Anaphylaxis and Allergic Reactions

Anaphylaxis is the most severe form of an allergic reaction, and has the potential to be life-threatening. Anaphylaxis occurs after exposure to an allergen (such as food, latex, insect sting or medicine), to which a person is already extremely sensitive. When a casualty has an anaphylactic episode the whole body is affected, usually within minutes of exposure to the allergen but sometimes after hours.
Anaphylaxis is a rare but preventable and treatable event. The most important aspect of the management of casualties with life-threatening allergic reaction is avoidance of any known triggers such as:

Food - most commonly nuts, sesame seeds, shellfish, cow milk, soy, egg and wheat.

Herbal remedies - such as Royal Jelly.

Insect stings - such as bees and wasps. The venom from these insects is different in each case, and therefore allergy to one does not increase the risk of reactions to another.

Latex allergy - rare, but more common in some people frequently exposed to latex such as healthcare workers.

Medication - particularly antibiotics and sometimes x-ray contrast dyes.

SIGNS AND SYMPTOMS

Some, or all of the following:

abdominal cramps

itchiness of palms and soles

feeling of generalised warmth

tingling

chest discomfort

unusual taste in the mouth

changes in heart rate

collapse and unconsciousness

difficulty breathing

difficulty in swallowing or speaking

generalised flushing of the skin

hives anywhere on the body, especially large hives

nausea and vomiting

sense of impending doom

severe asthma or throat swelling

sudden feeling of weakness

swelling of face, throat and mouth

choking or coughing

dizziness

The symptoms can occur in as little as 5-15 minutes, but life-threatening reactions may progress over a longer time. Some casualties may find that the symptoms they experience are always mild. For example, there may be a tingling or itching in the mouth and nothing more.

CARE AND TREATMENT

SRABC

call 000 for an ambulance urgently

reassurance

adrenaline is the only drug that will act fast enough to rescue someone from a life-threatening reaction

casualties who have a history of anaphylaxis are often prescribed self-administered adrenaline using EpiPen. If this is the case assist the casualty self-administer their adrenaline

remove the grey safety cap

hold the EpiPen (firmly) with the black tip against the thigh (do not cover the end of the EpiPen with your thumb!!)

apply moderate pressure and hold for 10 seconds

discard the unit safely

observe for relapse as severe symptoms (rebound) sometimes recurs after apparent recovery

Diabetes

Diabetes is a condition which is caused by an imbalance of sugar, or glucose, in the blood. Because all human cells require sugars as food, the body takes in complex sugars in a normal diet. So that the bodys cells can use these sugars the body, through an organ called the pancreas, secretes a protein hormone called insulin, which attaches to the sugars. This allows the cells to recognise the sugars as food, and absorb the necessary glucose. Diabetes is due to an imbalance in the production of vital insulin. Approximately 7% of the Australian population has diabetes, and this rate is increasing. Diabetic emergencies appear in two forms:

Hypoglycaemia, or low blood sugar, is a dramatic imbalance where the tissues, especially the brain cells, become starved of essential blood sugar. This condition is the more common type and especially dangerous as its onset is rapid. The result of further deprivation of sugar is that the casualty becomes unconscious and death may follow within hours.

Hyperglycaemia, or high blood sugar, is an imbalance of blood sugar, which usually requires the affected person to supplement his or her insulin requirements by periodic injections of the hormone. A casualty who is unable to obtain this supplement is liable to collapse into a serious state called diabetic coma. This condition is less common and has a slower onset than hypoglycaemia.

Not all diabetics are dependent on supplementary insulin, and many live normally on a controlled diet.

SIGNS AND SYMPTOMS

LOW BLOOD SUGAR

pallor

profuse sweating

hunger

confused or aggressive

rapid pulse

may appear to be drunk

seizures

unconsciousness

CARE AND TREATMENT

call 000 for an ambulance

if conscious, give sweet drink (not diet), or

5-7 jelly beans or sweets

glass of fruit juice

2-4 teaspoons of sugar or honey

repeat if casualty responds

on recovery, assist with medication and encourage ingestion of food high in carbohydrates such as a piece of fruit, glass of milk, sandwich or 2-4 dry biscuits

DO NOT attempt to give insulin injection

give nothing by mouth to a unconscious diabetic

SIGNS AND SYMPTOMS

HIGH BLOOD SUGAR

hot, dry skin

excessive thirst

frequent need to urinate

smell of acetone (nail polish remover) on the breath

drowsiness and extreme tiredness

blurred vision

unconsciousness, progressing to coma

CARE AND TREATMENT

definitive treatment for high blood sugar requires medical expertise

when in doubt if the casualty has low or high blood sugar, treat as for low blood sugar

Asthma

Australia has one of the highest prevalence of asthma in the world. Over 700 Australians die from asthma each year, and many of these deaths may be preventable. Asthma suffers have very sensitive airways, and when they are exposed to certain triggers, their airways narrow making it difficult for them to breathe. There are two main factors that cause airways to become narrow:

The inside lining of the airway becomes red and swollen and extra mucus is often produced

The muscles around the airways tighten

Trigger factors for asthma may include:

Viral respiratory infections

Exposure to known allergens, eg. dust mite, pollens, animal dander, moulds

Exposure to chemicals or other occupational sensitisers

Exposure to irritants eg. cigarette smoke, perfume

Reflux

Drugs eg. aspirin and beta-blockers

Foods eg. nuts, seafood

Food additives - colourings, metabisulphite, monosodium glutamate (msg)

Changes in weather, exposure to cool air

Exercise

Emotion

Asthma is usually considered in three classifications of severity, mild, moderate, and Severe & Life-threatening.

Symptoms

Mild

Talks in Sentences

Pulse rate <100/min

Wheeze intensity - Variable

Moderate

Talks in Phrases

Pulse rate <100-120/min

Central cyanosis may be present

Wheeze intensity - Moderate to loud

Severe & Life-threatening

Physical exhaustion

May have paradoxical chest wall movement

Talks in words

Pulse rate >120/min

Central cyanosis is likely to be present

Wheeze intensity - Often quiet

Asthma can be a life-threatening condition that may develop suddenly, or over several days. As a first aid provider you should be aware that both mild and moderate asthmatics are subject to unexpected severe attacks, and that minor respiratory infections such as colds and flu, as well as seasonal changes, may cause an asthmatic condition to worsen. Treat the condition with care, as the effects can be sudden and serious.

