PERCUTANEOUS
INFECTIONS (BITES)
Rabies
In Asia the principle animal vectors of rabies
are: dogs, cats, and monkeys. Rats can also carry the disease. If
you get bitten, immediately cleanse the wound with flowing water
for at least 15 minutes and then rinse with alcohol or iodine. Seek
medical advice. A tetanus toxoid vaccination may be necessary, and
if blood was drawn rabies vaccination is a must. If 5% of the dogs
in Bangkok have rabies then expect a similar percentage in Phnom
Penh.
Snake-bites
Unlike the situation in Burma, snake-bites in Cambodia
are uncommon. One clinic recorded 500 cases of dog bites and only
4 cases of snake-bites in the same period of time. Nevertheless
avoid the possibility by: (a) walking on clear paths, wearing boots,
and using a torch at night, (b) not putting your hand and feet in
places you can not see, (c) not sitting on logs (snake bites on
the bottom are not uncommon), (d) being wary when exploring dark
cool places such as inner temples and ruined houses where cobras
sometimes reside and (e) checking shoes and clothing in the morning.
The commonest snakes in Cambodia are pit vipers and cobras. 30-50%
of venomous bites result in no significant injection of venom. A
viper bite will usually cause local swelling, possibly bleeding
and has a 5% fatality rate. A cobra bite often produces little local
reaction but can affect the nerves to the heart and lungs, with
a fatality rate of 10%.
First aid: relax / remember what snake it was /
handle a dead snake cautiously as a decapitated head may retain
a bite reflex for up to an hour / wash bite with clean water / do
not cut or suck wound / apply compression bandage above the bite
/ immobilize the limb / seek medical advice. If after 6 hours there
is no local swelling and no signs of poisoning the patient may go
home. Antivenin is only given if there is massive swelling, tissue
destruction or signs of poisoning. Antivenin is expensive and has
a short expiry date and therefore there may be problems in getting
it.
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