Encyclopedia of Family Medicine

Chapter 21 First Aid Common Sense (4)
Dog bite

Dog bites are very common in rural areas.When a person is bitten by an ordinary dog, it can only cause local damage to the skin and flesh, and there is no danger to life. It is only acceptable for general wound treatment.However, if bitten by a dog with rabies virus and not treated in time, it can often cause rabies (hydrophobia), and the mortality rate of the patient is almost 100%.

1. Disease characteristics

The onset time after biting is uncertain, it can be as short as 10 days, and it can also be as long as several years, usually 1 to 2 months.

In the early stage of the onset, the patient has fatigue, headache, dizziness, sore throat, insomnia, nausea, vomiting, loss of appetite, fever, etc., followed by fear, anxiety, sound, light, wind, tightness in the throat, and pain at the bite site. , numbness, limbs seem to have ants crawling.In the mid-term, the patient is extremely frightened, with convulsions, difficulty in breathing and swallowing, sweating and salivation, and extreme thirst, but he is afraid of water and does not dare to drink.Late can be fatal.

2. Identification method

After the dog bites, it is necessary to distinguish whether the dog is a "mad dog". "Mad dog" generally has the following characteristics: sudden change in temperament, manic irritability, barking, erratic emotions, and biting when irritated.There are also "mad dogs" who are not crazy, behave quietly, live alone, don't like to get along with groups, stick out their tongues, and salivate, but when they are disturbed, they bark unceasingly, and may die due to general paralysis. Most of the "mad dogs" died within 10 days after the onset of symptoms.

3. On-site rescue

Tightly strangle the wound with a cloth band or tourniquet above and below the wound (5 cm away from the wound), and use a breast pump or cupping can to suck out the blood in the wound to suck out a large amount of rabies virus.

Wash the hands of the rescuer or the injured person with soap and water, then scrub the wound with strong soapy water and a clean brush, vigorously and thoroughly, for at least half an hour.

After washing, rub the area with shochu or 70% alcohol, but never bandage the wound.

After the above treatment, the patient should be sent to the hospital immediately, and the doctor should be asked to inject anti-rabies immune serum or rabies vaccine, as well as tetanus antitoxin.

Snake bite
There are a pair of venom glands on the lip and palate of the viper, which can secrete blood toxins and/or neurotoxins, and discharge venom to poison people when they bite.

1. Disease characteristics

(1) Symptoms caused by blood toxins.Local severe pain, rapid swelling, bleeding from multiple places such as skin, mucous membranes and internal organs, and dissolved blood continuously flowing out from the teeth marks, the patient feels thirsty, nausea, sore throat, clammy and cold skin, fast and weak pulse, and blood pressure drop , and even shock.The above symptoms can occur when bitten by five-step snake, bamboo leaf green, iron head, viper, etc.

(2) Symptoms caused by neurotoxins.Local mild burning pain, numbness, dizziness, blurred vision, inaudible hearing, chest tightness, nausea and sleepiness, weakness of limbs, salivation, drooping eyelids, dysphagia, quadriplegia, shallow and slow breathing, Suffocation, coma, dilated pupils, and even death.The above-mentioned symptoms may appear after being bitten by golden krait, coral snake, sea snake, etc.

Some poisonous snakes, such as cobras and vipers, can secrete the above two types of venom, so they can cause the above two manifestations.

2. Identification method

After being bitten by a snake, it is necessary to distinguish between being bitten by a venomous snake and being bitten by a non-venomous snake.Observing the condition of the wound can help to distinguish.Generally, there are two rows of tooth marks on the bitten place. If there are two particularly thick and deep marks on the top, it means the tooth marks after the bite of a poisonous snake. If only thinner or rows of fine tooth marks are seen, it is a Not bitten by poisonous snakes.In addition, the shape of a general venomous snake is a large head with a thin neck, a triangular head, and a short and thin tail, but there are exceptions.After being bitten by a venomous snake, the patient often feels the wound is numb, the pain gradually increases, and there are ecchymosis or swelling around the wound.

