21. Walgreens | Health Library | First Aid | Insect Bites And Stings Insect bites and stings Symptoms of an insect bite result from the injectionof venom or other agent into your skin. The venom triggers http://www.walgreens.com/library/firstaid/Insect.jhtml

Your Account Log In Help All Areas Products Drug Info General Site Insect Bites and Stings Symptoms of an insect bite result from the injection of venom or other agent into your skin. The venom triggers an allergic (immune) reaction. The severity of your reaction depends on your sensitivity to the insect venom or agent. Most reactions are mild, causing little more than an annoying itching or stinging sensation and mild swelling that disappear within a day or so. A delayed reaction may cause fever, painful joints, hives and swollen glands. You might experience both the immediate and the delayed reactions from the same bite or sting. Only a small percentage of people develop severe reactions to insect venom. Bees, wasps, hornets, yellow jackets and fire ants are typically the most troublesome insects. Mosquitoes, ticks, biting flies and some spiders can also cause reactions, but these are generally milder. For mild reactions: Move to a safe area to avoid more stings. Try to remove the stinger by scraping or brushing it off with a firm edge, such as a credit card. Swab the site with disinfectant. To reduce pain and swelling, apply ice or a cold pack.

22. PETsMART.com Select A Pet All Pets Dog Cat Bird Wild Bird Fish Insect bites and stings 10 Ways to Bite Back A Rodale Press contribution.To mosquitoes and other biting members of the insect http://www.petsmart.com/pet_library/home_remedies/insect_bites.shtml

Select a pet All Pets Dog Cat Bird Wild Bird Fish Reptile Small Pet Advanced Search Home Email Offers Register ... Wounds Insect Bites and Stings 10 Ways to Bite Back A Rodale Press contribution To mosquitoes and other biting members of the insect world, your pets are a four-legged free lunch. Bees, hornets and wasps, however, may be too irritated to lunch. They just sting. While close encounters of the buggy kind are rarely dangerous, they can be painful. Here are some tips for relieving your friend's stung feelings. For Dogs and Cats Get the point. Better yet, if the stinger is in an area that's easy to get to, try scraping it out with your fingernail or the corner of a credit card. That way you're less likely to squeeze additional venom into the wound. Soothe it with soda. Applying a paste of baking soda and water to the bite or sting several times a day can help ease discomfort, says Larry Thompson, D.V.M., clinical veterinary toxicologist at the Diagnostic Laboratory at the Cornell University College of Veterinary Medicine in Ithaca, New York. "The alkalinity helps relieve the itch," he explains. A dab of calamine can also help, he adds. Try milk of magnesia.

23. BITES AND STINGS bites and stings. PROPER PROCEDURES. Animal Bites Bee Stings SpiderBites Ticks and Lyme Disease Snakebites HOME. http://www.expage.com/page/bitesandstings

BITES AND STINGS PROPER PROCEDURES Animal Bites Bee Stings Spider Bites Ticks and Lyme Disease Snakebites HOME oas_ad('Bottom');

24. Insect Bites And Stings - Medicinal Herbs Online Herbal Glossary Medicinal Glossary Herbal Preparations. Insect bites and stings. Preventingthe stings or bites is far preferable than a remedy. Back to Top. http://www.egregore.com/diseases/insectbitesstings.html

Herbal Glossary Medicinal Glossary Herbal Preparations Insect Bites and Stings Contents: Definition Symptoms Treatment Herbs ... Bibliography Definition Bees, bumblebees, wasps, hornets, fire ants, yellow jackets, ticks, mosquitoes, chigger bites, etc., The stings may cause an allergic reaction, sometimes resulting in death. This reaction is known as an insect venom allergy. The problem is not with an allergy to the insect but with the venom. Back to Top Symptoms Difficulty in swallowing, hoarseness, labored breathing, weakness, confusion, severe swelling, and feeling of panic. A more severe reaction results in the closing of the airway and/or shock (cyanosis and a drop in blood pressure), producing unconsciousness. In the case of tick bites, Rocky Mountain spotted fever or Lyme disease may be carried by the ticks. Just as mosquitoes carry malaria. Preventing the stings or bites is far preferable than a remedy. Back to Top Treatment Back to Top Herbs Aloe Balm Basil, sweet Betony, wood Birthroot Bistort Black cohosh Borage Bowman's root Calendula Cedron Cohosh, black

