bites and stings
DESCRIPTION
Bites and Stings. Temple College EMS Professions. Bites and Stings. Arthropods Insects Spiders Scorpions Reptiles Pit Vipers Coral Snakes Venomous Marine Life. Bite & Sting Deaths. 50% insects 30% snakes 14% spiders 6% other. Hymenoptera. - PowerPoint PPT PresentationTRANSCRIPT
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Bites and StingsTemple 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% insects30% snakes14% 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 < 24 hours– 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 snakes10 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
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