Definition

Insect bites and stings can cause an immediate skin reaction. The bite from fire ants and the sting from bees, wasps, and hornets are usually painful. Bites caused by mosquitoes, fleas, and mites are more likely to cause itching than pain.

Alternative Names

Bedbug bite; Bee sting; Bites - insects, bees, and spiders; Black widow spider bite; Brown recluse bite; Flea bite; Honey bee or hornet sting; Lice bites; Mite bite; Scorpion bite; Spider bite; Wasp sting; Yellow jacket sting

Considerations

In most cases, bites and stings can be easily treated at home. However, some people have a severe allergic reaction to insect bites and stings. This is a life-threatening allergic reaction known as anaphylaxis, and it requires urgent emergency care. Severe reactions can affect the whole body and may occur very quickly, often within minutes. These severe reactions can be rapidly fatal if untreated. Call 911 if you are with someone who has trouble breathing or goes into shock.

Some spider bites, like those of the black widow or brown recluse, are also serious and can be life-threatening. Most spider bites, however, are harmless. If bitten by an insect or spider, bring it for identification if this can be done quickly and safely.

Symptoms

The non-emergency symptoms vary according to the type of insect and the individual. Most people have localized pain, redness, swelling, or itching. You may also feel burning, numbness, or tingling.

First Aid

For emergencies (severe reactions):

1. Check the person's airway and breathing. If necessary, call 911 and begin rescue breathing and CPR.
2. Reassure the person. Try to keep him or her calm.
3. Remove nearby rings and constricting items because the affected area may swell.
4. Use the person's Epi-pen or other emergency kit, if they have one. (Some people who have serious insect reactions carry it with them.)
5. If appropriate, treat the person for signs of shock. Remain with the person until medical help arrives.

General steps for most bites and stings:

1. Remove the stinger if still present by scraping the back of a credit card or other straight-edged object across the stinger. Do not use tweezers -- these may squeeze the venom sac and increase the amount of venom released.
2. Wash the site thoroughly with soap and water.
3. Place ice (wrapped in a washcloth) on the site of the sting for 10 minutes and then off for 10 minutes. Repeat this process.
4. If necessary, take an antihistamine or apply creams that reduce itching.
5. Over the next several days, watch for signs of infection (such as increasing redness, swelling, or pain).

Do Not

• DO NOT apply a tourniquet.
• DO NOT give the person stimulants, aspirin, or other pain medication unless prescribed by the doctor.

Call immediately for emergency medical assistance if

Call 911 if the person is having a severe reaction:

• Trouble breathing, wheezing, shortness of breath
• Swelling anywhere on the face
• Throat feels tight
• Feeling weak
• Turning blue

Prevention

• Avoid provoking insects whenever possible.
• Avoid rapid, jerky movements around insect hives or nests.
• Avoid perfumes and floral-patterned or dark clothing.
• Use appropriate insect repellants and protective clothing.
• Use caution when eating outdoors, especially with sweetened
• Beverages or in areas around garbage cans, which often attract bees.
• For those who have a serious allergy to insect bites or stings, carry an emergency epinephrine kit (which requires a prescription). Friends and family should be taught how to use it if you have a reaction. Wear a medical ID bracelet.

References

Goldman L, Ausiello D, eds. Cecil Textbook of Medicine, 22nd Ed. Philadelphia, Pa: Saunders; 2004:1617-1619, 2126-2128.

Noble J, ed. Textbook of Primary Care Medicine. 3rd Ed. St. Louis, Mo: Mosby; 2001:805-813.

Auerbach PS. Wilderness Medicine. 4th Ed. St. Louis, Mo: Mosby; 2001.

The importance of water safety:

Although most drownings occur in residential swimming pools, children can drown in just one inch of water (such as in buckets, bath tubs, wading pools, diaper pails, toilets, hot tubs, and spas). In addition, open waters such as oceans, rivers, and lakes pose a drowning threat to older children.

Consider these facts concerning drowning from the National SAFE KIDS Campaign:

• When a child is submerged two minutes in water, he/she loses consciousness.
• Irreversible brain damage sets in after four to six minutes of water submersion.
• Most children die if they are found after 10 minutes in the water.

Parents are advised to take the following preventive steps to protect their children from drowning:

A warning about personal flotation devices:

On boats, PFDs should be US Coast Guard-approved. Inflatable swimming devices such as "water wings," rafts, toys, and other items are not considered safe and should not be relied on to prevent drowning.

