9.8. BITES AND POISONING

Related titles

Stings.

Purpose of assistance

Bites, stings and poisoning can be caused by various insects, sea and land animals. There is a whole range of toxins and poisons when treatment in the EMD system is limited.

1. Ensuring adequate ventilation, oxygenation and treatment of hypoperfusion.
2. Pain control, which also includes limited, external pain relief interventions.

Description of the patient

Inclusion criteria

1. Bites, stings, poisoning caused by various marine and terrestrial animals, as well as insects, can cause local or systemic effects.

2. Patients may exhibit symptoms characteristic of a certain type of poison, including:

a) pain in the affected area;
b) edema;
c) muscle pain (a clear sign of a black widow spider bite);
d) erythema;
e) skin color change;
e) bleeding;
e) nausea;
e) abdominal pain;
g) hypotension;
h) tachycardia;
k) tachypnea;
y) violation of muscle coordination;
i) disorientation;
i) anaphylactic/allergic reaction.

3. There are a number of poisons and toxins against which workers have a very limited arsenal of interventions at the pre-hospital stage.
The most important intervention is to quickly admit the patient to a hospital that has the appropriate antidote.

Exclusion criteria

Absent.

Management of the patient

Status assessment

1. Perform a complete examination (ABCDE), if necessary, undress the patient and then cover to keep warm.
2. Assess vital signs, including body temperature.
3. Perform cardiac monitoring, assess for arrhythmias, then record a 12-lead ECG.
4. Check your glucose level.
5. Monitor pulse oximetry and ETSO2.
6. Collect medical history relevant to this case.
7. Do a physical examination, with special focus on the affected area (especially for viper bites).

Treatment and intervention

1. Infusion therapy bolus (physiological solution or combined medicine with the composition of sodium chloride + potassium chloride + sodium lactate + calcium chloride) 20 mg/kg up to 2 l.

2. Use vasopressors after adequate fluid resuscitation for hypotension (doses for children and adults according to the “Shock” guideline).

3. In case of convulsions, act according to the instruction “Convulsions”.

4. Specific therapy for bites, stings and poisoning:

a) antidotes for common poisonous substances (for example, black widow spiders, black scorpions, vipers, coral vipers) are usually distributed in medical facilities; in such cases, transport the patient to a hospital that has antidotes (if possible);
b) jellyfish (Medusozoan cnidarians):

• • • • as there is a wide variety of jellyfish, it is important to be knowledgeable about the species and appropriate handling of native aquatic creatures;
      • typically, any remaining tentacles or nematocysts are cleaned off, then the affected body part is immersed in hot water (113°F/45°C). Except for some species of jellyfish (eg Physalia, species found in Australian waters) in which the nematocysts can be activated by vinegar (acetic acid), it can be used to relieve pain by deactivating the nematocysts remaining in the skin. Vinegar can also activate sea nettle nematocysts and is not recommended after exposure to this type of jellyfish.

c) wingfish, scorpion, stingray:

• • • • submerge a part of the body in hot water to reduce the pain associated with the toxin.

5. Administer adequate analgesia according to the “Pain Control” guideline.

Patient safety

1. Prohibited:

a) apply tourniquets or a pressure bandage below or above the lesion;
b) cut and/or suction toxins from the lesion;
c) apply cold packs with ice or immerse the affected limb in ice water (cryotherapy).

2. EMD employeesshould not try to catch an animal or insect.

3. Despite death, remember that most dead insects and animals also have the ability to inject poison into the body through a sting or bite, so they should be placed in a closed container for later identification.

4. The patient may still have a stinger, tooth, nematocyst or needle in their body that can continue to inject venom. Carefully remove it from the affected area, while not squeezing the poison carrier itself.

Useful information for training

Key points

Vinegar can worsen the sting of certain jellyfish by activating the nematocysts. Rescuers must be familiar with poisonous species of animals and know how to properly counteract their poison.

Corresponding evaluation results

1. Assess for signs and symptoms of local/systemic exposure to potential toxin.
2. The patient may still have a stinger, tooth, nematocyst, or needle in their body that can continue to inject venom.

Key elements of documentation

1. Providing a detailed description of the bite or source of injury without risk to the patient or the EMD team would be very helpful.
2. Transport the affected animal or insect only in a closed container.
3. Conduct a repeat examination with further indication of signs and symptoms, as the patient’s clinical condition may rapidly deteriorate.
4. Time of manifestation of symptoms and time of initiation of treatment (specific to the causative agent of poisoning).
5. Treatment and response to treatment.

Criteria for the effectiveness of aid provision

1. The poisonous organism is properly removed without secondary effects.
2. Ensuring appropriate and timely treatment.
3. Appropriate analgesia.