1 Animal Bites Bites are extremely common and can cause significant pain and may rapidly progress

to infection and stiffness in the hand. Early and appropriate treatment is key to minimizing potential problems from a bite. factors contribute to development of an infection: type and location of the wound, pre-existing health conditions in the bitten person that impair their immunity (such as diabetes, vascular disease, cancer, HIV), delay in treatment, the presence of a foreign body in the wound (such as a chip off a tooth), the type of animal that bit the individual.

The majority of animal bites in the U. S. are caused by: dogs, cat bites rodents, rabbits, ferrets, farm animals, monkeys, snakes, alligators, and in coastal areas, marine animals (shark, eel).

Human Bites (Clenched fist injury) Human bite wounds contain very high concentrations of bacteria so the risk of infection is high. These infections can progress rapidly and result in substantial complications, so early treatment is necessary Often, human bites occur when a persons fist is driven into another persons mouth, such as during a fistfight. After the skin is broken, bacteria are seeded into the soft tissue and often into the knuckle joint, which if left untreated often results in deep infection of the joint that may ultimately destroy the joint. The extensor tendon is often cut by the victims tooth. The tooth may even break and be left in the wound. Early diagnosis, intravenous antibiotics, and surgery to drain the infection and wash out the joint can effectively treat these injuries. Symptoms of Concern with Bites to the Hand swelling,

2 redness, warmth and continued pain beyond 24 hours , pus draining from the bite wound, red streaks extending up the arm or forearm, swollen lymph nodes (glands) around the elbow or in the armpit, loss of mobility, loss of sensation in the hand or fingertip, fever, loss of energy, night sweats, or chills

Assessment includes: Examination of the bite wound and ask about contributing factors to the injury A complete history of the bite, including the type of animal and its health (behavior and rabies vaccine status), the time and location of the event, circumstances of the bite, whereabouts of the animal, a the pre-hospital treatment will be reviewed update your tetanus status if you have not had a booster shot within the past five years.

Diagnostic exam X-rays- may be used to identify any damage to the bones and joints or tooth fragments that may have broken off. If an infected bite to the hand goes untreated for too long, X-rays may reveal evidence of osteomyelitis, which is infection in the bone.

Intervention the affected part require meticulous cleansing. Your doctor or other medical personnel will wash the wound and might trim away any devitalized (dead) tissue, damaged skin, blood clots, or other particles that could be a source of infection. look for signs of lymphangitis, indicated by the presence of red streaks up the forearm.

3 When the wound is infected, a culture is obtained to identify the type of bacteria that is causing the infection and thus help determine the antibiotic that is most effective for treatment. use of antibiotics for animal bites depends on the particular circumstances of the injury, patient health, and sensitivity to various medications, and the appearance of the wound. Some bites require the use of intravenous (IV) antibiotics, while others may be treated with oral medications. Surgery Follow-up care

Dog Bite - First Aid Treatment A bite or scratch from a dog (or cat) that breaks the skin poses the danger of infection, especially if the wound is deep. Bites also carry the risk of rabies. Most household pets are immunized against rabies, but the possibility of infection still exists. It is also possible to contract a tetanus infection from an animal bite. Clostridium tetani, the microbe that causes tetanus, lives in the top layers of soil, and in the intestinal tracts of cows and horses, and easily infects wounds that result in reduced oxygen flow in the tissue, particularly crushing and puncture wounds. A dog bite can be nothing more than a minor graze, or it can be so severe as to be life-threatening. Children are at most risk from dog bites, and children under five years of age are victims of the most severe attacks-many of them requiring hospitalization. First aid treatment If the wound barely breaks the skin, treat it as a minor wound. Scrub the bite thoroughly with soap and running water. Apply antibiotic cream and a loose sterile bandage. If the bite creates a deep puncture of the skin or the skin is badly torn and bleeding, apply pressure to stop the bleeding and see your doctor.

Home remedies for dog bite treatment Echinacea, goldenseal, pau d'arco, and red clover, taken in tea form, are good for dog bites. Goldenseal extract can also be applied directly on the affected area. This is a natural antibiotic that helps to fight infection. Caution: Do not take goldenseal internally on a daily basis for more

4 than one week at a time, and do not use it during pregnancy. If you have a history of cardiovascular disease, diabetes, or glaucoma, use it only under supervision. If you are bitten by a dog, the first thing you should do is remove the animal's saliva from the wound. Wash the area thoroughly with warm water, then add soap and wash for at least five minutes more. Rinse the wound for a few more minutes with plain water and cover it with a gauze dressing for twenty-four hours. Finely ground red chili powder/ paste applied immediately on the wound neutralizes the virus. The wound does not get infected, and heals fast. This remedy really hurts, and the pain may cause shock Asafoetida, powdered fine and dusted thickly on the bite, apparently draws the infection out. It has a pronounced astringent effect and absorbs local moisture and the virus. An application of fresh onion juice and honey is another remedy.

