Ask the Expert

Dr. Robert Rothstein, who is Chairman of the Department of Emergency Medicine at Suburban Hospital , offers these tips for the summer's most common first-aid issues: bee stings, tick bites, mosquito bites, poison ivy, heat-related conditions, jelly fish stings, and bicycle injuries. You can also learn about the emergency services available at Suburban Hospital , and items to keep in a first aid kit.

1. Can bee stings be serious?

For most people, a sting from a bee, wasp, or hornet usually results in a bout of painful swelling that disappears in a few hours. Others, however, suffer allergic reactions to these stings, which result in symptoms like shortness of breath, swelling of the mouth or throat, dizziness, headache, abdominal cramps, or extreme nausea. If any of these symptoms occur, seek medical attention promptly.

Treatment : If the stinger remains in the skin, remove it by gently scraping it away or teasing it out with a clean pointed instrument. Do not squeeze; this may inject more venom into the skin. Thoroughly wash the sting area with soap and water. Apply an antiseptic anti-inflammatory ointment or cream, or a paste made of baking soda and water, to relieve itching and prevent infection.

Acetaminophen, ibuprofen or naproxen sodium may effectively relieve any pain, and an antihistamine will relieve the itching and swelling.

Prevention: Do not go barefoot, especially through vegetation. Do not swat at bees and yellow jackets with bare hands. Move slowly and steadily, and gently brush the insects off. Do not sit on or handle wet towels, washcloths, etc., without first making sure no insect is drinking the moisture. Avoid leaving soft drink with “pop tops” sitting in the open as bees like to get into the cans and you could swallow it.

2. How do I know if I've contracted Lyme disease from a tick bite?

Lyme disease is caused by bacteria that are spread by tiny infested ticks. Not all tick bites will cause Lyme disease but the East Coast is among the areas where it is commonly found. In 2004, it was estimated that 610 Maryland residents contracted the disease.

An early symptom of Lyme disease is usually, but not always, a rash where the tick was attached. The rash appears within three days to a month after the bite. It often starts as a small red area then spreads, clearing up in the center so it looks like a donut. However, the rash may not always look like this. Also common in the early stages of Lyme disease are flu-like symptoms, such as fever, headache, stiff neck, sore and aching muscles and joints, fatigue, and swollen glands. These early symptoms often go away by themselves after a few weeks, but the person may remain infected. Without medical treatment, about half the infected people will get the rash again in other places on their bodies, and many will experience more serious problems. An antibiotic treatment clears up the rash within days when taken within the first weeks after initial infection. This treatment usually prevents later problems.

Treatment (for tick removal): Remove any tick promptly. Do not use bare hands. The mouthparts of a tick are shaped like tiny barbs and may remain embedded, leading to infection at the bite site if not removed properly. The best way to remove a tick is to grasp it with tweezers as close to the skin as possible and gently, but firmly, pull it straight out. Do not twist or jerk the tick. If tweezers are not available, grasp the tick with a piece of tissue or cloth or whatever can be used as a barrier between your fingers and the tick.

Wash the bite area and your hands thoroughly with soap and water, and apply an antiseptic to the bite site. To dispose of ticks, flush them down a toilet or burn them with a match. Do not try to squash a tick. Squeezing it may release germs from the tick.

Prevention: Wear light-colored, protective clothing: long-sleeved shirts, pants, boots or sturdy shoes, and head covering. Apply insect repellent containing DEET to clothes and exposed skin (except the face). Check yourself and those around you every two to three hours for ticks. Most ticks attach slowly and rarely transmit disease until they have been attached for four to six hours.

3. Isn't a mosquito bite nothing more than an annoying itch?

Yes. In most cases that is true. There is little chance that a person will become ill from a single mosquito bite. However, West Nile Virus (WNV) is spread by the bite of an infected mosquito.

WNV symptoms include fever, headache, body aches, nausea, vomiting, and sometimes swollen lymph glands or a skin rash on the chest, stomach and back. Approximately 80 percent of people who are infected with WNV will not show any symptoms.

Treatment (for WNV): There is no specific treatment for WNV infection. In cases with milder symptoms, people experience fever and aches that clear up in a few days, although even healthy people have become sick for several weeks. In more severe cases, which include symptoms of acute headaches or confusion, people need to seek immediate hospital care.

Treatment (for mosquito bite) : Wash the infected area with soap and water as soon as you recognize that you've been bitten. Try to keep the site clean and dry until the irritation subsides. Avoid scratching. Although a mosquito bite should itch for only a few days, continual scratching will increase your discomfort and may prolong the itching. Make a paste of baking soda and water, using just enough water to make the paste sticky. Spread the mixture on the bites. Other remedies include applying an ice pack or ice wrapped in a cloth to the bite area and using calamine lotion or topical anesthetic with pramoxine to help relieve pain and itching.

