tangent
11-28-01, 23:06
Summary: Information post about allergic reactions, bites and
stings Keywords: allergic reactions, bites, stings Date: Tue, 31
May 1994 14:15:46 GMT Lines: 870
This post is long (about 900 lines)! There is an intro and two
section beyond dealing with specific bites/stings and what to do
about them.
I decided to post this information after seeing posts about
treatments that were not entirely accurate, or after reading
discussions about bee stings where people were recommending
taking lots of over-the-counter meds (a few months ago). - OK.
Let me start by saying a few words. This post is informational
only. I am not a physician. I have lots of experience at the
various levels of EMT (Emergency Medical Technician).
I have taught in the past (both medical and rescue), have
"worked" on a pharmacology text (soon to be published), and have
been a volunteer on various rescue squads since 1979 (I have been
a rescue squad commander and have held the rank of Lieutennant in
charge of training).
Currently, I am not active in EMS, (as a result of moving into an
area that doesn't have many volunteer organizations), but I still
hold many of my certifications and licenses and am nationally
registered with the Dept. of Transportation (the governing body
of EMS in the US). My current licenses are valid in those states
that recognize the National Registry of Emergency Medical
Technicians. OK - enough of the Resume! ;-)
My information comes from a variety of texts, many dealing
specifically with prehospital care, and my experiences. I do not
claim that this information is accurate for all jurisdictions in
this country. In fact, some of what I present is illegal in
certain areas (even for EMT-Paramedics). Again, its for those who
are curious...
After some soul-searching, I decided to include descriptions of
some of the advanced treatments often used for various
conditions.
These descriptions are clearly marked. I was hesitant to include
these descriptions because they are advanced, meaning you can do
more harm than good if you do it wrong, but in the end I thought
it would be OK as most people wouldn't be able to do them for
lack of equipment or people would try based on some "treatments"
that are based on "hollywood" and are only partially correct and
if performed as shown on TV are, by definition, wrong.
Advanced treatment requires medical training and certification!
This includes CPR and other procedures described. As stated
above, this info is provided as a matter of information and to
give an indication as to how serious certain events are given the
treatments used by individuals such as EMTs and others. DO NOT
ATTEMPT these treatments!!
-
A word about tourniquets... Tourniquets are used to stop both
venus and arterial blood flow to a limb. There is NEVER and
reason to use a tourniquest for bites or stings, unless the limb
is bleeding severely and it can't be stopped (e.g, the person
will die from blood loss).
Constricting band are used to stop venus blood flow only. When
properly used, there will still be a pulse in the wrist or foot,
for example. The use of the constriction band for bites is very
controversial in EMS, some areas still do not allow their use.
Don't use anything like these devices unless your on the top of
Mt. Everest and an MD tells you to do it!
ALWAYS call for help BEFORE doing anything!
Oe final note to this intro: NEVER eat or drink anything if there
is any question of a serious medical condition, such as an
allergic reaction.
Never eat "herbal remedies" or take chicken soup! I have had one
pateint die on me because she ate a common flowering plant used
to make a heart med (she knew quite a bit about medicinal flora).
Having "food" in your belly can complicate treatments at the ER,
especially if there is any medicinal value to what you have
eaten! Having you stomach pumped will delay proper treatment
(they will pump it.) In the case of a severe allergic reaction, I
am not aware of any "household" remedy that will stop someone
from going into anaphylactic shock and passing away.
The next two sections...
Section 1 provides background on allergic reactions
Section 2 deals with basic information and treatment of certain
common bites/stings.
-
Section 1 - Alleric Reactions =============================
Concepts and Terminology (boring, but useful)
---------------------------------------------
To understand what takes place during an allergic reaction and in
anaphylaxis, several concepts and terms need to de defined:
The imune response is designed to guard the body against
dangerous foreign substances such as infection and antigens.
In the normal imune response, the protective cells of the body
recognise the dangerous intruders, and destroy them. The allergic
reaction or response, on the other hand, is an _oversensitive_
and harmful response against a foreign body.
Immunity is the body's natural protective state of being
resistant to poisons and foreign substances.
An antigen is a foreign substance that induces the formation of
antibodies. Antigens are such things as bacteria or viruses.
An antibody is a protective protein substance formed in the body
as a result of contact with a foreign antigen.
When antigens and antibodies interact in the body, an immune
response develops. This response can cause allergies and
anaphylaxis.
An allergy is an abnormal and individual hypersensitivity to
substances that are ordinarily harmless.
An allergen is an antigen that the body is oversensitive to.
Sensitisation is the process of exposure to an allergen and then
results in the production of antibodies. An important fact to
note is that an allergic reaction cannot occur with the first
contact with a potential antigen because antibodies have not yet
formed.
Anaphylaxis means without protection (literally). It is an acute
generalised allergic reaction that occurs within minutes to hours
after the body has been exposed to an allergen. Anaphylaxis is a
serious medical condition that can lead to death in minutes.
Other definitions include:
edema - swelling stridor - harsh sounding breathing dyspnea -
shortness of breath cyanosis - bluish colour syncope - temporary
loss of consciouness tachycardia - very fast heart beat
bradycardia - very slow heart beat accessory muscles - muscles
used to help breath. located in neck, chest hypotension - low
blood pressure hypertension - high blood pressure sign -
objective evidence, such as edema symptom - subjective evidence,
such as nasuea Sx - signs and symptoms pulmonary edema -
fluid/blood build-up in the lungs (pink frothy mucus coughed up
while breathing) transport - CALL 911 or equivalent
Common Allergens ----------------
Allergen groups include drugs, insect venom, food, and pollen.
The causative agent may be injected, ingested, absorbed through
the skin or mucus membranes, or inhaled. Inhaled substances
rarely cause allergic reactions.
Insect stings/bites fall into the injection category. The
allergic reaction is different from the toxic effects of the
venom.
The insect order Hymenopter is the most common allergen. The four
prominent members include the bumblebee, honeybee, white- faced
hornet, and the yellow jacket.
About 8 in 1000 are allergic to stinging insects and half of
these are severe. This order has whats called "cross-sensitivity"
meaning a bite from one may lead to an allergic reaction to a
bite from another.
Ants, dear flies, ticks, and mosquitoes can all cause an allergic
reaction.
Pathophysiology ---------------
In a simple anaphylactic reaction, the antigen-antibody
interaction causes mild alleric signs and symptoms (Sx) limited
to usually one or two body systems and without systemic
cardiovascular effects.
In an anaphylactic reaction, however, the antigen-antibody
reaction is severe. This reaction takes place on the surface of
mast cells and basophils (types of white blood cells) and signals
the release of several chemicals, primarily histamine. Other
chemicals include serotonin, bradykinin, and SRS-A (slow reacting
substance of anaphylaxis).
These chemicals cause three primary reactions: capillary
dialation, increased capillary permeability, and smooth muscle
spasm. As these substances travel around the body, the following
Sx can be seen:
Skin flushing, edema, itching, hives, rash, a feeling of warmth
Eyes itching, tearing, edema Nose congestion, itching, sneezing
Upper Airway pharyngeal or laryngeal spasm, hoarsness, stridor,
bronchospasm, tightness in the neck Lower Airwar Dyspnea,
wheezing, use of accessory muscles to breath, cyanosis, pulmonary
edema Cardiovascular tachycardia, irregular pulse, weak pulse,
hypotension Gastrointestinal nasuea, vomiting, diarrhea,
abdominal cramps Neurogenic Anxiety, dizziness, syncope,
weakness, seizure, headache
A person may experience these Sx within seconds after exposure,
or the reaction may be delayed for several hours. The initial Sx
usually occur in the Skin.
The primary rule for determining severity is simple: the sooner
the onset of Sx after exposure, the more severe the reaction.
Injected antigens can produce Sx immediately, but usually this
happens after 5 minutes to as much as thirty minutes later.
Injested antigens usually cause a reaction in about 2 hours.
