A Parent’s Guide to Treating Snakebites

By Sandra Merino, clinical pharmacist and Jennifer Nguyen, clinical pharmacy resident at CHOC Children’s

Summer is here! That means more time for camping, hiking, and other outdoor activities. With the amount of rain we’ve received this year, Orange County experts are predicting an increase in snake encounters this summer. Part of the reason is flash floods have destroyed many snakes’ homes, forcing them out to look for new homes, shade, and water. The other reason is rain allows for more vegetation, and more vegetation allows for more rodents, and – you guessed it – more rodents mean more food for the snakes! With all this in mind, we encourage parents to learn how to prevent or treat a snakebite, just in case you encounter one on your adventures.

If you or someone you know is bitten by a snake:

  • Step One: Seek medical attention as soon as possible or call local Emergency Medical Services (EMS). First aid is important, but only to hold you over until you can get medical attention. Do not treat the bite by yourself, since the anti-venin is only available at medical centers.
  • Step Two: Keep the person still and calm. This prevents the venom from spreading, whereas moving around would allow the venom to spread to other parts of the body. Although it may seem strange, it’s best for the venom to stay in one place if possible.
  • Step Three: Try to remember the color, patterns, shape and sounds of the snake. These details can sometimes help emergency responders determine whether the snake is poisonous, which may impact treatment. Not all snakes have venom!
  • Step Four: While you wait for medical attention to arrive, practice these first-aid techniques:
    • Lay or sit the person down with the bite below the level of the heart
    • Keep him/her calm and still
    • Cover the bite with a clean, dry dressing
  • Step Five: Don’t overthink it. You might start remembering all sorts of crazy techniques that your neighbor, uncle, or childhood friend told you; but remember: the list of good first aid techniques is short. It’s better to do minimal first aid than bad first aid.
    • Do NOT suck out the venom
    • Do NOT slash the wound with a knife
    • Do NOT pick up the snake or try to trap it
    • Do NOT apply a tourniquet
    • Do NOT apply ice or immerse in cold water
    • Do NOT drink alcohol to ease the pain
    • Do NOT drink caffeinated beverages

What if you’re alone on a remote trail? What if there’s no cell service?

  • Stay calm. Slowly move yourself 20-30 feet from the snake and find a safe place to sit down. Sitting down can reduce the chances of fainting within the first couple minutes.
  • Remove any rings, jewelry, or restrictive clothing from the area of the bite.
  • Try calling 9-1-1. If you don’t have cell service, yell out loud for help. If someone is within earshot, they may be able to help you.
  • Take a minute or two to come up with a plan.
  • If you truly find yourself alone on the trails with no cell phone service, start walking to the nearest place where you can get help. This may be the trailhead, a park ranger station, or the last place you had cell phone service. The risk of spreading the venom while walking is less than the risks of staying in one place without medical help.

Signs and Symptoms of a Venomous Snake Bite:

  • Extreme pain
  • Ulceration, redness and swelling at the bite site
  • Excessive bleeding or bruising
  • Blood clots
  • Low blood pressure
  • Increased sweating
  • Disturbed vision
  • Nausea and vomiting

If you have a marker or pen, mark the area of swelling with the time noted. This can help emergency providers calculate how fast the venom is spreading.

Other dangers of snakebites:

Snake venom can cause bleeding problems. Do not take ibuprofen, naproxen, Aleve, Advil, Motrin or other non-steroidal anti-inflammatory drugs (NSAIDs) to relieve the pain from a snake bite. These medications increase risk of over-bleeding. Acetaminophen (Tylenol) is usually fine.

There is an antidote available at healthcare facilities called CroFab (crotalidae polyvalent immune fab, ovine). This is an antivenin specifically for some venomous snakebites. In the rare situation where you may find yourself needing this antidote, it is important to let your healthcare provider know if you have an allergy to sheep, papaya, papain, or pineapple enzymes. Having these allergies increases your risk of having an allergic reaction to the antidote, which your health care provider needs to take into account to manage treatment.