OTHER SIGNS AND SYMPTOMS

pale, cool, clammy skin

coughing, especially at night

shortness of breath - using all the chest and diaphragm muscles to breathe

wheezing - a high pitched raspy sound on breathing

anxiety and distress

exhaustion

rapid, weak pulse

cyanosis (bluish colour)

little or no improvement after using reliever medication

severe asthma attack: collapse - leading to eventual respiratory arrest

CARE AND TREATMENT

Conscious casualty:

sit the casualty comfortably upright

be calm and reassuring

give 4 separate puffs of a blue/grey reliever inhaler (puffer) - airomir, Ventolin, Respolin, Bricanyl, or Asmol

give 1 puff at a time

ask the person to breathe in and out normally 4 times after each puff

use the casualtys own inhaler if possible

if the casualty does not have an inhaler use the first aid kit inhaler or borrow one from someone else*

relievers are best given through a spacer if available

with spacer

shake inhaler and insert mouthpiece into spacer

place spacer mouthpiece in casualtys mouth and give 4 separate puffs of a blue/grey reliever inhaler (puffer) - airomir, Ventolin, Respolin, Bricanyl, or Asmol

give 1 puff at a time

ask the casualty to breathe in and out normally 4 times after each puff

wait 4 minutes. If there is little or no improvement, repeat the above sequence

without spacer

shake inhaler

place mouthpiece in casualtys mouth. Fire 1 puff as the person inhales slowly and steadily

ask the casualty to hold that breath for 4 seconds, then take 4 normal breaths

repeat until 4 puffs have been given

wait 4 minutes. If there is little or no improvement, repeat the above sequence

if still no improvement

call 000 for an ambulance

continuously repeat reliever medication every 4 minutes until the ambulance arrives

Collapsed casualty:

call 000 for an ambulance

adult - if possible, assist with 6-8 puffs of a reliever

children - if possible, assist with 4 puffs of a reliever

if little or no immediate improvement - repeat reliever medication every 4 minutes until the ambulance arrives

be calm and reassuring

if in respiratory arrest - expired air resuscitation (EAR)

if in cardiac arrest - cardiopulmonary resuscitation (CPR)

*Various Government state and territory laws or regulations may prohibit using a first aid kit inhaler (or having an inhaler in a first aid kit) or borrowing one from someone else.

No harm is likely to result from giving a reliever to someone who does not have asthma.

In a severe asthma attack, EAR will require a much greater force to inflate the lungs.

Epilepsy and Febrile Convulsions

Epilepsy is a disruption of brain function that interrupts the normal electrical activity of the brain. Normally neurons, which are cells that carry electrical impulses, form a network allowing communication between the brain and rest of the body. Neurons fire or send electrical impulses toward surrounding cells, stimulating neighbouring cells to fire at one time, causing an electrical storm within the brain, which results in physical changes called seizures or fits. It is only when there is a tendency to have recurrent seizures that epilepsy is diagnosed.

In 70 percent of all cases the cause of epilepsy cannot be identified. Head injuries, strokes, brain tumours, infections such as meningitis, lead poisoning or injury during childbirth mostly causes the remaining 30 percent. There are many different types of seizures. The main types of seizures are:

Convulsive seizures

Tonic clonic seizures are convulsive seizures where the body stiffens (tonic phase) followed by general muscle jerking (clonic phase), and involves the whole brain. The person loses consciousness, their body stiffens and limbs jerk. These seizures generally last up to three minutes. After the seizure the person may want to sleep, have a headache or be confused and disoriented. The person may experience an aura which can precede a tonic-clonic seizure, and act as a warning giving the person time to seek a safe place before losing consciousness.

Non-convulsive seizures

A absence seizure causes the person to lose contact with their surroundings for about 30 seconds, with little or no outward sign that anything is wrong. This type of seizure mainly occurs in children and is often mistaken for daydreaming or lack of concentration.

A complex partial seizure is accompanied by impaired consciousness and recall. It may also involve staring, automatic behaviour such as lip smacking, chewing, tumbling, walking, grunting, or the repetition of words or phrases. The person may experience an aura which can precede a complex partial seizure

A simple partial seizure produces a sudden shock-like jolt to one or more muscles which increases muscle tone and causes movement. These sudden jerks are like those that occur in healthy people as they fall asleep.

CARE AND TREATMENT

TONIC-CLONIC SEIZURES

protect from harm

place something soft under head

loosen tight clothing and tie

roll into recovery position when jerking stops

reassure until fully recovered

DO NOT put anything in the casualtys mouth, including fingers

DO NOT restrain the casualty

If seizure occurs while the person is seated in a wheelchair, car or pram, leave them safely strapped in seat until seizure is finished. Support their head during the seizure. Remove them after the seizure if unconscious and lay in the recovery position.

ABSENCES

nil active treatment required

reassurance

COMPLEX PARTIAL SEIZURES

protect from harm

reassure until fully recovered

do not restrain unless in danger

SIMPLE PARTIAL SEIZURES

nil treatment required

reassurance

One problem encountered by the first aid provider is that of the well meaning, but untrained, bystander. This person will usually insist that the epileptics tongue should be held before he or she swallows it. The bystander should be discouraged from actively pulling the casualtys tongue out.

Most epileptics understand what happened to them, and as soon as they recover sufficiently, they continue on with their business. They do not usually require ambulance care and may become upset when one is called. However, as the first aid provider, you must satisfy yourself that the person is recovering normally, and that there appears to be no complications.

Febrile convulsions

Febrile convulsions occur when a child has a high temperature. The growing brains of small children are more sensitive to fever than are more mature brains, and when the normal brain activity is upset a convulsion or fit can occur.

Febrile convulsions are common and approximately three per cent of children aged six months to six years may have a convulsion when they have a high temperature. Three out of 10 children who have a febrile convulsion will have another episode.

Most children have a body temperature around 37 degrees Celsius. You can take a childs temperature by placing the bulb of the thermometer under their armpit for three minutes with the arm held against their side.

SIGNS AND SYMPTOMS

previous history of infection

child is usually quiet, and appears sick

flushed, hot skin

eyes roll back

may become stiff or floppy

child becomes prostrate, and begins convulsing

salivary drool

may become blue

after one to three minutes, child begins breathing normally

recovers, commences crying

CARE AND TREATMENT

FOR CHILD

remain calm

put the child in the stable side position

remove any excessive clothing

on recovery, assess childs breathing

if not breathing give EAR

FOR PARENTS/BYSTANDERS

reassure

discourage removal of child by persons other than ambulance personnel or under trained medical assistance

The seizure affects not only the child, but also parents and bystanders who may not have observed this phenomenon before. As a first aid provider, it is part of your responsibility to reassure the witnesses. The greatest fear parents have is that the child is not breathing, and they think that death is imminent.