The effect on the cardiovascular system progresses as follows:
- caplillary beds dialate (located in skin and internal organs) -
increase in capillary permeability (fluid leaks out) - blood
pools in capillary beds (especially the skin) - decreased amount
of blood returns to heart - decreased cardiac output - early
stages of hypovolemic shock (low blood volume)
The effect on the airway is simply this: the airway constricts
(usually from swelling) and spasms resulting in decreased airflow
into the lungs and a reduced oxygenation of the blood. Loss of
the airway is the primary concern.
Commonly used drugs include epinephrin (adrenalin) and
diphenhydramine. Others are used in the prehospital setting as
well.
Epinephrin counteracts the effects of histamine and the other
chemicals by vasoconstriction, bronchial dialation, and
restoration of the tone and permeability of the blood vessels.
Epinephrin's major side effect is the development of cardiac
irritability. IV administration of Epinephrin can cause serious
arrhythmias. This drug is short acting and may be needed every 15
minutes.
Diphenhydramine is an antihistamine that antogonizes the adverse
effects of histamine and prevents further release of histamine.
This drugs is not used on pregnent patients. The major side efect
is a dry mouth and caridac arrhythmias.
Section 2 =========
Patient Assessment ------------------
The victim of a bite will usually be agitated. Try to calm them
and determine what happened, where, how long ago, and what the
culprit might have been (determine if it walked, flew, swam,
etc.).
Determine if the threat is still nearby and move from the area if
this is the case. If the culprit is dead, collect it carefully
and put it into a container that can be handled safely.
If the victim has no Sx, don't leave them alone - monitor them
for at least four hours. (Clearly, I'm not talking about a
mosquito bite here.)
If itching, a feeling of warmth, tightness in the throat or
chest, or a rash appear (usually the first signs) summon help
immediately. Knowing when the bite took place will help determine
how severe the condition is - remember the sooner Sx folow the
bite, the more severe the reaction. If the situation worsens,
concern yourself with maintaining an airway.
The airway is the primary concern. The simple rule of ABC is
used; Airway, Breathing, Circulation. The basic techniques tought
for CPR are whats used to establish and maintain an open (patent)
airway and to ensure circulation.
Establish basic vitals: A pulse in the wrist means a BP
sufficient for total body profusion, but it will not tell you if
the patient is in shock or not.
An very week pluse in the wrist means the person is very likely
in shock and is very likely in bad shape! One way to ascertain if
the person is on the way to shock is by pinching the bed of a
fingernail until it goes white and then releasing. If it takes
more than 2 seconds for the normal pink colour to return, this is
an ominous sign. (Obviously, nail polish must first be removed.)
Determine LOC (level of consciousness). If the person seems
"drunk" or "sleepy", you must seek treatment. If the person is
abnormally agitated or even verbally abusive, this is a sign of a
change in mentation, an early indicator of neurogenic
involvement.
If you suspect a severe reaction and the airway is failing,
judgement is called for. Don't wait for transport unless it is
very close at hand.
If you live in a rural or lightly suburban area, use the phone to
inform the dispatcher what is going on and that you feel as
though you should take the victim to the ER and what route will
be used.
Ask them to intercept you along the way. Follow your instincts,
BUT ALWAYS FOLLOW THE DISPATCHER'S INSTRUCTIONS! In any case, you
should explain the situation and ask for an "ALS" response, that
is, an Advanced Life Support response.
The victim of other vectors may exhibit similar Sx. The same
basic treatments apply.
Specific Treatments ------------------- Snakebite (Pit Vipors)
----------------------
There are posionous snakes in every state except Alaska, Hawaii
and Maine. Of the 120 species in the US, about 20 are posionous.
Of the bites that do take place, about 55% are from rattlesnakes,
34% from copperheads, 10% from water moccasins, and 1% from coral
snakes.
Sx generally occur immediately, but only about one-third of all
bites manifest Sx. When no Sx present themselves, probably no
venom was injected.
Nonpoisonous bites are not considered an emergency. Poisonous
bites contain some of the most complex toxins known; venoms can
affect the central nervous system, brain, heart, kidneys, and
blood.
Signs that indicate a poisonous bite include:
One or two distinct puncture wounds (fang marks). Nonposionous
bites usually leave a series of shallow, small puncture wounds.
The coral snake is one exception. This snake leavs a semicircular
marking from its teeth. A row of punctures does not rule out a
posionous bite, but fang marks _always_ confirms a posionous
bite. The patient experiences severe burning and pain almost
immediately, but always within 4 hours of the bite.
The wound begins to swell and discolour usually immediately, but
always within 4 hours.
Most posionous snakes have the following characteristics:
Large fangs Elliptical pupils - nonposionous snakes have round
pupils Presence of a pit - a heat sensitive organ - between the
eyes A variety of blotches on a brightly coloured skin, including
pink, yellow, olive, tan, grey, red, or brown. A triangular head
that is larger than the neck.
The one exception to all this is the coral snake. It has round
pupils, no fangs, and a small head. Because its mouth is so small
and teeth are short, most bites are on the finger or toes. Coral
snakes are generally small and have rings of red, yellow and
black; the red and yellow touch each other.
The seriousness of the bite can be determined by assessing
several items:
1 - Age, size and health of the victim. Bites are most dangerous
in children and the elderly.
2 - Depth, location, and number of bites. A single glancing blow
is less dangerous than multiple wounds. Bites on the head or
torso are usually fatal, as is a bite that punctures a blood
vessle.
3 - Duration of the bite. Was it a quick hit or did the snake
hold on.
4 - Clothing. A bite that hits the skin directly is worse than
one that went through clothing.
5 - Maturity of the snake. The older, the more dangerous.
6 - Condition of the fangs and venom sacs. (Not recommended for
inspection by untrained professional.)
7 - How angry the snake was. The more agitated, the more venom.
What to do when you go to help: -------------------------------
BE CAREFUL!!! Snakes will often be found within a twenty foot
radius of the area in which the bite occured!
The priorities of emergency care for snakebite are to limit the
spread of venom and to transport ASAP!
If the victim was bit by a pit vipor (rattlesnake, copperhead, or
cottonmouth), proceed as follows:
Look for Sx...
Immediate and severe burning pain, swelling. The entire
extremity swells within 8 to 36 hours. (As a rule, no
burning/pain, no venom.)
Purplish discoloration within 2 to 3 hours.
Numbness and possible blistering around the bite within a few
hours.
Nausea and vomiting.
Rapid heartbeat (tachycardia), low blood pressure (hypotension),
weakness and syncope (fainting).
Numbness and tingling of the tounge and mouth.
Excessive sweating (diaphoretic)
Fever and chills.
Muscular twitching.
Convulsions.
Dimmed vision.
Headache.
Priorities for treatment are:
1. Move the person away from the site. If you can do so without
endangering yourself, kill the snake and transport it with the
victim.
2. Lie the person down and keep them quiet.
3. Keep the extremity below the level of the heart and
immobilize it in a position of function. Remove jewelry.
4. Wash the wound area with alcohol, soap and COOL water,
hydrogen peroxide. Do not scrub or tear the tissue. Irrigate the
area with saline or clean cool water.
5. Transport ASAP!
6. NEVER EVER apply ice to the bite area! Ice can cause tissue
damage, gangrene, or rebound vasodialation when the ice is
removed!
ADVANCED TREATMENT
NOTE: The following descrption is provided in order to dispell
the "hollywood" treatment of how to deal with a snake bite.
7. Find the fang marks. Wrap _flat_, soft rubber tubing that is
at least 3/4" wide around the extremity two to four inches both
above and below the fang marks.
The tubing should be tight enough to stop blood flow through the
veins, but not stop arterial blood flow. You should be able to
put two fingers between the skin and constriction band.
There should still be a distal pulse. _Never_ place these bands
on either side of a joint, or around the neck, head, or torso.
Loosen these bands if swelling takes place.
--DISCLAIMER-- Many EMS jurisdictions do no allow for this
procedure, even by trained personnel.
8. --DISCLAIMER-- Only if you are more than 30 minutes from
medical treatment and only if directed to do so by a physician...