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Skin Reactions to the Sun

By Ara Jamasbi, pediatric resident at CHOC Children’s

Living in Southern California, we are lucky to experience beautiful sunny weather practically year round. While we’re all aware of the dangers of sunburns, there are other skin reactions to the sun to be mindful of as well.

Photosensitivity is abnormal or adverse skin reactions to the sun. and If your child develops a sunburn reaction, swelling, or intense itching after limited exposure to sunlight or shows a rash or scarring in a sun exposed area (ie. face, V of neck), they may actually have photosensitivity.

Polymorphous light eruption, also known as “sun allergy” or “sun poisoning” is the most common photosensitivity. It occurs 1-2 days after intense sun exposure. It may range from small red dots to clear fluid-filled dots (vesicles), eczema-looking dry patches, large plaques/papules, or target-like lesions. The commonly involved areas include the face, neck, arms and hands where there was sun exposure. In children, it starts as dry patches on the face with red small dots, with severe itching. Lesions disappear in 1-2 weeks spontaneously if no further sun exposure occurs.

Solar urticaria is another type photosensitivity characterized by itching and redness usually after about 30 min or less of sun exposure. After several hours, the skin returns to normal. The cause is unclear, but antihistamines, corticosteroids and limited sun exposure have all been beneficial.

Phytophotodermatitis occurs when UV light reacts with certain chemicals on the skin. These chemicals can come from common foods such as limes, carrots, parsley and celery. The rash typically appears 24 hours after the exposure, and can take weeks to months to completely resolve. It may appear as a red itchy rash, but sometimes may even blister. It is usually in the pattern of exposure to the food causing the reaction, such as spattering or drips from a squeezed lemon

Don’t forget basic sunscreen practices. It is important to use a water-resistant, broad spectrum sunscreen (protecting against both UVA and UVB rays) with SPF 30 or higher. The higher the SPF, the more protection, with SPF 50 giving maximal protection. Sunscreen should be applied 15-30 minutes before going outside and re-applied every two hours, but more often if the child is swimming or sweating. Throw away sunscreen that is older than three years or passed the expiration date. Don’t forget to put sunscreen on often-forgotten areas such as the tops of the feet, ears and back of the neck and scalp.

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Tick Bites: Fact vs. Fiction

Tick bites can be a common summer nuisance depending on where your activities or travels take you. Parents should be aware of common misconceptions related to ticks, says CHOC Children’s pediatrician Dr. Katherine Williamson.

Parents can help prevent tick bites: Fact

There are several things parents can do to help their children avoid tick bites.

  • Stay on a path when hiking
  • Wear long pants, and tuck pants into long socks
  • On clothes, use permethrin spray. On the skin, use insect repellent with 30 percent DEET. Be aware that this generally only lasts on the skin for one to two hours, so reapply often if you’re spending extended time outdoors.

Remove ticks by lighting a match near the arachnid: Fiction

This age-old myth can lead to accidental injuries, says Williamson, and should always be avoided. Instead, dip a cotton ball in liquid soap, and soak the tick for one to two minutes. Then locate the head of the tick and use a tweezers to pull it straight out. If the tick  is still latched on to the skin,  hold the head of the tick straight out for 30-60 seconds and it will release from the skin. Then drop the tick into a jar of rubbing alcohol to eliminate it. If the tick is too small to grab with a tweezers, use a credit card or popsicle stick to slide it off the skin. Most tick bites don’t result in any symptoms or side effects, and removal at home is sufficient care.

Tick bites lead to Lyme disease: Rarely

The likelihood of contracting Lyme disease via a tick bite in southern California is extremely small, says Williamson.  There are many variations of ticks and only one- deer ticks, not commonly found in this region- transmits Lyme disease. Since deer ticks are tiny, they are easily missed.  Always do a full body check for ticks after going outdoors, and pay close attention to the head, neck and scalp, since ticks gravitate to those areas.

