Bites and Envenomations

 

History:

 

  • Type of bite/sting
  • Bring description or photo with patient for identification
  • Time, location, size of bite/sting
  • Previous reaction to bite/sting
  • Domestic vs. wild
  • Tetanus and rabies risk
  • Immunocompromised patient

 

Significant Findings:

 

  • Rash/broken skin/wound
  • Pain
  • Soft tissue swelling
  • Redness
  • Blood oozing from the bite wound
  • Evidence of infection
  • Shortness of breath/wheezing
  • Allergic reaction/hives/itching

 

Differential:

 

  • Animal/human bite
  • Snake/spider bite
  • Insect sting/bite
  • Bee
  • Wasp
  • Ant
  • Tick
  • Infection risk

 

Treatment:

 

 

 

  • Consider Oxygen
  • Position patient supine; immobilize area of limb
  • Remove rings,bracelets, and other constricting items

 

 

 

  • Consider obtaining BGL
  • Consider 12- Lead EKG

 

 

 

  • Consider initiating IV

 

Allergic/anaphylactic reaction ?

 

  • Yes

 

 

  • No

 

Spider bite/bee/wasp ?

 

  • Yes

 

 

 

    • Apply ice to affected area

 

Muscle spasm ?

 

  • Yes

 

 

 

 

  • No

 

    • Notify receiving facility or contact Medical Control

 

Snake bite ?

 

  • Yes

 

 

 

    • if SBP > 90 request Morphine 0.1 mg/kg IV/IM, max 10 mg initial dose

 

Animal or human bite ?

 

  • Yes

 

 

 

    • Control bleeding

 

 

 

    • if SBP > 90 request Morphine 0.1 mg/kg IV/IM, max 10 mg initial dose

 

    • Notify receiving facility or contact Medical Control

 

 

PEARLS:

 

 

 

    • For pediatrics muscle spasms, call (Medical Control) prior to Midazolam (Versed) or Lorazepam (Ativan) administration.
  • Human bites have higher infection rates than animal bites due to normal mouth bacteria.
  • Carnivore bites are much more likely to become infected and all have risk of rabies exposure.
  • Cat bites may progress to infection rapidly due to a specific bacteria (Pasteurella multicoda).
  • For all animal bites document contact with animal control officer if not transported.
  • Poisonous snakes in this area are generally of the pit viper family:
    •  rattlesnake
    • copperhead
    • water moccasin.
  • Coral snake bites are rare:
    • Very little pain but very toxic. "Red on yellow - kill a fellow, red on black - venom lack."
  • Black widow spider (black spider with red hourglass on belly):
    • Bites tend to be minimally painful, but over a few hours, muscular pain and severe abdominal pain may develop.
  • Brown recluse spider (brown spider with fiddle shape on back):
    • Bites are minimally painful to painless.  Little reaction is noted initially but tissue necrosis at the site of the bite develops over the next few days.
  • Envenomation is generally worse with larger snakes and early in spring.  If no pain or swelling, envenomation is unlikely (except for coral snakes).
  • Evidence of infection:
    • swelling
    • redness
    • drainage
    • fever
    • red streaks proximal to wound.
  • Immunocompromised patients (i.e. diabetes, chemotherapy, transplant patients) are at an increased risk for infection.

NREMR

National Registry Emergency Medical Responder

NREMT

National Registry Emergency Medical Technician

NREMT-I

National Registry EMT-Intermediate

NREMR

National Registry Emergency Medical Responder

NRP

National Registry Paramedic

OLMC

Online Medical Control - Contact Medical Control

NREMR

National Registry Emergency Medical Responder

OLMC

Online Medical Control - Contact Medical Control

OLMC

Online Medical Control - Contact Medical Control