动物伤害后的医疗处理.docx
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动物伤害后的医疗处理
动物伤害后的医疗处理
动物伤害后的医疗处理
medicaltreatmentafterbeinghurtbyanimals
狗猫鼠伤害hurtbydog,catandmouse
1现场处理:
如果被狗猫鼠等动物咬伤或抓伤,重要的是做好现场的应急处理工作。
sitetreatment:
ifbeingbittenorclawedbydog,catandmouse,itisimportanttodothesiteemergencytreatment.
l凡是狗、猫、鼠等动物咬伤,不管是疯狗、病猫还是正常的狗、猫(有相当多的一部分正常的狗、猫的唾液中带有狂犬病毒),立即就地、彻底冲洗伤口。
咬伤部位在四肢时,可暂结止血带,用生理盐水或清水冲洗伤口。
ifbeingbittenbydog,cat,mouseandsuchanimals,notmatterrabiddog,sickcat,ornormaldogorcat(quiteabitofnormaldogsandcatshaverabiesvirusintheirsaliva),youshallwashthewoundthoroughlyinthatsiteimmediately.ifthebittenPOSTTTIONisinextremities,thetourniquetcanbeusedtemporarily,andthewoundshallbewashedbyphysiologicalsalineorcleanwater.
l冲洗伤口一是要快,二是要彻底,三是伤口不可包扎。
处理伤口分秒必争,以最快速度把沾染在伤口上的狂犬病毒冲洗掉。
因为时间一长病毒就进入人体组织,沿着神经侵犯中枢神经,置人于死地。
由于狗、猫咬的伤口往往外口小,里面深,这就要求冲洗时,尽量把伤口扩大,让其充分暴露,并用力挤压伤口周围软组织,而且冲洗的水量要大,水流要急,最好是对着自来水龙头急水冲洗。
washingthewoundshallbefirstlyquick,secondlycompleteandthirdlythewoundshallnotbeboundup.notasecondistobelostforwoundtreatment,andwashtherabidvirusfromthewoundatthefastestspeed.becauseincaseofalongtime,theviruswillintrudeintohumanbodytissue,goalongthenervestoencroachthenervouscentralisandkilltheperson.duetothesmalloutsideanddeepinsideofbittenwoundbydogorcat,itrequireswideningthewoundasbigaspossibletoexplorethewoundsufficientlywhenwashing,andextrudingthesofttissuearoundthewoundandthewashingwatershallbebigaspossiblewithrapidflow,it’sbettertowashthewoundbytapwatercockwithrapidflow.
特别要注意的是,如果被狗、猫、鼠咬伤,伤口不作任何处理是错误的,错上加错的是不仅伤口不冲洗,而是涂上红药水包上纱布更有害,切忌长途跋涉赶到大医院求治,而是应该立即就地、彻底冲洗伤口,在24小时内注射狂犬疫苗。
specialnote:
notreatmentforthewoundbitbydog,catandmouseiswrong,andmoreharmfulwrongtreatmentisnottowashthewound,butwipewithmercurochromeandbindupbygauze.itshallnotgolongwaytolargehospitalfortreatment,butshallwashthewoundthoroughlyatthatsiteimmediately,andinjectrabiesvaccinewithin24hours.
2诊所及医院处理:
clinicandhospitaltreatment:
伤口经过反复冲洗后,到诊所作进一步的处理,伤口还要认真冲洗、消毒,联系金山医院作进一步救治。
afterwashingthewoundrepeatedly,gototheclinicforfarthertreatment,andthewoundstillneedscarefulwashing,disinfection,andthencontactwithjinshanhospitaltodofarthertreatment.