Call 000 for an ambulance if:

you are in any doubt

a complex partial seizure lasts longer than 15 minutes

another seizure follows quickly

the person has been injured

it is the first known seizure

the seizure lasts longer than 5 minutes

the person has diabetes

the person is pregnant and has a tonic-clonic seizure

the seizure has occurred in water

the seizure lasts longer than normal for that person

Hyperventilation

Hyperventilation occurs when a person takes quick, shallow breaths from the top of their chest. These quick, shallow breaths reduce the level of carbon dioxide (CO2) in the blood. This reduced level of carbon dioxide causes the arteries to constrict, reducing the flow of blood throughout the body. When this occurs, our brain and body will experience a shortage of oxygen.

Hyperventilation may occur due to a number of causes, most of them related to anxiety, fear or irrational emotional outbursts. Reassurance of the casualty and a calm approach often lead to the condition being quickly relieved.

SIGNS AND SYMPTOMS

rapid respirations

rapid pulse

a feeling of shortness of breath

pressure, tightness or pain across the chest

anxiety

dry mouth

blurred vision

In extreme cases which have continued for some time

tingling in fingers and toes

hand and finger spasms and pain

fainting

CARE AND TREATMENT

reassurance

remove the cause of anxiety if possible

if fainted, lay casualty supine with legs elevated

if no improvement, call 000 for an ambulance

Not every casualty who is breathing rapidly is suffering from hyperventilation due to anxiety. In some cases the rapid respirations may be a sign of another, more serious, medical condition. It is important to eliminate more serious causes of rapid breathing, such as asthma.

DO NOT get the casualty to re-breathe into a paper or plastic bag.

Heart Conditions

The heart is a muscular pump, approximately the same size as its owners fist, and is located behind and slightly to the left of the breastbone. Its function is to pump oxygen-rich blood from the lungs to various parts of the body, and to pump the oxygenated reduced blood from the tissues back to the lungs to take on more oxygen. The heart pumps about 7,000 litres of blood around the body every day.

Pumping blood through the lungs removes carbon dioxide and re-supplies the blood with oxygen. The newly oxygenated blood is then pumped around the body to provide oxygen and nutrients and remove waste products.

Due to factors such as lack of exercise, poor diet, advanced age, and chronic disease, the heart is sometimes compromised, and serious cardiac conditions develop. The four major conditions are: angina, heart attack, heart failure, and cardiac arrest.

Heart attack and Angina

When the heart muscle is damaged because blood was blocked from reaching it, a heart attack occurs. Also known as a coronary occlusion or myocardial infarction, a heart attack can occur at any time, at any age.

Fatty deposits called plaque build up inside blood vessels and reduce the blood flow. In some cases the plaque builds up so that the vessel is blocked completely. Reduced blood flow can also allow a clot to form and the clot blocks the vessel. When the blockage occurs, oxygen is not delivered to the heart and part of the heart muscle dies. Blockage can occur in one or several coronary arteries.

Certain people are at greater risk, due to factors such as hereditary influence, lack of exercise, smoking, poor diet, and high blood pressure. Urgent medical attention is vital.

ANGINA PECTORIS (literally pain in the chest), is a condition due to constriction of the blood vessels supplying the heart muscle with blood. Angina sufferers may be aware of their condition, and take medication to relieve the symptoms. Medication is usually in the form of a tablet or spray, taken under the tongue.

SIGNS AND SYMPTOMS

Angina and heart attack have very similar signs and symptoms

pale, cool skin

chest pain or discomfort, possibly after exertion, a heavy meal or stress

crushing, or vice-like pain, usually in the centre of the chest, sometimes also in the jaw and arm

sweating

rapid, irregular, or weak pulse

rapid, shallow respirations, or difficulty breathing

partial or full collapse

nausea and/or vomiting

may feel the need to pass a bowel motion

lethargy

CARE AND TREATMENT

SRABC

call 000 for an ambulance

position of comfort, usually sitting

complete rest

assist with medication

reassurance

discourage visit to the toilet

n       It is important to realise that angina should be relieved by rest or medication.

n       If, after three tablets or sprays over 10 minutes, the pain does not diminish, then the condition should be considered a heart attack.

n       Hospital treatment should be sought without delay! Call 000 for an ambulance.

n       If the casualty collapses and appears to become unconscious, be prepared to provide resuscitation, as this is a sign of impending cardiac arrest.

Heart Failure

When the heart is unable to perform its proper function, blood and fluid collects around the lungs and in the body. This condition is called HEART FAILURE. It is typified by the casualty finding it difficult to breathe, and swelling of the ankles and legs as fluid pools in the extremities.

SIGNS AND SYMPTOMS

pale, cold, clammy skin

chest discomfort, difficulty breathing

bubbly, gasping breaths

frothy sputum

swelling of the extremities, especially the ankles, which may show dimples

partial collapse

CARE AND TREATMENT

SRABC

call 000 for an ambulance

position of comfort, usually sitting supported

do not elevate legs

reassurance

Cardiac arrest

When the heart ceases to function, then the casualty is said to be in CARDIAC ARREST. Whether the heart is at a complete standstill, or whether it is vibrating rapidly in a chaotic rhythm, it is no longer doing its task. The condition may be due to heart attack, heart failure, electrocution, drowning, trauma or other medical condition - first aid treatment is the same, CPR!

SIGNS AND SYMPTOMS

unconsciousness

no normal breaths, although there may be brief irregular, gasping breaths

no signs of circulation

CARE AND TREATMENT

call 000 for an ambulance

immediate CPR

Fainting or Syncope

Fainting, or syncope, is a sudden brief loss of consciousness that may only last a few seconds and is followed by full recovery within two minutes. Fainting is usually caused by a relatively minor event such as the sight of blood or just prior to receiving an injection. The casualty usually makes a full recovery once he or she is laid flat.

There are many causes of fainting, including:

standing for long periods

the sight of needles

the sight of blood

pain

emotional events

heat

SIGNS AND SYMPTOMS

dizziness or feeling light headed

nausea

pale, cool and clammy skin

anxious

collapse

loss of consciousness

rapid recovery after being laid flat

CARE AND TREATMENT

Syncope

if unconscious - stable side position

raise the legs if possible

if conscious - lay the casualty flat and raise the legs if possible

call 000 for an ambulance if not fully recovered in a few minutes

Heat Syncope

stable side position

cool casualty by fanning

loosen and remove excessive clothing

Do not confuse fainting with a loss of consciousness from other causes. Fainting in elderly people is often due to more serious underlying problem.

