this chapter, you should be able to:
1. Tell when a
- is unconscious,
- is not breathing,
- has no heartbeat.
2. Decide what
to do and give first aid in each case.
3. Give first
aid when a person:
- has fits (convulsions),
- has chemical in
- has chemical on
- has been bitten
or stung by a poisonous or venomous animal.
First aid is the help
a person gives straight away in a medical emergency.
This chapter can help
you learn first aid, but you also need someone to teach you first
aid, and check that you are doing it correctly. It is important
to have someone show you the right way to do mouth-to-mouth respiration
and heart massage. You should practise on a special training manikin
(a life-size model). Never practise heart massage on another person,
only on a manikin.
It is dangerous to
use heart massage if you have not had proper training.
People who are poisoned
- be unconscious,
- stop breathing,
- have no heartbeat,
- have fits (convulsions).
They need immediate
first aid to help them to breathe and to start the heart beating.
When people get chemical
in the eyes or on the skin, it may cause burns. These people need
immediate first aid to wash the chemicals out of the eyes and off
the skin. The chemical may also get into the body and cause poisoning.
People who have been
bitten or stung by a poisonous or venomous animal need first aid:
- to remove stings,
spines or tentacles,
- to clean the wound
and stop infection,
- to slow the spread
of poison through the body.
first aid at once
Immediate first aid
may stop serious poisoning and may save life. If breathing and the
heart stop, the person will die within a few minutes unless you
give first aid at once.
aid for poisoning
Here is an action
list. Each step is explained in more detail below the list. Start
with the first step and follow each step in the order given. Act
as quickly as you can, but stay calm.
- Check if the patient
Open the airway and make sure the tongue is not blocking the
Check if the patient is breathing.
Clean out the mouth and clear the throat.
- Give mouth-to-mouth
Check if the heart is beating.
If the heart is beating, but the patient is still not breathing,
carry on with mouth-to-mouth respiration.
If the heart is not beating, give heart massage.
Give first aid for fits if necessary.
Wash any chemical out of the eyes.
Remove contaminated clothing and wash any chemical off the skin
Give first aid for poisonous bites and stings.
Check if the patient is conscious
Try to make the patient
wake up. Shout "Are you all right?" and gently shake the
shoulders, but take care not to make any injuries worse (Fig. 15).
Pinch the skin on the neck and watch the face. A patient who is
just sleeping will wake up, but an unconscious patient will not.
15. Check that the patient is unconscious.
The airway is the
tube through which air passes from the mouth and nose to the lungs.
If it is blocked the patient cannot breathe and air cannot get into
or out of the lungs. A patient who cannot breathe will die within
In an unconscious
patient the tongue may block the throat and the airway. Make sure
the airway is open and air can get down the throat (Fig. 16):
16. In an unconscious patient, the tongue may fall back,
blocking the throat and stopping breathing.
17. Open up the airway by pressing the forehead back
and lifting the clin with the thumb and fingers.
whether the patient is breathing
After opening the
airway, quickly check whether the patient is breathing (Fig. 18):
- Look for the belly
or the chest moving up and down.
- Feel the chest
moving up and down.
- Feel the patient's
breath on your cheek.
- Listen for breath
sounds. Put your ear close to the patient's mouth.
18. Check whether the pacient is breathing by looking and
feeling for movement of the chest or belly, listening for breathing
sounds and feeling for the pacient's breath on your check.
Use all four checks.
Remember that the chest may move up and down even when the throat
is completely blocked and air cannot get to the lungs.
A person may stop
- Something is stuck
in the throat.
The throat is blocked by the tongue, or by blood, spit, vomit,
food, or false teeth. (If you have tilted the head back, the
tongue will not block the throat.)
The throat is blocked because the patient has swallowed poison
which has burnt the throat and made it swell.
The patient has been poisoned.
The patient has been hit on the head or chest.
The patient has had a heart attack.
The patient has nearly drowned.
out the mouth and clear the throat
If the patient is
not breathing after you have tilted the head back, something may
be blocking the throat.
Turn the head to one
side. With one or two fingers (and preferably wearing gloves) scoop
deeply round the mouth and throat to clear any blockage such as
vomit (see Fig. 19). Take out the patient's false teeth.