Incise and suction the fang marks. Only do so if on an extremity
and with a sterile instrument.
Locate the fang marks. Pinch the skin up between the thumb and
forefinger to avoid hitting a vein. Make longitudinal (vertical)
cut marks through each fang mark, only deep enough to go just
below the skin. Incision should be parallel to each other, 1/8"
to 1/4" long and made in the direction of the fang entry. NEVER
make an X or cross the cuts!
Apply suction to the wound directly over the incisions. You can
"milk" the incision with your fingers if necessary. Suction with
your mouth only as a last resort and only as directed by a
physician! Only use your mouth if you have no wounds in your
mouth.
NOTE - because venom spreads so rapidly, incising and suctioning
is of no value unless it is done withing 5 minutes of the bite.
--DISCLAIMER-- Many EMS jurisdictions do no allow for this
procedure, even by trained personnel. 9. Use basic life support
procedures as appropriate. Treat for shock, Keep the victim warm
and lying down, with legs elevated (unless bite is on leg). Be
prepared to perform CPR. Apply O2 at 2 to 4 L/min.
Snakebite (coral snake) -----------------------
Coral snakes - and other neurotoxic snakes like the cobra, mamba,
sea snake, and krait - are the most posionous of all.
Instead of having fangs, the coral snake has several pairs of
short, groved, fang-like teeth in its upper jaw. It chews its
victims instead of striking with a clean blow. The venom is
absorbed very quickly and is disseminated throughout the body.
There is generally little or no pain involved with the bite. The
bite leaves one or more tiny scratch marks in the area of the
bite.
One to eight hours after the bite, the victim will experience
blurred vision, drooping eyelids, slurred speech, increased
salivation and sweating, and drowsiness.
As time passes, nasuea, vomiting, difficulty of breathing,
paralysis, convulsions, shock and coma may ensue. Depending on
the size of the victim, total CNS (central nervous system)
shutdown can occur in as little as 10 minutes.
Treatment is similar to that of the Pit Vipor, with a few
important differences:
!. Transport the victim immediately. 2. Transport the victim
immediately. 3. Transport the victim immediately. 4. Flush the
bite area with WARM soapy water. Use several quarts. 5. NEVER
incise the bite. NEVER use constricting bands.
Black Widow Spider Bite -----------------------
Habitat background:
The female black widow spider is characterized by a shiny black
body, thin legs, and a crimson red marking on its abdomen,
usually in the shape of an hourglass or two red triangles.
Do not be confused by appearances, however. Of the five species
in the US, only three are black, and not all have the
characteristic red marking.
The female is one of the largest spiders in the US. Males
generally do not bite; females bite only when hungry, agitated,
or protecting the egg sack.
Contrary to folklore, the black widow spider is not aggressive.
In fact, many bites occur when a finger or hand enters the web
and is mistaken as prey.
Black widow spiders, as is true for most spiders, are usually
found in dry, secluded dimly lit areas. The spider is known for
its extremely strong, funnel-shaped web. More than 80% of all
bite victims are adult men.
Venom:
Black Widow Spider bites are among the leading cause of death
from _spider_ bites in the US. The venom - 14 times more toxic
than rattlesnake venom, is a neurotoxin that causes little
pronounced local reaction, bites results in pain and spasm in the
large muscle groups (which are the abdomen, upper leg, buttocks,
etc.) within thirty minutes to three hours. Severe bites will
affect the respiratory system and can result in respiratory
failure, coma, and death.
Those at the highest risk for developing severe bites are
children under 16, the elderly over 60, and people with chronic
illness and anyone with hypertension.
Signs and Symptoms (Sx):
The most common sign of a Black Widow Spider bite is high blood
pressure. The most common symptoms are flushing, sweating, and
grimacing of the face within ten minutes to two hours. Other Sx
include:
A pinprick sensation at the bite site, becomming a dull ache
within 30 to 40 minutes
Pain and spasms in the shoulders, back, chest, and abdominal
muscles within 30 minutes to 3 hours
Rigid, boardlike abdomen
Restlessness and anxiety
Fever
Rash
Headache
Nausea or vomiting
The symptoms generally last from 24 to 48 hours. The headache and
general weakness, however, may last for several months.
Treatment (Tx):
Prehospital care is generally not effective in the long-term
treatment of the bite. The goal is general wound care and
transport. General treatment consists of:
Administer care for shock
Apply a cold compress to the bite area - do not use ice!
Do not allow scratching of the would and do not clean the wound,
simply cover it with a loose dressing.
Transport as quickly as possible
Black Widow anitvenoms are risky and are reserved for high risk
patients. Nevertheless, you should try to find the spider and
bring it with you so that positive identification can be made. ID
can be made even if the spider is crushed.
Brown Recluse Spider (aka fidler)
---------------------------------
This spider is generally brown, but can range in color from
yellow to chocolat brown. The characteristic marking is a brown
violin-shaped marking on the upper back. The bite of this spider
is a serious medical condition.
The bite in non-healing and necrotic. It requires surgical
intervention and skin grafting to repair.
Most victims will never know they were bitten until several hours
after it takess place. The following Sx will result:
The bite becomes a bluish area with a white periphery, gradually
becomming surrounded with a red halo (a "bulls-eye" pattern).
Within 24 hours, the following will develope: fever joint pain
nasuea and vomiting chills
Within 7 to 10 days, the bite becomes a large ulcer.
Treatment:
1. Administer care for shock 2. Administer O2 and artificial
ventillation if needed 3. Transport ASAP 4. Positively identify
the culprit, but be careful! 5. Surgical Intervention Required
Ticks -----
Ticks often carry Rocky Mountain Spotted Fever and prolonged
attachment of a female tick can mimic Sx of Polio. 10% of victims
die.
Sx include nasuea and vomiting, abdominal pain, headache,
generalised weakness, flaccid paralysis, and respiratory failure.
Treatment:
1. Transport ASAP. If transport is delayed...
2. paint the tick with ether, gasoline, or nail polish, or coat
it with petrolium jelly.
3. Wait for the tick to back out on its own.
ADVANCED TREATMENT
4. If the tick doesn't back out, carefully scrape the tick away
from the skin.
5. If the head of the tick remains in the skin, cover and
transport for surgical removal.
6. provide BLS during transport.
Other Insects -------------
See the next section on insect stings
Insect Stings -------------
The normal reaction to an insect sting is a sharp "stinging" pain
(thats how a sting got its name) followed immediately by an
itchy, swollen, painful wheal. Swelling may persist for several
days, but usually subsides withing 24 hours.
Redness, tenderness, and swelling at or around the bite site,
even if severe, in the absence of other Sx, is considered to be a
local reaction. Local reactions are rearely serious or
life-threatening and can be treated successfully with a cold
compress.
An allergic reaction, however, is a serious matter. Stings may
cause death (on the average) within 10 minutes of the sting, but
almost always within one hour.
As noted earlier, the culprits most responsible are a group of
the hymenoptera, the insects with membranous (partially see
through) wings.
This group consists of the honeybee, the wasp, the hornet, and
the yellow jacket. Stings from wasps and bees are more common
than all other insect bites combined.
When someone falls victim to one of these little culprits, it is
important to determine what kind of insect inflicted the sting...
Honeybees leave the stinger and sac behind embedded in the skin.
Hornets and Wasps do not. Hornets like trees and shrubs. Yellow
jackets stay close to the ground and often nest in the ground.
Hornets build their nests close to the ground. Wasps love high
places, like attics and eaves. Honey bees cluster around flowers
and flowering shrubs, including clover.
Signs and symptoms of anaphylaxis:
Faintness, dizziness, generalised itching, hives flushing,
generalised swelling including the eyelids, lips and tongue,
upper airway obstruction (sounds like a seal bark), difficulty
swallowing, shortness of breath, wheezing or stridor, labored
breathing, abdominal cramps, confusion, syncope, convulsions, low
blood pressure/shock.
