If a person who has diabetes becomes confused, weak, or unconscious for no apparent reason, he may be suffering from insulin shock (low blood sugar) or diabetic ketoacidosis (high blood sugar).
INSULIN SHOCK (LOW BLOOD SUGAR)
If a person with diabetes takes too much insulin or fails to eat enough food to match his insulin level or his level of exercise, a rapid drop in blood sugar can occur. Symptoms may come on very rapidly and include an altered level of consciousness, ranging from slurred speech, bizarre behaviour, and loss of coordination, to seizures and unconsciousness.
Treatment
If still conscious, the victim should be given something containing sugar to drink or eat as rapidly as possible. This can be fruit juice, candy, or a non-diet soft drink. If the victim is unconscious, place sugar granules, cake icing, or Glutose® paste from your first aid kit under his tongue, where it will be rapidly absorbed.
DIABETIC KETOACIDOSIS (HIGH BLOOD SUGAR)
Diabetic ketoacidosis (formerly called diabetic coma) comes on gradually and is the result of insufficient insulin. This eventually leads to a very high sugar level in the victim’s blood. Early symptoms include frequent urination and thirst. Later, the victim will become dehydrated, confused, or comatose, and will develop nausea, vomiting, abdominal pain, and a rapid breathing rate with a fruity odor to his breath.
Treatment
The victim needs immediate evacuation to a medical facility. If vomiting is not present and the victim is awake and alert, have him drink small, frequent sips of water. If you are unsure whether the victim is suffering from insulin shock (low blood sugar) or ketoacidosis (high blood sugar), it is always safer to assume it is low blood sugar and administer sugar.
Lightning kills more people every year in the United States than all other natural disasters combined. Carrying or wearing metal objects, such as an ice axe, umbrella, backpack frame, or even a hairpin, increases the chances of being hit.
To calculate the approximate distance in miles from a flash of lightning, count in seconds from the time you see the flash to when you hear the thunder, then divide by five.
Prevention
When a thunderstorm threatens, seek shelter in a building or inside a vehicle (not a convertible).
Occupants of tents should stay as far away from the poles and wet cloths as possible.
Do not stand underneath a tall tree in an open area or on a hill top.
Get out and away from open water.
Get away from tractors and other metal farm equipment.
Get off bicycles and golf carts.
Stay away from wire fences, clotheslines, metal pipes, and other metallic paths which could carry lightning to you from some distance.
Avoid standing in small, isolated sheds or other small structures in open areas.
In a forest, seek shelter in a low area under a thick growth of saplings or small trees. In an open area, go to a low place such as a ravine or valley.
If you are totally in the open, stay far away from single trees to avoid lightning splashes. Drop to your knees and bend forward, putting your hands on your knees. If available, place insulating material (e.g. sleeping pad, life jacket, rope) between you and the ground. Do not lie flat on the ground.
LIGHTNING CAN CAUSE INJURY BY FOUR MECHANISMS:
1.DIRECT HIT
Lightning directly strikes a person in the open. It usually does not enter the body, but instead is conducted over the skin surface (“flashover”), producing a variety of injuries. The greatest damage may occur to skin beneath metal objects worn by the victim, such as jewelry, belt buckles, or zippers, which tend to disrupt the flashover and allow current to penetrate. Current may also penetrate the body through the eyes, ears, and mouth, causing deeper injuries to those parts. The victim is exposed to a tremendous elec-tromagnetic field, which can disrupt the workings of the brain, lungs and heart and lead to a cardiac and respiratory arrest. Finally, the instant vaporization of any moisture on the victim’s skin can blast apart his clothing and shoes.
2. SPLASH
A more common scenario is for the victim to be struck by lightning “splash,” which occurs when a bolt first hits an object, such as a tree or another person, and then “jumps” to the victim who may have found shelter nearby. Splashes may also occur from person to person who are standing close together.
3. STEP VOLTAGE
Lightning hits the ground or a nearby object and the current spreads like a wave in a pond to the victims. Step voltage is often to blame when several people are hurt by a single lightning bolt.
4. BLUNT TRAUMA
The explosive force of the pressure waves created by lightning can cause blunt trauma, such as spleen or liver injuries and ruptured ear drums.
TYPES OF INJURIES
1. HEART AND LUNG
Lightning can cause a cardiac arrest and paralyze the lungs. The heart will often restart on its own, but because the lungs are still not working, the heart will stop again from lack of oxygen.
