Bites, Stings & Poisons

FIRST AID FOR BITES AND STINGS

Snakebites, insect bites, or stings can cause intense pain and/or swelling.  If not treated promptly and correctly, they can cause serious illness or death.   The severity of a snakebite depends upon: whether the snake is poisonous or nonpoisonous, the type of snake, the location of the bite, and the amount of venom injected.  Bites from humans and other animals, such as dogs, cats, bats, raccoons, and rats, can cause severe bruises and infection and tears or lacerations of tissue.  Awareness of the potential sources of injuries can reduce or prevent them from occurring. Knowledge and prompt application of first-aid measures can lessen the severity of injuries from bites and stings and keep the Scout from becoming a serious casualty.
Types of Snakes
Nonpoisonous Snakes. There are approximately 130 different varieties of nonpoisonous snakes in the United States. They have oval shaped heads and round eyes. Unlike poisonous snakes, discussed below, nonpoisonous snakes do not have fangs with which to inject venom. Figure 6-1 depicts the characteristics of a nonpoisonous snake.
Poisonous Snakes. Poisonous snakes are found throughout the world, primarily in tropical to moderate climates. Within the United States, there are four kinds: rattlesnakes, copperheads, water moccasins (cottonmouth), and coral snakes. Poisonous snakes in other parts of the world include sea snakes, the fer-de-lance, the bushmaster, and the tropical rattlesnake in tropical Central America; the Malayan pit viper in the tropical Far East; the cobra in Africa and Asia; the mamba (or black mamba) in central and southern Africa; and the krait in India and Southeast Asia. Refer to Figure 6-2 for characteristics of a poisonous pit viper.
Figure 6-1
Figure 6-2.
Pit Vipers (Poisonous). Variety of poisonous snakes.
Tropical Rattlesnake
Water Moccasin
Bushmaster
Maylayan Pit Viper
Fer De Lance
Copperhead

The casualty’s condition provides the best information about the seriousness of the situation, or how much time has passed since the bite occurred. Pit viper bites are characterized by severe burning pain.  Discoloration and swelling around the fang marks usually begins within 5 to 10 minutes after the bite. If only minimal swelling occurs within 30 minutes, the bite will almost certainly have been from a nonpoisonous snake or possibly from a poisonous snake which did not inject venom. The venom destroys blood cells, causing a general discoloration of the skin. Blisters and numbness in the affected area follow this reaction. Other signs, which can occur, are weakness, rapid pulse, nausea, shortness of breath, vomiting, and shock.