More than half of all infant drownings (under age 1) occur in bathtubs. Supportive baby bathtub "rings" do not prevent drownings if the child is unsupervised. Water hazards in and around the home may include the following:

• buckets (especially 5-gallon size)
• diaper pails
• toilets
• ice chests with melted ice
• hot tubs, spas, and whirlpools
• ditches and post holes
• wells
• ponds and fountains

Small children can drown when they lean forward to look into a bucket or open the toilet. Because the head is the heaviest part of a small child, it is easy for him/her to fall over into a container. Containers filled with liquid often weigh more than the small child and will not tip over when the child falls in.

More than half of childhood drownings occur in swimming pools, either at the child's home or at a friend's, neighbor's, or relative's house. Pools are especially hazardous if:

• children swim unsupervised.
• the pool is not properly fenced in.
• there is no telephone with emergency numbers nearby.
• there is no rescue equipment near the pool.
• parents rely on personal flotation devices (PFDs) to keep their child safe.

Boating safety:

When boating, sailing, and canoeing, children of all ages should wear US Coast Guard-approved personal flotation devices (PFDs) such as life jackets. In fact, many states require the use of PFDs on all boats at all times. According to the National SAFE KIDS Campaign, it is estimated that 85 percent of boating-related drownings can be prevented if people wear PFDs.

Drowning in the winter:

Children can drown during the winter by falling through thin ice. In addition, pools with winter covers that do not completely cover the pools pose a threat, because children can slip between the cover into the pool.

If children are around bodies of water on a regular basis, it benefits parents to learn cardiopulmonary resuscitation (CPR), which, in case of an emergency, can save lives, reduce the severity of injury, and improve the chance of survival. CPR training is available through the American Red Cross, the American Heart Association, and your local hospital or fire department.

A warning about diving:

Diving accidents can result in permanent spinal cord injuries, brain damage, and/or death. Diving accidents occur when a person:

• dives into shallow water.
• dives into above-ground pools, which are usually shallow.
• dives into the shallow end of a pool.
• springs upward from the diving board and hits the board on the way down.

Definition

Heat emergencies fall into three categories of increasing severity: heat cramps, heat exhaustion, and heatstroke.

Alternative Names

Heatstroke

Considerations

Heat illnesses are easily preventable by taking precautions in hot weather.

Children, elderly, and obese people have a higher risk of developing heat illness. People taking certain medications or drinking alcohol also have a higher risk. However, even a top athlete in superb condition can succumb to heat illness if he or she ignores the warning signs.

If the problem isn't addressed, heat cramps (caused by loss of salt from heavy sweating) can lead to heat exhaustion (caused by dehydration), which can progress to heatstroke. Heatstroke, the most serious of the three, can cause shock, brain damage, organ failure, and even death.

Causes

The following are common causes of heat emergencies:

• High temperatures or humidity
• Dehydration
• Prolonged or excessive exercise
• Excess clothing
• Alcohol use
• Medications, such as diuretics, neuroleptics, phenothiazines, and anticholinergics
• Cardiovascular disease
• Sweat gland dysfunction

Symptoms

The early symptoms of heat illness include:

• Profuse sweating
• Fatigue
• Thirst
• Muscle cramps

Later symptoms of heat exhaustion include:

• Headache
• Dizziness and light-headedness
• Weakness
• Nausea and vomiting
• Cool, moist skin
• Dark urine

The symptoms of heatstroke include:

• Fever (temperature above 104°F)
• Irrational behavior
• Extreme confusion
• Dry, hot, and red skin
• Rapid, shallow breathing
• Rapid, weak pulse
• Seizures
• Unconsciousness

First Aid

1. Have the person lie down in a cool place. Elevate the person's feet about 12 inches.
2. Apply cool, wet cloths (or cool water directly) to the person's skin and use a fan to lower body temperature. Place cold compresses on the person's neck, groin, and armpits.
3. If alert, give the person beverages to sip (such as Gatorade), or make a salted drink by adding a teaspoon of salt per quart of water. Give a half cup every 15 minutes. Cool water will do if salt beverages are not available.
4. For muscle cramps, give beverages as above and massage affected muscles gently, but firmly, until they relax.
5. If the person shows signs of shock (bluish lips and fingernails and decreased alertness ), starts having seizures, or loses consciousness, call 911 and administer first aid accordingly.

Do Not

• DO NOT underestimate the seriousness of heat illness, especially if the person is a child, elderly, or injured.
• DO NOT give the person medications that are used to treat fever (such as aspirin or acetaminophen). They will not help, and they may be harmful.
• DO NOT give the person salt tablets.
• DO NOT give the person liquids that contain alcohol or caffeine. They will interfere with the body's ability to control its internal temperature.
• DO NOT use alcohol rubs on the person's skin.
• DO NOT give the person anything by mouth (not even salted drinks) if the person is vomiting or unconscious.