25. Bites And Stings bites and stings up. bites and stings, Information aimed at the generalpublic (with particular reference to the United States) regarding http://omni.ac.uk/browse/mesh/detail/C0005659L0005659.html

Bites and Stings [up] Related topics: broader Poisoning Wounds and Injuries other Abdominal Injuries Allergens Arm Injuries Arsenic Poisoning ... Wound Infection narrower Insect Bites and Stings Bites and stings Information aimed at the general public (with particular reference to the United States) regarding the self treatment of bites and stings. It covers venomous and non-venomous bites and stings, the differences between a bite and a sting, treatment at home and over the counter medicine, and when it is necessary to consult a health professional. The information contained in Quick Care's Self-Care Advisory is authored by physicians and pharmacists. Published on the web by the Protocare Corporation, and reviewed by the American Academy of Family Physicians. Bites and Stings Patient Education Self Care Marine-medic.com Marine-medic.com is compiled by Dr Peter Fenner, an Honorary National Medical Officer for Surf Life Saving Australia. Dr Fenner's research interests include jellyfish and other venomous marine creatures and in particular marine stings and bites. This resource provides information on simple marine biology which contains information on common jellyfish and how they sting their victims, a medical section covers different jellyfish species and focuses on envenomation, fatalities, first aid and the medical treatment of jellyfish stings. Also discussed are marine creatures such as the blue-ringed octupus, sea snakes, cone shell, stingray, and stonefish. First aid advice, a glossary of terms and Dr Fenner's published articles are all accessible from this Web site. Dr Fenner is also an adviser on marine envenomation for the WHO, AMA, and the Australian Poisons Information Centres.

26. Insect Bites And Stings Insect bites and stings up. Insect bites and stings / therapy Related topicsbroader, bites and stings. Allergy, Insect bites and stings / therapy. http://omni.ac.uk/browse/mesh/detail/C0021568L0021568.html

Insect Bites and Stings [up] Insect Bites and Stings / therapy Related topics: broader Bites and Stings Allergy A series of patient-oriented documents on the subject of allergies including: allergens triggers of allergy attacks eg - animals, chemical sensitivity, dust and dust mites, food, insect stings, mold, pollen, poison ivy; symptomatic conditions of allergy; diagnostic procedures and treatment. Published on the web by Loyola University Health System. Anaphylaxis Food Hypersensitivity Hay Fever Hypersensitivity ... Patient Education Insect Bites and Stings / therapy Immunotherapy for seasonal rhinitis, asthma and bee sting venom allergy This report, written by Dr Margaret Somerville, was published as STEER 2002 Volume 2 (7) as part of the Wessex Institute for Health Research and Development's STEER (Succinct and Timely Evaluated Evidence Review) service. The report addresses the question: "What are the effects of specific intra-dermal immunotherapy in people with seasonal rhinitis, asthma or bee sting venom allergy?" Produced for policy makers by the Wessex Institute for Health Research and Development, together with Brazian Ltd, a company specialising in evidence-based medicine. In PDF, which requires Adobe Acrobat Reader. Asthma / therapy Hay Fever / therapy Immunotherapy Injections, Intradermal

27. Bites And Stings Notes about downloading the bites and stings Information This informationis avaliable to download for printing as an Adobe Acrobat (.pdf) file. http://www.rch.unimelb.edu.au/poisons/pages/bites_stings.html

Victorian Poisons Information Centre Notes about downloading the Bites and Stings Information: This information is avaliable to download for printing as an Adobe Acrobat (.pdf) file. Adobe Acrobat Reader is avaliabe for free download from www.adobe.com . Just follow the links from Adobe's home page. Bites and Stings (224K) Further reading Sutherland SK, Sutherland J. Venomous creatures of Australia: a field guide with notes on first aid. Oxford University Press: Melbourne; 1999. Sutherland SK, Hawdon GM, Winkel KD. First aid for snake bite in Australia: with notes on first aid for bites and stings by other Australian venomous creatures. The Australian Venom Research Unit: Parkville; 1999. Victorian Poisons Information Centre Calling the VPIC First Aid Prevention of Poisoning ... Site Index . Authorised by: Brian Lilley . Designed by ERC. Enquiries: Adam Leadoux