Some people will have these symptoms delayed for as much as two
weeks! In these cases, the Sx are: rash, fever, joint pain,
neurological problems, and secondary infections.
What to do:
- Lower the affected limb below the heart and in a position of
function
- Get the person's medical history, including any medications
being taken
- If there is a history of asthma or heart disease, transport
ASAP.
- Keep the person warm. Lie them down and elevate the legs and
lower the head (DO NOT ELEVATE the leg if it is the site of the
bite).
- Transport the victim as soon as possible (e.g., call 911)
- Make certain the victim is under observation for at least 24
hours. If any Sx appear, transport immediately.
- Inhalation products and antihistime products WILL NOT WORK.
Nothing should be taken by mouth.
ADVANCED TREATMENT
- If the stinger is still in the skin, remove the stinger by
GENTLY scraping against it with your fingernail, with the edge of
a knife, or with a credit card. NEVER use "tweezers."
Be careful not to squeeze the stinger, you will inject additional
venom into the area. Make certain you also remove the sac as it
is capable of secreting venom even without the stinger attached.
- Apply a commerical cold pack or ice bags to the site to releive
pain and swelling. If using ice, DO NOT PLACE THE ICE ON THE
WOUND. Wrap the ice in a moist cloth and place the cloth on the
wound. DO NOT allow the ice to remain on the wound for more than
15 minutes.
- If the person begins to have difficulty breathing, apply O2 at
2 to 4 L/min. - If respiration are not adequate, give
mouth-to-mouth ventillation.
- Find the bite site. Wrap _flat_, soft rubber tubing that is at
least 3/4" wide around the extremity two to four inches above
bite. The tubing should be tight enough to stop blood flow
through the veins, but not stop arterial blood flow.
You should be able to put two fingers between the skin and
constriction band. There should still be a distal pulse. _Never_
place these bands above a joint, or around the neck, head, or
torso. Loosen this band if swelling takes place.
--DISCLAIMER-- Many EMS jurisdictions do no allow for this
procedure, even by trained personnel.
MORE ADVANCED TREATMENT
- If you know the person is allergic to stngs, DO NOT WAIT for
the Sx to occur - delay can be fatal. If the victim has an insect
sting kit, assist them in administering the contents of the kit.
Transport the person immediately!
--DISCLAIMER-- Many EMS jurisdictions do no allow for this
procedure, even by trained personnel.
OK, FROM HERE OUT, I'M DESCRIBING WHAT A EMT-I/A/P MIGHT DO
- Administer diphenhydramine, 25 to 100 mg IM or IV
- Frequently asses vitals, LOC, airway
- If respiratory involvement ensues without shock, administer 0.1
to 0.5 mg epinephrin 1:1000 subcutaneously. (This is what is
usually in the insect sting kit.) Pediactric dose is 0.01 mg/kg.
Diphenhydramine may be given IV in this case.
- If the victim is in shock, give high flow O2! Hyperventillate
the patient as ssoon as is possible. Intubation is required even
if the person is conscious, ventillate with a bag-valve-mask if
necessary.
Adminsiter lactated ringer's or normal saline solution, infusion
rate depending on blood pressure. Administer epinephrin 0.3 to
0.5 mg 1:1000 IV, very slowly. If IV initiation is delayed, give
subcutaneously.
- Administer additional drug therapy as ordered by a physician.
This usually includes phenhydramine 25 to 100 mg IV. Theophylline
ethyl- enediamine (aminophylline) at a loading dose of 6mg/kg IV
infusion, diluted in 100 mL D5W or normal saline over a 20 minute
period is useful for bronchospasm. The pediatric loading dose is
the same, but in D5 0.9% NaCl.
Aquatic Bites/Stings --------------------
There are some basic differences between bites from marine life
and those of land animals. The venom from aquatic creatures
usually cause more extensive damage to the tissues. Second,
venoms from marine life can be destroyed with heat.
So, NEVER EVER EVER USE ICE on this type of bite. This does not
mean that you should deep-fry the injury either! Just use
something WARM (heat pack, or water).
Given the amount of tissue damage likely, treat like any other
trauma:
Control bleeding (direct pressure, elevation, pressure points)
Treat for Shock (lye down, elevate the legs, keep warm) Give BLS
(Basic Life Support - mouth-to-mouth, etc.) Transport ASAP
General treatment for venomous bites includes:
Transport ASAP (call 911)
Apply a constricting band above the bite or sting. Check for a
pulse in the limb to ensure you havn't made a tournequit.
Remove any material that sticks to the site on the _surface_ of
the skin. Don't use your bare hands! Use forceps or tweezers.
Irrigate the wound thoroughly with water.
If the skin is _unbroaken_, wash the area with a mild agent such
as Alcoholic Zephiran, strong soap solution, or ammonia. NEVER
SCRUB THE WOUND. Make _certain_ the fluids flow away from both
you and the patient. These fluids will induce further reactions!
Remove stingers and barbs the same way in which you would remove
a bee stinger. Be careful not to squeese more venom into the
wound. If the stinger is barbed and you can't EASILY remove it,
support the stinger or barb with gause and bandages such that it
can't move. Transport for surgical removal.
Apply heat and maintain the area at a temperature of 110 to 114
degrees F for 30 to 40 minutes. Apply heat for another 30 minutes
if Sx reappear.
Specific Treatments:
For tentacle stings from jellyfish, coral, hydras, and anemones:
1 Remove the victim from the water, BE CAREFUL
2 Call 911
3 Pour rubbing alcohol on the affected areas to denature the
toxins
4 Sprinkle meat tenderizer on the affected areas to destroy the
toxins
5 Sprinkle talcum power on the affected areas
6 Transport ASAP
For puncture wounds like those from a stingray or from spiny
fish:
1 Remove the victim from the water, BE CAREFUL
2 Call 911
3 Immobolize the injured part
4 Soak the injured part in hot water for at least 30 minutes,
chaning the water to maintain temperature (~110 degress F)
5 Transport ASAP
Hope this is informative.
Regards, Steve --
- Date: Sat, 21 May 94 20:08 MDT From: Galatia.9@debug.cuc.ab.ca
Newsgroups: rec.gardens
[text deleted]
For wasp and bee stings, etc, my husband has found the "old wives
tale" of putting a cut onion on the wound to be true. Reading
several books on the matter, I think I know why. Onion releases
sulfer, which is antiseptic and anodyne, thus calming the
inflammation and pain.
It also seems to slow the toxin. For bee stings, the usual advice
is to scrape away the stinger and venom sac with a credit card,
never fingers or tweezers, since the sac can be easily squeezed.
For wasp, hornet and yellowjacket stings all you can do is try to
ease the pain.
Aloe vera gel seems to help here also. With all bees, once you
get stung, get the hell out of there! A stinging bee, wasp, etc
puts out a scent that calls the rest of the hive to war.
Since wasps, yellowjackets and hornets have much vicious natures
than honey bees (and much more dangerous venom), getting out of
town is even more important. Keeping wasps, yellowjackets and
hornets away from picnics and such is relatively easy once you
understand that they're carnivorous.
Set a piece of meat or fish away from the picnic site for them
and they'll generally converge on that and leave you alone. In
terms of temper, honeybees require a fair bit of provocation to
sting, wasps somewhat less, yellowjackets get irate if you swat
at them, and I've found that the less said about hornets, the
better ;-)
Bumble bee workers don't have stingers (and aren't generally
inclined to use them anyways), but the drones do and they
resemble wasps both in manner and appearance. Never mess with
queens of any kind :smile: The only colours that most bees-etc seem to
disdain are white and beige.
Anything else might grab attention and no one seems to be able to
say for sure which colours attract the most. Perfumes attract
bees-etc, but they dont seem to like coriander (Tom's of Maine
deodorant gets another star) I'm not certain how they feel about
lavender or cedar, but at least they keep mosquitos away. Not
much help, Im afraid, but thats what I know about them.. I
haven't been stung.
