Lesson 6: Bleeding and Wounds

Lesson Outlines Chapter 19

Lesson 19: Bites and Stings

Lesson Objectives After completing this lesson, participants should be able to:  Explain what rabies is.  Describe the care for an animal bite.  Describe the care for a human bite.  Discuss how to care for a pit viper bite.  Discuss how to care for a coral snake bite.  Discuss how to care for a nonpoisonous snakebite.  Describe how to care for insect bites and stings.  Describe how to care for a black widow spider bite.  Describe how to care for a brown recluse spider bite.  Describe how to care for a tarantula bite and embedded tarantula hairs.  Describe how to care for a common aggressive house spider (hobo spider) bite.  Describe how to care for a scorpion sting.  Describe how to care for a centipede bite.  Describe how to care for a mosquito bite.  Describe how to care for an embedded tick.  Describe how to care for a shark bite.  Describe how to care for barracuda and moray eel bites.  Describe how to care for marine animal injuries.  Describe how to care for a stingray puncture.

Points Animal Bites  It is estimated that one of every two Americans will be bitten at some time by an animal or by another person.  Dogs are responsible for about 80% of animal bite injuries. o Most are minor  Bacteria can enter through bite wound.  Cat bites have higher rate of infection.  Ferrets are especially likely to bite.  Children and older people are at greater risk.

Rabies  Virus found in warm-blooded animals, spread through saliva  An animal should be considered potentially rabid if it: o Attacked without provocation o Acted strangely or out of character o Is a high risk species

1 of 11 Lesson Outlines Chapter 19

 Report animal bites to the police or animal control  Animal control should capture or confine for observation

Recognizing an Animal Bite  Puncture wound  Tissue/skin crushed  Open wound on fingers, knuckles, or hand  Animal present

Care for an Animal Bite  Flush with soap and water under pressure.  Avoid scrubbing.  Control bleeding and cover the wound with sterile dressing.  Seek medical care for cleaning, tetanus shot, or rabies care.

Human Bites  After dogs and cats, most likely bit is from human.  Infection can occur.  Most occur during acts of violence.  Most common location is hand.  Recognizing human bites  Two types: o True bites—from fights or abuse o Clenched-in fist injury—cutting a fist on teeth

Care for Human Bites  Wash with soap and water.  Avoid scrubbing.  Flush with running water under pressure.  Control bleeding with direct pressure  Cover with sterile dressing. o Do not close wound.  Seek medical care for cleaning, tetanus shot, sutures.

Snakebites  Death from snakebites rarely occurs.  If death does occur, it occurs in the first 48 hours after the bite.  Only four snake species in the United States are poisonous. o Rattlesnake (pit viper) o Water moccasin (pit viper) o Copperhead (pit viper) o Coral snake

 Rattlesnake, water moccasin, coral snake are pit vipers. o Triangular, flat heads wider than necks o Elliptical pupils o Heat-sensitive pit between eye and nostril on each side  Adult snakebites are more serious.

Pit Vipers  Found in all states but Alaska, Maine, Hawaii  Most bites are on extremities.  Alcohol intoxication is a factor  Diamondback rattlesnake bites especially deadly o Antivenin must be given

Recognizing Pit Viper Bites  Severe, burning pain  One or two small puncture wounds (fang marks)  Swelling  Discoloration and blood-filled blisters  Nausea, vomiting, sweating, and weakness

Care for Pit Viper Bites  Get victim away from the snake.  Keep the victim calm and limit movement.  Wash area with soap and water  Stabilize bitten extremity like you would a fracture.  Seek medical care.

Coral Snake Bites  The coral snake is America’s most venomous snake.  It tends to hang on or chew rather than strike and release.  Symptoms begin 1 to 5 hours after bite.

Recognizing Coral Snake Bites  Minimal pain  Sagging or drooping upper eyelids  Weakness  Pricking, tingling skin  Double vision  Difficulty swallowing  Sweating  Abnormal flow of saliva

Care for Coral Snake Bites  Keep victim calm.

 Gently clean with soap and water.  Apply mild pressure and bandage.  Seek medical care for antivenin.

Nonpoisonous Snake Bites  Nonvenomous snakes inflict the most bites.  Some so-called nonpoisonous snakes have venom.  Can cause painful local reactions

Recognizing Nonpoisonous Snake Bites  Mild to moderate pinch  Horseshoe-shaped bite marks  Bleeding  Mild itching

Care for Nonpoisonous Snake Bites  Gently clean with soap and water.  Care is the same as for minor wound  Seek medical care.

