Bites And Stings Flashcards
� Bites and Stings
SNAKE BITE
Corticosteriods are of little or no value during poisoning except in treating ana- phylactic crisis. Avoid venopuncture in sites of generalized bleeding.
Referral criteria
Refer all patients with respiratory failure, heart failure, renal failure, muscle paralysis, muscle necrosis, bleeding or intravascular hemolysis to a regional hospital for specialist care.
Treatment— STG page 634
SNAKE BITE
Most snake bites are non-poisonous. Vipers are the commonest cause of poisonous snake bites in tropical Africa. Others are the cobras and water snakes. All cases of snake bites (venomous/non-venomous) should be observed for at least 6 hours. Identify the type of snake if possible. Don’t rely too much on fang marks; however multiple fang marks usually indicate a non-poisonous bite whereas one or two fang marks suggest a poisonous bite. It is important to determine whether envenomation has occurred. The role of tourniquets and incision over the site of the bite are controversial issues and are to be avoided.
Causes
y Snakes
Symptoms
y Pain
y Bleeding y Swelling
y Fainting
y Dark-coloured urine y Headache
y Muscle ache
y Fear
y Loss of consciousness
Signs
(Poisonous snake bites)
Cardiovascular:
y Hypotension, shock, cardiac arrhythmias
y Spontaneous systemic bleeding, from bite site, mucosa and old
wounds, haematuria
y Dark urine from myoglobinuria and intravascular haemolysis
Neuromuscular:
y Cranial nerve paralysis - ptosis, opthalmoplegia, slurred speech
y Bulbar respiratory paralysis - drooling, and inability to breath
properly
y Impaired consciousness, seizures y Meningism
y Tender and stiff muscles
Local effects:
y Rapid progression of swelling to more than half of bitten limb y Blistering, necrosis and bruising
y Fascial compartmentalisation on bitten digits
Investigations
y Full blood count
y Renal function test
y 20 minutes whole blood clotting test (leave 2-5 ml of blood in dried
test tube. Failure to clot after 20 minutes implies incoagulable blood) y Liver function test
SNAKE SPIT IN THE EYES
SNAKE SPIT IN THE EYES
The black-necked cobra or the spitting cobra sprays its venom into the eyes of its victim.
It causes irritation of the eyes and may cause conjunctivitis and even blindness if not washed away immediately.
Treatment
y Irrigate the eye with any liquid available (water, milk, saline etc).
y Instil diluted anti-venom (one part to five parts of Sodium Chloride
0.9%).
y Treatascornealabrasionwithtopicalantibiotics(Seesectionon‘Eye
Injuries’)
SCORPION STING
Scorpion stings leave a single mark, and the stings are extremely painful.
Symptoms
y Pain at the site of bite
y Localized swelling y Vomiting
y Abdominal pain
Signs
y Excessive salivation
y Sweating
y Rapid respiration
y Single-puncture wound
Treatment
Treatment objectives
y To relieve pain
y To maintain hydration y To reassure patient
Non-pharmacological treatment
y Detain for observation.
y Put ice compresses on the area.
y Give the patient plenty of fluids to drink
Pharmacological treatment
1st Line Treatment
y Paracetamol, Aspirin, Ibuprofen or Diclofenac, oral,
And
y 1% Lidocaine (Lignocaine), 2-5 ml for local infiltration to relieve pain
BEE AND WASP STINGS
Pharmacological treatment— STG page 637
Majority of bee and wasp stings only produce localized pain. They may occasionally cause allergic reactions, which may lead to anaphylaxis with local pain, generalized urticaria, hypotension, and difficulty in breathing as a result of bronchospasm and oedema of the glottis. Death may occur.