-==- Ennien
| Ennein & Robin Ashbrook | | | Internet:
Galatia.9@Debug.cuc.ab.ca | " To each, their own. " | | UUCP:
calgary!debug!galatia.9 | |
stings Keywords: allergic reactions, bites, stings Date: Tue, 31
May 1994 14:15:46 GMT Lines: 870
This post is long (about 900 lines)! There is an intro and two
section beyond dealing with specific bites/stings and what to do
about them.
I decided to post this information after seeing posts about
treatments that were not entirely accurate, or after reading
discussions about bee stings where people were recommending
taking lots of over-the-counter meds (a few months ago). - OK.
Let me start by saying a few words. This post is informational
only. I am not a physician. I have lots of experience at the
various levels of EMT (Emergency Medical Technician).
I have taught in the past (both medical and rescue), have
"worked" on a pharmacology text (soon to be published), and have
been a volunteer on various rescue squads since 1979 (I have been
a rescue squad commander and have held the rank of Lieutennant in
charge of training).
Currently, I am not active in EMS, (as a result of moving into an
area that doesn't have many volunteer organizations), but I still
hold many of my certifications and licenses and am nationally
registered with the Dept. of Transportation (the governing body
of EMS in the US). My current licenses are valid in those states
that recognize the National Registry of Emergency Medical
Technicians. OK - enough of the Resume! ;-)
My information comes from a variety of texts, many dealing
specifically with prehospital care, and my experiences. I do not
claim that this information is accurate for all jurisdictions in
this country. In fact, some of what I present is illegal in
certain areas (even for EMT-Paramedics). Again, its for those who
are curious...
After some soul-searching, I decided to include descriptions of
some of the advanced treatments often used for various
conditions.
These descriptions are clearly marked. I was hesitant to include
these descriptions because they are advanced, meaning you can do
more harm than good if you do it wrong, but in the end I thought
it would be OK as most people wouldn't be able to do them for
lack of equipment or people would try based on some "treatments"
that are based on "hollywood" and are only partially correct and
if performed as shown on TV are, by definition, wrong.
Advanced treatment requires medical training and certification!
This includes CPR and other procedures described. As stated
above, this info is provided as a matter of information and to
give an indication as to how serious certain events are given the
treatments used by individuals such as EMTs and others. DO NOT
ATTEMPT these treatments!!
-
A word about tourniquets... Tourniquets are used to stop both
venus and arterial blood flow to a limb. There is NEVER and
reason to use a tourniquest for bites or stings, unless the limb
is bleeding severely and it can't be stopped (e.g, the person
will die from blood loss).
Constricting band are used to stop venus blood flow only. When
properly used, there will still be a pulse in the wrist or foot,
for example. The use of the constriction band for bites is very
controversial in EMS, some areas still do not allow their use.
Don't use anything like these devices unless your on the top of
Mt. Everest and an MD tells you to do it!
ALWAYS call for help BEFORE doing anything!
Oe final note to this intro: NEVER eat or drink anything if there
is any question of a serious medical condition, such as an
allergic reaction.
Never eat "herbal remedies" or take chicken soup! I have had one
pateint die on me because she ate a common flowering plant used
to make a heart med (she knew quite a bit about medicinal flora).
Having "food" in your belly can complicate treatments at the ER,
especially if there is any medicinal value to what you have
eaten! Having you stomach pumped will delay proper treatment
(they will pump it.) In the case of a severe allergic reaction, I
am not aware of any "household" remedy that will stop someone
from going into anaphylactic shock and passing away.
The next two sections...
Section 1 provides background on allergic reactions
Section 2 deals with basic information and treatment of certain
common bites/stings.
-
Section 1 - Alleric Reactions =============================
Concepts and Terminology (boring, but useful)
---------------------------------------------
To understand what takes place during an allergic reaction and in
anaphylaxis, several concepts and terms need to de defined:
The imune response is designed to guard the body against
dangerous foreign substances such as infection and antigens.
In the normal imune response, the protective cells of the body
recognise the dangerous intruders, and destroy them. The allergic
reaction or response, on the other hand, is an _oversensitive_
and harmful response against a foreign body.
Immunity is the body's natural protective state of being
resistant to poisons and foreign substances.
An antigen is a foreign substance that induces the formation of
antibodies. Antigens are such things as bacteria or viruses.
An antibody is a protective protein substance formed in the body
as a result of contact with a foreign antigen.
When antigens and antibodies interact in the body, an immune
response develops. This response can cause allergies and
anaphylaxis.
An allergy is an abnormal and individual hypersensitivity to
substances that are ordinarily harmless.
An allergen is an antigen that the body is oversensitive to.
Sensitisation is the process of exposure to an allergen and then
results in the production of antibodies. An important fact to
note is that an allergic reaction cannot occur with the first
contact with a potential antigen because antibodies have not yet
formed.
Anaphylaxis means without protection (literally). It is an acute
generalised allergic reaction that occurs within minutes to hours
after the body has been exposed to an allergen. Anaphylaxis is a
serious medical condition that can lead to death in minutes.
Other definitions include:
edema - swelling stridor - harsh sounding breathing dyspnea -
shortness of breath cyanosis - bluish colour syncope - temporary
loss of consciouness tachycardia - very fast heart beat
bradycardia - very slow heart beat accessory muscles - muscles
used to help breath. located in neck, chest hypotension - low
blood pressure hypertension - high blood pressure sign -
objective evidence, such as edema symptom - subjective evidence,
such as nasuea Sx - signs and symptoms pulmonary edema -
fluid/blood build-up in the lungs (pink frothy mucus coughed up
while breathing) transport - CALL 911 or equivalent
Common Allergens ----------------
Allergen groups include drugs, insect venom, food, and pollen.
The causative agent may be injected, ingested, absorbed through
the skin or mucus membranes, or inhaled. Inhaled substances
rarely cause allergic reactions.
Insect stings/bites fall into the injection category. The
allergic reaction is different from the toxic effects of the
venom.
The insect order Hymenopter is the most common allergen. The four
prominent members include the bumblebee, honeybee, white- faced
hornet, and the yellow jacket.
About 8 in 1000 are allergic to stinging insects and half of
these are severe. This order has whats called "cross-sensitivity"
meaning a bite from one may lead to an allergic reaction to a
bite from another.
Ants, dear flies, ticks, and mosquitoes can all cause an allergic
reaction.
Pathophysiology ---------------
In a simple anaphylactic reaction, the antigen-antibody
interaction causes mild alleric signs and symptoms (Sx) limited
to usually one or two body systems and without systemic
cardiovascular effects.
In an anaphylactic reaction, however, the antigen-antibody
reaction is severe. This reaction takes place on the surface of
mast cells and basophils (types of white blood cells) and signals
the release of several chemicals, primarily histamine. Other
chemicals include serotonin, bradykinin, and SRS-A (slow reacting
substance of anaphylaxis).
These chemicals cause three primary reactions: capillary
dialation, increased capillary permeability, and smooth muscle
spasm. As these substances travel around the body, the following
Sx can be seen:
Skin flushing, edema, itching, hives, rash, a feeling of warmth
Eyes itching, tearing, edema Nose congestion, itching, sneezing
Upper Airway pharyngeal or laryngeal spasm, hoarsness, stridor,
bronchospasm, tightness in the neck Lower Airwar Dyspnea,
wheezing, use of accessory muscles to breath, cyanosis, pulmonary
edema Cardiovascular tachycardia, irregular pulse, weak pulse,
hypotension Gastrointestinal nasuea, vomiting, diarrhea,
abdominal cramps Neurogenic Anxiety, dizziness, syncope,
weakness, seizure, headache
A person may experience these Sx within seconds after exposure,
or the reaction may be delayed for several hours. The initial Sx
usually occur in the Skin.
The primary rule for determining severity is simple: the sooner
the onset of Sx after exposure, the more severe the reaction.
Injected antigens can produce Sx immediately, but usually this
happens after 5 minutes to as much as thirty minutes later.
Injested antigens usually cause a reaction in about 2 hours.