19. Explore el interior de la boca del paciente
para eliminar cualquier causa de obstrucción.
If the patient starts
breathing turn him or her onto one side, into the recovery position.
Check breathing and pulse frequently.
Whatever the cause,
if the patient does not start breathing you must act immediately
to help the patient to breathe.
You can help the patient
to breathe by blowing air from your lungs into his or her lungs
through the patient's mouth (mouth to mouth) or nose (mouth to nose).
This is called mouth-to-mouth (or mouth-to-nose) respiration.
If there is poison
on the patient's lips, or if corrosive chemicals have burnt the
lips and chin, wipe the chemical off, cover the mouth with a cloth
to protect yourself from getting poison on your lips or hands, and
give mouth-to-nose respiration. Breathe into the patient's nose
(see Fig. 20).
20. Mouth-to-nose respiration.
to give mouth-to-mouth respiration or mouth-to-nose respiration
to an adult
With the patient lying flat on his or her back, clear any blockage
from the mouth. Kneel beside the patient's head.
Tilt the head back.
Pinch the nose with one hand. With the other hand pull the mouth
open (Fig. 21). Do not press on the neck. For mouth-to-nose
respiration, close the patient's mouth with your thumb.
tilt the head back, pinch
the nose and pull the mouth open.
Breathe in deeply. Cover the patient's mouth completely with
your own mouth and breathe out steadily and smoothly so that
all your breath goes into the patient's mouth. Breathe out strongly
to fill the chest (see Fig. 22). Look for the patient's chest
rising. For mouth-to-nose respiration put your mouth around
the patient's nose.
Fig. 22. Mouth-to-nose
breather steadily and smoothly
into the patient's mouth, filling his or her chest with air.
Lift your mouth away so that the patient can breathe out and
you can take another breath of air. Turn your head, look for
the chest falling, feel the breathed-out air on your cheek,
and listen for the sound of the patient breathing out (see Fig.
23). For mouth-to-nose respiration you may have to open the
patient's mouth to let air out.
Fig. 23. Mouth-to-nose
lift your mouth away so that the patient
can breathe out; watch for the chest falling, feel for the
breath on your cheek, and listen for the sound of breathing.
Take another breath of air. Once the chest has fallen, blow
into the patient's mouth (or nose) again. Watch the patient
breathe out again. Then check that the heart is beating.
If the chest
does not rise with each breath, and you cannot feel or hear the
patient breathing out, then either the airway is blocked or some
of your breath is not going into the patient's chest. Check that
the head is held well back and clear the airway again. Make sure
there is no air escaping when you breathe into the patient's mouth
to give mouth-to-mouth respiration to a child or a baby
Open the airway in
a child or baby in the same way as for an adult, but do not tilt
the head too far back or the soft airway may kink.
If you can see something
blocking the throat carefully remove it, but do not sweep your finger
inside a baby's mouth if you cannot see anything there. If the throat
is swollen because of an infection, you might make the swelling
Do not pinch the nose.
Put your lips over both the nose and the mouth (Fig. 24). Breathe
gently, just enough to move the chest. For a very small baby only
small puffs are needed. Do not blow hard or you may harm the baby's
chest. Blow into the chest every 3 seconds.
24. If giving mouth-to-mouth respiration to a child, blow
very gently to avoid damaging the child's lungs.
if the heart is beating
Feel for the pulse
in the neck, in the hollow between the voice box and the muscle.
Place two fingers on the voice box (Adam's apple) and slide your
fingers into the groove under the jaw (Fig. 25). Keep your fingers
there for at least five seconds to feel if there is a pulse.
Feel for a pulse in the groove under the jaw.
If you cannot feel
a pulse, the heart has stopped. This is called cardiac arrest. The
patient will be unconscious and will probably have large pupils.
If the patient has white skin it will probably have a blue-grey
colour. If the patient has black or brown skin look for a blue colour
to the nails, lips and the inside of the lower eyelids. If the heart
stops, breathing will also stop and the patient will need both heart
massage and mouth-to-mouth respiration.
the heart is beating, but the patient is still not breathing, carry
on with mouth-to-mouth respiration
Take a deep breath
and blow once every 5 seconds, until the patient starts to breathe
without help. You may have to do this for more than one hour.
