Animal bites are best treated as puncture wounds and simply washed and dressed. In some cases ANTIBIOTICS may be given to minimise the risk of infection, together with TETANUS toxoid if appropriate. Should RABIES be a possibility, then further treat-ment must be considered. Bites and stings of venomous reptiles, amphibians, scorpions, snakes, spiders, insects and fish may result in clinical effects characteristic of that particular poisoning. In some cases specific ANTIVENOMS may be administered to reduce morbidity and mortality.
Many snakes are non-venomous (e.g. pythons, garter snakes, king snakes, boa constrictors) but may still inflict painful bites and cause local swelling. Most venomous snakes belong to the viper and cobra families and are common in Asia, Africa, Australia and South America. Victims of bites may experience various effects including swelling, PARALYSIS of the bitten area, blood-clotting defects, PALPITATIONS, respiratory difficulty, CONVULSIONS and other NEUROTOXIC and cardiac effects. Every year there are nearly 100,000 deaths from snakebite worldwide. Victims should be treated as for shock – that is, kept at rest, kept warm, and given oxygen if required, but nothing by mouth. The bite site should be immobilised but a TOURNIQUET must not be used. All victims require prompt transfer to a medical facility. When appropriate and available, antivenoms should be administered as soon as possible.
Similar management is appropriate for bites and stings by spiders, scorpions, sea-snakes, venomous fish and other marine animals and insects.
The adder (Vipera berus) is the only venomous snake native to Britain; it is a timid animal that bites only when provoked. Fatal cases are rare, with only 14 deaths recorded in the UK since 1876, the last of these in 1975. Adder bites may result in marked swelling, weakness, collapse, shock, and in severe cases HYPOTENSION, non-specific changes in the electrocardiogram and peripheral leucocytosis. Victims of adder bites should be transferred to hospital even if asymptomatic, with the affected limb being immobilised and the bite site left alone. ANAPHYLAXIS should be treated with ADRENALINE (epinephrine). Many who know they are at risk carry a portable injection device. Hospital management may include use of a specific antivenom, European viper venom antiserum.
The weever fish is found in the coastal waters of the British Isles, Europe, the eastern Atlantic, and the Mediterranean Sea. It possesses venomous spines in its dorsal fin. Stings and envenomation commonly occur when a bather treads on the fish. The victim may experience localised, increasing pain over two hours. As the venom is heat-labile, immersing the affected area in water at approximately 40 °C (uncomfortably hot but not scalding) for 30 minutes should ease the pain. Cold applications will worsen the discomfort. Simple ANALGESICS and ANTIHISTAMINES may be given.
If stung by a jellyfish, the best option is to lift off any tentacles sticking to the person's skin (using gloves or tweezers) and apply an ice pack or bicarbonate of soda – but not vinegar or suntan lotions which may make things worse.
Bees, wasps and hornets are insects of the order Hymenoptera and the females possess stinging apparatus at the end of the abdomen. Stings may cause local pain and swelling but rarely cause severe toxicity. ANAPHYLACTIC reactions can occur in sensitive individuals, and may be fatal. Deaths caused by upper-airway blockage as a result of stings in the mouth or neck regions are reported. In victims of stings, the sting should be removed as quickly as possible by flicking, scraping or pulling. The site should be cleaned. ANTIHISTAMINES and cold applications may bring relief. For ANAPHYLACTIC reactions ADRENALINE, by intramuscular injection, may be required.