《安全常识-灾害防范》之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Medical Treatment after being hurt by Animals狗猫鼠伤害Hurt by dog, cat and mouse1 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。Site treatment: if being bitten or clawed by dog, cat and mouse, it is important to do the site emergency treatment.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。If being bitten by dog, cat, mouse and such animals, not matter rabid dog, sick cat, or normal dog or cat (quite a bit of normal dogs and cats have rabies virus in their saliva), you shall wash the wound thoroughly in that site immediately. If the bitten position is in extremities, the tourniquet can be used temporarily, and the wound shall be washed by physiological saline or clean water.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。Washing the wound shall be firstly quick, secondly complete and thirdly the wound shall not be bound up. Not a second is to be lost for wound treatment, and wash the rabid virus from the wound at the fastest speed. Because in case of a long time, the virus will intrude into human body tissue, go along the nerves to encroach the nervous centralis and kill the person. Due to the small outside and deep inside of bitten wound by dog or cat, it requires widening the wound as big as possible to explore the wound sufficiently when washing, and extruding the soft tissue around the wound and the washing water shall be big as possible with rapid flow, its better to wash the wound by tap water cock with rapid flow.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。Special note: no treatment for the wound bit by dog, cat and mouse is wrong, and more harmful wrong treatment is not to wash the wound, but wipe with mercurochrome and bind up by gauze. It shall not go long way to large hospital for treatment, but shall wash the wound thoroughly at that site immediately, and inject rabies vaccine within 24 hours.2 诊所及医院处理：Clinic and hospital treatment: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。After washing the wound repeatedly, go to the Clinic for farther treatment, and the wound still needs careful washing, disinfection, and then contact with Jinshan Hospital to do farther treatment.第一步及时正确伤口处理The first stepcorrectly treat the wound in timel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。Shall immediately wash the wound repeatedly by 3%5% soapy water or 0.1% bromogeramineum at least for half an hour, the soapy water could not be used together with the bromogeramineum. And squeeze out the smear blood.l冲洗后用70% 酒精擦洗及浓碘酒反复涂拭。Swab down the wound by 70%alcohol and embrocate by thick iodine repeatedly.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。In general, the wound shall not be oversewed or bound up. Except the wound is very big, injuries the blood vein and needs hemostasia, normally do not apply any medical, neither binding up. Because the rabies virus is anaerobic, and it will largely grow under the condition of oxygen shortage.l必要时使用抗生素和精制破伤风抗毒素。If necessary, apply antibiotic and purified tetanic antitoxin.l局部伤口处理愈早愈好，即使延迟12天甚至34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。It will better to treat the partial wound as early as possible, though it was delayed 12 days even 34 days, the partial treatment shall not be ignored, and if the wound has scabbed at this time, it shall get off the scab and treat the wound according to the above method.第二步进行狂犬疫苗和抗狂犬病免疫血清免疫接种The second step inoculate the rabies vaccine and rabies antiserum 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See the following table for the explosion types and medical methods on animals bite sorts and suggestion recommended by World Health Organization (WHO) 分类Sort与动物接触类型Contact type推荐治疗方法 Recommended medical methodI 触摸或喂养动物，舔及完整皮肤Touch or feed animals, be lapped the unbroken skin如无皮肤破损，无需采取任何措施If no skin broken, no need to take any measuresII无流血，多为轻度擦伤或抓伤No blood, mostly light abrasion or claw立刻接种疫苗Inoculate the vaccine immediately III一处或多处皮肤穿透性咬伤,唾液污染黏膜One or several skins are penetrability bite, the saliva polluted the mucous membrane立刻使用抗狂犬病血清和接种疫苗Apply rabies antiserum and inoculate vaccine immediately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。Currently Shanghai Municipal treatment principle: in case being bitten by dog, especially the dubious dog, shall inoculate the rabies vaccine immediately and inoculate the vaccine all the month (each on 0, 3, 7, 14, 30 days, totally 5 injections). If the person seriously bitten by the dog on head and face, neck, upper limbs, bosom and back or with several bites on other parts shall apply rabies antiserum and add two more injection of rabies vaccine on the 45th and 60th days after being bitten. Especially such person who was bit on head, face, neck, fingers and toes and deep wound, for seriously bitten or with several bites, the rabies antiserum shall be firstly conduct wettability injection in the wound part, and the remnant serum shall be muscle injection. 毒蛇咬伤 Bit by poisonous snake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35分钟即被吸收，故急救越早越好。Normally it will have tooth track, pain and tumefaction on the bit part after being bitten by poisonous snake, and also can see blooding and enlargement of lymph nodes, and the whole bode symptoms will vary with the snake poisons characteristics. The first aid principle is to prevent the toxin from pervasion and absorption, and reduce the partial hurt as much as possible. The snake poison will be absorbed in 3-5minutes, so for the first aid, the earlier will be better. 1、 绑扎伤肢，在咬伤肢体近侧约510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。Colligate the hurt limb, colligate at about 5-10mm near the hurt limb by tourniquet or rubber belt and so on to prevent reflux of vein blood and lympha, and then squeeze around the wound by hands to discharge the venom out of body. 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。 Wash the wound, firstly wash the skin around the wound by soapy water and clean water, and then wash the wound by physiological saline or pure water repeatedly.3、局部降温，先将伤肢浸于47摄氏度的冷水中34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。 Decrease temperature of the part, firstly immerse the hurt limb into 4-7 cool water for 3-4 hours, and then use ice bag, which can reduce the toxin absorption speed and reduce 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。 Elimination of toxicant, for the person bit within 24 hours, open the wound in center of tooth track at “+” or “+” to let the venom flow out, and also can use milkpump or cupping to absorb the venom out. The opening shall not be too deep to prevent damaging the blood vessel. If the snake tooth left in, it is better to take out immediately. Open or absorption shall be done as soon as possible, or the effect will be unclear.5、药物治疗。 Medical treatment6、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。 Strengthen prevention of field work and master the habit of poisonous snake; do not bare the leg and foot, if necessary, wear high leg boots, so the snake hurt can be avoided. In case being bitten by poisonous snake, no running but bind up, suck and wash the wound, and then quickly go to hospital for treatment. 蝎和毒蜘蛛Scorpion and poisonous spider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。In daily life, it is easy to see the scorpion and poisonous spider bite. It will have flare and a violent pain in the part bit by scorpion, for serious case, the person will be chill, fever, nausea, vomit, tongue and muscle stiffen, salivation, headache, soporous state, night sweat, hyperpnea and weak pulse and so on. For the child bit by scorpion, the serious will be killed due to breath or circulatory failures. The person bit by poisonous spider will have partially paleness erythema or appear urticaria, the serious will get partial tissue necrosis or whole body symptoms. The treatment principle is same as that of poisonous snake bite. 蜂螫伤Bee Sting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。Normally it only appears partial flare and pain, mostly has no whole body symptoms, and it will disappear after several hours. If being singed by bee colony, it will appear dizzy, nausea, vomit and so on, the serious will appear shock, coma or death, and sometimes it will have hemoglobinuria and appear acute renal failure. The allergic patient is easy to appear urticaria, dropsy, asthma or allergic shock.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。It can use alkalescent solution(such as soapy water) and so on to apply on external to neutralize the acid poisoning, and also can use safflower oil, essential balm, floral water and so on to apply on external partially. Wasp sting can be neutralized by wea