The effect on the cardiovascular system progresses as follows:
- caplillary beds dialate (located in skin and internal organs) -
increase in capillary permeability (fluid leaks out) - blood
pools in capillary beds (especially the skin) - decreased amount
of blood returns to heart - decreased cardiac output - early
stages of hypovolemic shock (low blood volume)
The effect on the airway is simply this: the airway constricts
(usually from swelling) and spasms resulting in decreased airflow
into the lungs and a reduced oxygenation of the blood. Loss of
the airway is the primary concern.
Commonly used drugs include epinephrin (adrenalin) and
diphenhydramine. Others are used in the prehospital setting as
well.
Epinephrin counteracts the effects of histamine and the other
chemicals by vasoconstriction, bronchial dialation, and
restoration of the tone and permeability of the blood vessels.
Epinephrin's major side effect is the development of cardiac
irritability. IV administration of Epinephrin can cause serious
arrhythmias. This drug is short acting and may be needed every 15
minutes.
Diphenhydramine is an antihistamine that antogonizes the adverse
effects of histamine and prevents further release of histamine.
This drugs is not used on pregnent patients. The major side efect
is a dry mouth and caridac arrhythmias.
Section 2 =========
Patient Assessment ------------------
The victim of a bite will usually be agitated. Try to calm them
and determine what happened, where, how long ago, and what the
culprit might have been (determine if it walked, flew, swam,
etc.).
Determine if the threat is still nearby and move from the area if
this is the case. If the culprit is dead, collect it carefully
and put it into a container that can be handled safely.
If the victim has no Sx, don't leave them alone - monitor them
for at least four hours. (Clearly, I'm not talking about a
mosquito bite here.)
If itching, a feeling of warmth, tightness in the throat or
chest, or a rash appear (usually the first signs) summon help
immediately. Knowing when the bite took place will help determine
how severe the condition is - remember the sooner Sx folow the
bite, the more severe the reaction. If the situation worsens,
concern yourself with maintaining an airway.
The airway is the primary concern. The simple rule of ABC is
used; Airway, Breathing, Circulation. The basic techniques tought
for CPR are whats used to establish and maintain an open (patent)
airway and to ensure circulation.
Establish basic vitals: A pulse in the wrist means a BP
sufficient for total body profusion, but it will not tell you if
the patient is in shock or not.
An very week pluse in the wrist means the person is very likely
in shock and is very likely in bad shape! One way to ascertain if
the person is on the way to shock is by pinching the bed of a
fingernail until it goes white and then releasing. If it takes
more than 2 seconds for the normal pink colour to return, this is
an ominous sign. (Obviously, nail polish must first be removed.)
Determine LOC (level of consciousness). If the person seems
"drunk" or "sleepy", you must seek treatment. If the person is
abnormally agitated or even verbally abusive, this is a sign of a
change in mentation, an early indicator of neurogenic
involvement.
If you suspect a severe reaction and the airway is failing,
judgement is called for. Don't wait for transport unless it is
very close at hand.
If you live in a rural or lightly suburban area, use the phone to
inform the dispatcher what is going on and that you feel as
though you should take the victim to the ER and what route will
be used.
Ask them to intercept you along the way. Follow your instincts,
BUT ALWAYS FOLLOW THE DISPATCHER'S INSTRUCTIONS! In any case, you
should explain the situation and ask for an "ALS" response, that
is, an Advanced Life Support response.
The victim of other vectors may exhibit similar Sx. The same
basic treatments apply.
Specific Treatments ------------------- Snakebite (Pit Vipors)
----------------------
There are posionous snakes in every state except Alaska, Hawaii
and Maine. Of the 120 species in the US, about 20 are posionous.
Of the bites that do take place, about 55% are from rattlesnakes,
34% from copperheads, 10% from water moccasins, and 1% from coral
snakes.
Sx generally occur immediately, but only about one-third of all
bites manifest Sx. When no Sx present themselves, probably no
venom was injected.
Nonpoisonous bites are not considered an emergency. Poisonous
bites contain some of the most complex toxins known; venoms can
affect the central nervous system, brain, heart, kidneys, and
blood.
Signs that indicate a poisonous bite include:
One or two distinct puncture wounds (fang marks). Nonposionous
bites usually leave a series of shallow, small puncture wounds.
The coral snake is one exception. This snake leavs a semicircular
marking from its teeth. A row of punctures does not rule out a
posionous bite, but fang marks _always_ confirms a posionous
bite. The patient experiences severe burning and pain almost
immediately, but always within 4 hours of the bite.
The wound begins to swell and discolour usually immediately, but
always within 4 hours.
Most posionous snakes have the following characteristics:
Large fangs Elliptical pupils - nonposionous snakes have round
pupils Presence of a pit - a heat sensitive organ - between the
eyes A variety of blotches on a brightly coloured skin, including
pink, yellow, olive, tan, grey, red, or brown. A triangular head
that is larger than the neck.
The one exception to all this is the coral snake. It has round
pupils, no fangs, and a small head. Because its mouth is so small
and teeth are short, most bites are on the finger or toes. Coral
snakes are generally small and have rings of red, yellow and
black; the red and yellow touch each other.
The seriousness of the bite can be determined by assessing
several items:
1 - Age, size and health of the victim. Bites are most dangerous
in children and the elderly.
2 - Depth, location, and number of bites. A single glancing blow
is less dangerous than multiple wounds. Bites on the head or
torso are usually fatal, as is a bite that punctures a blood
vessle.
3 - Duration of the bite. Was it a quick hit or did the snake
hold on.
4 - Clothing. A bite that hits the skin directly is worse than
one that went through clothing.
5 - Maturity of the snake. The older, the more dangerous.
6 - Condition of the fangs and venom sacs. (Not recommended for
inspection by untrained professional.)
7 - How angry the snake was. The more agitated, the more venom.
What to do when you go to help: -------------------------------
BE CAREFUL!!! Snakes will often be found within a twenty foot
radius of the area in which the bite occured!
The priorities of emergency care for snakebite are to limit the
spread of venom and to transport ASAP!
If the victim was bit by a pit vipor (rattlesnake, copperhead, or
cottonmouth), proceed as follows:
Look for Sx...
Immediate and severe burning pain, swelling. The entire
extremity swells within 8 to 36 hours. (As a rule, no
burning/pain, no venom.)
Purplish discoloration within 2 to 3 hours.
Numbness and possible blistering around the bite within a few
hours.
Nausea and vomiting.
Rapid heartbeat (tachycardia), low blood pressure (hypotension),
weakness and syncope (fainting).
Numbness and tingling of the tounge and mouth.
Excessive sweating (diaphoretic)
Fever and chills.
Muscular twitching.
Convulsions.
Dimmed vision.
Headache.
Priorities for treatment are:
1. Move the person away from the site. If you can do so without
endangering yourself, kill the snake and transport it with the
victim.
2. Lie the person down and keep them quiet.
3. Keep the extremity below the level of the heart and
immobilize it in a position of function. Remove jewelry.
4. Wash the wound area with alcohol, soap and COOL water,
hydrogen peroxide. Do not scrub or tear the tissue. Irrigate the
area with saline or clean cool water.
5. Transport ASAP!
6. NEVER EVER apply ice to the bite area! Ice can cause tissue
damage, gangrene, or rebound vasodialation when the ice is
removed!
ADVANCED TREATMENT
NOTE: The following descrption is provided in order to dispell
the "hollywood" treatment of how to deal with a snake bite.
7. Find the fang marks. Wrap _flat_, soft rubber tubing that is
at least 3/4" wide around the extremity two to four inches both
above and below the fang marks.
The tubing should be tight enough to stop blood flow through the
veins, but not stop arterial blood flow. You should be able to
put two fingers between the skin and constriction band.
There should still be a distal pulse. _Never_ place these bands
on either side of a joint, or around the neck, head, or torso.
Loosen these bands if swelling takes place.
--DISCLAIMER-- Many EMS jurisdictions do no allow for this
procedure, even by trained personnel.