2. NEUROLOGIC INJURIES
The victim may be knocked unconscious and suffer temporary paralysis, especially in the legs. Seizures, confusion, blindness, deafness, and inability to remember what happened may result.
3. TRAUMATIC INJURIES
Bruises, fractures, dislocations, spinal injury, chest and abdominal injuries from the shock wave may occur. Ruptured eardrums can result in hearing loss.
4. BURNS
Superficial first or second-degree burns are more common than severe burns after a lightning strike and form distinctive fern patterns on the skin.
TREATMENT
Lightning strike victims are not “charged” and thus pose no hazard to rescuers.
The immediate treatment of lightning strike victims differs from other situations in which you have multiple trauma victims. Rather than adhere to the standard rescue dogma of ignoring the victims who appear dead and giving priority to those who are still alive, after a lightning strike, treat those victims first who appear dead, because they may ultimately recover if quickly given mouth-to-mouth rescue breathing and CPR. If you’re successful in obtaining a pulse with CPR, continue rescue breathing until the victim begins to breathe on his own or you are no longer able to continue the resuscitation.
Stabilize and splint any fractures.
Initiate and maintain spinal precautions if indicated.
The definitive treatment for snake venom poisoning is the administration of antivenin. The most important aspect of therapy is to get the victim to a medical facility as quickly as possible.
Signs and Symptoms of Envenomation
One or more fang marks (rattlesnake bites may leave one, two, or even three fang marks).
Local, burning pain immediately after the bite.
Swelling at the site of the bite, usually beginning within five to 20 minutes and spreading slowly over a period of six to 12 hours. The faster the swelling progresses up the arm or leg, the worse the degree of envenomation.
Bruising (black and blue discoloration) and blister formation at the bite site.
Numbness and tingling of the lips and face, usually 10 to 60 minutes after the bite.
Twitching of the muscles around the eyes and mouth.
Rubbery or metallic taste in the mouth.
After six to 12 hours, bleeding from the gums and nose may develop and denote a serious envenomation.
Weakness, sweating, nausea, vomiting and faintness may occur.
First Aid
Rinse the area around the bite site with water to remove any venom that might remain on the skin.
Clean the wound and cover with a sterile dressing.
Remove any rings or jewelry.
Immobilize the injured part as you would for a fracture, but splint it just below the level of the heart.
Transport the victim to the nearest hospital as soon as possible. If you pass by a telephone, stop and notify the hospital that you are bringing in a snakebite victim so they can begin to locate and procure antivenin.
It is not necessary to kill the snake and transport it with the victim for identification. If the snake is killed, it should not be directly handled, but should be transported in a closed container. Decapitated snake heads can still produce envenomation
Extractor pumps designed to provide suction over a snakebite wound are sold in many camping stores and endorsed by some as a first aid treatment for snakebites. Based on recent scientific evidence, these devices are no longer recommended. A study published in the Annals of Emergency Medicine in 2004 showed that these devices remove an insignificant amount of venom, and may also be harmful to the victim. The best first aid for snakebite is a cell phone (call the hospital that you are going to so that they can procure antivenin) and a car or helicopter to get the victim there as quickly as possible.
Other First-Aid Treatments That May Be Beneficial
Immediately wrapping the entire bitten extremity with a broad elastic bandage (the “Australian Compression and Immobilization Technique”) has proven effective in the treatment of elapid and sea snake envenomations only. It is only recommended when the victim appears to have suffered a severe envenomation and is several hours from medical care.
The wrap is started over the bite site and continued upward toward the torso in an even fashion about as tight as one would wrap a sprained ankle (Fig. 60). Monitor the color, pulse and temperature of the hand or foot to make sure that there is adequate circulation. If circulation appears compromised, loosen the wrap. Otherwise the bandage should not be released until after the victim has been brought to a medical facility. The limb should then be immobilized with a well-padded splint.
Things Not To Do
Do not make any incisions in the skin or apply suction with your mouth.
Do not apply ice or a tourniquet.
Do not shock the victim with a stun gun or electrical current.
If a person who has diabetes becomes confused, weak, or unconscious for no apparent reason, he may be suffering from insulin shock (low blood sugar) or diabetic ketoacidosis (high blood sugar).
Prevention