Call immediately for emergency medical assistance (911) if:

• The person loses consciousness at any time.
• There is any other change in the person's alertness (for example, confusion or seizures).
• The person has a fever over 102°F.
• Other symptoms of heat stroke are present (like rapid pulse or rapid breathing).
• The person's condition does not improve, or worsens despite treatment.

Prevention

• Wear loose-fitting, lightweight clothing in hot weather.
• Rest frequently and seek shade when possible.
• Avoid exercise or strenuous physical activity outside during hot or humid weather.
• Drink plenty of fluids every day. Drink more fluids before, during, and after physical activity.
• Be especially careful to avoid overheating if you are taking drugs that impair heat regulation, or if you are overweight or elderly.
• Be careful of hot cars in the summer. Allow the car to cool off before getting in.

References

Auerbach PS. Wilderness Medicine. 4th ed. St. Louis, Mo: Mosby; 2001:240-316.

DeLee JC, Drez Jr. D, Miller MD, eds. DeLee and Drez’s Orthopaedic Sports Medicine. 2nd ed. Philadelphia, Pa: Saunders; 2003:763.

Symptoms

Mechanism of asthma

Asthma signs and symptoms range from minor to severe, and vary from person to person. You may have mild symptoms such as infrequent wheezing, with occasional asthma attacks. Between episodes you may feel normal and have no trouble breathing. Or, you may have signs and symptoms such as coughing and wheezing all the time or have symptoms primarily at night or only during exercise.

Asthma signs and symptoms include:

• Shortness of breath
• Chest tightness or pain
• Trouble sleeping caused by shortness of breath, coughing or wheezing
• An audible whistling or wheezing sound when exhaling
• Bouts of coughing or wheezing that are worsened by a respiratory virus such as a cold or the flu

Signs that your asthma is probably getting worse include:

• An increase in the severity and frequency of asthma signs and symptoms
• A fall in peak flow rates as measured by a peak flow meter, a simple device used to check how well your lungs are working
• An increased need to use bronchodilators — medications that open up airways by relaxing the surrounding muscles

Work with your doctor to determine when you need to increase your medications or take other steps to treat symptoms of worsening asthma and get your asthma back under control. If your asthma keeps getting worse, you may need a trip to the emergency room. Your doctor can help you learn to recognize emergency signs and symptoms so you'll know when to get help.

Your ligaments are tough, elastic-like bands that attach to your bones and hold your joints in place. A sprain is an injury to a ligament caused by excessive stretching. The ligament can have tears in it, or it can be completely torn apart.

Of all sprains, ankle and knee sprains occur most often. Sprained ligaments swell rapidly and are painful. Generally the greater the pain, the more severe the injury. For most minor sprains, you can probably treat the injury yourself.

Follow the instructions for P. R. I. C. E. :

1. Protect the injured limb from further injury by not using the joint. You can do this using anything from splints to crutches.
2. Rest the injured limb. But don't avoid all activity. Even with an ankle sprain, you can usually still exercise other muscles to prevent deconditioning. For example, you can use an exercise bicycle, working both your arms and the uninjured leg while resting the injured ankle on another part of the bike. That way you still get three-limb exercise to keep up your cardiovascular conditioning.
3. Ice the area. Use a cold pack, a slush bath or a compression sleeve filled with cold water to help limit swelling after an injury. Try to apply ice as soon as possible after the injury. If you use ice, be careful not to use it for too long, as this could cause tissue damage.
4. Compress the area with an elastic wrap or bandage. Compressive wraps or sleeves made from elastic or neoprene are best.
5. Elevate the injured limb whenever possible to help prevent or limit swelling.

After the first two days, gently begin using the injured area. You should feel a gradual, progressive improvement. Over-the-counter pain relievers, such as ibuprofen (Advil, Motrin, others) and acetaminophen (Tylenol, others) may be helpful to manage pain during the healing process.

Get emergency medical assistance if:

• You heard a popping sound when your joint was injured, you can't use the joint, or you feel unstable when you try to bear weight on the joint.
• This may mean the ligament was completely torn. On the way to the doctor, apply a cold pack.
• You have a fever higher than 100 F (37.8 C), and the area is red and hot. You may have an infection.
• You have a severe sprain. Inadequate or delayed treatment may cause long-term joint instability or chronic pain.
• You aren't improving after the first two or three days.

Since the topic of allergies is quite an extensive area, here's a website we would like to share with you for more information:

Simply type in the word allergies, click on Search, and you will find approximately six pages of additional referencing.