8. --DISCLAIMER-- Only if you are more than 30 minutes from
medical treatment and only if directed to do so by a physician...
Incise and suction the fang marks. Only do so if on an extremity
and with a sterile instrument.
Locate the fang marks. Pinch the skin up between the thumb and
forefinger to avoid hitting a vein. Make longitudinal (vertical)
cut marks through each fang mark, only deep enough to go just
below the skin. Incision should be parallel to each other, 1/8"
to 1/4" long and made in the direction of the fang entry. NEVER
make an X or cross the cuts!
Apply suction to the wound directly over the incisions. You can
"milk" the incision with your fingers if necessary. Suction with
your mouth only as a last resort and only as directed by a
physician! Only use your mouth if you have no wounds in your
mouth.
NOTE - because venom spreads so rapidly, incising and suctioning
is of no value unless it is done withing 5 minutes of the bite.
--DISCLAIMER-- Many EMS jurisdictions do no allow for this
procedure, even by trained personnel. 9. Use basic life support
procedures as appropriate. Treat for shock, Keep the victim warm
and lying down, with legs elevated (unless bite is on leg). Be
prepared to perform CPR. Apply O2 at 2 to 4 L/min.
Snakebite (coral snake) -----------------------
Coral snakes - and other neurotoxic snakes like the cobra, mamba,
sea snake, and krait - are the most posionous of all.
Instead of having fangs, the coral snake has several pairs of
short, groved, fang-like teeth in its upper jaw. It chews its
victims instead of striking with a clean blow. The venom is
absorbed very quickly and is disseminated throughout the body.
There is generally little or no pain involved with the bite. The
bite leaves one or more tiny scratch marks in the area of the
bite.
One to eight hours after the bite, the victim will experience
blurred vision, drooping eyelids, slurred speech, increased
salivation and sweating, and drowsiness.
As time passes, nasuea, vomiting, difficulty of breathing,
paralysis, convulsions, shock and coma may ensue. Depending on
the size of the victim, total CNS (central nervous system)
shutdown can occur in as little as 10 minutes.
Treatment is similar to that of the Pit Vipor, with a few
important differences:
!. Transport the victim immediately. 2. Transport the victim
immediately. 3. Transport the victim immediately. 4. Flush the
bite area with WARM soapy water. Use several quarts. 5. NEVER
incise the bite. NEVER use constricting bands.
Black Widow Spider Bite -----------------------
Habitat background:
The female black widow spider is characterized by a shiny black
body, thin legs, and a crimson red marking on its abdomen,
usually in the shape of an hourglass or two red triangles.
Do not be confused by appearances, however. Of the five species
in the US, only three are black, and not all have the
characteristic red marking.
The female is one of the largest spiders in the US. Males
generally do not bite; females bite only when hungry, agitated,
or protecting the egg sack.
Contrary to folklore, the black widow spider is not aggressive.
In fact, many bites occur when a finger or hand enters the web
and is mistaken as prey.
Black widow spiders, as is true for most spiders, are usually
found in dry, secluded dimly lit areas. The spider is known for
its extremely strong, funnel-shaped web. More than 80% of all
bite victims are adult men.
Venom:
Black Widow Spider bites are among the leading cause of death
from _spider_ bites in the US. The venom - 14 times more toxic
than rattlesnake venom, is a neurotoxin that causes little
pronounced local reaction, bites results in pain and spasm in the
large muscle groups (which are the abdomen, upper leg, buttocks,
etc.) within thirty minutes to three hours. Severe bites will
affect the respiratory system and can result in respiratory
failure, coma, and death.
Those at the highest risk for developing severe bites are
children under 16, the elderly over 60, and people with chronic
illness and anyone with hypertension.
Signs and Symptoms (Sx):
The most common sign of a Black Widow Spider bite is high blood
pressure. The most common symptoms are flushing, sweating, and
grimacing of the face within ten minutes to two hours. Other Sx
include:
A pinprick sensation at the bite site, becomming a dull ache
within 30 to 40 minutes
Pain and spasms in the shoulders, back, chest, and abdominal
muscles within 30 minutes to 3 hours
Rigid, boardlike abdomen
Restlessness and anxiety
Fever
Rash
Headache
Nausea or vomiting
The symptoms generally last from 24 to 48 hours. The headache and
general weakness, however, may last for several months.
Treatment (Tx):
Prehospital care is generally not effective in the long-term
treatment of the bite. The goal is general wound care and
transport. General treatment consists of:
Administer care for shock
Apply a cold compress to the bite area - do not use ice!
Do not allow scratching of the would and do not clean the wound,
simply cover it with a loose dressing.
Transport as quickly as possible
Black Widow anitvenoms are risky and are reserved for high risk
patients. Nevertheless, you should try to find the spider and
bring it with you so that positive identification can be made. ID
can be made even if the spider is crushed.
Brown Recluse Spider (aka fidler)
---------------------------------
This spider is generally brown, but can range in color from
yellow to chocolat brown. The characteristic marking is a brown
violin-shaped marking on the upper back. The bite of this spider
is a serious medical condition.
The bite in non-healing and necrotic. It requires surgical
intervention and skin grafting to repair.
Most victims will never know they were bitten until several hours
after it takess place. The following Sx will result:
The bite becomes a bluish area with a white periphery, gradually
becomming surrounded with a red halo (a "bulls-eye" pattern).
Within 24 hours, the following will develope: fever joint pain
nasuea and vomiting chills
Within 7 to 10 days, the bite becomes a large ulcer.
Treatment:
1. Administer care for shock 2. Administer O2 and artificial
ventillation if needed 3. Transport ASAP 4. Positively identify
the culprit, but be careful! 5. Surgical Intervention Required
Ticks -----
Ticks often carry Rocky Mountain Spotted Fever and prolonged
attachment of a female tick can mimic Sx of Polio. 10% of victims
die.
Sx include nasuea and vomiting, abdominal pain, headache,
generalised weakness, flaccid paralysis, and respiratory failure.
Treatment:
1. Transport ASAP. If transport is delayed...
2. paint the tick with ether, gasoline, or nail polish, or coat
it with petrolium jelly.
3. Wait for the tick to back out on its own.
ADVANCED TREATMENT
4. If the tick doesn't back out, carefully scrape the tick away
from the skin.
5. If the head of the tick remains in the skin, cover and
transport for surgical removal.
6. provide BLS during transport.
Other Insects -------------
See the next section on insect stings
Insect Stings -------------
The normal reaction to an insect sting is a sharp "stinging" pain
(thats how a sting got its name) followed immediately by an
itchy, swollen, painful wheal. Swelling may persist for several
days, but usually subsides withing 24 hours.
Redness, tenderness, and swelling at or around the bite site,
even if severe, in the absence of other Sx, is considered to be a
local reaction. Local reactions are rearely serious or
life-threatening and can be treated successfully with a cold
compress.
An allergic reaction, however, is a serious matter. Stings may
cause death (on the average) within 10 minutes of the sting, but
almost always within one hour.
As noted earlier, the culprits most responsible are a group of
the hymenoptera, the insects with membranous (partially see
through) wings.
This group consists of the honeybee, the wasp, the hornet, and
the yellow jacket. Stings from wasps and bees are more common
than all other insect bites combined.
When someone falls victim to one of these little culprits, it is
important to determine what kind of insect inflicted the sting...
Honeybees leave the stinger and sac behind embedded in the skin.
Hornets and Wasps do not. Hornets like trees and shrubs. Yellow
jackets stay close to the ground and often nest in the ground.
Hornets build their nests close to the ground. Wasps love high
places, like attics and eaves. Honey bees cluster around flowers
and flowering shrubs, including clover.
Signs and symptoms of anaphylaxis:
Faintness, dizziness, generalised itching, hives flushing,
generalised swelling including the eyelids, lips and tongue,
upper airway obstruction (sounds like a seal bark), difficulty
swallowing, shortness of breath, wheezing or stridor, labored
breathing, abdominal cramps, confusion, syncope, convulsions, low
blood pressure/shock.