Prevention: The hours from dusk to dawn are peak biting times for mosquitoes. Use repellent and protective clothing during evening and early morning hours or consider avoiding outdoor activities during these times. Since m osquitoes lay their eggs in standing water, it is a good idea to clear standing puddles around your home and remove items that hold water. The Centers for Disease Control (CDC) recommend using an insect repellent containing DEET on exposed areas of skin.

4. I have heard that a poison ivy rash is contagious. Is that true?

No, it is not contagious. Nor can you contract the rash simply by being near the plant. Direct contact is needed to release its urusiol oil, the sticky, resin-like substance that causes the rash. You can, however, spread the rash by touching the oil that causes the rash. Breaking the rash blisters will not spread the urusiol oil. Poison ivy is characterized by three or five serrated-edge, pointed leaflets that assume bright colors in the fall. In the East, it grows as a vine or free-standing plant.

The first symptom of poisoning is a red rash and severe itching of the skin. The rash erupts in streaks or patches where the plant touched the skin. It will then become inflamed and skin blistering occurs.

Treatment: The good news is that poison ivy (and poison oak and sumac) are easy to treat if you do so within 30 minutes of contact. If you are exposed to any of these plants or their oils, wash thoroughly with soap and water as soon as possible. As an alternative, you can use rubbing alcohol, which dissolves and removes the oils from your skin. The irritation from a mild rash can usually be alleviated by the following: cool compresses with water or milk; Calamine, a non-prescription lotion; Aveeno oatmeal bath, a product you put in bath water to relieve itching; or oral antihistamines such as diphenhydramine (Benadryl). Non-prescription corticosteroid (i.e. hydrocortisone) creams usually do not help.

Do not attempt to treat severe reactions or "wait it out" at home. If you have large rash areas that cause significant discomfort, a rash area that becomes infected or drains pus, or a great deal of swelling, go immediately to the nearest emergency department.

Prevention: Do not burn the plants. Burning can release the allergens into the air. Wear proper clothing to protect your skin, such as gloves, long sleeves, and pants. Note that urusiol oil stays active on any surface, including dead plants, for up to five years. When bathing pets that may have the oil on their fur be sure to use soapy water and wear protective clothing. Wash any clothing that might contain the plant oil. Unwashed clothes can retain the oil and cause a rash in anyone who wears or handles them. Before you go out in a potentially infested area, you can apply nonprescription products such as Ivy Block or Stokoguard, which act as a barrier to the oils.

5. How can I tell if I'm in danger of too much sun exposure?

It is important to remember that it takes only a few serious sunburns to increase the risk for a child, teen, or young adult to develop skin cancer later in life. A person doesn't have to be at the pool, beach, or on vacation to get too much sun. Whenever anyone is outdoors, their skin needs protection from the sun's harmful ultraviolet (UV) rays.

There are three heat-related conditions to be aware of: heat exhaustion, heatstroke, and heat cramps.

Heat exhaustion , one of the more mild summer health problems, results from spending too much time in the heat. Heatstroke is caused by prolonged exposure to high temperatures. Just sitting or lying too long in the heat can result in heatstroke, which can be fatal and is a medical emergency. Heat cramps are muscle pains or spasms — usually in the abdomen, arms, or legs — that affect people who sweat a lot during strenuous activity. Seek medical attention for heat cramps if they do not respond to hydration with fluid containing electrolytes and do not subside within an hour.

Treatment: Stop all activity and sit quietly in a cool place. Loosen or remove patient's clothing, spray body and head with tepid (not cold) water, and cool by large fans to maximize evaporative heat loss. Drink extra amounts of liquids to replace body fluids lost through perspiration. Water, fruit juices or fruit-based drinks, such as lemonade, are preferable to tea, soft drinks, coffee, or alcohol. Beverages that contain caffeine or alcohol often result in more frequent urination, which increases the body's loss of fluids.

Prevention: UV rays are strongest and most harmful from 10 a.m. to 4 p.m. If you must be outdoors at this time, seek shade under a tree, an umbrella, or a pop-up tent. UV rays can also penetrate cloud and haze cover, making cloudy and overcast days dangerous as well. Clothing that covers the skin helps protect against UV rays. Hats with a wide brim offer good protection for the face, head, ears, and neck. To protect your eyes from UV rays, of which overexposure can lead to cataracts later in life, wear sunglasses. Look for sunglasses that wrap around and block as close to 100 percent as possible of both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Use sunscreen with a minimum Sun Protection Factor (SPF) of 15 that blocks both UVA and UVB rays. For most effective protection, apply sunscreen generously 30 minutes before going outdoors. Remember to apply to ears, noses, and tops of feet.

6. What is the best way to deal with a jelly fish sting?

While most jellyfish stings are harmless, they can be agonizing. The skin often displays a painful, itchy, and raised red rash that may persist for days or weeks. This may be accompanied by m uscle spasms in the affected extremity. Other symptoms may include excessive tearing, a runny nose, and painful breathing. With extensive stings, reactions such as nausea, vomiting, headache, dizziness, muscle weakness, and irregular heart rate can develop.

