動物傷害后的醫療處理 Medical Treatment after being hurt by Animals 狗貓鼠傷害Hurt by dog, cat and mouse 1    現場處理：如果被狗貓鼠等動物咬傷或抓傷，重要的是做好現場的應急處理工作。 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、貓、鼠等動物咬傷，不管是瘋狗、病貓還是正常的狗、貓（有相當多的一部分正常的狗、貓的唾液中帶有狂犬病毒），立即就地、徹底沖洗傷口。咬傷部位在四肢時，可暫結止血帶，用生理鹽水或清水沖洗傷口。   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 沖洗傷口一是要快，二是要徹底，三是傷口不可包扎。處理傷口分秒必爭，以最快速度把沾染在傷口上的狂犬病毒沖洗掉。因為時間一長病毒就進入人體組織，沿著神經侵犯中樞神經，置人于死地。由于狗、貓咬的傷口往往外口小，里面深，這就要求沖洗時，盡量把傷口擴大，讓其充分暴露，并用力擠壓傷口周圍軟組織，而且沖洗的水量要大，水流要急，最好是對著自來水龍頭急水沖洗。   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, it’s better to wash the wound by tap water cock with rapid flow.   特別要注意的是，如果被狗、貓、鼠咬傷，傷口不作任何處理是錯誤的，錯上加錯的是不僅傷口不沖洗，而是涂上紅藥水包上紗布更有害，切忌長途跋涉趕到大醫院求治，而是應該立即就地、徹底沖洗傷口，在24小時內注射狂犬疫苗。    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    診所及醫院處理： Clinic and hospital treatment: 傷口經過反復沖洗后，到診所作進一步的處理，傷口還要認真沖洗、消毒，聯系金山醫院作進一步救治。 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 及時正確傷口處理 The first step correctly treat the wound in time l 應盡快用3%～5%肥皂水或0.1%新潔爾滅反復沖洗至少半小時，肥皂水與新潔爾滅不可合用。并擠出污血。 Shall immediately wash the wound repeatedly by 3%～5% soapy water or 0.1% bromo—geramineum at least for half an hour, the soapy water could not be used together with the bromo—geramineum. And squeeze out the smear blood. l 沖洗后用70% 酒精擦洗及濃碘酒反復涂拭。 Swab down the wound by 70%alcohol and embrocate by thick iodine repeatedly. l 傷口一般不予縫合或包扎。除了個別傷口大，又傷及血管需要止血外，一般不上任何藥物，也不包扎，因為狂犬病毒是厭氧的，在缺乏氧氣的情況下，狂犬病病毒會大量生長。 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 必要時使用抗生素和精制破傷風抗毒素。 If necessary, apply antibiotic and purified tetanic antitoxin.  l 局部傷口處理愈早愈好，即使延遲1～2天甚至3～4天也不應忽視局部處理，此時如果傷口已結痂，也應將結痂去除后按上法處理。 It will better to treat the partial wound as early as possible, though it was delayed 1～2 days even 3～4 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 進行狂犬疫苗和抗狂犬病免疫血清免疫接種 The second step  inoculate the rabies vaccine and rabies antiserum 世界衛生組織（WHO）推薦動物咬傷分類、建議的暴露類型和治療方法見表 See the following table for the explosion types and medical methods on animals’ bite sorts and suggestion recommended by World Health Organization (WHO)  

 

分類 Sort	與動物接觸類型 Contact type	推薦治療方法 Recommended medical method
I	觸摸或喂養動物，舔及完整皮膚 Touch or feed animals, be lapped the unbroken skin	如無皮膚破損，無需采取任何措施 If no skin broken, no need to take any measures
II	無流血，多為輕度擦傷或抓傷 No blood, mostly light abrasion or claw	立刻接種疫苗 Inoculate the vaccine immediately
III	一處或多處皮膚穿透性咬傷,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種疫苗 Apply rabies antiserum and inoculate vaccine immediately