Choking

Choking is due to the lodgement of a foreign object in the casualtys airway. In some instances, the object lodges at the epiglottis, the entry to the airway, but does not actually enter the airway itself. Both cases cause initial coughing, the bodys reflex action to dislodge the object

If an object is firmly lodged in the airway, coughing at least keeps it high in the trachea, though may not expel it. However, coughing with an object at the entrance to the airway will generally cause it to be expelled.

Should you encounter a person with an apparent obstruction who is COUGHING EFFECTIVELY, DO NOT SLAP him or her on the back. If the obstruction is at the entrance to the trachea, then reactions to the slaps may cause the person to inhale the object and cause complete obstruction.

If a casualty appears to be in increasing distress, then the object may be totally obstructing the airway.

SIGNS AND SYMPTOMS

PARTIAL OBSTRUCTION

difficulty in breathing

wheezing

persistent cough

cyanosis (blue skin colour)

CARE AND TREATMENT

4 encourage to keep coughing

4 place small children and infants face down

4 if blockage has not been cleared call 000 for an ambulance

4 reassurance

SIGNS AND SYMPTOMS

COMPLETE OBSTRUCTION

unable to breathe

unable to speak or cough

agitated and distressed

may grip the throat

cyanosis (blue skin colour)

rapid loss of consciousness

CARE AND TREATMENT

position the casualty

adults on their side

children head down

deliver four firm slaps between the shoulder blades

check mouth and clear any obstructions that may have come loose

reassess the casualtys attempts to breathe

repeat four firm slaps between the shoulder blades

if blockage has not been cleared call 000 for an ambulance

If this fails to free the object and the casualty has collapsed, quickly roll the casualty onto his or her side, place your hands over the ribs, and deliver quick, firm thrusts. This may expel the object through the forcing of residual air from the lungs.

alternate slaps and lateral chest thrusts

if ineffective, and the casualty is in respiratory arrest begin expired air resuscitation (EAR) immediately

if the casualty is in cardiac arrest begin cardiopulmonary resuscitation (CPR) immediately

EAR may be effective, as the object lodged in the airway causes muscular deformity of the trachea. Complete collapse of the casualty causes relaxation of the muscles, this allows some space around the object through which EAR can provide essential oxygen

Poisoning

Poisons are substances that if inhaled, ingested, absorbed or injected, harm the structures or functions of the body. Some types of poisons may act immediately on the body, others may act more slowly. Some poisons, such as cyanide, are so toxic they only require a tiny amount to be harmful, while others, such as garden sprays, are cumulative and require exposure over a long period to achieve the same level of toxicity. Some may be carcinogenic, and cause fatal cancers some years after exposure. Whatever the substance, remember that Prevention Is Better Than Cure!

How to prevent poisoning

n       Store medicines, chemicals and household products safely out of reach and out of sight of children, up high (at least 1.5m) in a locked or child resistant cupboard.

n       Do not take other peoples medicines.

n       Separate medicines from household products.

n       Use medicines and chemicals safely. Be sure that all products are properly labelled and in their original containers.

n       Clean out your medicine cupboard periodically. Take out-of-date medicines to a pharmacy for disposal.

n       Children tend to mimic adults, so avoid taking medicines in their presence.

n       Refer to medicines by their correct names. They are not sweets or lollies.

n       Use personal protection equipment (PPE) when spraying or painting. Ensure there is adequate ventilation, with circulating air.

n       Remove any contaminated clothing immediately.

n       Keep everything in original containers never in cups or soft drink bottles.

Obtain a history, look for empty bottles, containers, and sometimes suicide notes. If possible, ascertain what poison or medicine has been taken, including how much and when.

The wide varieties of poisonous substances present with a similarly wide variety of signs and symptoms. The list on the next page is not exhaustive, but casualties may present with all, or at least some of them.

SIGNS AND SYMPTOMS

May include the following:

pale, cool, clammy skin

rapid, weak (sometimes erratic) pulse

nausea and/or vomiting

cyanosis

headache

burns around the mouth

burning pain in the mouth or throat

blurred vision

ringing in the ears

smell of fumes or odours

stomach pains or cramps

drowsiness, which may lead to unconsciousness

seizures

breathing difficulties

CARE AND TREATMENT

If the casualty has collapsed ring 000 for an ambulance before ringing the Poisons Information Centre for advice on 13 11 26

EAR and CPR as required

monitor the casualty at all times

call the Poisons Information Centre on 13 11 26

SWALLOWED POISON

do not try to make the patient vomit

pick up the container and take it to the telephone

call the Poisons Information Centre on 13 11 26

POISON ON THE SKIN

remove contaminated clothing, taking care to avoid contact with the chemical

flood the skin with cool running water for 20 minutes

call the Poisons Information Centre on 13 11 26

POISON IN THE EYE

irrigate the eye with cool running water for 20 minutes

call the Poisons Information Centre on 13 11 26

INHALED POISON

get the person to fresh air as quickly as possible if safe to do so. Do not place yourself at risk

if safe, open doors and windows

call the Poisons Information Centre on 13 11 26

DO NOT use Syrup of Ipecac (Ipecacuanha Syrup) in the first aid treatment for poisoning unless advised by the Poisons Information Centre

the first aid advice on the product labels are often outdated. Call the Poisons Information Centre

When to call the poisons information centre

You can call your Poisons Information Centre on 13 11 26:

If you or someone in your care may have been poisoned

Do not wait for any symptoms to occur before calling

If in doubt call and check

Poisons may include:

car products

cleaning products

insecticides, weed killers, rodent and snail baits

kerosene, petrol, methylated spirits, etc.

any over-the-counter medicines

paints and thinners

perfumes and aftershaves

plants and mushrooms

prescription medicines

and many more, so always check

If a person is bitten or stung by a marine creature, animal, reptile, spider or insect

If you have any questions or concerns about:

prevention of poisoning

hazards associated with drugs, medicines, chemicals, plants, pesticides and any other products

Drug Overdose

Drugs are usually medicinal substances that come in a variety of forms: pills, capsules, powders, liquids, aerosols and pastes. They are chemical concoctions or refined natural products that are used for specific purposes ranging from relieving headaches to stopping the heart. Most are supplied under control, either by doctors prescriptions, or by government-controlled sale. Some however, are illegal and pose a danger to users.

