Notes – Bites and Envenomation

Bites and Envenomation

Patient Safety Considerations

  1. Do not:
    1. Apply tourniquets, tight Ace®/crepe bandage, or constricting bands above or below the site of the envenomation
    2. Incision and/or suction wound to remove toxin
    3. Apply cold packs or immerse the effect extremity in ice water (cryotherapy)
  2. EMS providers should not try to capture the offending marine or terrestrial animal or insect
  3. If the offending organism has been killed, beware that many dead insect, marine, or fanged animals can continue to bite or sting with venom and should be safely placed in a hard sided and closed container for future identification
  4. Patient may still have an imbedded stinger, tooth, nematocyst, or barb which may continue to deliver toxin if left imbedded. Consider safe removal without squeezing the toxin delivery apparatus

Notes/Educational Pearls

Key Considerations

Pertinent Assessment Findings

  1. Assess for signs and symptoms of local and systematic impact of the suspected toxin

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914079 – Injury-Bites and Envenomations-Land
  • 9914081 – Injury-Bites and Envenomations-Marine

Key Documentation Elements

  • It is helpful to accurately describe the suspect bite or sting source without risking patient or EMS provider
  • Only transport source animal or insect if can be done safely in a hard-sided container
  • Repeat evaluation and documentation of signs and symptoms as patient clinical conditions may deteriorate rapidly
  • Time of symptoms onset and time of initiation of exposure-specific treatments
  • Therapy and response to therapy

Performance Measures

  • Offending organism was managed appropriately without secondary exposure
  • Appropriate and timely definitive treatment was provided
  • Appropriate pain management

References

  1. Aacharya RP, Gastmans C, Denier Y. Emergency department triage: an ethical analysis. BMC Emerg Med. 2011;11:16.
  2. American College of Medical Toxicology, American Academy of Clinical Toxicology, American Association of Poison Control Centers, European Association of Poison Control Centres, International Society on Toxinology, Asia Pacific Association of Medical Toxicology. Pressure immobilization after North American crotalinae snake envenomation. J Med Toxicol. 2011;7(4):322-3.
  3. Hoffman RS, Howland MA, Lewin NA, Nelson LS, Goldfrank LR. Goldfrank’s Toxicologic Emergencies, 10th Edition. China: McGraw-Hill Education; 2015.
  4. Lavonas EJ, Ruha AM, Banner W, et al. Unified treatment algorithm for the management of crotaline snakebite in the United States: results of evidence-informed consensus workshop. BMC Emerg Med. 2011;11:2.
  5. Prestwich H, Jenner R. Best evidence topic report. Treatment of jellyfish stings in UK coastal waters: vinegar or sodium bicarbonate? Emerg Med J. 2007;24(9):664.
  6. Ward N. Evidence-based treatment of jellyfish stings in North America and Hawaii. Ann Emerg Med. 2012;60(4):399-414.
  7. Weinstein SA, Dart RC, Stables A. Envenomations: an overview of clinical toxinology for the primary care physician. Am Fam Physician. 2009;80(8):793-802.