If the patient has
breathed in an irritant gas, the mouth and throat may be full of
froth. You cannot remove this froth by wiping, so do not waste time
trying to remove it. As this froth is air bubbles, all you have
to do to move air in and out of the lungs is to blow the froth into
the lungs. So blow as usual.
When the patient starts
to breathe, turn him or her onto one side into the recovery position.
The patient may vomit when breathing starts again but the vomit
will not block the throat if the patient is lying on one side. Let
the vomit come out and clear it out of the mouth with your finger.
Watch carefully in
case the patient stops breathing again. If breathing stops turn
the patient onto his or her back and start mouth- to-mouth respiration
the heart is not beating give heart massage
If you cannot feel
a pulse in the neck, you should try to start the heart beating again
by giving heart massage (see below).
Heart massage (or
chest compression) means pressing down on the heart to push blood
out of it and round the body. This may start the heart beating again.
It will only be effective if the patient is lying on a hard surface.
If there is no heartbeat,
the patient will have stopped breathing. Always start mouth-to-mouth
respiration before heart massage.
Do not give heart
massage if the heart is beating, even faintly. Stop as soon as you
feel a pulse in the neck, but carry on with mouth- to-mouth respiration
if the patient is still not breathing.
to give heart massage to an adult
- Check that there
is no heartbeat.
Lay the patient on his or her back on a firm surface. Kneel
beside the patient's chest.
Find the right place to put your hands. Find the lower edge
of the ribs. Follow the edge of the ribs to where they meet
the breastbone. Place your middle finger on the base of the
breastbone, and the index finger next to it (Fig. 26), then
place the heel of your other hand next to these two fingers,
on the breastbone in the midline of the chest (Fig. 27).
26. Heart massage: place your middle finger on the base
of the breastbone and your index finger nexto to it.
Fig. 27. Heart
place the heel of your free
hand next to the two fingers on the breastbone.
- Now cover this
hand with the heel of your other hand, lock your fingers together,
keeping them off the chest (Fig. 28). Put your shoulders above
the patient's chest and keep your arms straight.
massage: interlock the fingers of both hands
and, with the arms straight,
press down 4-5 cm.
Press down on the lower half of the breastbone 4-5 centimetres,
keeping your arms straight. Then stop pushing. While counting
"one and two and three and...", press 15 times, in
time with the numbers (80 presses a minute). Presses should
be regular and smooth, not jerky and jabbing.
Remember that both mouth-to-mouth respiration and heart massage
are needed. After 15 presses tilt the head back again so that
air can get down the throat, put your mouth round the patient's
mouth and give two breaths.
Continue with 15 presses followed by two full breaths. After
one minute check the heartbeat, then after 3 minutes or every
12 cycles check the heartbeat again. As soon as the heartbeat
returns stop heart massage immediately. You may see the patient's
colour become more normal and the pupils return to normal size.
Continue mouth-to-mouth respiration at 12 breaths a minute,
until the patient breathes without help. It may be some time
before breathing starts again, even after the heart has started
beating. When breathing starts again put the patient onto his
or her side in the recovery position.
person is with you, get him or her to do the breathing while you
do the heart massage (Fig. 29). The other person should kneel by
the patient's head while you kneel by the middle of the chest. The
other person should give two breaths and check the heartbeat. If
there is no heartbeat you should give five presses on the chest.
Continue with the other person giving one breath and you giving
five presses on the chest. Check the heartbeat after one minute
then after every three minutes or 12 cycles.
29. If there are two of you, work together so that one person gives
heart massage while the other gives mouth-to-mouth respiration.
to give heart massage to a child or a baby
The best place to
feel the pulse in a small child or a baby is on the inside of the
upper arm. With your thumb on the outside of the arm press your
first and middle fingers into the groove below the muscle.
When giving heart
massage to a child or baby, press with less force but slightly faster
than you would for an adult.
For a child use one
hand only and press lightly on the chest (Fig. 30). Press down 2.5-3.5
30. To give heart massage to a child, use one hand
only and press lightly on the chest.