Drugs are generally classified as either:

Prescription drugs require a doctors authority to purchase them. They are drugs to which the relevant government authority has given a Schedule Number, indicating the toxicity or cautionary usage of the substance. Most prescription drugs are at least Schedule 4, and range up to Schedule 8 which are dangerous narcotic-based drugs. The associated (usually typewritten) label, indicating that a pharmacist has dispensed them readily identifies prescription drugs. Some common examples are; Valium, Normison, and Anginine.

Non-prescription drugs are those which may be purchased without prescription. They consist of headache compounds, cough elixirs, and similar mild medications, and can be purchased at virtually any chemist or retail outlet. Common examples are; Panadol, Aspro, Vicks Cough Syrup, alcohol, and nicotine (cigarettes).

Illicit drugs are drugs that are imported, grown or manufactured illegally. All illicit drugs are dangerous and usually imply a degree of dependence, or in some cases, addiction. Examples are: heroin, cocaine, amphetamines, ecstasy, marijuana, and LSD.

All drugs, even non-prescription drugs, are dangerous when taken as an overdose. Many people have suffered severe renal and kidney impairment from ingesting an overdose of what they considered to be an innocuous drug. As an example, Paracetamol (Panadol, Panadeine) is an excellent analgesic if taken as directed, but is particularly dangerous, even fatal, if taken as an overdose.

Using another persons medication is also a very dangerous practice. Elderly people are at risk of accidental overdose due to memory lapses, and unsupervised children are also potential risks.

SIGNS AND SYMPTOMS

evidence of empty containers, suicide notes, etc

altered level of consciousness

slurred speech

depressed respirations

slow pulse, or alternatively, rapid, weak pulse

irrational behaviour

pin-point pupils (narcotics)

injection (track) marks on arms, behind knees, thighs, and groin

unconsciousness

respiratory/cardiac arrest

CARE AND TREATMENT

treat as for poisoning

urgent ambulance transport

psychological support

resuscitation as required

be aware of Hepatitis and HIV

The first aid provider should be aware that care and treatment may not be restricted to the chemical effects of drugs, but psychological disturbances and trauma are also associated with drug abuse and overdose. Certain amphetamines and cocaine cause delusions and behavioural problems, which can lead to self-inflicted injury or inadvertent serious trauma. Overdosing on alcohol (drunkenness) is also an example of potentially injurious behaviour.

Croup and Epiglottotis

Croup is a viral infection of the voice box and windpipe. Epiglottitis is an viral infection of the epiglottis, the flap-like valve that guards the airway. Both croup and epiglottitis are conditions that mainly affect children.

Croup

The onset of croup is slow, usually after another illness, such as a cold or a sore throat, and is usually caused by a viral infection. Croup will normally last three to four days, and the child may have repeated attacks.

SIGNS AND SYMPTOMS

signs and symptoms appear worse at night

cold-like symptoms

hoarse, barking cough (like a seal)

pale, cool, clammy skin

may have a slight temperature

may have breathing difficulty

may have inspiratory or expiratory stridor (a shrill, harsh sound)

CARE AND TREATMENT

reassure the child

seek medical aid where there the child is having severe difficulty breathing or if the child has noisy breathing (stridor)

the doctor may direct you to give them paracetamol if they have a fever. Follow the instructions on the packet regarding dose

give frequent drinks to keep the child well hydrated

DO NOT examine the throat

Humidification of the air is often recommended but there is no information to prove that it does benefit the symptoms of croup. If moisture is used be aware of the risk of burns from the hot water or steam. Never leave the child alone with hot water or steam.

Epiglottitis

Epiglottitis is usually due to infection by the Influenza B bacteria. It is a life-threatening condition. It affects children in the two to seven year range with four years the most common age affected. The infection of the epiglottis causes a gradual obstruction of the airway by the swollen tissue. Epiglottitis is an emergency and requires urgent ambulance transport to hospital.

SIGNS AND SYMPTOMS

skin often flushed, and a high temperature

child is quiet, doesnt cough, leans forward, and wont talk

appears anxious

salivary drool, child is unable to swallow

rapid onset over one or two hours

child usually has an expiratory purr, though other noisy breathing is common

CARE AND TREATMENT

urgent medical aid - call 000 for an ambulance

reassure the child, and avoid crying - keep calm

allow the child to sit in a position of comfort, usually leaning forward and nursed by a parent in the sitting position

DO NOT examine the childs throat as this may cause complete blockage

Summary of croup and epiglottitis

Characteristic of Croup

Appearance - Well looking

Onset - Slower

Fever - Moderate

Stridor - Usually mild/moderate

Cough - Barking, seal-like quality

Speech - Hoarse voice

Secretions - Able to swallow

Characteristic of Epiglottitis

Appearance - looking Unwell

Onset - Abrupt

Fever - High fever (>38.5oc)

Stridor - Usually moderate/severe

Cough - Minimal or absent

Speech - Unable to speak

Secretions - Unable to swallow, drooling of saliva

Environmental Conditions

The huma body maintains a temperature between 36-37^o C. Any excessive variation to this range has a detrimental effect on the functions of the body. As a general observation, it may be said that the human brain does not react well to excessive body heat, and the heart is sensitive to cold.

The body has some natural defence mechanisms against excessive heat and cold. It regulates body heat by sweating, releasing heat through the body surface (heat loss), and through lung moisture evaporation. Cold is managed by shivering, which generates heat within the body.

Often, environmental influences determine the stability of the human bodys temperature. In a country like Australia, subject to extremes of heat and cold, such influences are important in relation to first aid. Either heat or cold related conditions may bring on serious functional impairment.

Heat related conditions are those conditions brought on by exposure to high temperatures and humidity. The most spectacular example of a serious heat related problem, is the televised distress suffered by athletes during long distance running events, conducted during hot and humid conditions. Heat may induce heat cramps, heat exhaustion and/or heat stroke.

Dehydration

Dehydration is a condition caused by the casualtys loss of fluids from perspiration and prolonged exposure to heat and humidity. When the casualtys fluid loss exceeds his or her input through drinking, dehydration occurs and the blood volume lessens. A prolonged period of dehydration will lead to shock and in susceptible casualties, such as the frail elderly and very young, can be fatal.

SIGNS AND SYMPTOMS

pale, cool, clammy skin

rapid breathing

profuse and prolonged sweating

thirst

loss of skin elasticity (pinch test on back of hand)

sunken eyes in children

CARE AND TREATMENT

complete rest in the shade, no further exertion

remove unnecessary clothing

give cool water to drink

ensure casualty has assistance when recovered

Heat cramps

Heat cramps are caused by the loss of complex salts (electrolytes) through an imbalance in the bodys fluid requirements - the body is losing more fluids than it is replacing. This debit causes the hard-working muscles to lose their vital electrolyte balance, causing muscular contraction.