Dog Bite Prevention Most dog bites can be prevented. Teach children not to disturb dogs while they eat, sleep or care for puppies. Children should never be left alone with a dog. Neuter your dog. Keep pets on a leash when in public. Select your family pet carefully, and be sure to keep your pet's vaccinations (shots) up-to-date. If a dog attacks, curl up into a ball to protect your face, neck and head. Teach children how to behave around animals, and teach them not to approach strange animals. Never leave a young child alone with an animaleven the family pet.

Snakebite - Treatment and Prevention There are four types of poisonous snakes in the United States: copperheads, coral snakes, cottonmouths (or water moccasins), and rattlesnakes. Approximately 7,000 Americans are bitten by snakes each year, most commonly in the summer months, in grassy or rocky environments. The toxicity of snake venom, which varies from species to species, can kill local tissue and release toxins into the body that can cause serious problems with blood pressure, heart rate, and pain. Causes of snakebite Poisonous snake bites include bites by any of the following: rattlesnake copperhead

5 cottonmouth (water moccasin) coral snake

Symptoms of snakebite: swelling or discoloration of the skin in the area of the bite a racing pulse, weakness, shortness of breath, nausea, fever and vomiting.

In extreme cases, pain and swelling can be severe, the pupils may dilate, and shock and convulsion may occur. The person may twitch and his or her speech may become slurred

In the most severe cases paralysis, unconsciousness, and death can result.

Natural herbal home treatment for snakebite Black cohosh syrup helps to relieve pain. Take 1/2 to 1 tablespoon of the syrup three times daily. Poultices of comfrey, slippery elm, or white oak bark leaves and bark can be used. Comfrey salve, plantain poultice, or plantain salve can also be used. Echinacea, taken in tea and/ or capsule form, boosts the immune system. Olive leaf extract has antibacterial properties. Yellow dock can be used to alleviate symptoms. Drink a cup of yellow dock tea or take 2 capsules of yellow dock every hour until the symptoms are gone. If medical help is not available, apply a constricting band two to four inches above the bite. Keep calm and immobilize the affected area, keeping it below heart level if possible. If rapid swelling or severe pain develops, an incision can be made directly below the fang marks and suction performed. The cut should be made along the long axis of the limb with a sharp, sterilized blade. Cut just through the skin (about an eighth of an inch deep), making an incision about one-half-inch long, and then apply suction for at least thirty minutes with a suction cup, snakebite kit, or with the mouth (spit out the blood).Caution: This procedure should be performed only in an extreme situation, only if the bite occurred less than five minutes ago, and only if you

6 have had some training in how to do it. Otherwise, it can cause more problems than it solves. Never make cuts on the head, neck, or trunk. Do not perform this procedure if the snake was a coral snake. Snake Bite Don'ts Do not apply cold therapy, such as an ice pack. This can cause tissue damage. Don't use the small rubber suction cups found in some first aid kits because they are too weak to remove any significant amount of venom. Do not raise the site of the bite above the level of the victim's heart. Don't excite the victim or even allow the victim to walk if it can be avoided. Doing so will increase blood circulation, speeding the spread of the venom beyond the area of the bite.

Snake Bite Do's GET MEDICAL help immediately. If possible, splint the wounded area to immobilize it. This helps to prevent muscle contractions from spreading the poison faster. Limit liquid intake because the body pumps fluids to the bite site, increasing painful swelling. Avoid alcohol, which increases metabolism and impairs judgment. Remember that most bites, even from poisonous snakes, are not fatal. Panic can increase the danger to the victim by inducing rapid heartbeat.

Prevention 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: Even though most snakes are not poisonous, avoid picking up or playing with any snake unless you have been properly trained. Most cases of snakebite occur between sunrise and sunset. Snakes are coldblooded and are more likely to be out then, basking in the warmth of the day. Tap ahead of you with a walking stick before entering an area with an obscured view of your feet. Snakes will attempt to avoid you if given adequate warning. Be cautious and alert when climbing rocks. Stay out of tall grass unless you wear thick leather boots, and remain on hiking paths as much as possible.

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DISASTER NURSING

Disaster is an occurrence arising with little or no warning, which causes serious disruption of life and perhaps death or injury to large number of people. It is may be a man made or natural event that causes destruction and devastation which cannot be relieved without assistance.

Types of disaster Natural. Eg : earthquake, floods, hurricane, tsunami. Manmade.Eg: nuclear accidents, industrial accidents Hybrid Eg: spread of disease in community, global warming.

Levels of disaster Level iii disaster considered a minor disaster. These are involves minimal level of damage Level ii disaster- considered a moderate disaster. The local and community resources has to be mobilized to manage this situation Level i disaster- considered a massive disaster- this involves a massive level of damage with severe impact.

