Stings and Bites: What To Do About Envenomation Injuries

The radio and pager alert your unit to a possible envenomation injury. The dispatcher tells you the caller was working in his garage, and, when he reached under his workbench for a tool, something bit him. Now, 10 minutes later, his right arm is swollen, and the swelling is slowly moving up toward his elbow.

Many questions should come to mind at this point. What bit him? You should generally know what poisonous creatures are in your area and begin forming ideas about the culprit. Was the creature poisonous? This is obvious from the dispatcher’s information, but what about specifics: How much venom? Was the injury a direct hit or a glancing bite or sting?

What treatment steps have the patient or bystanders taken? Some arcane but often used treatments are deleterious to the patient. Most important, does the creature pose a threat? Will you need to enter the house with a weapon, preferably one with a long handle? In a best-case scenario, someone will have captured the creature and will hand it to you as you walk in.

What Is An Envenomation Injury?

Envenomation, in the purest sense, is the introduction of poisonous venom into the body by means of a bite or sting. Envenomation can occur from a wide variety of creatures: large or small, aggressive or passive, cute and cuddly, or ugly and menacing. A large number of envenomation injuries occur from creatures that are barely noticed until an injury occurs, or from creatures that may appear quite harmless. The majority of envenomations occur from accidental or chance encounters. Rarely does a venomous creature attack or show unprovoked aggressive action. As Isaac Newton said, two objects cannot occupy the same space at the same time. When you inadvertently attempt to occupy the space held by another creature, it will usually defend itself.

In the United States, there are relatively few venomous creatures, compared with other parts of the world. For instance, Australia seems to be a particularly dangerous place to live, where venomous creatures on land and sea include: 61 species of snakes, 28 species of spiders and scorpions, 16 species of insects and 53 species of marine life. Even the benign duck-billed platypus has a venomous defense system.1 Other than for comparison, this article only covers the most common envenomation injuries by creatures indigenous to the United States. Because envenomation injuries comprise only a small number of emergency calls, only the most common creatures and injuries will be discussed, but emergency workers should become acquainted with creatures that live in their particular regions. Although many exotic venomous creatures reside in zoos and personal collections, most handlers are more prepared than emergency workers to manage those injuries.

General Treatment Protocols

Although a select few envenomation injuries require venom-specific hospital treatment, most injuries are treated the same way. Prehospital treatment consists of three objectives: 1) treating life-threatening symptoms; 2) treating other immediate symptoms; and 3) slowing the spread of venom. Additional treatments, such as antivenin administration or wound debridement, will take place at the hospital.

First and foremost is scene safety. The provider must make sure the venomous organism does not pose a threat to the patient or crew. If it does, take precautions to remove the threat. Depending on the creature, suitable precautions may range from summoning animal control to placing an insect between a boot and a hard place. Use common sense when ensuring scene safety. Reputably, half of all snakebites occur when people are trying to catch or harass the snake.2 Don’t become one of those people.