  目前上海市的處理原則：一旦被犬特別是可疑犬咬傷后，立刻接種狂犬病疫苗，全程接種疫苗（0、3、7、14、30天共5針）。被犬咬傷頭面、頸部、上肢、胸背部及其它部位的多處或嚴重咬傷者立刻接種疫苗，并應用抗狂犬病血清，并于咬傷后的第45、60天加注2針狂犬病疫苗。特別是對咬傷頭、面、頸部、手指和腳趾及傷口深者，對嚴重、多處咬傷者，抗狂犬病血清應先在傷口部位進行浸潤性注射，余下血清再進行肌肉注射。 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 45^th and 60^th 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.   毒蛇咬傷 Bit by poisonous snake 一般毒蛇咬傷后在局部留有牙痕、疼痛和腫脹，還可見出血及淋巴結腫大，其全身性癥狀因蛇毒性質而不同。急救原則是及早防止毒素擴散和吸收，盡可能地減少局部損害。蛇毒在3－5分鐘即被吸收，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、 綁扎傷肢，在咬傷肢體近側約5－10厘米處用止血帶或橡膠帶等綁扎，以阻止靜脈血和淋巴液回流，然后用手擠壓傷口周圍，將毒液排出體外。   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、沖洗傷口，先用肥皂水和清水清洗周圍皮膚，再用生理鹽水或凈水反復沖洗傷口。    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、局部降溫，先將傷肢浸于4－7攝氏度的冷水中3－4小時，然后改用冰袋，可減少毒素吸收速度，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，咬傷在24小時以內者，以牙痕為中心切開傷口成“＋”或“＋＋”形，使毒液流出，也可用吸奶器或拔火罐吸吮毒液。切口不宜過深，以免損傷血管。若有蛇牙殘留宜立即取出。切開或吸吮應及早進行，否則效果不明顯。   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、藥物治療。    Medical treatment 6、加強野外作業的防護，掌握毒蛇習性，不要裸露腿足，必要時穿長統靴，蛇傷即可避免。被毒蛇咬傷后切忌奔跑，宜就地包扎、吸吮、沖洗傷口后速到醫院治療。      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傷也是常見的。蝎螫傷局部可見大片紅腫、劇痛，重者可出現寒戰、發熱、惡心、嘔吐、舌和肌肉強直、流涎、頭痛、昏睡、盜汗、呼吸增快及脈搏細弱等，兒童被螫傷后嚴重者可因呼吸、循環衰竭而死亡。毒蜘蛛咬傷者局部蒼白發紅或出現蕁麻疹，重者可發生局部組織壞死或全身癥狀。處理原則與毒蛇咬傷相同。 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.   蜂螫傷Bee Sting 一般只表現局部紅腫疼痛，多無全身癥狀，數小時后即自行消退。若被蜂群螫傷時，可出現如頭暈、惡心、嘔吐等，嚴重者可出現休克、昏迷或死亡，有時可發生血紅蛋白尿，出現急性腎功能衰竭。過敏病人則易出現蕁麻疹、水腫、哮喘或過敏性休克。 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. 可用弱堿性溶液如肥皂水等外敷，以中和酸性中毒，也可用紅花油、風油精、花露水等外搽局部。黃蜂螫傷可用弱酸性溶液〔如醋〕中和，用小針挑拔或紗布擦拭，取出蜂刺。全身癥狀較重者宜速到醫院診療。對蜂群螫傷或傷口已有化膿跡象者宜加用抗菌素。 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 weak acid solution (such as vinegar), and get rid of the sting of a bee by small needle or clean by gauze. The person with serious whole body symptoms shall go to hospital for treatment as soon as possible. And the person stung by bee colony or with fester wound shall use antibiotic. 蜈蚣咬傷 Centipede bite 局部表現有急性炎癥和痛、癢，有的可見頭痛、發熱、眩暈、惡心、嘔吐，甚至譫語和抽搐及昏迷等全身癥狀。應立即用弱堿性溶液〔如肥皂水等〕洗滌和冷敷，有全身癥狀者宜速到醫院治療。 Partial symptoms appear acute inflammation, pain and itch, some of the persons will have headache, fever, dizzy, nausea, vomit and even delirium, twitch and coma and such whole body symptoms. It shall be immediately washed and cold compressed by alkalescent solution (such as soapy water), and the person with whole body symptoms shall go to hospital for treatment quickly.    注意Notice： 不管被何種動物咬傷，現場應立即傷口沖洗，同時呼救診所作進一步處理，必要時轉送金山醫院作進一步的處理。 No matter being bitten by any animal, you shall wash the wound at the site immediately; meanwhile call the Clinic for farther treatment. If necessary, you will be sent to Jinshan Hospital for farther treatment.