Phases of disaster management Prevention phase Identify community risk factors and to develop and implement programs to prevent disasters from occurring.

Preparedness phase Personal preparedness Professional preparedness

Community preparedness The level of community preparedness for a disaster is only as high as the people and organization in the community make it. Community must have adequate warning system and a back up evaluation plan to remove people from the area of danger.

Response phase The level of disaster varies and the management plans mainly based on the severity or

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extent of the disaster. Recovery phase During this phase actions are taken to repair, rebuilt, or reallocate damaged homes and businesses and restore health and economic vitality to the community. Psychological recovery must be addressed.Both victims and relief workers should be offered mental health activities and services.

Disaster management cycle Prevention I Recovery <--------------> preparedness v response

Disaster management plans Aims of disaster plans to provide prompt and effective medical care to the maximum possible in order to minimize morbidity and mortality

Objectives To optimally prepare the staff and institutional resources for effective performance in disaster situation To make the community aware of the sequential steps that could be taken at individual and organizational levels

Disaster management committee The following members would comprise the disaster management committee under the chairmanship of medical superintendent/ director Medical superintendent/ director Additional medical superintendent Nursing superintendent/ chief nursing officer Chief medical officer (casualty) Head of departments- surgery, medicine, orthopedics, radiology, anesthesiology, neurosurgery Blood bank in charge Security officers Transport officer Sanitary personnel

Disaster control room

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the existing casualty may be referred as the disaster control room.

Rapid response team The medical superintendent will identify various specialists, nurses and pharmacological staff to respond within a short notice depending up on the time and type of disaster. The list of members and their telephone numbers should be displayed in the disaster control room.

Information and communication the disaster control team would be responsible for collecting, coordinating and disseminating the information about the disaster situation to the all concerned.

Disaster beds Requirement of beds depends up on the magnitude of the disaster. Utilization of vacant beds, day care beds, and pre-operative beds Convalescing patients, elective surgical cases and patients who can have domiciliary care or opd management should be discharged Utility areas to be converted in to temporary wards such as wards with side rooms, corridors, seminar rooms etc. Creating additional bed capacity by using trolleys, folding beds and floor beds

Logistic support system Resuscitation equipments Iv sets, iv fluids, Disposable needles, syringes and gloves Dressing and suturing materials and splints Oxygen masks, nasal catheters, suction machine and suction catheters Ecg monitors, defibrillators, ventilators Cut down sets, tracheostomy sets and lumbar puncture sets Linen and blankets Keys of these cupboards should be readily available at the time of disaster

Training and drills Mock exercise and drills at regular intervals are conducted to ensure that all the staff in the general and those associated with management of causalities are fully prepared and aware of their responsibilities.

Elements of disaster plan A disaster plan should have the following elements Chain of authority Lines of communication Routes and modes of transport Mobilization

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Warning Evacuation Rescue and recovery Triage Treatment Support of victims and families Care of dead bodies Disaster worker rehabilitation

Activation of disaster management plans Standard operating procedures (SOPs) Reception area Triage o Priority one- needing immediate resuscitation, after emergency treatment shifted to intensive care unit o Priority two- immediate surgery, transferred immediately to operation theatre. o Priority three- needing first aid and possible surgery- give first aid and admit if bed is available or shift to hospital o Priority four- needing only first aid-discharge after first aid. Documentation Public relations. Essential services. Crowd management/ security arrangement.

Disaster management- nurses role in community Assess the community Assessment - the local climate conducive for disaster occurrence, past history of disasters in the community, available community disaster plans and resources, personnel available in the community for the disaster plans and management, local agencies and organizations involved in the disaster management activities, availability of health care facilities in the community etc.

Diagnose community disaster threats Determine the actual and potential disaster threats (eg; explosions, mass accidents, tornados, floods, earthquakes etc).

Community disaster planning Develop a disaster plan to prevent or deal with identified disaster threats Identify local community communication system Identify disaster personnel, including private and professional volunteers, local emergency personnel, agencies and resources Identify regional back up agencies and personnel Identify specific responsibilities for various personnel involved in the disaster plans

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Set up an emergency medical system and chain for activation Identify location and accessibility of equipment and supplies Check proper functioning of emergency equipments Identify outdated supplies and replenish for appropriate use.

Implement disaster plans Focus on primary prevention activities to prevent occurrence of manmade disasters Practice community disaster plans with all personnel carrying out their previously identified responsibilities (eg: emergency triage , providing supplies such as food, water, medicine, crises and grief counseling) Practice using equipment; obtaining and distributing supplies

Evaluate effectiveness of disaster plan Critically evaluate all aspects of disaster plans and practice drills for speed, effectiveness, gaps and revisions. Evaluate the disaster impact on community and surrounding regions Evaluate the response of personnel involved in disaster relief efforts.