For a small child
or a baby press on the chest with just two fingers. Press down 1.5-2.5
cm (Fig. 31).
Keep your hand or fingers
below the level of the nipples.
Press down at a rate
of 100 presses a minute giving 15 compressions followed by two breaths.
31. To give heart massage to a baby, press lightly
on the chest with two fingers.
the patient is breathing but is unconscious, turn him or her onto
one side, into the recovery position
An unconscious patient
should be turned to lie on one side to stop the tongue blocking
the throat and to allow fluid to come out of the mouth. This is
called the recovery position.
Before you turn the
If breathing is noisy, sweep your finger round the mouth to
remove anything blocking the airway, and take out the patient's
false teeth if they are loose.
Empty the patient's pockets of anything that would be uncomfortable
to lie on.
Take off the patient's spectacles in case they injure the eyes.
Look for injury to the head or neck, and feel with your fingers
to see whether the back of the neck or the backbone is bent
Get help if the patient has an injury to the head or neck. Three
people should roll the patient keeping the head, neck and body
in a straight line. Do not let the patient sit up when he or
she wakes up.
The patient should
be turned onto one side with:
- the head, neck
and body in a straight line,
- the head placed
so that the tongue will not block the throat, and vomit or saliva
can come out of the mouth;
- the arms and legs
placed so that the patient stays in the same position.
way of turning a patient
Kneel beside the patient, turn the patient's face towards you,
and tilt it back, with the jaw jutting forward so the airway
stays open. Place the arm nearest you above the head. Place
the patient's other arm across the chest. Raise the patient's
far leg under the knee, to bend it (Fig. 32).
Fig. 32. Putting
a patient into the recovery position: place the arm
nearest you above the patient's head, bring the other arm
the chest, and bend the leg further from you.
Protect the patient's face with one hand. With your other hand,
grasp the patient's clothes at the hip and pull the patient
towards you until he or she is resting on one side, against
your knees (Fig. 33). The patient's head should be resting on
the lower arm. Check that the airway is still open.
Fig. 33. Putting
a patient into the recovery position: pull the
patient towards you until he or she is lying on one side
with the head resting on the arm.
Take the patient's upper arm and place the hand under the face
(Fig. 34). This will help to keep the head tilted back and the
airway open. Now position the upper leg so that the bent knee
rests on the ground and supports the patient's body.
If the patient is too heavy
for you, get help. Someone else can support the patient's head
while you do the turning, or can push the patient towards you
as you pull.
The recovery position: make sure that
the patient's head is tilted back so that
the airway stays open.
first aid for fits (convulsions) if necessary
If the patient has a fit, make him or her
lie down in a safe place. Make sure there are no hard or sharp
objects nearby and protect the patient from injury.
Turn the patient to lie on one side so that the tongue comes
to the front of the mouth and froth can come out of the mouth
Put a folded cloth under the patient's head, or hold the head
so that it does not bang on hard things.
Do not try to stop the shaking movements.
Loosen any tight clothing.
Do not put anything in the patient's mouth or try to open it.
After the fit, let the patient rest in the recovery position.
Wash any chemical out of the eyes
Wash chemicals out
of the eyes at once, with plenty of cool, clean water, before you
wash the skin. Even a delay of a few seconds can make the injury
35. Wash any chemical out of the eye
for 15-20 minutes.
While you are rinsing the eyes check that the inside of the
eyelids has been well washed. Check that there are no solid
pieces of chemical in the folds of skin round the eyes, or on
the eyelashes or eyebrows. If you are not sure whether all the
chemical has been removed, wash out the eyes for 10 more minutes.
Do not let the patient rub the eyes.
The patient's eyes should be examined by a doctor even if there
is no pain, because damage may be delayed.
If light hurts the patient's eyes, cover them with a sterile
eye pad, a dry gauze pad, or a pad of clean cloth. Bandage the
pad in place securely, but not too tightly. This will protect
the eyes and help them to heal.
If the patient is in pain, give aspirin or paracetamol every
Medical treatment of chemical contamination of the eye
contaminated clothing and wash any chemical off the skin and hair
Take the patient
immediately to the nearest shower or source of clean water.
