Bites and Stings Other Flashcards
Irukandji (carukia barnesi) syndrome
Tiny jellyfish can cause this severe, potentially fatal delayed (~30 mins) syndrome.
Be prepared for CPR.
Give morphine IV or fentanyl IV every 5 mins as required.
CPAP and oxygen for pulminary oedema.
Consider IV magnesium (minimal evidence).
No antivenom to date.
‘Blue bottle’ and other stinging jellyfish
Wash sting site with sea water.
Remove any tentacles with sea water or gloved hand
Immerse site in tolerably hot water (about 45°C) for 20 min.
- (test tolerance on other limb or check with thermometer)
Give oral paracetamol ASAP.
Box jellyfish or sea wasp (Chironex fleckeri)
Treatment
Remove the victem from the water to prevent drowning
Immediately remove any tentacles with a glove
Inactivate the tentacles by pouring vinegar over the sting site and surrounding area for 30 secs (do not use alcohol)
- —use up to 2 L of vinegar at a time.
- Use a cold pack for small stings.
Check respiration and the pulse
- Start immediate CPR (if nec.)
- Gain IV access and use colloid
- give oxygen and ionotropes (if nec.)
Immobilisation for major stings
Give box jellyfish antivenom by IM or IV injection
Provide pain relief if required (ice, lignocaine and analgesics) and/or parenteral fentanyl or morphine
Mollusc bite (blue-ringed octopus, cone shell)
Mollusc venoms usually cause numbness and paraesthesia
- but can be rapidly fatal because of prolonged muscular weakness leading to respiratory paralysis.
Treatment
- Apply compression bandage to bite site
- Immobilise the limb
- Arrange ambulance to a medical facility
- Observe (and manage) for respiratory paralysis.
- Ensure adequate ABC.
Sandfly (biting midges) bites
Use soothing anti-itch cream or 5% lignocaine ointment if painful.
For some reason, possibly the nature of body odour, the use of oral thiamine may prevent sandfly bites (thin evidence).
Dose: Thiamine 100 mg orally, daily.
Bed bug bites
Now a common problem, usu. in children and teenagers:
- the ‘backpacker itch’.
Presents as a linear group of ≥3 bites commonly on;
- neck
- shoulders
- arms
- torso
- legs
- corresponding to the superficial blood vessels.
Appears as extremely itchy maculopapular red lesions ± weals.
Treatment
- Clean the lesions
- Apply corticosteroid ointment qid or a simple antipruritic ointment
- Call in a licensed pest controller
Spider bites
Stinging fish
The sharp spines of the stinging fish have venom glands that can produce severe pain if they spike or even graze the skin.
The best known of these is the stonefish.
The toxin is usu. heat sensitive.
Envenomation
- intense pain
- localised swelling
- bluish discolouration
Treatment
Bathe or immerse the affected part in very warm to hot water (not scalding
- —about 45°C) for 20 mins
- —may give instant relief
If pain persists, give a local injection/infiltration of lignocaine 1% or even a regional block.
- If still persisting, morphine IV or fentanyl IV.
A specific antivenom is available for the sting of the stonefish
Bites from ants, wasps, mosquitos and some jellyfish.
First aid
Wash the site with large quantities of cool water. Soapy water for mosquito bites.
Apply vinegar (liberal amount) or Stingose to the wound for ~30 secs
Apply ice for several mins
Use soothing anti-itch cream e.g. hydrocortisone cream or 5% lignocaine cream or ointment if very painful
Medication is not usually necessary
- for a jellyfish sting the direct application of Antistine-Privine drops onto the sting (after washing the site) is effective.
- Can use topical liquid antacid containing aluminum sulphate or hydroxide.
Bee stings
First aid:
Scrape sting off sideways with a fingernail or knife blade.
Do not squeeze it with fingertips.
Apply 20% aluminium sulphate solution (Stingose)
or methylated spirits
Apply ice to the site
Rest and elevate the limb that has been stung
If anaphylaxis, treat as appropriate.
