Bites and Stings

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Bites and Stings

• Temple College
• EMS Professions

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Bites and Stings

• Arthropods
• Insects
• Spiders
• Scorpions
• Reptiles
• Pit Vipers
• Coral Snakes
• Venomous Marine Life

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Bite Sting Deaths

• 50 insects
• 30 snakes
• 14 spiders
• 6 other

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Hymenoptera

• Bees, wasps, hornets, yellow-jackets, ants
• About 25 deaths/year
• Honeybees 50
• Yellow-jackets, other wasps 50
• Problems
• Allergic reactions
• Anaphylaxis
• Toxic venom effects (rare)

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Local Reactions

• Sharp, burning pain
• Itching
• Edema
• Extensive reactions may involve entire extremity
• Tongue/throat stings may cause airway loss

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Systemic Reactions

• Mild
• Diffuse itching
• Urticaria
• Swelling distant from sting site
• Flushing

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Systemic Reactions

• Severe
• Laryngeal edema, upper airway obstruction
• Severe bronchospasm, difficulty breathing
• Profound hypotension

Anaphylaxis
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Anaphylaxis Management

• Remove stinger (scrape)
• Manage airway
• Oxygen, assist ventilations
• Shock position
• Epinephrine Auto-Injector
• Consider ALS back-up

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Epi Auto-Injector

• Actions
• Dilates airways
• Constricts blood vessels
• Raises peripheral resistance, BP

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Epi Auto-Injector

• Supplied as solution in auto-injector unit

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Epi Auto-Injector

• Indication
• Allergic reaction with
• Respiratory compromise Rapid, labored breathing
  chest, throat tightness hoarseness, stridor
  wheezing
  
• Hypoperfusion Rapid, weak pulse altered level
  of consciousness decreased BP

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Epi Auto-Injector

• No contraindications for severe allergic
  reactions
  

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Epi Auto-Injector

• Dosage
• Adult system 0.3 mg
• Pediatric system 0.15 mg

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Epi Auto-Injector

• Procedure
• Expose, clean site if possible
• Remove safety cap
• 90o to skin lateral thigh midway between waist,
  knee
  
• Push against thigh
• Hold until medication injected (10 seconds)

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Epi Auto-Injector

• Side Effects
• Rapid heart rate
• Pale skin
• Headache
• Chest pain
• Nausea, vomiting
• Anxiety

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Epi Auto-Injector

• Precautions
• Oxygen first
• Monitor vital signs following use

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Spiders

• 37,000 species
• All venomous
• 50 U.S. species can bite humans
• 15 U.S. species produce symptoms
• Only two are dangerous
• Black widow (Latrodectus mactans)
• Brown recluse (Loxosceles reclusa)

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Black Widow

• As far north as Oregon, New York Common in
  South, Southwest
  
• Irregular webs in wood piles, trash dumps,
  outdoor structures, under rocks
  
• Occasionally in houses
• Females rarely leave web
• Only females bite humans

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Black Widow

• Neurotoxic
• Immediate sharp, stinging pain
• Muscle cramps in 15 minutes to 2 hours
• Upper extremity pleuritic chest pain
• Lower extremity/genitalia abdominal pain,
  rigidity

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Black Widow

• Muscle twitching, weakness, paralysis, drooping
  eyelids
  
• Sweating, tearing, salivation, increased
  bronchial secretions
  
• Anxiety, headache, restlessness, dizziness,
  nausea, vomiting, hypertension
  
• Edema, skin rash, conjunctivitis, itching
• Shock, respiratory depression

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Black Widow

• Symptoms peak in few hours, diminish
• Usually last
• Some symptomatic up to 4 days
• Mortality rate unknown
• Most recover completely

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Black Widow

• Treatment
• Local cold application
• Symptomatic care
• Antivenin available

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Brown Recluse

• Fiddle-back spider
• Southeast, South Central U.S.
• Related species in desert Southwest
• Shy, nocturnal
• Dark closets, basements
• On floors, behind furniture in houses

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Brown Recluse

• Local signs/symptoms
• No pain or only mild stinging
• Within 2 hours Local pain, blue-gray halo
• 12 to 18 hours Bleb formation, growing ischemic
  zone
  