第一步及时正确伤口处理
thefirststepcorrectlytreatthewoundintime
l应尽快用3%~5%肥皂水或0.1%新洁尔灭反复冲洗至少半小时,肥皂水与新洁尔灭不可合用。
并挤出污血。
shallimmediatelywashthewoundrepeatedlyby3%~5%soapywateror0.1%bromo—geramineumatleastforhalfanhour,thesoapywatercouldnotbeusedtogetherwiththebromo—geramineum.andsqueezeoutthesmearblood.
l冲洗后用70%酒精擦洗及浓碘酒反复涂拭。
swabdownthewoundby70%alcoholandembrocatebythickiodinerepeatedly.
l伤口一般不予缝合或包扎。
除了个别伤口大,又伤及血管需要止血外,一般不上任何药物,也不包扎,因为狂犬病毒是厌氧的,在缺乏氧气的情况下,狂犬病病毒会大量生长。
ingeneral,thewoundshallnotbeoversewedorboundup.exceptthewoundisverybig,injuriesthebloodveinandneedshemostasia,normallydonotapplyanymedical,neitherbindingup.becausetherabiesvirusisanaerobic,anditwilllargelygrowundertheconditionofoxygenshortage.
l必要时使用抗生素和精制破伤风抗毒素。
ifnecessary,applyantibioticandpurifiedtetanicantitoxin.
l局部伤口处理愈早愈好,即使延迟1~2天甚至3~4天也不应忽视局部处理,此时如果伤口已结痂,也应将结痂去除后按上法处理。
itwillbettertotreatthepartialwoundasearlyaspossible,thoughitwasdelayed1~2dayseven3~4days,thepartialtreatmentshallnotbeignored,andifthewoundhasscabbedatthistime,itshallgetoffthescabandtreatthewoundaccordingtotheabovemethod.
第二步进行狂犬疫苗和抗狂犬病免疫血清免疫接种
thesecondstepinoculatetherabiesvaccineandrabiesantiserum
世界卫生组织(who)推荐动物咬伤分类、建议的暴露类型和治疗方法见表
seethefollowingtablefortheexplosiontypesandmedicalmethodsonanimals’bitesortsandsuggestionrecommendedbyworldhealthorganization(who)
分类
sort与动物接触类型
contacttype推荐治疗方法
recommendedmedicalmethodi触摸或喂养动物,舔及完整皮肤
touchorfeedanimals,belappedtheunbrokenskin如无皮肤破损,无需采取任何措施
ifnoskinbroken,noneedtotakeanymeasuresii无流血,多为轻度擦伤或抓伤
noblood,mostlylightabrasionorclaw立刻接种疫苗
inoculatethevaccineimmediatelyiii一处或多处皮肤穿透性咬伤,唾液污染黏膜
oneorseveralskinsarepenetrabilitybite,thesalivapollutedthemucousmembrane立刻使用抗狂犬病血清和接种疫苗
applyrabiesantiserumandinoculatevaccineimmediately
目前上海市的处理原则:
一旦被犬特别是可疑犬咬伤后,立刻接种狂犬病疫苗,全程接种疫苗(0、3、7、14、30天共5针)。
被犬咬伤头面、颈部、上肢、胸背部及其它部位的多处或严重咬伤者立刻接种疫苗,并应用抗狂犬病血清,并于咬伤后的第45、60天加注2针狂犬病疫苗。
特别是对咬伤头、面、颈部、手指和脚趾及伤口深者,对严重、多处咬伤者,抗狂犬病血清应先在伤口部位进行浸润性注射,余下血清再进行肌肉注射。
currentlyshanghaimunicipaltreatmentprinciple:
incasebeingbittenbydog,especiallythedubiousdog,shallinoculatetherabiesvaccineimmediatelyandinoculatethevaccineallthemonth(eachon0,3,7,14,30days,totally5injections).ifthepersonseriouslybittenbythedogonheadandface,neck,upperlimbs,bosomandbackorwithseveralbitesonotherpartsshallapplyrabiesantiserumandaddtwomoreinjectionofrabiesvaccineonthe45thand60thdaysafterbeingbitten.especiallysuchpersonwhowasbitonhead,face,neck,fingersandtoesanddeepwound,forseriouslybittenorwithseveralbites,therabiesantiserumshallbefirstlyconductwettabilityinjectioninthewoundpart,andtheremnantserumshallbemuscleinjection.
