Last time in our first aid series we advised you on broken bones, unconsciousness, head injuries, open wounds and choking. Now we address burn injuries, eye emergencies, and bites and stings from snakes and other creepy-crawlies encountered when camping. Don’t forget to enter our competition to win one of nine comprehensive Alpha Pharm camping first aid kits –
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The initial assessment of a burn is the first and most important step in its treatment. Determine what caused the burn: whether it was dry heat (fire or hot surfaces) or wet heat (steam or hot liquids), which causes what are called thermal injuries. Friction, the sun, electricity and chemicals are other causes of burns.
The depth of the burn or extent of the damage can be judged by its appearance, texture and sensitivity. You have to know whether you’re dealing with a minor or serious burn. Let’s first look at the three main categories or levels of burns.
Only the outer layer of skin is affected. The patient will suffer pain, the skin will be red and there may be some swelling.
Known as ‘partial thickness’ (referring to the depth of the damage), this level of burn affects both the outer and underlying layers of skin. There will be pain, redness, swelling and blistering.
Referred to as ‘full thickness’ damage, this level of burn extends into the deeper tissues. The damaged areas will appear white and the skin will be charred. The injured area may be numb due to nerve damage. This is the most serious level of burn.
If the skin is not broken, run cool water over the burn or soak it in cool water – that’s cool, not iced! Keep the burn area under water for at least five minutes. A cold, wet towel applied to the wound afterwards will help reduce the pain. Then cover the burn with a dry, sterile bandage or dressing. Avoid touching the wound, and give the patient an over-thecounter painkiller. Minor burns will normally heal naturally without further treatment.
If cooking oil, petrol or paraffin has caught fire and spilled over a person, and is still alight, here are the three golden words to remember: STOP, DROP and ROLL. Running or moving about quickly will fan the flames, making the situation even more serious. Wrapping the patient in a coat, blanket or rug will help smother the flames, but do not use flammable fabric like nylon. Also use water to douse the flames.
Remove any smouldering material, but don’t remove burnt clothing that is stuck to the injured areas. Make sure the patient is breathing and does not have a partially blocked airway. Apply cardiopulmonary resuscitation (CPR) if necessary (details in last month’s first aid article). Gently cover the burns with a dry sterile bandage or clean cloth. Use a damp sheet for large burns. Do not apply any ointments to burnt skin or wounds and don’t break blisters. Burnt fingers or toes must be separated with dry, sterile dressings or material. Lift the burnt body part slightly higher than the heart and make sure the burn area isn’t touched. Watch out for signs of shock in the patient (see page 49 of our March issue): symptoms can be cold and sweaty skin, a weak and fast or irregular pulse, irregular breathing, a dry mouth and dilated (enlarged) pupils. Lie the patient down, covered with a blanket and with feet raised about 30 cm. Monitor their vital signs until medical help arrives or you can get them to a hospital or doctor.
A person trapped in a fire may inhale hot air or burning gas and suffer burns to the inner mouth, airways and lungs. Look out for a charred mouth or lips, singed nose-hairs or eyebrows, and dark, carbon-stained mucus. Take note if the patient sounds hoarse when talking, or has difficulty breathing or a painful cough. These are all signs of internal burn damage. Do not place a pillow under a victim’s head if they have an airway burn, because that could close the airway. Prop the patient up in a semi-seated position with the knees up. People with suspected airway burn injuries should always be seen by a doctor even if they appear to be okay.
Remember that sunburn treatment starts with prevention. Always use sunscreen when out and about, even if it’s a cloudy day. Sunburn is caused by ultraviolet radiation and not by the sun’s heat – that’s why we can get sunburnt on overcast days too, because the UV radiation isn’t blocked by the cloud cover. People with severe sunburn must stay out of the sun or cover the affected skin when venturing outdoors. A patient with extensive sunburn must be examined for blisters, because that’s where infection could start. Protect the burnt skin from being touched and avoid breaking the blisters. The burnt person can take a cool shower or bath to help relieve pain. Apply aloe or a similar type of topical cooling agent. Never rub butter onto burnt skin: this advice is a myth and actually makes the burn worse.
Get the patient to wear loose clothing made of silk or light cotton until the burn has healed. Heavier, coarse fabrics may irritate the skin. Watch the victim for signs of heat illness, such as heat exhaustion or heatstroke (see details below).
An increase in core body temperature and a loss of fluids (dehydration) are signs of heat exhaustion. Look out for symptoms like weakness, dizziness, clammy, pale skin and nausea or vomiting.
In severe cases of heat exhaustion, when the patient may be unconscious or semi-conscious, make sure the patient’s airway is unobstructed, listen for breathing and administer CPR if necessary. Place the victim in a cooler environment and remove their clothing. Give the patient some water to drink.
Heatstroke is more serious than heat exhaustion because the victim’s body temperature continues to rise. This can lead to unconsciousness. The patient may go into a coma or appear confused and disoriented. A heatstroke victim will be hot and flushed with dry skin. Listen for rapid breathing and watch out for seizures.