SIGNS AND SYMPTOMS

pale, clammy skin

sweating if associated with exertion

cramping pains in the limbs or abdomen

nausea

uncontrolled spasms of affected limb(s)

CARE AND TREATMENT

rest in the shade

gently stretch the affected muscle

apply ice pack

when nausea passes, give sips of cool water to drink (with caution)

avoid massaging affected limb

avoid any further exercise

Heat exhaustion

Heat exhaustion is caused by exertion accompanied by heat and high humidity.

SIGNS AND SYMPTOMS

pale, cool, clammy skin

rapid breathing

profuse and prolonged sweating

cramps in the limbs and/or abdomen

thirst, nausea and/or vomiting

constant headache

exhaustion and lethargy

CARE AND TREATMENT

complete rest in the shade, no further exertion

remove unnecessary clothing

cool casualty by sponging with water

when nausea passes, give cool water to drink (cautiously)

ensure casualty has assistance when recovered

Heat stroke

This condition is not to be confused with sun stroke, the common ailment of headache and nausea suffered by children and careless adults who remain in the sun too long without a hat. Also known as Core Temperature Emergency, heat stroke is potentially fatal. In this condition, the bodys temperature regulation centre in the brain has been rendered inoperable, and the temperature continually rises, causing eventual brain damage. Immediate active intervention is necessary to avoid coma and death.

SIGNS AND SYMPTOMS

flushed, hot, dry skin

the casualty has ceased sweating

rapid pulse, gradually weakening

irrational or aggressive behaviour

staggering gait, fatigue

visual disturbances, headache

vomiting

collapse and seizures

coma - death

CARE AND TREATMENT

call 000 for an ambulance

complete rest in shade

remove casualtys clothing

cool casualty by any means possible - ice packs to neck, groin and armpits

cover casualty with wet sheet and fan to increase cooling

be prepared to resuscitate as required

fluids can be given if casualty is fully conscious

if unconscious or semi-conscious, nothing by mouth. Re-hydration is required by intravenous fluids administered by a doctor or ambulance crew

Exposure to cold

Exposure to cold has effects which are no less serious than exposure to heat and humidity. Serious illness and death from exposure to cold and hypothermia is not as common in Australia as in colder climates, but they do occur. Remember that an elderly person in an unheated house during winter, who is incapacitated and unable to summon assistance, is at risk from exposure to cold and hypothermia.

The most common situation relating to persons suffering from low temperatures may be due to being caught out in inclement weather during bushwalking, soaked in cold water and unable to change, subject to cold winds (wind chill) without proper protection, or simply by being elderly, or not able to afford proper heating and clothing.

SIGNS AND SYMPTOMS

pale, cold skin

increasing lethargy, drowsiness, lack of muscular co-ordination

uncommunicative, poor judgement

shivering

CARE AND TREATMENT

warm slowly by adding additional clothing, heating source, body heat

if wet, change the casualtys clothing if in stable environment

if conscious, give warm, sweet drinks

when able to stand, encourage mild exercise

Hypothermia

Hypothermia is a potentially fatal condition that especially affects the elderly. The bodys core temperature has been lowered to the extent that the brain function is impaired and the hearts activity is about to be compromised. Urgent first aid intervention is required.

SIGNS AND SYMPTOMS

pale, cold skin - no capillary return when fingernails are pressed

slow pulse, sometimes irregular

slow, shallow respirations

blurred, or double vision

casualty is silent, appears asleep, difficult to rouse; may be unconscious

casualty experiences a sense of wellbeing

absence of shivering

if very cold, may have non-reacting pupils and appear death-like

CARE AND TREATMENT

provide shelter from cold, rain, wet ground, and wind

call 000 for an ambulance

actively warm casualty, wrap in space blanket or similar

if wet, change the casualtys clothing

once casualty commences shivering, reassess heating

be prepared for sudden collapse and resuscitation

if conscious, give warm, sweet drinks

DO NOT rub affected area

DO NOT expose to excessive heat

DO NOT give alcohol

A casualty is not dead until WARM and dead. Resuscitation must always be attempted until medical advice states otherwise.

Near Drowning

Near drowning is the term for survival after suffocation caused by submersion in water or another fluid. Some experts exclude from this definition cases of temporary survival that end in death within 24 hours, which they prefer to classify as drowning. Near drowning may be classified as either:

Wet - where the casualty has inhaled water into the lungs and function has been affected.

Dry - a less common condition, but one that involves the closing of the airway due to spasms, preventing both air and water from entering the lungs.

The most important consideration to be made by the first aid provider is to ensure SAFETY. Do not attempt a rescue beyond your capabilities, and have the casualty brought to you. Meet the rescuer in the water and begin EAR immediately.

SIGNS AND SYMPTOMS

pale, cool skin

absent, rapid or laboured respirations

decreased level of consciousness

coughing

cyanosis (bluish colour)

may have rapid, weak, slow or absent pulse

CARE AND TREATMENT

SRABC

call 000 for an ambulance

commence immediate EAR or CPR as required

on recovery, stable side position

treat hypothermia if present

suspect and treat spinal injuries

It should be remembered that near drowning has a detrimental effect on the respiratory system, and on recovery, the nearly drowned casualty may experience a build up of fluid in the lungs. This fluid can lead to at best, pneumonia and at worst, a fatal condition called late drowning.

All casualties who have experienced near drowning must see a doctor.

Bites and Stings

Bites and stings are injected poisons. Many of Australias creatures are particularly poisonous, with eleven of the worlds twelve most venomous snakes residing here. As for general poisoning, prevention is better than cure, so take care when in an area frequented by snakes and spiders, and treat venomous sea creatures with respect

Snakes

Australias venomous snakes are regarded as dangerous because of the frequency with which they come in contact with humans. Generally, the snakes with the most feared reputation is the variety of Brown Snakes. These snakes, Tiger Snakes, and the Taipan are responsible for most of the fatal encounters with humans. Black Snakes and Death Adders are also dangerous and are known to have caused deaths. Anti-venom is generally available for all species.

In most cases, the snake strikes swiftly and injects venom below the surface of the skin into the tissues, then absorbed by the lymphatic system. The lymphatic system is a network of tubes that drains fluid (lymph) from the bodys tissues and empties it back into the bloodstream. Only rarely does the venom penetrate directly into the blood stream. As the venom is contained within the lymphatic system, the John Wayne Method of slashing the wound and sucking vigorously, is of no value, and should not be used under any circumstances.