28. Bites And Stings Spiders Victorian Poisons Information Centre Calling the VPIC First Aid Preventionof Poisoning Information Sheets Bites Stings Pamphlets Stickers http://www.rch.unimelb.edu.au/poisons/pages/bites_stings/spider.html

Victorian Poisons Information Centre Redback Spider (Latrodectus hasselti) Medical treatment is NOT always required following a bite from a Redback Spider. Many bites will only cause a local reaction, including pain, redness, swelling and heat. The treatment for these symptoms is to wash the bite area with soap and water and apply a cold pack. Application of a bandage will not help; it may make the pain worse. Medical attention is required for Redback Spider bites if the victim is allergic to Redback Spider venom has heart disease is pregnant or for anyone if the following symptoms appear: severe pain spreading from the bite area swollen or painful glands in the affected limb (armpits for bites on the arm or hand, groin for bites on the foot or leg) sweating all over the body, or only in patches shivering tremors increased heart rate headache pins and needles in hands or feet Victorian Funnel-Web Spider (Hadronyche modesta) When the term "Funnel-Web Spider" is used, it is generally a reference to the dangerous spider Atrax robustus , which is found in and around Sydney. There are some related spiders in the Funnel-Web Spider family that are found in other parts of Australia, including Victoria. There are few case reports of people being bitten by the Victorian Funnel-Web Spider, but because of the danger of its Sydney relative, the same first aid that would be used for Sydney Funnel-Web Spider bite is also recommended for a bite from the Victorian Funnel-Web Spider.

29. Health Ency.: Injury: Insect Bites Or Stings Ency. home Injury I Insect bites or stings. Insect bites or stingsSee images. Most bites and stings do not require emergency medical care. http://www.accessatlanta.com/shared/health/adam/ency/article/000033.html

SEARCH: The Web Yellow Pages HOME AJC.COM Illustrated Health Encyclopedia Important notice Ency. home Injury I Insect bites or stings See images Overview Symptoms Treatment ... Prevention Alternative names: Bedbug bite; Bee sting; Bites - insects; Black widow bite; Brown recluse bite; Flea bite; Honey bee sting; Louse bite; Mite bite; Scorpion bite; Spider bite; Tick bite; Yellow jacket sting Definition: This sting or bite is from an insect or spider. Considerations If bitten or stung by an insect, try to kill it and have it identified (if it can be done quickly and safely). Most bites and stings do not require emergency medical care. However, possible complications to insect bites and stings include: allergic reaction shock , reaction to venom (see wasp and bee poison documents), toxic reaction, or infection. Allergic reactions to insect bites or stings occur very quickly, usually within minutes, and severe reactions can be rapidly fatal if untreated. Approximately 0.5% of the population develop severe allergic reactions (anaphylaxis) to insect stings. Causes Common causes include: Black widow spider bite Brown recluse spider bite Bumblebee sting Fire-ant sting Honey bee sting Hornet sting Scorpion bite Tarantula bite Tick bite Wasp sting Yellow jacket sting Ency. home

30. BBC Health - Features - Insect Bites And Stings Feature. Insect bites and stings By Dr. Trisha Macnair Worse nasties abroad Insectbites can transmit other infections What happens when an insect bites? http://www.bbc.co.uk/health/features/bites_stings.shtml

CATEGORIES TV RADIO COMMUNICATE ... INDEX SEARCH MONDAY 31st March 2003 Text only BBC Homepage Health Homepage Ask the Doctor ... Help Like this page? Send it to a friend! Feature Insect bites and stings By Dr. Trisha Macnair Worse nasties abroad Insect bites can transmit other infections What happens when an insect bites? ... If you are bitten It is peak time for biting insects out there in the garden. Fortunately in the UK insect bites and stings are rarely more than a temporary irritation. But, if you are holidaying abroad then insects can be a much more significant danger. Bee and wasp stings can be dangerous Occasionally, even in this country, insects are more of a threat. For example, I am one of the 1 in 100 people who have a life-threatening allergy to wasp stings. Just one brief encounter can trigger a potentially fatal anaphylactic reaction (with symptoms that include breathing problems, rather like a very bad asthma attack, and an extreme drop in blood pressure). It is possible to protect yourself from such an allergy by having a series of injections of dilute venom. For many months now, I've been traipsing along to my local hospital for my regular shot of venom immunotherapy, and I can now tolerate a sting the equivalent of 3 monster wasps. It could save your life. The Ohio State University have the facts at: www.ag.ohio-state.edu/~ohioline/hyg-fact/2000/2076.html

