Animal Bites Stings

Section 6 – TRAUMA

6.01 ANIMAL BITES / STINGS

PATIENTS PRESENTING WITH SIGNS AND SYMPTOMS CONSISTENT WITH ANAPHYLAXIS MUST BE TREATED WITH THE APPROPRIATE PRACTICE PARAMETERS (5.02).

INITIAL MEDICAL / TRAUMA CARE, (2.01) / (2.02)

• Irrigate and cleanse wound with Normal Saline.
• Assess degree of bite or sting by measuring bite / sting marks. Outline edematous, erythemic and ecchymotic areas with pen, and note time. Repeat every 15 minutes.
• If systemic reaction occurs, treat as anaphylaxis. NaCl boluses and be prepared to administer DOPAMINE (5-20 mcq/kg/min, titrate to BP> 90 mmHg) if no response or if conditions worsens.
• Keep patient supine and calm. Immobilize affected part. Keep the injured area low. Remove distal jewelry.
• Remove stingers, if present, taking care to avoid compression.
• Attempt to identify animal, insect, or reptile that caused the injury.
• If multiple stings, administer DIPHENHYDRAMINE (BENADRYL) for histamine reaction. May need to be repeated. (If no IV, give IM). Think METHYLPREDNISOLONE (SOLU-MEDROL) early; dosage 125 mg, rapid IV or IM. Consider a second dose, if stings approximately 30 or more.
• For severe muscle spasms with spider bites or scorpion stings, administer either,
  • DIAZEPAM (VALIUM), 5 mg IVP slowly,
  • MIDAZOLAM (VERSED) IVP slowly or IN for sedation if needed
    • Less than 60 y/o 1 mg/minute titrate to effect (Maximum of 5 mg)
    • Greater than 60 y/o 0.5 mg/minute titrate to effect (Maximum of 3 mg).
• If animal bite, contact animal services:
  • Orange County 407-352-4390
  • Seminole County 407-665-5110

BROWN RECLUSE SPIDER BITE:

• Brown Recluse Spiders colonies are not found in the peninsula of Florida. It is extremely rare to find a Brown Recluse Spider in our area. Wounds that appear like they could be a bite from a Brown Recluse Spider are more than likely MRSA and should be handled as any other infected wound.

For more information on Brown Recluse Spiders, please refer to this website from the University of California: Brown Recluse Spiders

BLACK/RED/BROWN WIDOW SPIDER BITE:

• Evaluate for specific signs / symptoms
  • Immediate localized pain
  • Progressive muscle spasms (usually beginning in the abdomen and back)
  • Rigid abdomen
  • Seizures
  • Paralysis

If ALS required: support airway, cardiac monitoring, O2 saturation and end-tidal CO2,

• Establish an IV in uninjured extremity
• For severe muscle spasms administer either;
  • DIAZEPAM (VALIUM), 5 mg IVP slowly,
  • MIDAZOLAM (VERSED) IVP slowly or IN for sedation if needed
    • Less than 60 y/o 1 mg/min titrate to effect (Maximum of 5 mg)
    • Greater than 60 y/o 0.5 mg/minute titrate to effect (Maximum of 3 mg)
• RAPID TRANSPORTATION and alert the receiving facility of the specific bite/sting.

VIPERIDS (PIT VIPERS): Includes rattlesnakes, copperheads, cottonmouths

• Evaluate for specific signs / symptoms
  • Distinct “fang marks” or puncture wounds
  • Swelling or pain at the site
  • Weakness, nausea or vomiting
  • Parenthesis fasciculations
  • Numbness and tingling around the face and head
  • Metallic taste, change in taste sensation
  • Hypotension and shock
  • Allergic reaction/ Anaphylaxis

IF ALS required: support airway, cardiac monitoring, O2 saturation and end-tidal CO2, establish an IV in uninjured extremity

RAPID TRANSPORTATION and alert the receiving facility of the specific bite/sting.

ELAPIDS: Includes coral snakes, cobras and mamba

• Evaluate for specific signs / symptoms
• Contact Florida Poison Control at 1-800-222-1222. There is limited supply of coral snake antivenin available and Poison Control will advise which hospital to transport to. There are very few hospitals that have the antivenin on hand.
• Most signs /symptoms may be delayed up to 12 hours and are related to the type of Venom (a neurotoxin)
• CNS disturbances may be observed
• Respiratory paralysis may develop
• Follow treatment for pit vipers

IF ALS required: Support airway, cardiac monitoring, O2 saturation and end-tidal CO2, establish an IV in an uninjured extremity.

RAPID TRANSPORTATION and alert the receiving facility of the specific bite sting.

SCORPION STINGS:

• Evaluate for specific signs / symptoms
  • Mild to sharp pain which progresses to numbness
  • Salivation
  • Slurred speech or Muscle twitching
  • Allergic reaction

IF ALS required: Support airway, cardiac monitoring, O2 saturation and end-tidal CO2, establish an IV in an uninjured extremity.

For severe muscle spasms administer either,

• DIAZEPAM (VALIUM), 5 mg IVP slowly,
• MIDAZOLAM (VERSED) IVP slowly or IN for sedation if needed
  • Less than 60 y/o 1 mg/min titrate to effect (Maximum of 5 mg)
  • Greater than 60 y/o 0.5 mg/minute titrate to effect (Maximum of 3 mg).

RAPID TRANSPORTATION and alert the receiving facility of the specific bite or sting.

DO NOT APPLY ICE OR COLD PACKS, TOURNIQUETS, MAKE INCISIONS AROUND THE AREA OR ATTEMPT TO SUCTION SNAKE BITES OR MARINE STINGS.