毒蛇咬伤bitbypoisonoussnake
一般毒蛇咬伤后在局部留有牙痕、疼痛和肿胀,还可见出血及淋巴结肿大,其全身性症状因蛇毒性质而不同。
急救原则是及早防止毒素扩散和吸收,尽可能地减少局部损害。
蛇毒在3-5分钟即被吸收,故急救越早越好。
normallyitwillhavetoothtrack,painandtumefactiononthebitpartafterbeingbittenbypoisonoussnake,andalsocanseebloodingandenlargementoflymphnodes,andthewholebodesymptomswillvarywiththesnakepoisonscharacteristics.thefirstaidprincipleistopreventthetoxinfrompervasionandabsorption,andreducethepartialhurtasmuchaspossible.thesnakepoisonwillbeabsorbedin3-5minutes,soforthefirstaid,theearlierwillbebetter.
1、绑扎伤肢,在咬伤肢体近侧约5-10厘米处用止血带或橡胶带等绑扎,以阻止静脉血和淋巴液回流,然后用手挤压伤口周围,将毒液排出体外。
colligatethehurtlimb,colligateatabout5-10mmnearthehurtlimbbytourniquetorrubberbeltandsoontopreventrefluxofveinbloodandlympha,andthensqueezearoundthewoundbyhandstodischargethevenomoutofbody.
2、冲洗伤口,先用肥皂水和清水清洗周围皮肤,再用生理盐水或净水反复冲洗伤口。
washthewound,firstlywashtheskinaroundthewoundbysoapywaterandcleanwater,andthenwashthewoundbyphysiologicalsalineorpurewaterrepeatedly.
3、局部降温,先将伤肢浸于4-7摄氏度的冷水中3-4小时,然后改用冰袋,可减少毒素吸收速度,降低毒素中酶的活力。
decreasetemperatureofthepart,firstlyimmersethehurtlimbinto4-7℃coolwaterfor3-4hours,andthenuseicebag,whichcanreducethetoxinabsorptionspeedandreduce
4、排毒,咬伤在24小时以内者,以牙痕为中心切开伤口成“+”或“++”形,使毒液流出,也可用吸奶器或拔火罐吸吮毒液。
切口不宜过深,以免损伤血管。
若有蛇牙残留宜立即取出。
切开或吸吮应及早进行,否则效果不明显。
eliminationoftoxicant,forthepersonbitwithin24hours,openthewoundincenteroftoothtrackat“+”or“++”toletthevenomflowout,andalsocanusemilkpumporcuppingtoabsorbthevenomout.theopeningshallnotbetoodeeptopreventdamagingthebloodvessel.ifthesnaketoothleftin,itisbettertotakeoutimmediately.openorabsorptionshallbedoneassoonaspossible,ortheeffectwillbeunclear.
5、药物治疗。
medicaltreatment
6、加强野外作业的防护,掌握毒蛇习性,不要裸露腿足,必要时穿长统靴,蛇伤即可避免。
被毒蛇咬伤后切忌奔跑,宜就地包扎、吸吮、冲洗伤口后速到医院治疗。
strengthenpreventionoffieldworkandmasterthehabitofpoisonoussnake;donotbarethelegandfoot,ifnecessary,wearhighlegboots,sothesnakehurtcanbeavoided.incasebeingbittenbypoisonoussnake,norunningbutbindup,suckandwashthewound,andthenquicklygotohospitalfortreatment.
