

Treating a Non-poisonous Snake Bite

• Even non-venomous snake bites may lead to infections.
• Stop the bleeding, bites from non-poisonous snakes are unlikely to be life threatening, but do they still require first aid treatment to prevent infection.
• Don't treat the bite as a non-venomous bite unless you are absolutely sure that the snake was not venomous.
• Clean the wound carefully with clean water and soap for several minutes.
• Apply a thin coating of antibiotic ointment to the clean wound.
• Bandage the wound to prevent infection.
• Get a medical attention.

Prevention

• Avoid areas where snakes may be hiding, such as under rocks and logs.
• Even though most snakes are not venomous, avoid picking up or playing with any snake unless you have been properly trained.
• Don't provoke a snake. That is when many serious snake bites occur.
• Tap ahead of you with a walking stick before entering an area where you can't see your feet. Snakes will try to avoid you if given enough warning.
• When hiking in an area known to have snakes, wear long pants and boots if possible.

Dog Bites

Dog bites are sometimes very serious. All the dog bite cases must be referred for medical treatment especially in Nepal because rabies virus is present in almost all dogs. Do not wait for symptoms to appear, seek medical aid immediately. There is no treatment once the symptoms appear. Dog bite is the primary source of human and animal rabies infection. More than 96 percent hydrophobia patients in Nepal were exposed to a rabid dog. On the other hand, more than 94 per cent patients are given post-exposure vaccination due to dog bite.

Sign and Symptoms of Dog Bite

In the early stage:

• History of dog bite
• Sensitivity of wound site (tingling and burning sensation)/bleeding
• Fever/pain/swelling
• Headache
• Sore throat
• Loss of appetite

In the later stage:

• Restlessness, strange behavior like a person who is mentally unbalanced.
• Hydrophobia (fear of water due to contraction of throat muscles).
• Thick saliva dripping from the mouth, because the patient is unable to swallow.
• Convulsion but the person remains conscious.
• Death occurs- the patient dies after a couple of days when symptoms appear. symptoms are due to respiratory failure and general paralysis.

First Aid Treatment of Dog Bite

• Reassure the victim and keep him in a comfortable position.
• Wash the wound with soaps water before saliva gets into the body. Allow the wound to bleed for a while.
• Apply antiseptic solution if available.
• Cover the wound with a clean cloth.
• Seek for medical aid immediately.
• If possible advise the patient's relatives to watch the dog for 10 days. If the dog is alright, no need to worry. Otherwise, advice for anti-rabies vaccine.

Choking

Choking is mechanical obstruction or blockage of the flow of air from the environment into the lungs by food or other objects. The person cannot breathe properly in mild and moderate condition of choking. In severe condition, the victim will be asphyxiated, which leads to anoxia and is potentially fatal. Choking is a true medical emergency that requires fast, appropriate action by anyone available.

Causes of Choking

In adults:

• When food is not chewed properly.
• Talking or laughing while eating.
• Drinking alcohol or taking drugs before or during meals (normal swallowing mechanisms may be slowed).
• Eating too fast.

In children:

• Chewing food incompletely.
• Attempting to eat large pieces of food or too much food at one time.
• Children also put small objects in their mouth, which may become lodged in their throat, like nuts, pins, marbles, and coins.
• Running, playing with food or objects in their mouth.

Signs and Symptoms of Choking

• Violent coughing
• Asphyxiated
• Unable to speak or breathe
• Blue or pale lips and skin
• Weak cry, weak cough
• Complaining of burning sensation in the sub sternal region
• Prominent veins in face and neck
• May develop loss of consciousness in complete throat obstructional 