Treatment: The first aid goals for jellyfish stings are to prevent injury to rescuers, inactivate the stinging cells, and remove any tentacles stuck to the patient. All rescuers should wear protective clothing and gloves. The affected area should be rinsed with salt water. Do not rinse with fresh water because it will further activate the stinging cells and worsen the reaction. Using protective gloves or forceps, remove any tentacles still in contact with the victim. Apply a 5% acetic acid solution, such as white vinegar, which is the preferred method. Alternative treatments use meat tenderizer or baking soda, which also neutralize any stinging cells that have not yet discharged into the skin. Meat tenderizer should not be left on the skin for more than 15 minutes, and none of these substances should be used in or near the eyes. Once the stinging cells are deactivated and large pieces of the jellyfish are removed, shaving cream may be applied to the area and a knife edge, safety razor, or credit card may be used to take away any remaining stinging cells.

Use over-the-counter medications such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to control pain symptoms. Immobilize the poisoned area to prevent further spread. If the victim appears ill, lay the person down and call an ambulance.

Prevention: Do not swim in waters where large numbers of jellyfish have been reported. Wearing a wet suit or Lycra dive/swim suit can prevent stings. Do not touch any corals or feathery creatures underwater without appropriate protection.

7. Are bike helmets just a personal preference or am I required to wear one?

It is a Maryland law that all persons under 16 years of age wear a bicycle helmet o n all public roads where bicycling is allowed. All persons riding a bike should wear a helmet. Aside from head wounds, riders can suffer many common injuries.

Treatment: If you feel leg strains coming on, try an anti-inflammatory medication such as Ibuprofen (Motrin/Advil), together with an method nicknamed “RICE:” R est the injury; I ce it (try two bags of frozen peas in a gallon zip bag for 20 minutes on, 10 minutes off); Compression (wrap the injured area in an elastic bandage); and E levation (raise the injured area to reduce swelling). Though they may feel good at first, avoid hot tubs, spas and saunas for at least 72 hours. If pain persists, see your doctor.

Prevention: Look for a helmet approved by the Snell Memorial Foundation (www.smf.org) or review the guidance provided by the Bicycle Helmet Safety Institute (www.helmets.org). The most common bicycling injury is excessive bend at the knee, which is a result of the seat being to set too low. A good rule of thumb is if the front of your knees hurts, raise the seat. If the back of your knees hurts, lower the seat. Don't move the seat height more than 1/8th inch per week to allow your body time to adapt. Also, use a leg curl machine to strengthen your hamstrings. Cyclists tend to over develop thigh muscles and under develop hamstrings, leading to injury problems. Remember to include a few minutes of slow riding to warm up and cool down when you start and finish your ride.

8. Should a summer ailment/injury require emergency treatment, what services does Suburban Hospital offer?

Suburban Hospital is home to the Eby Emergency/Trauma Center, where more than 40,000 patients are treated annually, including 1,500 trauma cases. As the state-designated regional trauma center for Montgomery County and the surrounding area, we offer superior emergency care in a high-tech facility with a specially trained medical team.

Our expert staff and specially trained trauma team can do diagnostic testing and treatment rapidly in a specially equipped trauma area. As well, the NIH Stroke Center at Suburban Hospital offers 24-hour access to stroke experts and cutting-edge diagnostic technology and treatment. Our stroke program is one of only five in Maryland to be nationally certified as a Primary Stroke Center . With the recent opening of the NIH Heart Center at Suburban, we offer the full spectrum of cardiac care.

Our family-friendly Pediatric Center offers children and parents comfort in a specially designed pediatric emergency area, where board-certified pediatricians and pediatric nurses care for our youngest patients. The Center also features inpatient beds for routine medical or surgical admissions or outpatient care for children 17 years old and younger.

9. I'd like to keep a first aid kit handy. What items should it contain?

Having a first aid kit readily available in your home and car is an excellent idea. Remember, however, that the kit contains items that may be dangerous to young children, so store it out of their reach. Suggested contents include:

• Adhesive Tape
• Activated Charcoal (use only if instructed by a Poison Control Center )
• Antiseptic Ointment
• Band-Aids (assorted sizes)
• Aspirin
• Cold Pack
• Disposable Gloves
• EpiPen (prescribed by your doctor if you have severe allergies)
• Gauze Pads and Roller Gauze (assorted sizes)
• Hand Cleaner
• Plastic Bags
• Scissors and Tweezers
• Syrup of Ipecac (use only if instructed by a Poison Control Center )
• Thermometer

Dr. Robert Rothstein has been practicing Emergency Medicine for over 30 years and has been Chairman at Suburban for 20 of those. He is Board Certified by the American Board of Emergency Medicine and was a director and examiner for the Board. He has held academic appointments at several medical schools around the country, and has published dozens of papers and texts in Emergency Medicine.