++
Most bites do not result in envenomation, which tends to occur in snake handlers or in circumstances where the snake has a clear bite of the skin.
++
Keep the patient as still as possible.
Do not wash, cut or manipulate the wound, or apply ice or use a tourniquet.
Immediately bandage the bite site firmly (not too tight). A crepe bandage is ideal: it should extend above the bite site for 15 cm, e.g. if bitten around the ankle, the bandage should cover the leg to the knee.
Splint the limb to immobilise it: a firm stick or slab of wood would be ideal.
Transport to a medical facility for definite treatment. Do not give alcoholic beverages or stimulants.
If possible, the dead snake should be brought along.
++
Note: A venom detection kit can be used to examine a swab of the bitten area or a fresh urine specimen (the best) or blood.
++
The bandage can be removed when the patient is safely under medical observation. Observe for symptoms such as vomiting, abdominal pain, excessive perspiration, severe headache and blurred vision.
+++
Treatment of envenomation
++
Set up a slow IV infusion of N saline.
Give IV antihistamine cover (15 minutes beforehand) and 0.3 mL of adrenaline 1:1000 SC (0.1 mL for a child).
Dilute the specific antivenom (1:10 in N saline) and infuse slowly over 30 minutes via the tubing of the saline solution.
Have adrenaline on standby.
Monitor vital signs.
++
Sydney funnel-web: as for snake bites.
++
Other spiders: apply ice pack, do not bandage.
+++
Treatment of envenomation
++
Sydney funnel-web:
Red-back spider:
+++
Human bites and clenched fist injuries
++
Human bites, including clenched fist injuries, often become infected by organisms such as Staphylococcus aureus, streptococcus species and beta-lactamase producing anaerobic bacteria.
+++
Principles of treatment
++
Clean and debride the wound carefully, e.g. aqueous antiseptic solution or hydrogen peroxide.
Give prophylactic penicillin if a severe or deep bite.
Avoid suturing if possible.
Tetanus toxoid.
Consider rare possibility of HIV, hepatitis B or C, or infections.
++
+++
For severe penetrating injuries, e.g. joints, tendons
++
+++
Dog bites (non-rabid)
++
Animal bites are also prone to infection by the same organisms as for humans, plus Pasteurella multocida.
+++
Principles of treatment
++
Clean and debride the wound with aqueous antiseptic, allowing it to soak for 10 to 20 minutes.
Aim for open healing—avoid suturing if possible (except in ‘privileged’ sites with an excellent blood supply, such as the face and scalp).
Apply non-adherent, absorbent dressings (paraffin gauze and Melolin™) to absorb the discharge from the wound.
Tetanus prophylaxis: immunoglobulin or tetanus toxoid.
Give prophylactic penicillin for a severe or deep bite: 1.5 million units of procaine penicillin IM statim, then orally for 5 days. Tetracycline or flucloxacillin are alternatives.
Inform the patient that slow healing and scarring are possible.
++
Cat bites have the most potential for suppurative infection. The same principles apply as for management of human or dog bites, but use flucloxacillin. It is important to clean a deep and penetrating wound. Another problem is cat-scratch disease, presumably caused by a Gram-negative bacterium.
+++
Sandfly (biting midges) bites
++
For some reason, possibly the nature of body odour, the use of oral thiamine may prevent sandfly bites.
++
Dose: Thiamine 100 mg orally, daily.
++
For relief of itching apply an anti-itch cream and consider oral anti-histamines if severe.
++
The common bed bug (Cimex lectularis, Fig. 17.17) is now a major problem related to international travel. It travels in baggage and is widely distributed in hotels, motels and backpacker accommodation. Clinically bites are usually seen in children and teenagers. The presentation is a linear group of three or more bites (along the line of superficial blood vessels), which are extremely itchy. They appear as maculopapular red lesions with possible wheals. The lesions are commonly found on the neck, shoulders, arms, torso and legs. A bed bug infestation can be diagnosed by identification of specimens collected from the infested residence. Look for red- or rust-coloured specks about 5 mm long on mattresses.
++
++
Clean the lesions.
Apply a corticosteroid ointment.
A simple anti-pruritic agent may suffice.
Call in a licensed pest controller.
++
Control treatment is basically directed towards applying insecticides to the crevices in walls and furniture.
++
Tip: If a backpack is thought to harbour the bugs, put it in the freezer overnight.