3. On-site rescue

Let the patient sit or lie down, keep calm, and do not walk or run to prevent the spread of the venom from accelerating.

Apply a tourniquet to the patient within 1 to 2 minutes.Cloth strips, bandages, handkerchiefs, triangular towels, etc. can be used as tourniquets.The position of the upper tourniquet should be near the heart of the wound, and the tourniquet should be relaxed every 15 to 30 minutes, 1 minute each time.After the venom has been removed and the medication is administered, the tourniquet can be removed.

Rinse the wound with clean water or soapy water while constantly squeezing it to promote the outflow of venom, or make a "cross" incision (the edge of the incision should reach the normal tissue), and suck the venom with a cupping can or a breast pump.If necessary, if the oral mucosa is not damaged and there is no dental caries, you can directly suck it with your mouth, spit it out while sucking, and then rinse your mouth with water.

Those who have conditions can give the patient Jidesheng snake medicine (Nantong snake medicine), Shanghai snake medicine, etc., or drink 100-200 ml of rice vinegar immediately, and add 5 grams of Wulingzhi and 2 grams of realgar to grind into powder, and take it orally with wine. detoxification.

After the above treatment, the patient should be immediately transferred to the hospital for medical treatment.During the transfer, activities of injured limbs should be avoided as much as possible.

Drowning
The human body is submerged in water, and the airway is blocked by water, sediment, etc., resulting in hypoxia and suffocation, which is called drowning.A drowning person generally dies within 4 to 6 minutes after falling into the water. Therefore, the rescue of the drowning person must race against time.

1. Disease characteristics

Most people have bruised complexion, bloodshot eyes, bloody foam in the mouth and nose, sludge or algae, distended abdomen, cold body, swollen skin, weak and irregular heart sounds, rapid or irregular breathing, or even stopped.Some people are in a coma due to panic and fear, and the strong stimulation of cold water causes laryngeal convulsion and glottis closure, resulting in stop of heartbeat and breathing, showing pale complexion, little or no water in the mouth, and soft abdomen.

2. On-site rescue

(1) Self-help.The drowning person should keep a clear mind, don't struggle indiscriminately, and throw his hands up.In addition to calling for rescue, you should take the supine position, with your head back, so that your mouth and nose are above the water surface, exhale shallowly, and inhale deeply, and wait for rescue.

(2) Rescue by others.The rescuer quickly took off his underwear, shoes and socks, swam behind the drowning person, and held his right hand from the middle of his left arm and body with his left hand, or dragged his head and dragged him to the shore by backstroke.The rescuer must not let the weak water person hold tightly and hinder the rescue.In case of being hugged, the rescuer should let go and sink, so that the drowning person can leave, and then rescue him, or push his face back, squeeze his nose, let him let go, and then rescue him.If the rescuer cannot swim, a lifebuoy with rope, wooden board, long pole, rope, etc. can be used to drag the drowning person ashore.If such equipment is not available, call for help loudly.

3. Medical rescue

Keep the airway unobstructed: the rescuer should immediately remove the sand, vomit, etc. in the mouth and nose; wrap the tongue with a cloth strip and pull it out of the mouth; remove the dentures, and untie the collar, underwear, bra, and belt of the drowning person Wait.

For those who have stopped breathing and heartbeat, artificial respiration and chest cardiac compression should be implemented: when rescued in water, artificial respiration should be started.Blow hard, keep going, don't stop, give up easily.

Water control: If there is too much water in the stomach, water should be controlled immediately, but not for too long.The method of water control is as follows: the rescuer kneels on one leg and bends the other knee, places the drowning victim’s abdomen on the rescuer’s knee-bent thigh, droops his head, and then presses his back to make the water in the respiratory tract and stomach pour out. To get out: Or the rescuer picks up the drowning person by the waist so that the back is up and the head is down.

Keep warm and wrap the drowning person with clothes or blankets.If the body temperature of the drowning person drops sharply in severe winter or after being immersed in water for a long time, heating measures should be taken immediately.