Consult your pediatrician if you cannot remove the tick in its entirety, or if your child becomes symptomatic. Lyme disease symptoms include fever, muscle aches, joint aches and headaches. If you were recently in an area known for deer ticks, most notably the northeastern United States or the upper Midwest, watch out for small red rings one to two inches from a possible bite site, which may be a sign of Lyme disease. Treatment includes one to two weeks of antibiotics, and most children make a complete recovery with no complications.

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Keeping Kids Active This Summer

By Michael Molina, MPH, Community Educator at CHOC Children’s

Children and adolescents should meet a minimum of 60 minutes of physical activity every day. The full 60 minutes doesn’t have to be all at once- you can break it down in smaller sessions such as 15-20 minutes. Being active is an essential part a child’s growth and development, and keeping them healthy. Incorporate these easy tips into your family’s summer plans to make sure everyone gets the physical activity they need and deserve.

Be active with your children

Be a role model for your kids. Children are more likely to stay active when they are having fun with their parents. Using words like “play time” or “fun time” makes it more exciting and appealing than “exercise” or “working out.” Tap into activities or sports that they are interested in, such as walking the dog, playing catch, soccer, riding a bike, or an obstacle course in your backyard.

Parents should encourage physical activities for the whole family, and time together should concentrate on 3 areas:

  • Endurance (increase heart rate)- Run away from the person who’s “it” or balloon tag
  • Strength (using our muscles)-Try crossing the monkey bars. No need for weights for this one; use your body weight for pull-ups, pushups, and sit-ups at the playground
  • Flexibility (stretching our muscles)- Fun yoga poses or something as simple as bending down to tie their shoes

Limit screen time for the entire family

Children should not exceed more than two hours of screen time each day. Screen time is considered watching TV, playing video games, or using the computer, tablet or smartphones.

Children are more likely to eat foods that are high in fat, sugar and sodium during long periods of screen time that surpass their serving size.

Screen time means time away from being active. Long term consequences of being physically inactive increase one’s risk of diabetes, high blood pressure and heart disease.

Join a summer camp or program

Look for your city’s summer camps or programs, or join your local Boys and Girls Club.

Ask what types of activities  these summer programs provide for your child and if they are age appropriate. Also try to find ways that you can be involved with the summer program.

Drink plenty of water

Provide water as a source of rehydration, not fruit drinks. Many fruit drinks are advertised as “healthy” drinks because they have images of real fruit on the packages when really it is made with a small percent of real fruit.

Water is a great source of hydration and it is calorie-free.  Try adding slices of real fruit in the water for more flavor.

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Avoid heatstroke with these sun safety tips

Heatstroke can happen when body temperature rises to dangerous levels and it isn’t able to cool itself quickly enough. On average nationwide, 37 children die in hot cars every year from heat-related incidents. Nearly every state has experienced a child vehicular heatstroke death.

Community educators at CHOC Children’s recommend the following tips for avoiding heatstroke:

  • Never leave your child alone in the car, for any amount of time. In California it’s against the law to leave any child under age of six alone in a vehicle without a person who is at least 12 years old.
  • Teach kids not to play in cars, and kept your car locked so they can’t get in on their own.
  • Create reminders for yourself not to forget your child in the backseat of your car. Leave an important item in the backseat near your child, like a wallet or cellphone that is needed at your final destination.
  • If you notice a child alone in a car, call 911.

Parents can retain these tips by remembering to ACTAvoid leaving your child alone in the car. Create reminders, such as one that ensures you dropped your child off at daycare that morning. Take action- if you see a child alone in a car, calling 911 could mean saving their life.

Heatstroke symptoms include dizziness, disorientation, agitation, confusion, sluggishness, hot and dry skin that is flushed but not sweaty, loss of consciousness, rapid heartbeat and hallucinations. These symptoms can progress to seizures, organ failure or death if not immediately treated.