蝎和毒蜘蛛scorpionandpoisonousspider
在日常生活中蝎和毒蜘蛛咬伤也是常见的。
蝎螫伤局部可见大片红肿、剧痛,重者可出现寒战、发热、恶心、呕吐、舌和肌肉强直、流涎、头痛、昏睡、盗汗、呼吸增快及脉搏细弱等,儿童被螫伤后严重者可因呼吸、循环衰竭而死亡。
毒蜘蛛咬伤者局部苍白发红或出现荨麻疹,重者可发生局部组织坏死或全身症状。
处理原则与毒蛇咬伤相同。
indailylife,itiseasytoseethescorpionandpoisonousspiderbite.itwillhaveflareandaviolentpaininthepartbitbyscorpion,forseriouscase,thepersonwillbechill,fever,nausea,vomit,tongueandmusclestiffen,salivation,headache,soporousstate,nightsweat,hyperpneaandweakpulseandsoon.forthechildbitbyscorpion,theseriouswillbekilledduetobreathorcirculatoryfailures.thepersonbitbypoisonousspiderwillhavepartiallypalenesserythemaorappearurticaria,theseriouswillgetpartialtissuenecrosisorwholebodysymptoms.thetreatmentprincipleissameasthatofpoisonoussnakebite.
蜂螫伤beesting
一般只表现局部红肿疼痛,多无全身症状,数小时后即自行消退。
若被蜂群螫伤时,可出现如头晕、恶心、呕吐等,严重者可出现休克、昏迷或死亡,有时可发生血红蛋白尿,出现急性肾功能衰竭。
过敏病人则易出现荨麻疹、水肿、哮喘或过敏性休克。
normallyitonlyappearspartialflareandpain,mostlyhasnowholebodysymptoms,anditwilldisappearafterseveralhours.ifbeingsingedbybeecolony,itwillappeardizzy,nausea,vomitandsoon,theseriouswillappearshock,comaordeath,andsometimesitwillhavehemoglobinuriaandappearacuterenalfailure.theallergicpatientiseasytoappearurticaria,dropsy,asthmaorallergicshock.
可用弱碱性溶液如肥皂水等外敷,以中和酸性中毒,也可用红花油、风油精、花露水等外搽局部。
黄蜂螫伤可用弱酸性溶液〔如醋〕中和,用小针挑拔或纱布擦拭,取出蜂刺。
全身症状较重者宜速到医院诊疗。
对蜂群螫伤或伤口已有化脓迹象者宜加用抗菌素。
itcanusealkalescentsolution(suchassoapywater)andsoontoapplyonexternaltoneutralizetheacidpoisoning,andalsocanusesaffloweroil,essentialbalm,floralwaterandsoontoapplyonexternalpartially.waspstingcanbeneutralizedbyweakacidsolution(suchasvinegar),andgetridofthestingofabeebysmallneedleorcleanbygauze.thepersonwithseriouswholebodysymptomsshallgotohospitalfortreatmentassoonaspossible.andthepersonstungbybeecolonyorwithfesterwoundshalluseantibiotic.
蜈蚣咬伤centipedebite
局部表现有急性炎症和痛、痒,有的可见头痛、发热、眩晕、恶心、呕吐,甚至谵语和抽搐及昏迷等全身症状。
应立即用弱碱性溶液〔如肥皂水等〕洗涤和冷敷,有全身症状者宜速到医院治疗。
partialsymptomsappearacuteinflammation,painanditch,someofthepersonswillhaveheadache,fever,dizzy,nausea,vomitandevendelirium,twitchandcomaandsuchwholebodysymptoms.itshallbeimmediatelywashedandcoldcompressedbyalkalescentsolution(suchassoapywater),andthepersonwithwholebodysymptomsshallgotohospitalfortreatmentquickly.
注意notice:
不管被何种动物咬伤,现场应立即伤口冲洗,同时呼救诊所作进一步处理,必要时转送金山医院作进一步的处理。
nomatterbeingbittenbyanyanimal,youshallwashthewoundatthesiteimmediately;meanwhilecalltheclinicforfarthertreatment.ifnecessary,youwillbesenttojinshanhospitalforfarthertreatment.