31. Bites And Stings bites and stings. bites and stings usually occur during the warmermonths. The warm weather sends most of us outdoors and increases http://www.hsc.wvu.edu/charleston/wvpc/bites_stings.htm

Bites and Stings Bites and stings usually occur during the warmer months. The warm weather sends most of us outdoors and increases our exposure to bees, spiders, caterpillars, and snakes. These animals use poisonous venom as a means to capture prey or defending of themselves or nesting areas. Take time to practice prevention and learn first aid. The West Virginia Poison Center is available 24 hours a day to help you if a bite or sting occurs. A little about Bees and Wasps Bees and wasps usually will avoid contact with humans unless threatened. When a bee or wasp flies close, don't swat it away. A slow, quiet retreat out of harm's way is the best move. Avoid wearing bright colors, clothing with flower patterns, and heavily scented perfumes and hair sprays. Some plants such as clover and fruit trees, attract bees and wasps. Keep away. Bees and Wasps A little about Spiders There are only two spiders in West Virginia that are harmful to humans. These spiders are the brown recluse (or fiddleback spider) and the black widow. Bites from all of the other spiders can result in mild redness and pain. Recommended treatment for these bites are: clean the area with soap and water then apply a cool compress over the affected area. Call the poison center or your family physician if symptoms are more severe or if you suspect you have been bitten by the brown recluse or the black widow. Prevent spider bites by keeping attics, garages, and basements clean. Dispose of old storage boxes. Carefully shake out stored clothing or shoes before putting them on. Avoid reaching into dark closets, boxes or other places where spiders may live without looking first. As a rule, a bite from a spider means that the victim interfered with a nesting area.

32. Insect Bites And Stings Insect bites and stings, biting insects. Top. Also Listed As Bites andStings, Insect; Stings and Bites, Insect. Top. Signs and Symptoms http://www.ivillagehealth.com/library/onemed/content/0,7064,241012_245646,00.htm

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33. Bites And Stings: Bite And Sting Information At IVillage.com bites and stings Bite and sting information, advice and support at allhealth.com. youare here iVillage.com parenting child health first aid bites and stings. http://www.ivillage.com/topics/parenting/0,,166030,00.html

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34. FamilyFun: First Aid Handbook: Bites And Stings An excerpt on first aid for bites and stings from the Disney Encyclopediaof Baby and Child Care. bites and stings, Injuries from http://familyfun.go.com/raisingkids/child/health/firstaidguide/dony79hl_bite/

Search FamilyFun shortcuts Parenting Tools Field Guide to Parenting Parent Problem Solver Pregnancy Calendar Baby Name Finder ... Article Library Parenting Checklists Immunizations Nursery Planner Holidays All Checklists Parenting Experts Jan Faull, Child Development Dominic Cappello, Learning All Experts parent ... to parent Get tips, support Parenting Boards Expecting Potty Training Sleep Stay-at-Home Moms ... E-Cards Creative. Fun. Free. Catching up is easy to do. Send an E-Card BITES AND STINGS Injuries from bites and stings range from trivial to fatal, depending upon the source of the bite and the child's response to it. For example, a bee sting is usually a minor, albeit painful, event. However, if the child is hypersensitive to bee venom, such a sting can result in a fatal anaphylactic response (see section on hypersensitivity and anaphylaxis). An animal or human bite not only can cause tissue damage, but it may also lead to a serious infection. Some bites, such as those of a tick or certain mosquitos, may be trivial themselves but can lead to serious illnesses such as Lyme disease, malaria or encephalitis if the insect is a vector (carrier) of the causative organism. HOW TO GIVE FIRST AID FOR ANIMAL BITES HOW TO GIVE FIRST AID FOR HUMAN BITES Human bites that have broken the skin are likely to cause infection if they are not treated because the human mouth is home to many types of microorganisms that can infect the wound. Clean the wound as described above, and consult your child's physician as soon as possible. Your child will probably need to be given antibiotics to ward off infection.

