Bites/Envenomation 

Assessment

Pediatric Pearls: Signs & Symptoms: Differential: 
□ Use approved reference document for medication dosing, electrical therapy, and equipment sizes.□ Rash, skin break, wound 
□ Pain, soft tissue swelling, redness 
□ Blood oozing from the bite wound 
□ Evidence of infection 
□ Shortness of breath, wheezing 
□ Allergic reaction, hives, itching 
□ Hypotension or shock		□ Animal bite 
□ Human bite 
□ Snake bite (poisonous) 
□ Spider bite (poisonous) 
□ Insect sting / bite (bee, wasp, ant, tick) 
□ Infection risk 
□ Rabies risk 
□ Tetanus risk
□ Abscess
□ Rash

Clinical Management Options

EMT-B
• Oxygen, target SpO2 92 – 96% 
• If Insect Bite: 
• Remove stinger, if appropriate 
• Apply ice pack 
• Minimize movement and remove constricting items 
• If Snake Bite 
• Splint limb, bandage, and place at level below heart 
• Minimize movement and remove constricting items 
• NO ice pack
Paramedic
• Vascular access as appropriate for patient condition 
• Pain management as needed
Consult Online Medical Control as Needed

Pearls

  • Do not try and catch a live animal (snake, spider, etc) to bring to the Emergency Department. You may take pictures or bring dead animals in a jar. 
  • Human bites have a very high risk of infection due to oral bacteria. 
  • Dog and Cat bites should be transported/seen that day for antibiotics.
  • Carnivore bites are much more likely to become infected and all have risk of Rabies exposure. 
  • Cat bites may rapidly progress to infection due to a specific bacterium (Pasteurella). 
  • Venomous snakes in this area are generally of the pit viper family: rattlesnake, copperhead, and water moccasin. 
  • Coral snake bites are rare: Very little pain but very toxic. “Red on yellow – kill a fellow, red on black – venom lack.” 
    • It is NOT necessary to take the snake to the ED with the patient. Take Picture if possible. 
  • Black Widow spider bites have minimal pain initially but may develop muscular pain and severe abdominal pain (spider is black with red hourglass on belly). 
  • Brown Recluse spider bites are minimally painful to painless. Little reaction is noted initially but tissue necrosis at the site of the bite develops over the next few days (brown spider with fiddle shape on back). OK to use ice pack for this bite. Most are uncomplicated. 
  • Evidence of infection: swelling, redness, drainage, fever, red streaks proximal to wound. 
  • Immunocompromised patients are at an increased risk for infection (diabetes, chemotherapy, transplant patients) 
  • May use soap and water to clean wounds if time and patient condition allows. 
  • Consider contacting the Poison Control Center for guidance. 1-800-222-1222 
  • Bats, skunks, foxes, and raccoons are the most common rabies vectors. Dogs have been eliminated    as reservoirs of rabies, unless known contact with a high-risk animal.