If there is no water nearby dab or gently wipe the skin and
hair with cloths or paper. Do not rub or scrub the skin.
the affected part of the body under cold or lukewarm running
water, using soap if you have some. If there is no running water
use buckets of water. Do it quickly and use a lot of water (Fig.
36). Wear gloves and an apron if needed, to protect yourself
from splashes of chemical. Some chemicals give off vapour: be
careful not to breathe it in.
36. If running water is not available, use buckets
of water to rinse chemicals off skin.
At the same time
quickly remove any of the patient's clothes contaminated with
chemical or vomit, as well as shoes and wrist watch if necessary.
Speed is important - cut the clothes off if the chemicals are
very poisonous or corrosive.
If large areas
of the body are contaminated with chemical, wash the patient
under a shower or a hose. Remember to clean the hair and under
the fingernails, in the groin and behind the ears, if necessary.
Continue to pour
water over the patient for 10 minutes, or longer if you can
still see chemicals on the skin. If the skin feels sticky or
soapy, wash it until the feeling disappears. This may take an
hour or more.
Make sure the
water drains away freely and safely as it will have chemical
Dry the skin gently
with a clean, soft towel. If clothing stays stuck to the skin
even after water has been poured over it, do not remove it.
many chemicals can pass through the skin very quickly. Look
for signs of poisoning (see Chapter
clothes in a separate sealed container and do not use them again
until they have been washed. Throw away shoes contaminated with
chemical. If you have used cloths or paper to wipe the skin,
put these in a container and burn them.
If the patient has burns, and there is no doctor:
Do not break open blisters or remove skin. Where the skin is
red and painful or raw, cover it and the skin round it with
a sterile, dry dressing and bandage. Keep the bandage loose.
This will protect the burn and speed up healing.
Dress the patient in clean clothes or cover with a sheet.
Replace fluid loss: if a large area is burnt give the patient
half a cup of water every 10 minutes until the patient reaches
Treat pain: give aspirin every four hours until the pain is
Get the patient to a doctor or hospital as soon as possible.
Give first aid for poisonous bites and stings
This section gives
general advice first, followed by specific advice for dealing with:
- snake bites,
- stings or bites
by bees, wasps, hornets, fire ants, scorpions, spiders or ticks,
- stings by jellyfish,
- stings by venomous
People often panic if they have been bitten or stung. You should
tell the patient that many snakes, spiders, insects and sea
creatures are harmless and that even the bites and stings of
dangerous animals often do not cause poisoning.
Keep the patient calm and still. Moving the bitten or stung
limb speeds up the spread of venom to the rest of the body.
Fear and excitement also make the patient worse. The patient
should be told not to use the limb and to keep it still and
below the level of the heart. The limb may swell after a while,
so take off the patient's rings, watch, bracelets, anklets and
shoes as soon as possible. A splint and a sling may help to
keep the limb still.
following measures should not be used. They may cause infection,
or make the effects of the venom worse.
Time spent giving traditional remedies and herbal medicines
would be better spent getting the patient quickly to hospital.
Such "remedies" are often of no use and may be dangerous
or even life- threatening.
The patient should lie on one side in the recovery position
so that the airway is clear, in case or vomiting or fainting.
Do not give the patient anything by mouth - no food, alcohol,
medicines or drinks. However, if it is likely to be a long time
before the patient gets medical care, give the patient water
to drink to stop dehydration.
Try to identify the animal, but do not try to catch it or keep
it if this will put you, the patient or others at risk. If the
animal is dead take it to hospital with the patient, but handle
it very carefully, because even dead animals can sometimes inject
As soon as possible, take the patient to a hospital, medical
dispensary, or clinic where medical care can be given. The patient
should not walk but should keep as still as possible. If there
is no ambulance or car, carry the patient on a stretcher or
trestle, or on the crossbar of a bicycle.
Antivenom should only be given in a hospital or medical centre
where resuscitation can be given, because the patient may have
an allergic reaction. If available, antivenom should be used
if there is evidence of severe poisoning. It should not be used
when there are no signs of poisoning.
Using traditional medicines to treat
poisonous bites and stings
No home remedy or
traditional cure for poisonous bites or stings (from snakes, scorpions,
spiders or other poisonous animals) has any effect beyond that of
the healing power of belief.
