Bites and Envenomation

Table of Contents

Aliases

Stings

Patient Care Goals

Bites, stings, and envenomations can come from a variety of insects, marine and terrestrial animals. There is a spectrum of toxins or envenomations with very limited EMS interventions.

  1. Assure adequate ventilation, oxygenation and correction of hypoperfusion
  2. Pain control which also includes limited external interventions to reduce pain

Patient Presentation

Inclusion Criteria

  1. Bites, stings, and envenomations can come from a variety of marine and terrestrial animals and insects causing local or systemic effects
  2. Patients may present with toxin specific reactions which may include:
    1. Site pain
    2. Swelling
    3. Muscle pain (hallmark of black widow spider bites)
    4. Erythema
    5. Discoloration
    6. Bleeding
    7. Nausea
    8. Abdominal pain
    9. Hypotension
    10. Tachycardia
    11. Tachypnea
    12. Muscle incoordination
    13. Confusion
    14. Anaphylaxis/allergic reactions
  3. There is a spectrum of toxins or envenomations and limited EMS interventions that will have any mitigating effect on the patient in the field
    1. The critical intervention is to get the patient to a hospital that has access to the antivenin if applicable.

Exclusion Criteria

None

Patient Management

Assessment

  1. Assess ABCDs and if indicated expose and then cover to assure retention of body heat
  2. Vital signs which include temperature
  3. Apply a cardiac monitor, examine rhythm strip for arrhythmias, and consider obtaining a 12-lead EKG
  4. Check blood glucose Level
  5. Monitor pulse oximetry and ETCO2 for respiratory decompensation
  6. Patient pertinent history
  7. Patient physical with special consideration to area of envenomation especially crotalid bite

Treatment and Interventions

  1. Consider an IV fluid bolus 20 mL/kg up to 1 liter, repeat as necessary
  2. Consider vasopressors after adequate fluid resuscitation for the hypotensive patient [for adult vs. pediatric dosing see Shock guideline]
  3. If seizure, treat per Seizures guideline
  4. Specific therapy for select bites, stings, or envenomation
    1. Contact poison control center, 1-800-222-1222 and follow their recommendations.
  5. Provide adequate analgesia per the Pain Management guideline

Notes – Bites and Envenomation