First Aid Treatment of Choking 

• Reassure the victim. Open airway and remove any false teeth or foreign bodies.
• Encourage the victim to cough.
• Help the victim to bend forward with the head lower than the lungs.
• Firmly slap the victim between the shoulder blades up to four times with your hand. This should help to remove the obstruction.
• Check the victim's mouth. If the obstruction is visible, then take it out with fingers.
• If person is still chocking. Perform Heimlich's maneuver.
• If the patient is conscious, Stand behind the victim and wrap the arms around the patient's waist.
• Make a fist with one hand and grasp the fist with your other hand, placing the thumb side of the fist against the patient's abdomen. The fist should be placed midline, below the xiphoid process and lower margins of the ribcage and above the navel.
• Perform a quick upward thrust into the patient's abdomen: Each thrust should be separate and distinct. Repeat this process six to ten times until the patient either expels the foreign body or loses consciousness.
• If patient is unconscious, position the patient supine. Kneel astride the patient's thighs.
• Place the heel of one hand midline, below the xiphoid process and lower margin of the ribcage and above the navel. Place the second hand directly on top of the first hand.
• Perform a quick upward thrust into the diaphragm, repeating six to ten times.
• Perform a finger sweep.
• Use one hand to grasp the lower jaw and tongue between your thumb and fingers and lift. This will open the mouth and pull the tongue away from the back of the throat.
• Insert the index finger of the other hand in to the patient's mouth next to the cheek and using a hooking motion dislodge any foreign body.
• If the victim is still unable to breath start artificial respiration and transfer to hospital.

Prevention of Choking

• Cut food into small pieces.
• Chew food slowly and thoroughly, especially if wearing dentures.
• Avoid laughing and talking during chewing and swallowing.
• Avoid excessive intake of alcohol before and during meals.
• In case of children, keep marbles, beads and other small objects out of their reach.
• Prevent them from walking, running or playing with foods or toys in their mouth.
• Give soft food that they do not need to chew.

Haemorrhage

Haemorrhage is the condition in which the blood flows out from the blood vessels due to some accident or injury. The blood may flow externally through an orifice or a break in the skin or it may flow internally into cavity, on organs or spaces between the tissues.

Type of Haemorrhage

According to time:

• Primary haemorrhage: It is immediate bleeding from a cut, injury or operative incisions.
• Reactionary haemorrhage: Bleeding occurs within 24 hours of injury, cut or operative incision.
• Secondary haemorrhage: Bleeding occurs after 24 hours of injury, cut or operative incision.

According to site:

• Internal hemorrhage (concealed): Blood flow internally into cavity, an organ or space between the tissues.
• External hemorrhage (revealed): Blood flow externally through an orifice or a break in the skin.

According to nature of blood vessels:

• Arterial haemorrhage: An artery which carries oxygenated blood is broken. The blood comes out in jets because it corresponds to the beats of heart in action.
• Venous haemorrhage: Blood is dark in color being deoxygenated blood and it flows in continuous stream.
• Capillary haemorrhage: Blood oozes out from capillaries and is very slow in flow. If it is on surface of skin, it is not serious and stops without any first aid/medical treatment.

Sign and Symptoms of Haemorrhage

• Visible or non-visible bleeding.
• Dizziness and faintness, especially when the patient is in upright or standing position.
• Pallor, cold and clammy skin
• Low blood pressure
• Restlessness
• Thirsty
• Weak feeble and rapid pulse
• Difficulty in breathing
• Patient feels light headache and may even collapse.
• Excessive sweating
• There may be blueness of the lips and paleness of skin.

First Aid Management of Haemorrhage

• Lay the victim down. Reassure the victim.
• Loosen tight clothing and expose the bleeding part.
• Remove any foreign bodies which can easily be removed or wiped out.
• Look for the source of bleeding. There may be more than one site.
• Raise the bleeding part, if there is no fracture.
• Apply firm pressure over the bleeding site/part using a clean pad or clothes. Apply dressing and bandage on the bleeding part.
• Check the pulse and general condition of the victim.
• Call the emergency services.
• If the bleeding is still not controlled, apply pressure to the pressure point for 5-15 minutes. Then release the pressure point. If necessary reapply after 1-2 minutes to facilitate a circulation in the distal part.
• Immediately transfer the victim to the hospital.