Anyone who says that
a traditional medicine kept a snake's venom from harming him or
her was probably bitten by a snake that did not inject poison.
Some traditional medicines
may do some good. If a person believes in them he or she will feel
less afraid, the pulse will slow down, the person will move and
tremble less, and as a result, the poison will spread through the
body more slowly. So there is less danger.
But the benefit of
these traditional medicines is very limited. Even when they are
given traditional medicines, many people still become very ill or
die from snake bite. Using traditional medicine may delay more effective
treatment. It is better to use hospital treatment.
Do not use traditional
remedies that contain animal or human waste or that involve eating
animals not usually used as food. They do not help at all. They
are often dangerous and can cause serious infections.
treatment of poisonous bites and stings
Antivenom should only be given in a hospital or medical centre
where resuscitation can be given, because the patient may develop
an allergic reaction. If available, antivenom should be used
if there are signs of severe systemic envenoming. It should
not be used when there are no signs of systemic envenoming.
To decide whether venom has been injected, and how serious the
poisoning is, look for these signs:
- swelling and
local tissue injury at the site of the bite;
- blood that
does not clot, causing bleeding from gums, nose, wounds and
- shock caused
by circulatory failure;
paralysis (ptosis, ophthalmoplegia, dysarthria, peripheral
muscle weakness, respiratory distress);
muscle pain and local tissue damage;
- kidney failure,
red or black urine;
- tender swollen
lymph nodes near the bite site.
To test clotting time of whole blood: Place 2-3 ml of whole
venous blood in a clean, dry, glass test-tube and leave undisturbed
for 20 minutes at room temperature. Normal blood should have
clotted by this time. Tip the tube to see if the blood is still
If the wound becomes infected, treat as for any other local
infection. Use antibiotics if needed.
If there is local tissue injury, do not cover the wound but
leave it open.
What to do if someone is bitten by a snake
Venomous snakes often
bite without injecting venom. In other words, the bites are "dry".
Many people survive being bitten by venomous snakes, even the most
dangerous species, without being poisoned.
Keep the patient lying on one side, in the recovery position,
to lessen the risk of vomit blocking the throat. Check breathing
Do not use any of the harmful measures listed on chapter 5.
Clean the wound gently so that there is no venom left on the
skin. Use clean water and soap, or wipe the wound gently with
a clean cloth.
Give first aid as follows for the bites of elapid snakes that
do not cause local tissue injury or swelling (coral snakes,
kraits, mambas, some cobras, but not African and some Asian
cobras or vipers). Apply a broad, firm bandage over the bite
site, then bandage as much of the bitten limb as possible over
the patient's clothing. The bandage should be firm but not so
tight that it acts as a tourniquet. You should still be able
to feel the pulse in the lower part of the limb. Severe pain
in the bandaged limb may mean that the bandage is too tight.
It is important to use a splint so that the patient cannot move
the limb. Once the patient is in a hospital or medical centre
the bandage should be taken off. It should not be taken off
before then because, once the bandage is removed, venom may
spread rapidly through the body.
Some snake bites cause severe pain, although most do not. Paracetamol
can be given for the pain, but aspirin should not be given,
as it may make the patient bleed.
If the snake has been killed, take it to the hospital with the
patient so that it can be identified. Handle the dead snake
very carefully, because it can still inject venom, even after
the head has been cut off.
Medical treatment of snake bites
Snake bites may cause
tetanus (lockjaw). The patient should be given an injection of tetanus
antitoxin if possible.
Do not give unnecessary
injections because of the risk of bleeding if the blood does not
A patient with respiratory
paralysis may need artificial ventilation for hours, days or even
If the patient has
kidney failure, make sure the patient is given the right amount
of fluids and carefully monitor fluid balance. Dialysis may be needed,
preferably haemodialysis or, if this is not possible, peritoneal
Shock and low blood
pressure may be caused by fluid moving out of the blood vessels
that have been damaged by the snake venom. This happens especially
with viper bites. Intravenous fluids may be life- saving.