35. MEL: Bites And Stings bites and stings. Insect Bites. Bee and Wasp Stings; Ohio State University ExtensionFactsheet; Bites Stings; Quick Care's SelfCare Advisory Web Site; http://mel.lib.mi.us/health/health-disease-allerg-bitesting.html

Michigan.gov Home HAL Home MeL Internet MeL Magazines and eBooks Health Information Resources About the Health Collection Back to the Health Index Medline Evaluating Health Information ... Michigan Health and Hospitals Bites and Stings Columbia University Complete Home Medical Guide Bites and Stings Oklahoma State University Online Safety Library: Poisonous Plants, Animals, and Arthropods Animal/Insect Bites M-Care Health at Home University of Arizona Venomous Critters Insect Bites Bee and Wasp Stings; Ohio State University Extension Factsheet MEL Science page: Insects Protection Against Mosquitoes and Other Arthropod Vectors CDC Health Information for International Travel Reducing the Likelihood of Stings During Outdoor Activities NC Cooperative Extension Service Spider Bites Blue Cross and Blue Sheild of Texas Spider Bites Michigan State University Extension Spiders of Medical Importance Spiders in Ohio homepage Spider Bites Snake Bites California Poison Control System Rattlesnake Bites University of California, San Diego Snakebite Protocols Wisconsin Department of Natural Resources Avoiding and Treating Timber Rattlesnake Bites See Also MEL Safety Index See Also MEL Allergies page See Also MEL West Nile Virus page See Also MEL Lyme Disease page Selector and Collection Librarian: Metta Lansdale ( lansdale@mel.org

36. EMJA: Articles On Insects, Bites And Stings eMJA Home Topic lists Search Articles on Insects, bites and stings,42 articles. Fatal envenomation by jellyfish causing Irukandji http://www.mja.com.au/Topics/Insects, bites and stings.html

e MJA Home Topic lists Search Articles on Insects, bites and stings 42 articles Fatal envenomation by jellyfish causing Irukandji syndrome [Letters] Paul M Bailey Med J Aust 2003; 178 (3): 139-140. [Letters] Ian R Cheong Med J Aust 2003; 178 (3): 143. Fatal envenomation by jellyfish causing Irukandji syndrome [Letters] Andrew H Dawson Med J Aust 2003; 178 (3): 139. In reply: Fatal envenomation by jellyfish causing Irukandji syndrome [Letters] Peter J Fenner and John C Hadok Med J Aust 2003; 178 (3): 139-140. Itching bites may limit Ross River virus infection [Letters] Peter A Ryan, Jillann F Farmer, Brian H Kay and Andreas Suhrbier Med J Aust 2003; 178 (3): 144. Itching bites may limit Ross River virus infection [Letters] Michael Sorokin Med J Aust 2003; 178 (3): 143-144. Severity of Irukandji syndrome and nematocyst identification from skin scrapings [Bites and Stings] Truc T Huynh, Jamie Seymour, Peter Pereira, Richard Mulcahy, Paul Cullen, Teresa Carrette and Mark Little Med J Aust 2003; 178 (1): 38-41. Jellyfish envenoming syndromes: unknown toxic mechanisms and unproven therapies [Bites and stings] Paul M Bailey, Mark Little, George A Jelinek and Jacqueline A Wilce

37. Virtual Children's Hospital: CQQA: Bites And Stings bites and stings. Title Page. See related Patient Topics bites and stings,Immune System/AIDS, Injuries and Wounds or Insect bites and stings. http://www.vh.org/pediatric/patient/pediatrics/cqqa/sting.html

Pediatrics Common Questions, Quick Answers Bites and Stings Donna D'Alessandro, M.D. Lindsay Huth, B.A. Peer Review Status: Internally Reviewed Creation Date: October 2001 Last Revision Date: April 2002 Common Questions, Quick Answers When am I at risk for getting a bite or sting? What are normal reactions to a bite or sting? How do you treat a normal reaction? ... When should I call the doctor? When am I at risk for getting a bite or sting? Most stings happen in the summer or fall. Stinging insects in the U.S. are bees, yellow jackets, hornets, wasps, and fire ants. Insects are found near bushes, trees, and grass. Perfumes, hairsprays, scented lotions, and bright-colored clothes attract insects. What are normal reactions to a bite or sting? Reactions are different for everyone. Some reactions are worse than others. Most people aren't allergic to bites or stings. Normal reactions to a bite or sting are pain, swelling, and redness around the sting. More of the body than the stung area might swell. The whole arm might swell after a sting near the wrist. Swelling may last for 2 to 3 days.

