Bites and Stings

1. Bites and Stings Temple College EMS Professions

2. Bites and Stings • Arthropods • Insects • Spiders • Scorpions • Reptiles • Pit Vipers • Coral Snakes • Venomous Marine Life

3. Bite & Sting Deaths • 50% insects • 30% snakes • 14% spiders • 6% other

4. 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)

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

6. Systemic Reactions • Mild • Diffuse itching • Urticaria • Swelling distant from sting site • Flushing

7. Systemic Reactions • Severe • Laryngeal edema, upper airway obstruction • Severe bronchospasm, difficulty breathing • Profound hypotension Anaphylaxis

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

9. Epi Auto-Injector • Actions • Dilates airways • Constricts blood vessels • Raises peripheral resistance, BP

10. Epi Auto-Injector • Supplied as solution in auto-injector unit

11. 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

12. Epi Auto-Injector • No contraindications for severe allergic reactions

13. Epi Auto-Injector • Dosage • Adult system: 0.3 mg • Pediatric system: 0.15 mg

14. 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)

15. Epi Auto-Injector • Side Effects • Rapid heart rate • Pale skin • Headache • Chest pain • Nausea, vomiting • Anxiety

16. Epi Auto-Injector • Precautions • Oxygen first • Monitor vital signs following use

17. 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)

18. 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

19. 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

20. 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

21. Black Widow • Symptoms peak in few hours, diminish • Usually last < 24 hours • Some symptomatic up to 4 days • Mortality rate unknown • Most recover completely

22. Black Widow • Treatment • Local cold application • Symptomatic care • Antivenin available

23. 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

24. 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

25. Brown Recluse • Systemic signs, symptoms • Mild • Fever, chills • Malaise • Nausea, vomiting • Joint pain • Severe • Bleeding disorders • Renal failure • Convulsions • Heart failure • Death

26. Brown Recluse • Prehospital management • Local cold application • Wound cleansing • Padded splint, bulky dressing

27. 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

28. Centuroides sculpturatus • Local signs, symptoms • No local swelling, inflammation • Local pain, hypersensitivity

29. 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

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

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

32. U.S. Venomous Snakes • Pit vipers (Crotalidae) • Rattlesnakes • Copperheads • Water moccasins (cotton mouth) • Coral snakes (Elapidae)

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

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

35. Pit Vipers • Copperhead • Deaths VERY rare • Minimal edema, pain

36. Pit Vipers • Watermoccasin • Average of one death a year • Mild systemic symptoms • Potential for severe local tissue injury, necrosis

37. Pit Viper Bites • Pain, swelling • Progressive edema • Bruising • Blood-filled vesicles

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

39. 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.

40. Coral Snake Bite • Increased salivation • Difficulty swallowing, talking • Visual disturbances • Respiratory distress, failure • Shock • Little, no pain/ swelling • Tingling around bite • Muscular incoordination • Weakness Most deaths occur from respiratory arrest within 36 hours

41. 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

42. 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

43. Venomous Marine Life

44. 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

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

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