Insect Stings  Severe allergic reactions to insect stings can be life-threatening.  Honeybees and some yellow jackets have barbed stingers that embed in skin. o Stingers leave venom, continue to release after the bee leaves  Wasp, yellow jacket, hornet, and fire ant stingers not barbed o Can sting multiple times  Mostly self-limited, local reactions  Swelling/redness might peak 2-3 days after sting  Life-threatening symptoms: nausea, vomiting, wheezing, fever, drippy nose  Anaphylactic symptoms: difficulty speaking, tightness in throat/chest, shortness of breath, chest pain  Sting can be fatal in minutes if the victim is severely allergic.

Recognizing Insect Stings  Pain, redness, itching, swelling  Worrisome symptoms o Hives, swelling of lips or tongue, tickle in throat, wheezing  Life-threatening symptoms o Blue/gray skin color, seizures, unresponsiveness, inability to breathe  Range of symptoms can vary

 Stings to mouth or eye are more dangerous.

Care for Insect Stings  Remove stinger and venom sac.  Wash with soap and water.  Apply ice.  Give aspirin (adults), acetaminophen, or ibuprofen.  Consider topical steroid or antihistamine.  Observe victim for 30 minutes.  Assist with prescribed epinephrine kit if reaction is severe.  Call 9-1-1 for signs of severe allergic reaction.

Spider and Insect Bites  Only a few spiders produce significant poisoning.  Most bites are from female spiders.  Little immediate pain, difficult to diagnose

Black Widow Spiders  Can also be brown or gray  Females are large; up to 2-inch leg span  Venom contains neurotoxin  Causes severe muscle pain, cramping

Recognizing Black Widow Spider Bites  Sharp pinprick, then dull pain  Two fang marks  Very severe pain  Bite on lower body o Muscle stiffness, abdominal cramps  Bite on upper body o Muscle stiffness/pain in shoulders, back, chest  Headache, chills, fever, sweating, dizziness, nausea, vomiting

Care for Black Widow Spider Bites  Catch spider if possible.  Clean with soap and water or rubbing alcohol.  Apply ice.  Give aspiring (adults), ibuprofen, or acetaminophen.  Monitor breathing.

 Seek medical care.

Brown Recluse Spiders  Violin-shaped figure on back  Males and females are venomous.

Recognizing Brown Recluse Spider Bites  Local reaction, mild to severe pain at bite site  Redness, swelling, itching  Blister forms, becomes red, bursts o Bull’s-eye pattern o Scab forms, falls off and leaves crater o Process recurs, leaving larger crater  Fever, weakness, vomiting, joint pain, rash  Stomach cramps, nausea, vomiting

Care for Brown Recluse Spider Bites  Catch spider if possible.  Clean with soap and water or rubbing alcohol.  Apply ice.  Give aspirin (adults), ibuprofen, or acetaminophen.  Seek medical care.

Tarantulas  Bite only when provoked or roughly handled  Will scratch its abdomen with its legs when upset  Hairs flick onto person’s skin  Bite pain ranges from almost painless to deep throbbing pain lasting up to 1 hour.

Recognizing Tarantula Bites and Embedded Hairs  Pain—aching or stinging  Hairs cause itching, inflammation that can last several weeks

Care for Tarantula Bites and Embedded Hairs  Tarantula bite o Catch spider if possible. o Clean with soap and water or rubbing alcohol. o Apply ice. o Give aspirin (adults), ibuprofen, or acetaminophen. o Seek medical care.  Embedded tarantula hairs o Remove hairs with sticky tape. o Wash with soap and water. o Apply hydrocortisone cream.

o Give aspirin (adults), ibuprofen, or acetaminophen. o Give antihistamine.

Common Aggressive House Spider  Also called the hobo spider  Most common large spider in Pacific Northwest

Recognizing Common Aggressive House Spider Bites  Redness, blisters  Later: gangrene (dead tissue)  Headache, visual problems, weakness

Care for Common Aggressive House Spider Bites  Catch spider if possible.  Clean with soap and water or rubbing alcohol.  Apply ice.  Give aspirin (adults), ibuprofen, or acetaminophen.  Seek medical care.

Scorpion Stings  Look like miniature lobsters  Bark scorpion is only threatening to humans. o Primarily found in Arizona  Severe cases usually only in children  Death is rare.  Ensure airway and breathing

Recognizing Scorpion Stings  Local immediate pain and burning, followed by numbness and tingling  No swelling or blanching  Tapping finger over site causes pain.  Can cause paralysis, spasms in legs/arms, facial twitching  Severe reactions: fast heart rate, salivation, breathing distress

Care for a Scorpion Sting  Monitor breathing.  Gently clean with soap and water or rubbing alcohol.  Apply ice.  Give aspirin (adults), ibuprofen, or acetaminophen.  Seek medical care. Centipede Bites  Giant desert centipede is only US centipede dangerous to human.  Can inject venom through fangs (not legs)  Venom is relatively weak.