• 5 to 7 days Aseptic necrosis, necrotic ulcer
• Severe lesions up to 30 cm in diameter

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Brown Recluse

• Systemic signs, symptoms
• Mild
• Fever, chills
• Malaise
• Nausea, vomiting
• Joint pain

• Severe
• Bleeding disorders
• Renal failure
• Convulsions
• Heart failure
• Death

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Brown Recluse

• Prehospital management
• Local cold application
• Wound cleansing
• Padded splint, bulky dressing

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Scorpions

• 40 U.S. species
• Only one potentially lethal (Centuroides
  sculpturatus)
  
• Primarily in Arizona
• Occasionally in western New Mexico, southeast
  California, northern Mexico, far West Texas

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Centuroides sculpturatus

• Local signs, symptoms
• No local swelling, inflammation
• Local pain, hypersensitivity

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Centuroides sculpturatus

• Systemic signs, symptoms
• Extreme restlessness, agitation
• Roving eye movements
• Poor coordination, slurred speech, difficulty
  swallowing
  
• Salivation, wheezing, stridor
• Tachycardia, tachypnea, hypertension, nausea,
  vomiting

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Centuroides sculpturatus

• Treatment
• Symptomatic, non-specific
• Antivenin available from Arizona State University
  (National Venomous Desert Animal Study Center)

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Snakes

• 45,000 bites per year in U.S.
• 8,000 from venomous snakes
• 10 deaths

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U.S. Venomous Snakes

• Pit vipers (Crotalidae)
• Rattlesnakes
• Copperheads
• Water moccasins (cotton mouth)
• Coral snakes (Elapidae)

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Pit Vipers

• Heavy bodies
• Diamond-shaped heads
• Vertical, elliptical pupil
• Heat sensing pit on upper lip between eye.
  nostril
  
• Erectile fangs
• Hemotoxic, necrotoxic venom

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Pit Vipers

• Rattlesnakes
• 13 Species
• 7,000 bites/year
• 9 to 10 fatalities
• Most deaths from western diamondback, eastern
  diamondback

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Pit Vipers

• Copperhead
• Deaths VERY rare
• Minimal edema, pain

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Pit Vipers

• Water moccasin
• Average of one death a year
• Mild systemic symptoms
• Potential for severe local tissue injury,
  necrosis

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Pit Viper Bites

• Pain, swelling
• Progressive edema
• Bruising
• Blood-filled vesicles

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Pit Viper Bites

• Weakness, sweating, nausea, vomiting
• Tachycardia, hypotension, shock
• Prolonged clotting
• Bleeding gums
• Hematemesis, melena, hematuria
• Numbness, tingling, neurological symptoms

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Coral Snake

• Thin-bodied
• Small, rounded head
• Brightly colored
• Small, non-erectile fangs
• Injects venom by chewing
• Venom mostly neurotoxic

Red on yellow, kill a fellow. Red on black, venom
lack.
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Coral Snake Bite

• Little, no pain/ swelling
• Tingling around bite
• Muscular incoordination
• Weakness

• Increased salivation
• Difficulty swallowing, talking
• Visual disturbances
• Respiratory distress, failure
• Shock

Most deaths occur from respiratory arrest within
36 hours
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Snakebite Management

• Calm victim
• Oxygen
• Proximal constricting band ( )
• Clean, bandage wound
• Immobilize bitten area, keep dependent
• Watch constricting bands, bandages, splints
  carefully for edema
  
• Transport

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Snakebite Management

• Do NOT
• Apply ice
• Apply arterial tourniquets
• Cut and suck
• Use electrical shock
• Actively attempt to locate snake
• Bring live venomous snake to hospital

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Venomous Marine Life
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Coelenterates

• Jellyfish, Portuguese man-of-war
• Stinging cells in tentacles
• Intense, burning pain
• Red, hemorrhagic lesions
• Nausea, vomiting
• Fever, chills
• Dyspnea, wheezing, stridor
• Hypotension, shock
• Cardiovascular collapse
• Kill stinging cells with alcohol, vinegar

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Venomous Fish

• Sting ray
• Scorpionfish (Lion fish, Stonefish)
• Immerse stung area in hot water

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Sea Urchins

• Immerse injured area in hot water
• Use vinegar to dissolve embedded spines
• Larger spines may require surgical removal