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

 

• • See Allergic Reaction Protocol

 

• No

 

Spider bite/bee/wasp ?

 

• Yes

 

• • Apply ice to affected area

 

Muscle spasm ?

 

• Yes

 

• • Midazolam (Versed) 1-5 mg slow IV push or Lorazepam (Ativan) 1-2 mg IV/IM (for pediatrics see PEARLS)

 

• No

 

• • Notify receiving facility or contact Medical Control

 

Snake, Animal or human bite ?

 

• Yes

 

• • Control bleeding

 

Significant Pain?

 

• Yes

 

• • See Pain Management Protocol

• • 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).
• An animal bit incident report must be made to SC DHEC i the patient is not transported by EMS and animal control is not on-scene.
• 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.