<b>First aid</b><br> ffImmediately clean the wound thoroughly with plenty of clean water and soap to remove any dirt or foreign bodies ffStop excessive bleeding by applying pressure where necessary ffRinse the wound and allow to dry ffApply an antiseptic: Chlorhexidine solution 0.05% or Povidone iodine solution 10%}<b>Supportive therapy</b><br> ffTreat anaphylactic shock (see section 1.1.1) ffTreat swelling if significant as necessary, using ice packs or cold compresses ffGive analgesics prn ffReassure and immobilise the patient}<b>Antibiotics</b><br> ffGive only for infected or high-risk wounds including: –– Moderate to severe wounds with extensive tissue damage –– Very contaminated wounds –– Deep puncture wounds (especially by cats) --Wounds on hands, feet, genitalia or face –– Wounds with underlying structures involved –– Wounds in immunocompromised patients ffSee next sections on wound management, human and animal bites for more details}<b>Tetanus prophylaxis</b><br> ffGive TT immunisation (tetanus toxoid, TT 0.5 ml) if not previously immunised within the last 10 years}<b>Snakebites</b><br>Snakebites can cause local effects (swelling, redness, laceration) and in case of poisonous snakes, local and systemic effects caused by envenomation. More than 50% of bites are “dry” i.e. no envenomation occurs, and most bites are from non-venomous snakes. In the event that poison is injected, the effect depends on the type of venom, quantity, location of the bite and size and general condition of the victim. <b>Cause</b><br>Common poisonous snakes in Uganda: puff adder, Gabon viper, black and green mambas, boomslang and several cobras <br><b>Clinical features</b><br>Puncture wounds, pain, swelling, discoloration.<b>Treatment</b><br>ffWash site with a lot of clean water ffWipe away excess venom ffAssess skin for fang penetration ffIf there is a wound, clean it with a lot of clean water<br><b>If signs of fang penetration</b>ffApply firm crepe bandage to entire limb to ensure constant pressure (except if cytotoxic) ffImmobilise limb with a splint ffAnalgesic e.g. paracetamol (avoid aspirin) ffIf no signs and symptoms for 6-8 hours: most likely bite without envenomation ffObservation for 12-24 hours recommended ffTetanus toxoid (TT) IM 0.5 ml if not previously immunised in the last 10 years<br><b>If local necrosis develops</b><br>ffRemove blisters, clean and dress daily, debride after lesions stabilise (minimum 15 days)<br><b>Venom in eyes</b>ffIrrigate eyes with plenty of water ffCover with eye pads<br><b>Criteria for referral for administration of antivenom</b> Signs of systemic poisoning (paralysis, respiratory difficulty, bleeding) yy Spreading local damage: –– Swelling of hand or foot (site of most bites) within 1 hour of bite –– Swelling of elbow or knee within 3 hours of bite –– Swelling of groin or chest at any time –– Significant swelling of head or neck ffAntivenom sera polyvalent (E & C Africa) –– Check package insert for IV dosage details. Ensure the solution is clear and check that patient has no history of allergy Antibiotics ffIndicated only if wound is infected}<b>Insect Bites & Stings</b><br><b>Bees, wasps, hornets and ants: venom is usually mild and causes only local reaction but may cause anaphylactic shock in previously sensitized persons yy Spiders and scorpions: Most are non-venomous or only mildly venomous yy Other stinging insects</b><br><b>Clinical features</b><br>Swelling, discolouration, burning sensation, pain at the site of the sting yy There may be signs of anaphylactic shock<b> Differential diagnosis</b><br>Allergic reaction<b>Management</b><br>ffIf the sting remains implanted in the skin, carefully remove with a needle or knife blade ffApply cold water/ice<b>If severe local reaction</b><brffGive chlorpheniramine 4 mg every 6 hours (max: 24 mg daily) until swelling subsides Child 1-2 years: 1 mg every 12 hours Child 2-5 years: 1 mg every 6 hours (max: 6 mg daily) Child 6-12 years: 2 mg every 6 hours (max: 12 mg daily) ffApply calamine lotion prn every 6 hours>