Conclusion Disaster is an emergency situation, therefore coordination of actions and various departments is an essential requisite for efficient management of mass casualties.

Drowning When a person is drowning, the air passages close to prevent water from entering the lungs. This also prevents air from entering the lungs, thus depriving the victim of oxygen and eventually leading to unconsciousness and death. Usually, only if the victim has been unconscious in the water for some time do the lungs fill up with water. More commonly, the water goes into the stomach. A secondary risk for the rescued person is that he or she may choke on vomit as water in the stomach forces the stomach contents upward. A neardrowning person also faces the risk of hypothermia. Children and young adults are at the greatest risk of drowning.

VOMITING A person who has nearly drowned is very likely to vomit. Maintain a close watch for this. If the victim vomits while you are resuscitating him, turn him toward you, and clear out the mouth before turning him on to the back and resuming rescue breathing. If the victim vomits while in recovery position, clear out the mouth and keep a close eye on breathing to ensure that it has

12 not stopped. If the victim is conscious and become sick encourage him to lean forward and give support while he is vomiting. Do not make any effort to remove water from the lungs by applying chest compressions or abdominal thrusts. The risk of water in the lungs is minimal, while compressing the chest or stomach will increase the risk of the victim choking on his own vomit. Most drowning victims don't yell or wave their arms to alert someone that they are in trouble. They are in a state of shock, and are often silent. There are typically five stages to a drowning: Surprise In this stage, the victim recognizes danger and becomes afraid. The victim assumes a near-vertical position in the water, with little or no leg movement. The arms will be at or near the water's surface, making random grasping or flipping motions. The head will be tilted back with the face turned up. Victims rarely make any sounds; they are struggling just to breath. Involuntary Breath Holding The victim has now dropped below the static water line and the body, in an attempt to protect itself, initiates involuntary breath holding. This occurs because water has entered the mouth and causes the epiglottis to close over the airway. Though a victim may continue to struggle, he/she will not usually make any sounds as he/she cannot breathe. Without oxygen, the victim will lose consciousness. Unconsciousness Because the victim has been without oxygen, the body shuts itself down as unconsciousness results. In this stage, the victim will be motionless. Because breathing has stopped, he/she is in respiratory arrest. There is no chest movement or breathing sounds. At this point, the victim sinks to the bottom of the water, either slowly or rapidly, depending on factors such as the amount of air trapped in the lungs, body weight, and muscle mass. The victim will remain unconscious (and die) unless breathing is reestablished.

Hypoxic Convulsions Due to the lack of oxygen in the brain, the victim may look as if he/she is having a convulsion, which is why this stage is called the hypoxic convulsion stage. The victim's skin turns blue, especially in the lips and fingernail beds, and the body may appear rigid. There may be violent jerking of the body and

13 frothing at the mouth. Clinical Death The final stage in the drowning process is death. Clinical death occurs when both breathing and circulation stop. The victim is in cardiac arrest. The heart stops pumping blood. The vital organs are no longer receiving oxygen rich blood. The lack of oxygen causes the skin to turn blue. The earlier a lifesaver begins cardiopulmonary resuscitation (CPR) after the victim's heart stops and provides defibrillation (if needed), the better the victim's chance of surviving the incident. The longer the victim is submerged, the greater the chance of permanent brain damage or death. After four minutes without oxygen, brain cells begin to die, and irreversible brain damage occurs. This is called biological death. TREATMENT OF A NEAR-DROWNING VICTIM Your priority is to ensure an open airway and that the person is breathing. 1. Open the airway by tilting the head, checking the mouth, and lifting the chin. Check for breathing for up to 10 seconds. 2. If the victim is breathing, place into the recovery position. 3. If the victim is not breathing, provide rescue breathing before moving on to an assessment of circulation and full CPR as necessary. HYPOTHERMIA Hypothermia is a lowering of the bodys core temperature and is very common secondary problem of near-drowning. If untreated, hypothermia leads to the breathing and heart rate slowing down and eventually stopping. To reduce the risk of hypothermia in a case of near-drowning, place the victim on a blanket or layer of coats to insulate him from the ground. Remove wet clothing if you are able to replace it quickly with warm and dry clothing; if not, then cover the wet clothing with blanket and coats. Cover the head to prevent heat loss. Warm the external environment if possible.

14 RESCUING A DROWNING PERSON As in all first aid, the key rule is to protect yourself. A person who is drowning will strike out and pull down even the most competent swimmer; dirty water can hide dangers such as metal rubbish with sharp edges; and cold water can cause muscles to cramp very quickly. If possible, reach to the person from the safety using a pole, rope, or buoyancy aid to enable him to help himself out of the water. If in doubt about your ability to rescue the person safely, call for emergency help.