Should you see a snake, LEAVE IT ALONE - do not attempt to kill it as all snakes are protected by law, and besides, the creature will defend itself vigorously. Stay clear of likely habitats, and always pay special attention to young children playing near long grass and bush. Only approximately 15% of people struck by poisonous snakes are envenomated, but always treat for the worst case, and assume that venom has been injected.

SIGNS AND SYMPTOMS

puncture marks, or parallel scratches on the skin - rarely any pain

anxiety

pale, cool skin with progressive onset of sweating

rapid, weak pulse

rapid, shallow breathing

breathing difficulties

blurred vision, drooping eyelids

difficulty swallowing and speaking

abdominal pain

nausea and/or vomiting

headache

collapse - progressing to a comatose state

CARE AND TREATMENT

SRABC

reassure

complete rest

call ambulance urgently

apply direct pressure over the bitten area

obtain a history

apply a firm bandage (pressure immobilisation bandage) starting from over the bite site, and then wind as far up the limb as possible to the armpit or groin

immobilise the limb with a splint

send any evidence of the snake to the hospital only if safe to do so.

avoid washing the bitten area, as a venom sample may be obtained

avoid elevating the limb

DO NOT use an arterial tourniquet

DO NOT remove the bandage and splint once it has been applied

DO NOT try to capture the snake

The main treatment for a snake bite is the application of a pressure immobilisation bandage. This bandage is applied as firmly as bandaging a sprained ankle, and is designed to slow the movement of venom through the lymphatic system. Bandaging the wound firmly tends to compress the lymph vessels, which helps to slow or prevent the venom from leaving the bite site.

Spiders

FUNNEL WEB SPIDER

The Sydney Funnel Web spider is considered to be the most venomous spider in the world. It is found in the NSW coastal zone from Nelsons Bay to Nowra. Its habitat is under rocks and houses, in a web-lined burrow. The spider is very aggressive and will attack at the slightest provocation.

Despite its fearsome reputation, there are only 14 recorded deaths due to funnel web spider bite. However, when the spider does inject a dangerous quantity of venom, the effects can be rapid and severe, and death within an hour may occur.

A second type of spider called the Bush (or Blue Mountains) Funnel Web is also recorded as being responsible for fatal bites. Its habitat ranges over most of the NSW coast and the Great Dividing Range. This creature lives in trees behind the bark, or in holes in the trunk. Other types of related spiders such as the Northern and Southern Tree Dwelling species, are suspected of similar venom potency, and are found mostly along the south eastern area of Australia.

There are at least 37 species of funnel web spiders. All are medium to large, robust spiders, mostly dark or black in colour, with stout legs and large fangs. Males search for female mates, a process which may increase the chance of unwanted interaction with people, as they may get underfoot, or into shoes or clothing left on or near the floor.

The funnel web will bite successively if in contact with the skin, and when bitten by the funnel web spider the venom enters the body similarly to that of snakes. Anti-venom is available.

SIGNS AND SYMPTOMS

pain at the site of the bite

pale, cool skin

tingling or numbness around the mouth

rapid, weak pulse

rapid onset of breathing difficulties

nausea

vomiting

abdominal pain

profuse sweating

copious production of saliva and pulmonary fluids

mental confusion

collapse - coma - death

CARE AND TREATMENT

treat as for snakebite

RED-BACK SPIDER

This spider with the telltale red or orange mark on its thorax is the female of the species. It is common all over Australia, and its preferred habitat is under any old building material, or inside sheds and garages.

The spiders bite is not generally regarded as fatal, although there are recorded deaths prior to the introduction of the anti-venom. Less than 20% of bites actually result in significant envenomation, but generally, the bite is very painful, and causes distress.

SIGNS AND SYMPTOMS

intense pain at the site of the bite

may be localised redness, swelling and sweating

nausea, vomiting and abdominal pain

rapid pulse

loss of co-ordination

tremors and muscle spasms

rapid, shallow breathing

CARE AND TREATMENT

SRABC

reassure

obtain history

cold compress to relieve pain

observe casualty for any sign of deterioration

Other spiders

Other spiders that have been associated with venomous bites are the White-Tailed Spider, Trapdoor Spider and Wolf Spider. The bite of these spiders causes tissue necrosis, the death of the tissue around the bitten area. A doctor should treat bites from these spiders and assess the bitten area over a period to observe for any detrimental effects.

Ticks

Only the Australian paralysis tick or scrub tick causes envenomation in humans. Ticks are capable of spreading diseases eg. Scrub Typhus. Ticks can be found anywhere on the body, but hairy areas, skin clefts and crevices should be examined carefully.

SIGNS AND SYMPTOMS

local irritation

lethargy

muscle weakness, especially in children

unsteady gait

double vision

difficulty in swallowing or breathing

rarely allergic reactions occur:

rapid local swelling

wheezing and difficulty breathing

collapse

Symptoms and signs generally develop over several days but allergic symptoms can occur within hours.

CARE AND TREATMENT

SRABC

reassure

if the victim has a history or signs of allergy:

use pressure immobilisation if possible

seek medical advice immediately

slide the open blades of sharp pointed tweezers on each side of the tick and lever it upwards

always check the whole body of the victim, including the ears, skin creases and hair for further ticks

after removal of a tick the victim should be advised to see a doctor to check that no further treatment is required.

avoid squeezing the tick because even slight pressure may inject more venom

Bee and ant stings

Bee and ant stings for most people are only a temporary irritation. For others however, these stings have the potential to cause death. The venom associated with bee stings causes a severe allergic reaction in susceptible people, and can cause respiratory and cardiac arrest. In most cases ant stings, while painful, rarely cause serious problems.

SIGNS AND SYMPTOMS

evidence of bee sting with the barb present

pain and itching at the site

swelling of the stung area

in allergic casualties:

onset of wheezing and breathing difficulties

facial swelling and hives

rapid pulse

collapse

CARE AND TREATMENT

SRABC

reassure

remove bee sting by scraping with fingernail or similar

cold compress to reduce swelling and pain

if onset of allergic reaction:

pressure immobilisation bandage

call 000 for an ambulance

avoid squeezing or touching the barb

Fire Ant Stings

SIGNS AND SYMPTOMS

Fire ants inflict a fiery sting, which causes a small blister to form at the site of each sting after several hours. The blisters become itchy while healing and are prone to infection if broken

pain, burning and itching at the site

swelling of the stung area

in allergic casualties:

onset of wheezing and breathing difficulties

facial swelling and hives

rapid pulse

collapse

CARE AND TREATMENT

SRABC

reassure

cold compress to reduce swelling and pain

gently wash the affected area with soap and water

leave the blisters intact

if onset of allergic reaction:

pressure immobilisation bandage

call 000 for an ambulance

European wasp

This introduced insect has been identified with some deaths. The European Wasp is coloured yellow and black, with stripes similar to those of a bee. The yellow stripes are brighter in colour than those on a bee, and the insect is slightly larger.