Symptoms
y Localized pain at the site of sting
Signs
y Swelling at site
y Urticuria
y Hypotension
y Difficulty in breathing y Bronchospasm
Treatment
Treatment objectives
y To relieve pain
y To manage anaphylaxis if necessary
Non-pharmacological treatment
y Detain for observation
y Put ice compresses on the area
y Give the patient plenty of fluids to drink
y Inthecaseofbeestingremovestingerfromskinbyscraping.Donot
pull it out
Referral Criteria
Refer all patients with anaphylaxis who are not responding to treatment
HUMAN BITES
Pharmacological treatment— sTG page 638
HUMAN BITES
Human bites (which usually occur during fights) lead to infections, which if neglected, almost invariably produce a highly destructive, necrotizing lesion contaminated by a mixture of aerobic and anaerobic organisms. A deliberately inflicted bite on the hand or elsewhere should be considered as contaminated.
Symptoms
y Pain
y Swelling
y Bleeding
y Fever, if bites get infected
Signs
y Teeth impression on bitten site
y Wound
Treatment
Treatment objectives
y To relieve pain
y To treat any secondary infection
Non-pharmacological treatment
y Clean wound thoroughly
As a general rule, do not suture wounds from human bite.
Referral Criteria
Refer if there is necrotising fasciitis.
DOG AND OTHER ANIMAL BITES
Pharmacological treatment page 639 STG
DOG AND OTHER ANIMAL BITES
Mammals, including dogs, may carry the rabies virus. Saliva from an infected animal contains large numbers of the rabies virus which is inoculated through a bite, laceration, or a break in the skin. There is also risk of tetanus and other bacterial infection following the bites of any
mammal.
Symptoms
y Pain
y Swelling
y Bleeding
y Fever, if bites get infected
Signs
y Teeth impression on bitten site y Wound
Treatment
Treatment objectives
y To treat laceration
y To prevent rabies infection
y To prevent other infections
y To treat any secondary infection
Non-pharmacological treatment
Immediate local care
y Wash site with soap and water
y All injuries-abraded skin: minor bites and scratches, major bites and
scratches are treated in the same way by thorough irrigation with copious amounts of saline solution or cleansing with cetrimide plus chlorhexidine solution
Indication for use of Rabies Immunoglobulin and Rabies vaccine
Table 23-1: Indication for use of Rabies Immunoglobulin and Rabies vaccine—- STG page 640
Indication for use of Rabies Immunoglobulin and Rabies vaccine
It should be remembered that not every animal carries rabies, although the possibility should be borne in mind for every animal bite. The treatment provided is dependent on both the certainty of the presence of the rabies virus in the animal and the Immunisation state of the patient.
Rabies Immunisation post exposure
Patients vaccinated within last three years
Day 0
Infiltrate wound and around wound with
y Rabies immunoglobulin (10 IU/kg body weight); And
Rabies Immunoglobulin (10 IU/kg body weight) by IM injection; 1 ml Rabies vaccine by IM injection*
Day 3 (or any day up to day 7)
1 ml Rabies vaccine by IM injection*
Patients with no vaccination or more than 3 years since vaccination
Day 0
Infiltrate wound and around wound with
y Rabies immunoglobulin (10 IU/kg body weight);
y Rabies Immunoglobulin (10 IU/kg body weight) by IM injection;
And
1 ml Rabies vaccine by IM injection* Days 3, 7, 14, 30
Note 23-13
Evidence shows that when this vaccine is injected into the gluteal region there is a poor response. Always use the deltoid muscle, or in small children the an- terolateral thigh, to give the IM injection of rabies vaccine.
Always complete the rabies vaccine monitoring form. Check availability of treat- ment for the next patient
First dose of anti-rabies vaccine may be given whilst observing for presence or absence of rabies in the dog
These guidelines are prepared with respect to the use of Rabies Immunoglobu- lin of human origin and human diploid cell rabies vaccine.
For the use of other products seek advice and guidance from the Pharmacist or SMO Public Health at either Regional or District level.
RABIES IMMUNISATION
Prophylactic immunisation should be offered to those at high risk (eg. laboratory staff working with rabies virus, animal handlers, veterinary surgeons, and wildlife officers likely to be exposed to bites of possibly infected wild animals).
y Rabies vaccine, IM, 1 ml on each of days 0, 7 and 28 Booster doses should be given every 2-3 years
Referral Criteria
Refer to a tertiary centre when symptoms of rabies set in.