38. Insect Bites And Stings Insect Bites Stings. Seek medical attention for scorpion stings, multiple bitesor stings, or if signs of allergic reaction develop, especially in children. http://insect-repellent.net/bites-stings.htm

Insect bites can inject offensive or defensive poisons, or anticoagulants Offensive Poisons Offensive Poisons are used to disable or kill a potential meal. Used by spiders and some wasps, these stings can cause dizziness, difficulty breathing, swelling and pain. Tissue and/or nerve damage may result, especially if left untreated. Seek medical treatment if stung by a venomous spider such as Black Widow or Brown Recluse. Defensive Poisons Defensive Poisons are used to discourage intruders from disturbing nests, hives or young, or for self-defense. Used by Ants, Bees, Wasps, Hornets, Yellow-Jackets, and Scorpions, these stings cause pain lasting a short time (usually 5 to 15 minutes), swelling, and possible allergic reaction. Seek medical attention for scorpion stings, multiple bites or stings, or if signs of allergic reaction develop, especially in children. Though rare, these reactions can be dangerous. Anticoagulants Anticoagulants are designed to prevent a victim's blood from clotting and closing a wound after being bitten, so the insect or arachnid can drink it. Used by Biting Flies, Mosquitoes, Fleas, Ticks, and Chiggers, it's most common effects on the human victim include itching (which is the body's reaction to the anticoagulant), pain from tearing of the skin in the case of mosquito and fly bites (ticks and chiggers don't cause pain because they insert their mouthparts so slowly), and possible allergic reaction. Seek medical attention if significant swelling appears in the area of the bite, or if fever develops. Some people are allergic to antigens found in insect saliva.

39. Queensland Poisons Information Centre Website: Bites & Stings In addition to providing information on poisoning, the Queensland PoisonsInformation Centre also provides information on bites and stings. http://www.health.qld.gov.au/PoisonsInformationCentre/bitesAndStings.htm

This page updated: 22 January 2003 Entry Home About Us First Aid ... Feedback In addition to providing information on poisoning, the Queensland Poisons Information Centre also provides information on bites and stings. First aid for bites and stings: General first aid for bites and stings Pressure immobilisation technique Some of the more commonly encountered Australian creatures that cause concern are: Spiders Snakes Insects Marine creatures ... Link to the Queensland Health Home Page Find information about Queensland Health, our services, fact sheets, brochures, public health and other health topic information. This page has been published by the: Queensland Health Electronic Publishing Service For enquiries regarding Queensland Health: Telephone: +61 7 3234 0111 Write to: GPO Box 48, Brisbane, Queensland, Australia, 4001 For poisons information: Telephone: 13 11 26 For information regarding this website: Telephone: +61 7 3234 1561 Contact Information TOP

40. Queensland Poisons Information Centre Website: Bites &: Stings - General First A General first aid for bites and stings. For bites or stings from these creaturesrefer to pressure immobilisation first aid. For all other bites and stings http://www.health.qld.gov.au/PoisonsInformationCentre/bitesStingsFirstAid.htm

This page updated: 12 December 2002 Entry Home About Us First Aid ... Feedback General first aid for bites and stings For bites or stings from these creatures refer to pressure immobilisation first aid. Do not follow the advice below for bites or stings from: all Australian venomous snakes, including sea snake bites funnel web spiders box jelly fish stings blue ringed octopus cone shell stings Australian paralysis tick For all other bites and stings: Wash with soap and water and apply an antiseptic if available. Ensure that the patient's tetanus vaccination is up to date. Apply an ice-pack to reduce local pain and swelling. Pain relief may be required eg. paracetamol or an antihistamine (to reduce swelling, redness and itch). The patient should seek medical advice if they develop any other symptoms or signs of infection. Anaphylaxis is a severe allergic reaction that can occur in sensitive individuals from exposure to any chemicals foreign to the body, including bites and stings, plants, or medications. Parts of the body, for example the face or throat, swell up so much that the patient can't breathe. In severe cases the patient may go into shock within a few minutes and the heart can stop. For any patient who shows signs of anaphylaxis, call 000 for an ambulance, and have the patient taken immediately to the emergency department of the nearest hospital

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