Usually there is no
need for surgery, and unnecessary surgery could cause complications
or permanent damage to the bitten limb.
to do if someone is stung or bitten by bees, wasps, hornets, fire
ants, scorpions, spiders or ticks
Scorpion stings and insect stings or bites cause local pain
and swelling. Spider bites may cause deep ulcers or blisters.
The greater the number of stings or bites, the more severe is
the effect. Some spiders (for example, the brown recluse or
violin spider, widow spiders) and at least one scorpion (Hemiscorpion
lepturus found in the Islamic Republic of Iran and Iraq) may
cause local tissue injury and ulcers at the bite site, which
may spread over the bitten limb.
Some people are sensitive to insect venom. They may get a local
or generalized rash, itching, and red skin. In serious cases
the patient will feel sick and as if there is a tight band around
the chest, the face may swell, the patient may not be able to
breathe properly, may wheeze and gasp for air, and may become
unconscious. If breathing becomes difficult, lie the patient
on his or her side in the recovery position. If breathing and
heartbeat stop, give mouth-to-mouth respiration and heart massage.
Patients should be given an intramuscular injection of epinephrine
Bees leave their sting behind and can only sting once, but wasps
and hornets do not leave their sting behind and can sting many
times. If the sting has been left, remove it, but be careful
not to squeeze the venom sac on the end. Either use tweezers
to grasp the sting as near to the skin as possible and remove
it (Fig. 37), or scrape the sting off the skin. Take off the
patient's rings, bracelets and anklets in case the limb swells.
37. Use tweezers to draw a sting out of the skin.
A tick can sometimes be washed off with alcohol, or removed
with the heat from a cigarette. If not, lever the tick off the
skin using fine tweezers or forceps, but try not to squeeze
A cold compress, using cold water but not ice, may help lessen
the swelling, itching and pain.
Paracetamol may be given for pain, but aspirin should not be
Medical treatment for scorpion stings and insect stings
Antivenom is available in South America for some spiders: brown
recluse spiders (Latrodectus spp.), widow spiders ( Loxosceles
spp.), Phoneutria spp., and some scorpions (for example species
of Centruroides, Tityus, Buthotus, and Leiurus).
Antivenom may be useful in treating local tissue injury by Loxosceles
spp., and Hemiscorpion lepturus, even when there are no signs
of general poisoning. The wound should be treated open as for
Pain can be treated with local analgesia (e.g. lidocaine, digital
nerve block, peripheral nerve block), or with systemic analgesics.
Morphine should not be used to treat pain because of the risk
of respiratory depression. Antivenom may be useful in treating
pain caused by bites from Latrodectus spp.
What to do if someone is stung by jellyfish
Jellyfish tentacles cling to the skin and can be hard to get
off. Keep the patient calm and still to avoid the tentacles
causing more stings.
There is no sure way to stop the tentacles stinging if they
are moved, so it is best not to touch them until the first effect
of the sting has worn off.
To stop the cells from stinging, immediately flood the area
with vinegar (5% acetic acid), unless the jellyfish is known
to be a bluebottle (Portuguese man-of-war; Physalia species).
If you do not have vinegar, use seawater. Do not use alcohol,
methylated spirits, petrol or fresh water.
Cold packs or crushed
ice wrapped in a cloth may help to relieve pain caused by stings
from Physalia and other jellyfish. Stings from box jellyfish
and similar species (Chironex) often have very serious effects.
Patients may need mouth-to-mouth respiration and heart massage.
Gently scrape off the tentacles with a knife.
Medical treatment of jellyfish stings
should be given by intramuscular injection if available.
to do if someone is stung by a venomous fish
Many venomous fishes,
such as stonefish, lionfish, scorpion fish, and weever fish, have
spines that puncture the skin. Venom is injected into the wound
through the spines. The stingray may cause cuts that bleed a lot.
If the patient
is stung while in the water, rescue from the water.
At once soak
the wounded part of the body in a bowl or bath of water as
hot as the patient can safely bear (not more than 45°C),
until the pain goes, but for no longer than 30 minutes. The
venom may be destroyed by heat and pain may disappear.
Clean the wound
and remove any broken spines.
treatment of fish stings
should be given by intramuscular injection if available,.
Pain can be treated
with local anaesthetics or pain killers such as paracetamol. It
may be dangerous to give morphine because it may depress respiration.