Bites and stings: complications and management

Question 1

Bees and wasps

Answer 1

Anaphylaxis

Antihistamines and steroids; IM epinephrine if anaphylaxis develops

Question 2

Spiders

Answer 2

Necrosis, hypocalcemia

Supportive measures; antivenom if available. Surgical resection and skin grafts for severe necrosis

Question 3

Scorpions

Answer 3

In severe cases, cranial nerve dysfunction, excessive motor activity, respiratory compromise

Supportive with benzodiazepines and analgesics; atropine for hypersalivation and respiratory distress (not to be used with foreign scorpion stings); IV scorpion-specific antibody

Question 4

Snakes

Answer 4

Venom poisoning

Antivenom is the mainstay of treatment. Elevate the affected limb above the heart. Compression bands help, but tourniquets are contraindicated. Suction and incision are dangerous and should not be done.

Question 5

Dogs and cats

Answer 5

Infection, rabies/tetanus

Amoxicillin / clavulanate for puncture wounds, bites to hands/feet, and high-risk or immunocompromised patients.

Question 6

Humans

Answer 6

Infection

Amoxicillin / clavulanate unless very minor

Question 7

Rodents

Answer 7

Low risk of infection; not known to carry rabies

Local wound care

Question 8

Bats, skunks, raccoons, ferrets, dogs, cats

Answer 8

Rabies

If an animal displays signs of rabies, administer 1 dose of human rabies immune globulin and 4 doses of rabies vaccine over 14 days if the patient has never been vaccinated.

Previously vaccinated patients do not need immune globulin and require only 2 doses of vaccine

Question 9

Any wound

Answer 9

Tetanus

Administer tetanus toxoid if the patient had ≤ 3 lifetime toxoids and the las was ≥ 10 years ago for a minor / clean wound, or ≥ 5 years for all other wounds.

Administer tetanus immune globulin only if wound is major/dirty, and the patient had ≤ 3 lifetime toxoids.