Recognizing Centipede Bites  Burning pain  Local inflammation  Mild swelling of lymph nodes  Giant desert centipede bite: inflammation, swelling, redness lasting 4-12 hours  Swelling and tenderness can last 3 weeks, or disappear and recur

Care for Centipede Bites  Millipedes (2 pairs of legs per body segment) do not have venom, but can irritate skin. o Wash with soap and water. o Apply cortisone cream or ointment.  Centipedes (1 pair of legs per body segment): o Clean with soap and water. o Apply ice. o Give aspirin (adults), acetaminophen, or ibuprofen. o Seek medical care for severe reactions.

Mosquito Bites  Mosquitoes can carry malaria, yellow fever, dengue fever, and encephalitis.  No evidence of transmitting HIV or AIDS  Need blood to lay eggs  Breed in water  Most bite at twilight

Care for Mosquito Bites  Wash with soap and water.  Apply ice.  Apply calamine lotion or hydrocortisone ointment.  Victims with many bites or allergic reaction may take antihistamine or physician- prescribed cortisone.

Embedded Ticks  Hard ticks familiar from domestic animals  Soft ticks mainly in western states  Can carry diseases  Need blood meal to grow to next stage  Bites are nearly painless  Burrows head in skin  As they feed, their body size increases. Care for Embedded Ticks  Remove with tweezers as soon as possible.  Grasp as close to skin as possible.

o Lift with enough force to tent skin. o Hold until tick lets go (1 minute). o Pull tick away from skin. o Wash with soap and water. o Apply rubbing alcohol. o Apply ice. o Apply calamine lotion. o Watch bite site for rash for one month. o Seek medical care for rash. o Watch for fever, muscle aches, sensitivity to bright light, leg weakness, and paralysis.

Fire Ants  Aggressive, can sting repeatedly  Immediate pain  Red, swollen area which disappears in 45 minutes  Blister forms, ruptures in 30-70 hours, can become infected  Anaphylaxis can occur  Apply ice.  Use topical corticosteroid cream.

Marine Animal Injuries  Most sting in defense, not attack  Can cause anaphylaxis  If serious reaction, keep airway open

Sharks  Very minimal chance of attack  Leg is most frequently bitten part  Injuries are similar to boat propeller injuries or chainsaw injuries.  Immediate bleeding control and shock treatment are essential.

Recognizing a Shark Bite  Severe bleeding  Large, open wounds, most often on legs  Abrasions from contact with sharkskin

Care for a Shark Bite  Control bleeding.  Treat for shock.  Seek medical care.

Barracudas and Moray Eels  Barracuda bites are rare.

 Moray eels can give multiple puncture wounds.  Have high infection risk  First aid for both is identical as for shark bite.

Recognizing Barracuda and Moray Eel Bites  Barracuda lacerations o Similar to shark lacerations  Eel bites o Severe puncture wounds o Hold on to victim o Leave multiple, small puncture wounds

Care for Barracuda and Moray Eel Bites  Barracuda bite o Same care as shark bite.  Eel bite o Flush wound with water under pressure. o Control bleeding.

Marine Animals That Sting  Important to identify specific animal  Reactions include mild dermatitis to severe reactions  Portuguese man-of-war sting o Well-defined linear welts  Jellyfish sting o Severe muscle cramping, thin lines of welts in zigzag pattern  Anemones also sting

Recognizing Marine Animal Injuries  Stinging  Severe itching, burning  Prickling, tingling  Blisters  Severe allergic reaction  Difficulty breathing  Muscle cramping  Nausea, vomiting

Care for Marine Animal Injuries  Apply vinegar or alcohol.  Scrape off tentacles.  Reapply vinegar or alcohol, soaking for 15 minutes.  Monitor breathing.

Stingrays  Usually peaceful, lie buried in sand or mud  Wounds occur when victim steps on ray  Barbed tail thrusts into victim’s leg or foot  Usually like a laceration  Venom causes intense burning pain

Recognizing a Stingray Puncture  Sudden, intense pain  Open wound  Swelling

Care for a Stingray Puncture  Immerse injured part in hot water for 30-90 minutes.  Wash with soap and water.  Irrigate with water under pressure.  Treat like any puncture wound.

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