Corals, Cobras, Kraits, and Mambas. Corals, cobras, kraits, and mambas all belong to the same group even though they are found in different parts of the world. All four inject their venom through short, grooved fangs, leaving a characteristic bite pattern.
Rattlesnakes, bushmasters, copperheads, fer-de-lance, Malayan pit vipers, and water moccasins (cottonmouth) are called pit vipers because of the small, deep pits between the nostrils and eyes on each side of the head (Figure 6-2). In addition to their long, hollow fangs, these snakes have other identifying features: thick bodies, slit-like pupils of the eyes, and flat, almost triangular-shaped heads. Color markings and other identifying characteristics, such as rattles or a noticeable white interior of the mouth (cottonmouth), also help distinguish these poisonous snakes. Further identification is provided by examining the bite pattern of the wound for signs of fang entry. Occasionally there will be only one fang mark, as in the case of a bite on a finger or toe where there is no room for both fangs, or when the snake has broken off a fang.
The small coral snake, found in the Southeastern US, is brightly colored with bands of red, yellow (or almost white), and black completely encircling the body. Other nonpoisonous snakes have the same coloring, but on the coral snake found in the US, the red ring always touches the yellow ring. To know the difference between a harmless snake and the coral snake found in the United States, remember the following: “Red on yellow will kill a fellow, Red on black, venom will lack.”
The venom of corals, cobras, kraits, and mambas produces symptoms different from those of pit vipers. Because there is only minimal pain and swelling, many people believe that the bite is not serious.  Delayed reactions in the nervous system normally occur between 1 to 7 hours after the bite. Symptoms include blurred vision, drooping eyelids, slurred speech, drowsiness, and increased salivation and sweating. Nausea, vomiting, shock, respiratory difficulty, paralysis, convulsions, and coma will usually develop if the bite is not treated promptly.
Sea snakes are found in the warm water areas of the Pacific and Indian oceans, along the coasts, and at the mouths of some larger rivers. Their venom is VERY poisonous, but their fangs are only 1/4 inch long. The first aid outlined for land snakes also applies to sea snakes.
Snakebites
Poisonous snakes DO NOT always inject venom when they bite or strike a person. However, all snakes may carry tetanus (lockjaw); anyone bitten by a snake, whether poisonous or nonpoisonous, should immediately seek medical attention.
• In the event you are bitten, attempt to identify and/or kill the snake. Take it to medical personnel for inspection/identification. This provides valuable information to medical personnel who deal with snakebites. TREAT ALL SNAKEBITES AS POISONOUS.
• Poison is injected from the venom sacs through grooved or hollow fangs. Depending on the species, these fangs are either long or short. Pit vipers have long hollow fangs. These fangs are folded against the roof of the mouth and extend when the snake strikes. This allows them to strike quickly and then withdraw. Cobras, coral snakes, kraits, mambas, and sea snakes have short, grooved fangs. These snakes are less effective in their attempts to bite, since they must chew after striking to inject enough venom (poison) to be effective.
If the bite is on an arm or leg, place a constricting band (narrow cravat [swathe], or narrow gauze bandage) one to two fingerbreadths above and below the bite (Figure 6-3). If the bite is on the hand or foot, place a single band above the wrist or ankle. The band should be tight enough to stop the flow of blood near the skin, but not tight enough to interfere with circulation. In other words, it should not have a tourniquetlike affect. If no swelling is seen, place the bands about 1 inch from either side of the bite. If swelling is present, put the bands on the unswollen part at the edge of the swelling. If the swelling extends beyond the band, move the band to the new edge of the swelling. (If possible, leave the old band on, place a new one at the new edge of the swelling, and then remove and save the old one in case the process has to be repeated.)
The venoms of different snakes cause different effects. Pit viper venom (hemotoxin [blood toxin]) destroys tissue and blood cells.  Cobras, adders, and coral snakes inject powerful venom (neurotoxin [nerve toxin]) which affect the central nervous system, causing respiratory paralysis.  Water moccasins and sea snakes have venom that is both hemotoxic and neurotoxic.
The identification of poisonous snakes is very important since medical treatment will be different for each type of venom. Unless it can be positively identified, the snake should be killed and saved. When this is not possible or when doing so is a serious threat to others, identification may sometimes be difficult since many venomous snakes resemble harmless varieties. When dealing with snakebite problems in foreign countries, seek advice, professional or otherwise, which may help identify species in the particular area of operations.
Get the casualty to a Hospital as soon as possible and with minimum movement. Until evacuation or treatment is possible, have the casualty lie quietly and not move any more than necessary. If the casualty has been bitten on an extremity, DO NOT elevate the limb; keep the extremity level with the body. Keep the casualty comfortable and reassure him. If the casualty is alone when bitten, he should go to the medical facility himself rather than wait for someone to find him. Unless the snake has been positively identified, attempt to kill it and send it with the casualty. Be sure that retrieving the snake does not endanger anyone or delay transporting the casualty.
Figure 6-3
If the bite is located on an arm or leg, immobilize it at a level below the heart. DO NOT elevate an arm or leg even with or above the level of the heart.

CAUTION  When a splint is used to immobilize the arm or leg, take EXTREME care to ensure the splinting is done properly and does not bind. Watch it closely and adjust it if any changes in swelling occur.

When possible, clean the area of the bite with soap and water. DO NOT use ointments of any kind.
NEVER give the casualty food, alcohol, stimulants (coffee or tea), drugs, or tobacco.
Remove rings, watches, or other jewelry from the affected limb.

CAUTION  DO NOT attempt to cut open the bite nor suck out the venom. If the venom should seep through any damaged or lacerated tissues in your mouth, you could immediately lose consciousness or even die.
Human or Animal Bites
Human or other land animal bites may cause lacerations or bruises. In addition to damaging tissue, bites always present the possibility of infection.
a. Human Bites. Human bites that break the skin may become seriously infected since the mouth is heavily contaminated with bacteria. Medical personnel MUST treat all human bites.
b. Animal Bites. Land animal bites can result in both infection and disease. Tetanus, rabies, and various types of fevers can follow an untreated animal bite. Because of these possible complications, the animal causing the bite should, if possible, be captured or killed (without damaging its head) so that it can be tested for disease.
c. First Aid.
(1) Cleanse the wound thoroughly with soap.
(2) Flush it well with water.
(3) Cover it with a sterile dressing.
(4) Immobilize the injured arm or leg, if appropriate.
(5) Transport the victim immediately to a Hospital.