At the same time of on-site rescue, it is necessary to get in touch with the hospital as soon as possible, and ask a doctor to come for rescue or transfer to the hospital for treatment.

If the drowning person is in good condition when they are rescued, they should also be closely observed for 12 to 24 hours, paying attention to the patient's body temperature, pulse, respiration, consciousness, and urination.

Dislocation
A dislocation is when a joint is dislocated, i.e. the joint is not in its normal position.Trauma and neuromuscular disease can lead to dislocation, but dislocation is common in children. This is because the ligaments and muscles around the joints of children are underdeveloped. When there is a strong external force, the joints are easily prolapsed from their normal positions, resulting in dislocation.Common dislocations include radial head subluxation, mandibular joint dislocation and shoulder dislocation.

1. On-site rescue

(1) Reduction of radial head subluxation.The rescuer holds the child's wrist with one hand, and the thumb of the other hand presses the radial head backwards and inwards, gradually bends the elbow, pulls the forearm slightly, and rotates back and forth. If a slight sound is heard and the child feels pain disappears, the reset is considered successful.Then, hang the elbows on the chest with cloth strips for 3 days.

(2) Reduction of mandibular joint dislocation.Ask the patient to sit against the wall, with the back of the head close to the wall, and the rescuer stands opposite, put two thumbs wrapped with gauze into the patient's mouth, put them on the lower molars on both sides, and hold the lower jaw with the other four fingers outside the mouth, first use the two thumbs Slowly press down, and then move the lower jaw back and up with the other four fingers at the same time. When you hear a sound, it means that the reset is successful.

(3) reduction of shoulder dislocation.Have the patient lie down.The rescuer pushes the injured armpit with one foot, holds the patient's wrist with one hand, and the elbow joint with the other hand, pulls the injured arm downward, externally rotates the upper arm, and then retracts and internally rotates. reset.

acute labor
When the mother is close to the due date, she still travels or goes to work in the field, but gives birth suddenly on a train, ship or in the field, which is called an emergency.Sudden labor is common in women who have given birth (parous women).In order to ensure the health of mothers and babies, it is necessary to quickly prepare for delivery according to the specific conditions of the site.

1. Normal childbirth process

Doctors divide normal labor into three stages of labor.The so-called acute labor means that the puerpera is in the second stage of labor. At this time, the uterine orifice has been fully opened, the fetal membranes have ruptured, and the amniotic fluid has flowed out.

Generally, it takes about 1 to 2 hours for primiparous women, and about 30 minutes for multiparas.

2. On-site rescue

It is advisable to ask a doctor or someone with fertility knowledge to serve as a birth attendant.

Place the mother in a clean, sheltered place to lie down, and pay attention to ensure fresh air.

Before delivery, put a raincoat, plastic sheet or clean clothes on the mother's buttocks, preferably with a layer of toilet paper.

After the midwife cleans his hands with soap and water, let the mother bend her legs and separate them to expose the vulva, and wash the vulva with soap or water.

Fold a clean towel or handkerchief, and hold it in the genitals to help deliver the fetal head and protect the perineum.If the fetal head is difficult to deliver, an episiotomy can be performed (with sterilized scissors).Try to avoid contamination of the birth canal.

After the baby is delivered, the umbilical cord can be cut.The method is: use 70% alcohol to rub around the umbilical cord close to the fetus, twice in total; use sterile thread to ligate near the root of the umbilicus, and then ligate again at a distance of 2 cm. Cut the umbilical cord between the two lines; wipe the root with iodine for disinfection, and then wrap the broken root of the umbilical cord with sterile gauze.The disinfection method of scissors and thread is: put the two into a clean container, pour cold water, set a pair of chopsticks in the water, wait for about half an hour after the water boils, use chopsticks to remove the scissors and thread, and keep them in a sterile state , especially the blades of the scissors must not be contaminated.

Rinse the mother's vulva again with alcohol or water, and carefully check whether the placenta is intact after the placenta is delivered.

Pay attention to the warmth of the fetus and mother.

Send to the hospital immediately, and observe the contraction of the mother's uterus.

(End of this chapter)