1. Chapter 19
Bites and Stings

2. Animal Bites
Dogs are responsible for about 80% of animal bite injuries.
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.

3. Rabies Spread through saliva by bite or lick Consider rabies if:
Animal attacked without provocation
Animal was behaving strangely
High-risk species
Report animal bites to police or animal control.
Animal control should capture or confine for observation

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

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

6. 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.

7. Recognizing Human Bites
Two types:
True bites
Clenched-in fist injury

8. 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.
Do not close wound.
Seek medical care for cleaning, tetanus shot, sutures.

9. Snakebites (1 of 2) Death from snakebites rarely occurs.
If death does occur, occurs in first 48 hours.
Poisonous species in United States:
Rattlesnake
Water moccasin
Coral snake
Copperhead

10. Snakebites (2 of 2)
Rattlesnake, water moccasin, coral snake are pit vipers.
Triangular, flat heads wider than necks
Elliptical pupils
Heat-sensitive pit between eye and nostril on each side
Adult snakebites are more serious.

11. 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.
Antivenin must be given.

12. Recognizing Pit Viper Bites
Severe burning pain
Fang marks
Swelling
Discoloration and blood-filled blisters
Nausea, vomiting, sweating, weakness

13. Care for Pit Viper Bites
Get victim away from snake.
Keep victim calm; limit movement.
Wash area with soap and water.
Stabilize extremity.
Seek medical care.

14. Coral Snake Bites America’s most venomous snake
Tends to hang on or chew
Symptoms begin 1 to 5 hours after bite.

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

16. Care for Coral Snake Bites
Keep victim calm.
Gently clean with soap and water.
Apply mild pressure and bandage.
Seek medical care for antivenin.

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

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

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

20. Insect Stings (1 of 2) Some people are allergic.
Honeybees and some yellow jackets have barbed stingers that embed in skin.
Stingers leave venom, continue to release after bee leaves
Wasp, yellow jacket, hornet, and fire ant stingers not barbed.
Can sting multiple times

21. Insect Stings (2 of 2) 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 severely allergic.

22. Recognizing Insect Stings
Pain, redness, itching, swelling
Worrisome symptoms
Hives, swelling of lips or tongue, tickle in throat, wheezing
Life-threatening symptoms
Blue/gray skin color, seizures, unresponsiveness, inability to breathe
Range of symptoms can vary
Stings to mouth or eye are more dangerous.

23. 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 for signs of severe allergic reaction.

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

25. 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

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

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

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

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

30. 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.

31. 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.

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

33. Care for Tarantula Bites and Embedded Hairs (1 of 2)
Catch spider if possible.
Clean with soap and water or rubbing alcohol.
Apply ice.
Give aspirin (adults), ibuprofen, or acetaminophen.
Seek medical care.

34. Care for Tarantula Bites and Embedded Hairs (2 of 2)
Embedded tarantula hairs:
Remove hairs with sticky tape.
Wash with soap and water.
Apply hydrocortisone cream.
Give aspirin (adults), ibuprofen, or acetaminophen.
Give antihistamine.

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

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

37. 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.

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

39. Recognizing Scorpion Stings
Local immediate pain and burning
Later, 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

40. Care for Scorpion Stings
Monitor breathing.
Gently clean with soap and water or rubbing alcohol.
Apply ice.
Give aspirin (adults), ibuprofen, or acetaminophen.
Seek medical care.

41. Centipede Bites
Giant desert centipede is only US centipede dangerous to human.
Can inject venom through fangs (not legs)
Venom is relatively weak.

42. 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

43. Care for Centipede Bites
Millipedes do not have venom, but can irritate skin.
Wash with soap and water.
Apply cortisone cream or ointment.
Centipedes
Clean with soap and water.
Apply ice.
Give aspirin (adults), acetaminophen, or ibuprofen.
Seek medical care for severe reactions.

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

45. 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.

46. 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.

47. Care for Embedded Ticks (1 of 2)
Remove with tweezers as soon as possible.
Grasp as close to skin as possible.
Lift with enough force to tent skin.
Hold until tick lets go (1 minute).
Pull tick away from skin.

48. Care for Embedded Ticks (2 of 2)
Wash with soap and water.
Apply rubbing alcohol.
Apply ice.
Apply calamine lotion.
Watch bite site for rash for one month.
Seek medical care for rash.
Watch for fever, muscle aches, sensitivity to bright light, leg weakness, paralysis

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

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

51. 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.

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

53. Care for a Shark Bite or Puncture
Control bleeding.
Treat for shock.
Seek medical care.

54. 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.

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

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

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

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

59. Care for Marine Stings Apply vinegar or alcohol. Scrape off tentacles.
Reapply vinegar or alcohol, soaking for 15 minutes.
Monitor breathing.

60. 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.

61. Recognizing a Stingray Puncture
Sudden, intense pain
Open wound
Swelling

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