Treat the patient as for heat exhaustion, but also put ice on the armpits, groin and neck. Strip the victim completely to accelerate a drop in body temperature. Use a sheet soaked in cold water to cover the victim. A heatstroke patient may only drink fluids if fully conscious, but must be sitting and must not choke. No alcohol or drinks containing caffeine should be given to a heatstroke patient.
If you’re absolutely certain that the snake responsible was not venomous, treat the bite as a puncture wound. But it’s important to always find out what snake bit the patient, or at the very least make a note of what it looked like. Lie the patient down with the bite wound lower than the heart, and lying still to prevent the venom from spreading. Never cut a snake bite wound or try to suck the venom out. Bandage the entire limb to reduce circulation, and apply ice or cold water to the bite area.
The most common venomous snakes in South Africa include mambas, boomslang, puff adders and cobras. Look for fang marks, a swelling or a wound with a bloody discharge. The patient may also get diarrhoea, start to sweat and develop blurred vision. Other symptoms are a numb, tingling sensation across the body and thirst.
Also watch out for fever, a loss of muscle co-ordination, an increased pulse and signs of convulsions. A person who’s been bitten by a venomous snake needs an antivenom administered by a doctor, so seek medical help urgently.
Bee and wasp stings
A bee leaves its stinger and venom sac in its victim’s skin, which causes it to die. Try to remove the sting as quickly as possible by scraping it off with a bank card, or a piece of paper or plastic. Wasps, however, don’t leave their stingers behind, which means they can sting again and again. Wash the area with soap and water. Apply ice wrapped in a damp cloth for a few minutes. If someone is stung in the mouth or throat it must always be considered serious, because severe swelling can block an airway.
Call a doctor if you notice a large rash or swelling around the sting, or if swelling and pain persist for more than three days. This means an infection has set in. Get the patient to a doctor urgently if you notice wheezing or difficulty breathing, swelling of the face, lips or tongue, dizziness or nausea. This means the person is allergic to the bee sting, which can be a life-threatening condition.
There aren’t many very dangerous spider species in South Africa, though button, violin, six-eyed crab, black widow and brown widow spiders can cause violent reactions. Always try to identify the spider that has bitten the patient. Clean the bite with soap and water and apply a cool compress over the wound. If the bite is on an arm or leg, lower the limb to a position that’s below the heart. Bandage the entire limb firmly to reduce circulation, but make sure it’s not so tight that it cuts off circulation entirely. If you’re not sure what spider has bitten the patient, it’s vital to seek medical help. Antivenom medication may be needed. Always try to identify the spider, or at least note its shape, size and markings.
Although very painful, most scorpion stings are harmless. There are more than 15 000 species of scorpions in the world, but only about 30 are dangerous. All scorpions in South Africa are venomous, but only the stings from the Buthidae family can be deadly. They have thick tails and small pincers.
Symptoms include intense pain, numbness and tingling. The victim may also become nauseous, vomit and experience stomach pain. After a sting, vision can become blurry and speech slurred. Also watch out for difficulty breathing or swallowing and signs of shock.
Wash the wound under cold water immediately and apply ointment containing an antihistamine (a drug for treating allergies). Put ice over the wound to reduce pain and inflammation. Take the patient to a doctor or a hospital for examination, in case an antivenom serum is needed. Foreign objects like grains of sand, or wood, glass and metal splinters, or even small coals from a crackling campfire, can cause eye injuries. Soap and household cleaning chemicals can injure the eyes too. And, of course, insects flying into the eye or snakes spitting venom can also be culprits.
Last, but not least, an often forgotten cause of eye injuries that is always present, at least during daytime, is sunlight. Let’s look at the more common eye injuries that are likely to occur around the campsite and how to treat them.
Scratched eye (corneal abrasion)
Rubbing the eye when dirt, dust or sand is in it damages its surface. This type of corneal abrasive injury is very uncomfortable, causes sensitivity to light and can make the eye prone to infection If you have a scratchy eye, don’t rub it and don’t place a patch over it. Bacteria on the damaged surface of the eyeball like dark, warm places, where they grow and multiply. Simply administer antibacterial eye drops and keep the eye closed or put a loose plaster over it.
If a foreign object like a spike, needle or a fish hook is lodged in the eye you can cause even more damage trying to remove it. Loosely tape a paper cup cut in half or an eye shield over the injured eye and get the patient to a doctor urgently.
Foreign substances (chemical burn)
A chemical substance splashed or sprayed in the eye can cause serious eye injury. Put the patient’s head under a steady stream of lukewarm tap water and let it run over the open contaminated eye for about ten minutes. Find out what chemical was involved and consult a doctor urgently.
Black eye (bruised eye)
Hold a cold compress such as ice covered with a wet cloth for five minutes on the injured eye; then take it away and wait five minutes before holding it on the eye again for another five minutes. Repeat this process for a few hours. After a day or two you can use warm compresses intermittently to help the body reabsorb the leaked blood under the skin and to speed up the fading of the bruising. A cloth soaked in hot water will do.