If a child is experiencing heatstroke, there are several things you can do while medical assistance arrives. Take the child to a cool place, remove as much of their clothing as possible, and apply cold packs or ice to areas with large blood vessels (neck, groin, armpits) to accelerate the cooling process.

Learn more safety information from CHOC’s community education department.

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Summer Safety Checkup

Supervision is the best way to keep your children safe in the home.  There are, however, some things you can do to make your children’s environment safer. These tips will help you have a stress-free summer knowing your home is the safest it can be for your children.

  • Double check alarms: Make sure your smoke alarms and carbon monoxide detectors are working properly. There should be one on every level of your home and in every bedroom.
  • Poison precautions: Avoid household poisoning hazards and save the Poison Control Center’s phone number in your cell phone: 1-800-222-1222. This free, 24-hour hotline can help with serious emergencies or simple questions.
  • Helmet safety: Most serious head injuries can be avoiding by wearing a properly-fitting helmet. It should fit snugly and not slide around on the child’s head. Place two fingers above the child’s eyebrows and the helmet should be resting comfortably there. When worn correctly, the straps should form a letter “V” behind the ears. By law in California, everyone under 18 years of age must wear a Consumer Product Safety Commission-approved helmet while bicycling, riding a scooter, skateboard, or using roller-skates or in-line skates.

When accidents happen, CHOC Children’s is ready with the only pediatric-dedicated emergency department and trauma center in Orange County. Learn more about the Julia and George Argyros Emergency Department.

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OC Reports First West Nile Virus Case – What You Need to Know

An Orange County man tested positive recently for West Nile virus (WNV) infection, becoming the county’s first human WNV infection in 2015. The man has CHOC Children's Infectious Diseasenow recovered.

As of August 12, there are 36 human cases of WNV reported in California. Last year, there were 280 reported human infections of WNV and nine WNV related deaths in Orange County. The disease is recurring every year during the summer months and into the fall, according to county health officials.

For answers on how to protect your family from this virus, check out the following Q&A with Dr. Jasjit Singh, pediatric infectious disease specialist at CHOC Children’s.

Q: What is West Nile virus and who is at risk for infection?

A: West Nile virus is transmitted by the bite of an infected mosquito. Serious illness can occur in people of any age. However, most cases of human infection occur in the elderly and in those with impaired immune systems.

Q: What are the symptoms?

A: The vast majority of WNV infections (~80%) are asymptomatic. Most symptomatic patients will have fever, sometimes accompanied by other nonspecific signs such as headache, nausea, vomiting or rash. Less than 1% of infected individuals will develop a neurologic disease, such as meningitis, encephalitis (inflammation of the brain) or acute flaccid paralysis.

Q: What is the treatment?

A: No vaccine or specific antiviral treatments for West Nile virus infection are available. Over-the-counter pain relievers can be used to reduce fever and relieve some symptoms, however. In severe cases, particularly those with neurologic involvement, patients often need to be hospitalized.

Q: How can families protect themselves from this virus?

A:

  • Eliminate standing water on your property, which can serve as a breeding area for mosquitoes.
  • Install door and window screens, to prevent mosquitoes from entering the home.
  • When possible, avoid being outdoors between dusk and dawn when mosquitoes are most active.
  • When outdoors, if possible, wear long pants and long sleeves and use an insect repellent during the summer and fall. Look for repellents containing DEET, picardin or oil of lemon eucalyptus, which often provide longer-lasting protection.

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August is Heatstroke Awareness Month – 5 Tips You Must Know

CHOC Children's Community EducationIt’s Heatstroke Awareness Month and CHOC Children’s would like to remind everyone never to leave a child alone in a car. Sadly, there have been 11 vehicular heatstroke deaths in the United States, this year alone.