The insect is attracted to aromatic or sweet-tasting things, and will enter food containers such as open soft-drink cans. The creature will then sting when inadvertently handled, and can sting multiple times. Similar to bees, the wasps become aggressive when their nest is disturbed.

SIGNS AND SYMPTOMS

severe pain at the affected site

immediate swelling, especially if the throat has been stung

breathing difficulties

CARE AND TREATMENT

SRABC

reassure

call 000 for an ambulance or see own doctor

cold compress to reduce swelling and pain

if onset of allergic reaction;

pressure immobilisation bandage over affected limb(s)

call ambulance urgently

EAR if respiratory arrest

Scorpions

In Australia there are over 100 species of scorpion and they can be found in a wide variety of habitats all over the country. Australian scorpions can give a painful sting but are not considered dangerous.

SIGNS AND SYMPTOMS

pain and itching at the site

swelling of the stung area

in allergic casualties;

onset of wheezing and breathing difficulties

facial swelling and hives

rapid pulse

collapse

CARE AND TREATMENT

SRABC

reassure

cold compress to reduce swelling and pain

if onset of allergic reaction;

pressure immobilisation bandage

call 000 for an ambulance

Sea creatures

Many sea creatures are venomous, and the best way to avoid envenomation is to give the creatures a wide berth. As an example, dont pick up or handle creatures washed up on the beach or in rock pools, and dont swim where Box Jellyfish or Portuguese Man-of-War are prevalent.

Box Jellyfish

The Box Jellyfish, also known as Stingers, are prevalent in the north of Australia during the season from November to March. These creatures are deadly, and are responsible for many fatal encounters.

Warning signs at popular beaches should be complied with, and extreme care taken at unpatrolled locations.

SIGNS AND SYMPTOMS

immediate severe pain, with irrational behaviour because of the pain

rapid, irregular pulse

frosted pattern of sting marks

collapse

respiratory arrest

cardiac arrest

CARE AND TREATMENT

SRABC

reassure

restrain anyone from rubbing the sting

apply liberal quantities of VINEGAR for a minimum of 30 seconds

dry cold compress to relieve pain

call 000 for an ambulance and call lifesavers urgently

EAR and/or CPR as required

Irukandji syndrome

Irukandji syndrome is caused by Irukandji jellyfish such as the Carukia barnesi, and are small, transparent jellyfish about 25 mm across the body or bell with a single tentacle from each corner of its box-shaped body. Irukandji jellyfish are found along coastal beaches as well as offshore and appear to be restricted to waters between the Tropic of Capricorn and the northern tip of Torres Strait. They are mainly prevalent between November and May each year.

SIGNS AND SYMPTOMS

minor pain initially, the pain increases over time (5-60 minutes) to severe

shooting pains in chest and abdomen muscles

lower back pain

restlessness and anxiety

collapse

coma

CARE AND TREATMENT

SRABC

reassure

restrain anyone from rubbing the stung area

gently apply a vinegar soaked pad to the stung area for a minimum of 30 seconds

call 000 for an ambulance

Stonefish

The Stonefish is virtually invisible amongst rocks. The creature has venomous spines on its back that it erects when threatened or stepped on. This fish lives in the tropical regions, and as far south as Forster/Tuncurry in NSW.

SIGNS AND SYMPTOMS

severe pain at the site of envenomation

swelling

open wound and/or bleeding

irrational behaviour

rapid pulse

breathing difficulties

collapse - coma

CARE AND TREATMENT

SRABC

reassure

call 000 for an ambulance

HOT water immersion of the site to relieve pain - ensure that the water will not scald the casualty

EAR and/or CPR as required

BLUE-RINGED OCTOPUS AND CONE SHELL

The Blue-Ringed Octopus is an attractive little creature that lives in rock pools on the shores of Australia. When threatened, the creature pulses luminous bright blue rings on its body. Its bite is painless, and will only occur if the creature is handled.

The Cone Shell is a variegated shell, usually brown and white, which is common on tropical beaches. The shell contains a dagger-like spine, which can inject toxin into any unwary person who handles the creature.

SIGNS AND SYMPTOMS

a spot of blood

numb feeling of the face and tongue

progressive weakness in the legs and body

eventual collapse

respiratory arrest

CARE AND TREATMENT

SRABC

reassure

pressure immobilisation bandage

call ambulance urgently

EAR as required

PORTUGUESE MAN-OF-WAR (BLUEBOTTLE)

The Portuguese Man-of-War, or Bluebottle, found on most beaches in Australia, is really a colony of small creatures living as one. The creatures have small stinging cells, which when encountered as a group, impart a venomous sting. People who are susceptible to bee sting are usually sensitive to Bluebottle venom.

SIGNS AND SYMPTOMS

trails of blue tentacles adhering to the body or limbs

stinging sensation associated with the contact

reddening of the skin

pain for some hours

may cause severe allergic reaction (rare)

CARE AND TREATMENT

SRABC

reassure

remove the tentacles with a copious amount of sea water

dry cold compress to relieve pain

call ambulance or own doctor

if severe allergic reaction:

call 000 for an ambulance

Sea snakes

Sea snakes may grow to be several metres in length, and are found mainly in warmer waters. They appear similar to land snakes, but have flatter tails.

SIGNS AND SYMPTOMS

relatively painless

drowniness

weakness

nausea and vomitting

breathing difficulities

visual disturbances

CARE AND TREATMENT

as for snakebite

FISH STINGS

Many fish, such as the flathead and the stingray, have poisonous spines that can inject venom deep in the unwary victim, causing excruciating pain. Handle all fish with care, avoiding the spinous areas along the backbone and around the gills. Constant handling of fish may cause skin irritation due to the fluids and secretions of the fish oils.

SIGNS AND SYMPTOMS

intense pain at the site

swelling

bleeding

often a grey/bluish discolouration at the site

there may be an open wound or barb in the skin

irrational behaviour or panic may occur

CARE AND TREATMENT

SRABC

reassure

HOT water immersion of the site to relieve pain or apply a hot compress * ensure that the water will not scald the casualty

if heat does not alleviate the pain, try a cold compress for pain relief

call 000 for an ambulance or call own doctor

If handling fish without protective gloves, wash hands frequently to avoid skin problems.