1. Part Two Dr.S.Nishan Silva (MBBS)

2. Insect Sting

3. Features Features result from the injection of venom or other substances into your skin. The venom sometimes triggers an allergic reaction. Most reactions to insect bites are mild, causing little itching or stinging. A delayed reaction may cause fever, hives, painful joints and swollen glands. Only a small percentage of people develop severe reactions (anaphylaxis) to insect venom.

4. Some - NO reactions…

5. Some – Moderate reactions

6. Some – SEVERE reactions

7. Signs and symptoms of a severe reaction Nausea Facial swelling Difficulty breathing Abdominal pain Deterioration of blood pressure and circulation (shock)

9. Severe reaction : Pathophysiology

10. For mild reactions…. Move to a safe area. Remove the stinger. Apply a cold pack Apply hydrocortisone cream (If necessary). Take an antihistamine Allergic reactions may include mild nausea and intestinal cramps, diarrhea, or swelling.

11. For severe reactions.. If possible give adrenaline. Have the person take an antihistamine pill if he or she is able to do so without choking. Have the person lie still on his or her back with feet higher than the head. Loosen tight clothing and cover the person with a blanket. Don't give anything to drink. Turn the person on his or her side to prevent choking if there's vomiting or bleeding from the mouth. Begin CPR if there are no signs of circulation, such as breathing, coughing or movement.

12. Snake Bites

13. Features

14. Poisonous Snakes in Sri Lanka Cobra Sri Lankan Krait Indian Krait Russell’s Viper Humped nose viper Green pit viper Saw scaled viper Sea snake

15. Cobra

16. Sri Lankan Krait

17. Indian Krait

18. Russell’s viper

19. Humped nose viper

20. Green pit viper

21. Saw scaled viper

22. Sea snake

23. Do’s in Snake Bite… Safety ! Call for help Relieve anxiety Wash with water and soap (gloves) Remove constricting jewelry or clothes Take to hospital – May need AVS If possible; the dead / alive snake or photo too

24. Dont’s in Snake Bite… Waste time trying to kill the snake No cutting or sucking Do not apply any oils / home medications on the wound Do not elevate the limb / keep below heart level Do not tie with anything Assume the snake is non-poisonous

25. Fainting

26. Why? Hypoglycaemia – Lack of glucose to the brain –Diabetes medication –Missed meals Lack of oxygen to the brain –Cardiac cause –Respiratory cause –Vascular cause –Poisonings Other

27. So??? History – Missed meals, previous illnesses Time of the day Check –Pulse Rhythm for regularity Volume –Breathing Do –Head among knees –Legs elevated if necessary

29. Recovery Position

31. Hypoglycaemia

32. Features Changes in levels of consciousness, including dizziness, drowsiness and confusion. Irregular breathing. Abnormal pulse (rapid or weak). Feeling or looking ill. Frankly fainting

33. Do.. If the conscious victim can take food or fluids, give him or her sugar, preferably in liquid form. Any sweet drink would do. No need of tea. Dextrose vials – best. If recovered – Advice to inform usual follow up clinic / doctor If not recovering –Re check – Pulse, breathing –Hurry to the Hospital

34. Heart Attacks

35. Features Known to have previous heart disease? Risk factors of heart disease? “Angina Pectoris” – Typical ischaemic chest pain? Autonomic features – Nausea, sweating Shotness of breath Arrythmias – Palpitations Unconsciousness May be even “Arrest”

36. First Aid Video

37. Do’s Assess vital signs CPR if arrested Good ventilation Prop up if necessary GTN (nitrate) sub-lingual – can repeat Aspirin – 300mg at once Pain killer Take to hospital ASAP