1. Once Bitten, Twice Stung, and other Toxins: Treatment Applications in the Backcountry

2. Learning Objectives Identify common poisonous & venomous native to Utah (plant & animal) Understand BASIC biology of haemotoxins and neurotoxins Treatments of venomous and non-venomous exposures in the backcountry setting Recognize signs and symptoms of anaphalaxis & provide appropriate care of medicines

3. Poisonous vs. Venomous Many differing definitions Poisonous (toxins): in biological terms an organism that contains a substance throughout the body that causes harm – Poison ivy, poison oak, poison sumac toxin – Monarch butterflies and milkweed toxin

4. Venomous (toxins): in biological terms an organism that injects from internal gland – Crotalids (rattlesnakes) – Black widow spiders – Gila monsters

5. Native Utah Poisonous & Venomous Species Utah State Extension Office Reptiles – Great Basin Rattlesnake – Midget Faded Rattlesnake – Mojave Rattlesnake – Desert Sidewinder – Prairie Rattlesnake – SW Speckled Rattlesnake – Gila Monster Arthropods – Blackwidow spider – Sac spider – Huntsman spider – Ticks & bacteria/viruses – Bark scorpion Plants – Baneberry – Deadly Nightshade – Death Camus – Donkey’s Tail (Spurge) – False Hellebore – Jimson Weed – Lupine – Oregon Grape – Poison Hemlock, parley – Poison Ivy – Snow on Mountain – Stinging Nettle – Wart weed – Water Hemlock – W Monkshood, wolfsbane – Poison Sumac

6. Identification of the Reptiles Crotalids (pit vipers in Utah) – infrared sensing “pits” on either side of head – ambush predators, mostly nocturnal – head shape (not always reliable)

7. Identification of Arthropods Spiders – Black Widow = red hourglass for females

8. – Yellow Sac Spider = known for building silk sacs under plants, between leaves, under bark, & rocks; bright yellow to bright green

9. – Huntsman Spider = gold color, darkened feet or socks; under bark or other secluded areas

10. Ticks and associated bacteria/viruses – similar to spiders, but distinct head shape – often carries/vectors bacteria and viruses to humans Rocky Mt. spotted fever (bacteria) Q-fever (bacteria) Tularemia (bacteria) Colorado tick fever (virus) Powassan encephalitis (virus) Tick paralysis (neurotoxin)

11. Rocky Mt. wood tick

12. American Dog tick

13. Bark Scorpion = light or pale color, 8 legs, & “stinger” tail

14. Identification of Poisonous Plants Stinging Nettle: 1-2 ft. tall; covered with brittle, hollow, silky hairs; leaves and stems are toxic; often confused with mint

15. Poison Ivy: low shrub, less than 4 ft.; shady wooded areas; poisonous sap in all plant parts

16. Poison Oak: leafy vine growing low to ground; leaves are toxic; typical oak leaf shape

17. Jimsonweed: annual herb up to 5 ft.; green/purplish colored leaves w/ serrated edges; entire plant is toxic

18. Poison Hemlock: often confused with wild carrot; entire plant is toxic; up to 8 ft.

19. Deadly Nightshade: belladonna; shrub with bell-shaped flowers; leaves and fruit are toxic; source of Atropine used to increase heart rate

20. Death Camus: grass-like, 6-28 in.; perennial; often confused with wild onion; entire plant is toxic

21. Basic Biology of Toxins Haemotoxins: natural substance (enzymes) that causes damage to blood – Disruption in clotting mechanisms (increase or decrease) – Haemolysis: destruction of RBCs by breaking membrane – Organ degeneration & tissue damage – Swelling, in some cases extreme – Decreased blood pressure – Some venoms have enzyme to increase tissue permeability for increased absorption

22. – Almost all Utah native rattlesnakes use haemotoxin – Exception is the Mojave Rattlesnake that uses haemotoxin and neurotoxin

23. Neurotoxins: disables the CNS causing muscles to stop working – Mojave Rattlesnake – this includes diaphragm leading to suffocation – inhibits neuron control over ion concentrations across membranes – Inhibits communication between nerve cells Can induce tentany (involuntary muscle contraction) Enzymatic disruption of acetylcholine degeneration

25. Signs & Symptoms of Envenomation Bleeding from wound; can be severe Pain/Burning sensation at site May have fang marks at site Swelling (edema) at site; can be severe Blurred vision/drooped eyelids Tiredness/weakness Numbness Decreased BP; rapid, weak pulse Nausea/vomiting Breathing difficulty Skin color changes Tissue damage paralysis

26. Bite Treatments in the Backcountry Understand that ANY bite from a venomous or non-venomous animal is an EMERGENCY! – Skin barrier has been violated, risk of infection – Venomous bites will swell almost immediately

27. – No way to know how much venom has been injected – Victim may/may not be able to help with evacuation (tough to move immobile person) – Lack of pain management – Juveniles are at greater risk because of size

28. Stay calm; you and patient – Knowledge is power; explain what is happening and what will happen – Call for assistance (911) right away Restrict movement Cover and bandage

29. Remove any restricting clothing (including jewelry) Monitor vitals: – BP, HR, breathing rate, temperature – Just note rate, then notice any changes – This becomes important at handoff to professionals

30. Note time of bite, type of snake – Do not catch snake – Do not bring live/dead snake to professionals – Take a picture Sawyer kit, Stun Gun, tourniquet, cross-cuts – No reliable data on Sawyer kit

31. – Stun gun: REALLY!?! Not FDA approved 20-25 volts or more - not safe for children Hasn’t been reproduced in lab setting No scientific evidence

32. – Tourniquet: risk of circulation damage, not recommended – Cross cuts: no evidence to suggest this works and too risky anyway DO NOT attempt to suck venom out by mouth DO NOT give pain medicines Keep affected area below the heart

33. Sting Treatments in the Backcountry Non-allergic – Remove stinger – Control swelling with limited exposure to ice – Remove restricting clothing and jewelry – Acetaminophen or ibuprofen (no aspirin) – Antihistamine, mix of baking soda and water, calamine, or mud for itch – Keep area clean to prevent infection

34. Anaphalaxis Exaggerated response by immune system to foreign substance Can develop within seconds; life threatening Massive histamine response – Vasodilation – Increased capillary permeability = loss of plasma from circulation Spasm of bronchial muscle & swelling = breathing difficulties

35. Signs and Symptons of Anaphylaxis Chest pain, trouble swallowing Hives, swelling, tingling, itchiness, and skin rash Nausea, vomiting, dizziness, diarrhea, and stomach cramps

37. Treatment of Anaphylaxis Epinephrine is most effective – Patient prescription – Patient may need help with injector – Temporary relief; this is still an EMERGENCY – Evacuation to facility