Some people will have these symptoms delayed for as much as two
weeks! In these cases, the Sx are: rash, fever, joint pain,
neurological problems, and secondary infections.
What to do:
- Lower the affected limb below the heart and in a position of
function
- Get the person's medical history, including any medications
being taken
- If there is a history of asthma or heart disease, transport
ASAP.
- Keep the person warm. Lie them down and elevate the legs and
lower the head (DO NOT ELEVATE the leg if it is the site of the
bite).
- Transport the victim as soon as possible (e.g., call 911)
- Make certain the victim is under observation for at least 24
hours. If any Sx appear, transport immediately.
- Inhalation products and antihistime products WILL NOT WORK.
Nothing should be taken by mouth.
ADVANCED TREATMENT
- If the stinger is still in the skin, remove the stinger by
GENTLY scraping against it with your fingernail, with the edge of
a knife, or with a credit card. NEVER use "tweezers."
Be careful not to squeeze the stinger, you will inject additional
venom into the area. Make certain you also remove the sac as it
is capable of secreting venom even without the stinger attached.
- Apply a commerical cold pack or ice bags to the site to releive
pain and swelling. If using ice, DO NOT PLACE THE ICE ON THE
WOUND. Wrap the ice in a moist cloth and place the cloth on the
wound. DO NOT allow the ice to remain on the wound for more than
15 minutes.
- If the person begins to have difficulty breathing, apply O2 at
2 to 4 L/min. - If respiration are not adequate, give
mouth-to-mouth ventillation.
- Find the bite site. Wrap _flat_, soft rubber tubing that is at
least 3/4" wide around the extremity two to four inches above
bite. The tubing should be tight enough to stop blood flow
through the veins, but not stop arterial blood flow.
You should be able to put two fingers between the skin and
constriction band. There should still be a distal pulse. _Never_
place these bands above a joint, or around the neck, head, or
torso. Loosen this band if swelling takes place.
--DISCLAIMER-- Many EMS jurisdictions do no allow for this
procedure, even by trained personnel.
MORE ADVANCED TREATMENT
- If you know the person is allergic to stngs, DO NOT WAIT for
the Sx to occur - delay can be fatal. If the victim has an insect
sting kit, assist them in administering the contents of the kit.
Transport the person immediately!
--DISCLAIMER-- Many EMS jurisdictions do no allow for this
procedure, even by trained personnel.
OK, FROM HERE OUT, I'M DESCRIBING WHAT A EMT-I/A/P MIGHT DO
- Administer diphenhydramine, 25 to 100 mg IM or IV
- Frequently asses vitals, LOC, airway
- If respiratory involvement ensues without shock, administer 0.1
to 0.5 mg epinephrin 1:1000 subcutaneously. (This is what is
usually in the insect sting kit.) Pediactric dose is 0.01 mg/kg.
Diphenhydramine may be given IV in this case.
- If the victim is in shock, give high flow O2! Hyperventillate
the patient as ssoon as is possible. Intubation is required even
if the person is conscious, ventillate with a bag-valve-mask if
necessary.
Adminsiter lactated ringer's or normal saline solution, infusion
rate depending on blood pressure. Administer epinephrin 0.3 to
0.5 mg 1:1000 IV, very slowly. If IV initiation is delayed, give
subcutaneously.
- Administer additional drug therapy as ordered by a physician.
This usually includes phenhydramine 25 to 100 mg IV. Theophylline
ethyl- enediamine (aminophylline) at a loading dose of 6mg/kg IV
infusion, diluted in 100 mL D5W or normal saline over a 20 minute
period is useful for bronchospasm. The pediatric loading dose is
the same, but in D5 0.9% NaCl.
Aquatic Bites/Stings --------------------
There are some basic differences between bites from marine life
and those of land animals. The venom from aquatic creatures
usually cause more extensive damage to the tissues. Second,
venoms from marine life can be destroyed with heat.
So, NEVER EVER EVER USE ICE on this type of bite. This does not
mean that you should deep-fry the injury either! Just use
something WARM (heat pack, or water).
Given the amount of tissue damage likely, treat like any other
trauma:
Control bleeding (direct pressure, elevation, pressure points)
Treat for Shock (lye down, elevate the legs, keep warm) Give BLS
(Basic Life Support - mouth-to-mouth, etc.) Transport ASAP
General treatment for venomous bites includes:
Transport ASAP (call 911)
Apply a constricting band above the bite or sting. Check for a
pulse in the limb to ensure you havn't made a tournequit.
Remove any material that sticks to the site on the _surface_ of
the skin. Don't use your bare hands! Use forceps or tweezers.
Irrigate the wound thoroughly with water.
If the skin is _unbroaken_, wash the area with a mild agent such
as Alcoholic Zephiran, strong soap solution, or ammonia. NEVER
SCRUB THE WOUND. Make _certain_ the fluids flow away from both
you and the patient. These fluids will induce further reactions!
Remove stingers and barbs the same way in which you would remove
a bee stinger. Be careful not to squeese more venom into the
wound. If the stinger is barbed and you can't EASILY remove it,
support the stinger or barb with gause and bandages such that it
can't move. Transport for surgical removal.
Apply heat and maintain the area at a temperature of 110 to 114
degrees F for 30 to 40 minutes. Apply heat for another 30 minutes
if Sx reappear.
Specific Treatments:
For tentacle stings from jellyfish, coral, hydras, and anemones:
1 Remove the victim from the water, BE CAREFUL
2 Call 911
3 Pour rubbing alcohol on the affected areas to denature the
toxins
4 Sprinkle meat tenderizer on the affected areas to destroy the
toxins
5 Sprinkle talcum power on the affected areas
6 Transport ASAP
For puncture wounds like those from a stingray or from spiny
fish:
1 Remove the victim from the water, BE CAREFUL
2 Call 911
3 Immobolize the injured part
4 Soak the injured part in hot water for at least 30 minutes,
chaning the water to maintain temperature (~110 degress F)
5 Transport ASAP
Hope this is informative.
Regards, Steve --
- Date: Sat, 21 May 94 20:08 MDT From: Galatia.9@debug.cuc.ab.ca
Newsgroups: rec.gardens
[text deleted]
For wasp and bee stings, etc, my husband has found the "old wives
tale" of putting a cut onion on the wound to be true. Reading
several books on the matter, I think I know why. Onion releases
sulfer, which is antiseptic and anodyne, thus calming the
inflammation and pain.
It also seems to slow the toxin. For bee stings, the usual advice
is to scrape away the stinger and venom sac with a credit card,
never fingers or tweezers, since the sac can be easily squeezed.
For wasp, hornet and yellowjacket stings all you can do is try to
ease the pain.
Aloe vera gel seems to help here also. With all bees, once you
get stung, get the hell out of there! A stinging bee, wasp, etc
puts out a scent that calls the rest of the hive to war.
Since wasps, yellowjackets and hornets have much vicious natures
than honey bees (and much more dangerous venom), getting out of
town is even more important. Keeping wasps, yellowjackets and
hornets away from picnics and such is relatively easy once you
understand that they're carnivorous.
Set a piece of meat or fish away from the picnic site for them
and they'll generally converge on that and leave you alone. In
terms of temper, honeybees require a fair bit of provocation to
sting, wasps somewhat less, yellowjackets get irate if you swat
at them, and I've found that the less said about hornets, the
better ;-)
Bumble bee workers don't have stingers (and aren't generally
inclined to use them anyways), but the drones do and they
resemble wasps both in manner and appearance. Never mess with
queens of any kind :smile: The only colours that most bees-etc seem to
disdain are white and beige.
Anything else might grab attention and no one seems to be able to
say for sure which colours attract the most. Perfumes attract
bees-etc, but they dont seem to like coriander (Tom's of Maine
deodorant gets another star) I'm not certain how they feel about
lavender or cedar, but at least they keep mosquitos away. Not
much help, Im afraid, but thats what I know about them.. I
haven't been stung.
-==- Ennien
| Ennein & Robin Ashbrook | | | Internet:
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