Heatstroke occurs when the body isn’t able to cool itself quickly enough and the body temperature rises to dangerous levels. Symptoms can quickly progress to seizures, organ failure and even death. Young children are particularly at risk, as their bodies heat up three to five times faster than an adult’s. More importantly, these injuries are completely preventable.

Keep your little ones safe with these tips:

  1. Never leave your child alone in a car, not even for a minute. No exceptions.

 

  1. Teach kids not to play in cars. Keep your car locked when you’re not in it so kids don’t get in on their own. Remind kids that trunks are for transporting cargo and are not safe places to play.

 

  1. Create reminders by putting something in the backseat of your car next to your child, such as a briefcase, purse or cell phone that is needed at your final destination.

 

  1. Go a step further – create extra reminders. Develop a plan with your daycare so that if your child is late, you’ll be called within a few minutes. Be especially careful if you change your routine for dropping off children at daycare.

 

  1. Take action. If you notice a child alone in a car, call 911. If your child is missing, get help and check swimming pools, vehicles and trunks. If your child is locked in a car, get him out as quickly as possible and call 911 immediately.

Download this important tip sheet.

Check out this video for more information.

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Be Safe this Fourth of July with these Must-Know Tips

CHOC summer safetyEvery year, fireworks cause thousands of eye injuries and burns. CHOC Children’s and the Orange County Fire Authority ask you to consider taking your family to a professional fireworks show as a safer alternative.

If consumer fireworks are part of your family’s festivities, however, take a minute to check out these important tips:

• Supervise children at all times. Fireworks should be handled by adults only.

• Buy only state fire marshal-approved (“Safe and Sane”) fireworks, from a licensed firework stand. Police in Orange County will be vigorously enforcing laws against illegal fireworks. You can be fined upto $1,000.

• Only these OC cities allow consumer fireworks: Anaheim, Buena Park, Costa Mesa, Fullerton, Garden Grove, Huntington Beach, Santa Ana, Stanton, Villa Park and Westminster.

• Back up to a safe distance immediately after lighting fireworks. Spectators should also keep a safe distance.

• Never re-light or pick up fireworks that have not ignited fully.

• Do not alter fireworks or combine them.

• Point fireworks away from people, homes and cars, and keep away from leaves, dry grass and flammable materials.

Find a public fireworks display near you.

Check out this video from the Orange County Fire Authority and the Santa Ana Police Department.

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Medication Safety Tips for Summer Camp Counselors and Caregivers

Summer camp counselors, caregivers and family members alike, can rest assured with these medication safety tips for children under their care. Read below to make sure you’re asking the parent/guardian the right questions about their child’s medications:

• Review the child’s complete medication list with the child’s parent/guardian.
This includes which medications are scheduled (For example:  to be given twice daily at 9 a.m. and 9 p.m.) vs. which medications are only to be given as needed. For as needed medications, make sure you fully understand when it is appropriate to give. For patients with asthma, ask if they have a copy of their asthma action plan.


• Do any medications need to be taken with food or on an empty stomach?

• Can I crush any of these tablets? Do not crush extended release, controlled release or sustained release medications.

• Will any devices be needed to administer the medications?
For example: a spacer will be needed for an inhaler.

• Do any of the medications need to be stored in special conditions such as the refrigerator?

• How do I measure an oral liquid?
For oral liquids, make sure the dose is written in both mg and mL so that you understand how to draw up the dose correctly with an oral syringe. Ask the parents to bring the oral syringe and bottle adapter provided by the pharmacy. Avoid using a measuring cup or household teaspoon/tablespoon as this is not an accurate measurement.

• What is the duration of each medication and do they have stop dates?
For example: if the child is supposed to get seven days of antibiotic, how many days left do they need to take it?

• What are the common side effects your child experiences on these medications?

Lastly, make sure you have a contact number for the family, provider and the Poison Center Hotline (800-222-1222) should any questions arise.

Learn more about pharmacy services at CHOC.

 

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