NOTE  If unable to capture or kill the animal, provide medical personnel with any information that will help identify it.

Marine (Sea) Animals
With the exception of sharks and barracuda, most marine animals will not deliberately attack. The most frequent injuries from marine animals are wounds by biting, stinging, or puncturing. Wounds inflicted by marine animals can be very painful, but are rarely fatal.
a. Sharks, Barracuda, and Alligators. Wounds from these marine animals can involve major trauma as a result of bites and lacerations. Bites from large marine animals are potentially the most life threatening of all injuries from marine animals. Major wounds from these animals can be treated by controlling the bleeding, preventing shock, giving basic life support, splinting the injury, and by securing prompt medical aid.
b. Turtles, Moray Eels, and Corals. These animals normally inflict minor wounds. Treat by cleansing the wound(s) thoroughly and by splinting if necessary.
c. Jellyfish, Portuguese Man-of-War, Anemones, and Others.  This group of marine animals inflict injury by means of stinging cells in their tentacles. Contact with the tentacles produces burning pain with a rash and small hemorrhages on the skin. Shock, muscular cramping, nausea, vomiting, and respiratory distress may also occur. Gently remove the clinging tentacles with a towel and wash or treat the area. Use diluted ammonia or alcohol, meat tenderizer, and talcum powder. If symptoms become severe or persist, seek medical assistance.
d. Spiny Fish, Urchins, Stingrays, and Cone Shells. These animals inject their venom by puncturing the skin with their spines. General signs and symptoms include swelling, nausea, vomiting, generalized cramps, diarrhea, muscular paralysis, and shock. Deaths are rare. Treatment consists of soaking the wounds in hot water (when available) for 30 to 60 minutes.  This inactivates the heat sensitive toxin. In addition, further first aid measures (controlling bleeding, applying a dressing, and so forth) should be carried out as necessary.

CAUTION  Be careful not to scald the casualty with water that is too hot because the pain of the wound will mask the normal reaction to heat.

Insect (Arthropod) Bites and Stings
An insect bite or sting can cause great pain, allergic reaction, inflammation, and infection. If not treated correctly, some bites/stings may cause serious illness or even death. When an allergic reaction is not involved, first aid is a simple process. In any case, medical personnel should examine the casualty at the earliest possible time. It is important to properly identify the spider, bee, or creature that caused the bite/sting, especially in cases of allergic reaction.
• If there is a stinger present (for example, from a bee), remove the stinger by scraping the skin’s surface with a fingernail or knife.                        DO NOT squeeze the sac attached to the stinger because it may inject more venom.

• Wash the area of the bite/sting with soap and water (alcohol or an antiseptic may also be used) to help reduce the chances of an                        infection and remove traces of venom.

• Remove jewelry from bitten extremities because swelling may occur.

• In most cases of insect bites the reaction will be mild and localized; use ice or cold compresses (if available) on the site of the                             bite/sting. This will help reduce swelling, ease the pain, and slow the absorption of venom. Meat tenderizer (to neutralize the                            venom) or calamine lotion (to reduce itching) may be applied locally. If necessary, seek medical assistance.

• In more serious reactions (severe and rapid swelling, allergic symptoms, and so forth) treat the bite/sting like you would treat a                            snakebite; that is, apply constricting bands above and below the site.

• Be prepared to perform basic life-support measures, such as rescue breathing.

• Reassure the casualty and keep him calm.

• In serious reactions, attempt to capture the insect for positive identification; however, be careful not to become a casualty                                     yourself.

• If the reaction to the bite/sting appears serious, seek medical assistance.
Signs and Symptoms.
Discussed in paragraphs (1) and (2) below are the most common effects of insect bites/stings. They can occur alone or in combination with the others.
Types of Insects. The insects found throughout the world that can produce a bite or sting are too numerous to mention in detail. Commonly encountered stinging or biting insects include brown recluse spiders, black widow spiders, tarantulas, scorpions, urticating caterpillars, bees, wasps, centipedes, conenose beetles (kissing bugs), ants, and wheel bugs. Upon being reassigned, especially to overseas areas, take the time to become acquainted with the types of insects to avoid.
Less serious. Commonly seen signs/symptoms are pain, irritation, swelling, heat, redness, and itching. Hives or wheals (raised areas of the skin that itch) may occur. These are the least severe of the allergic reactions that commonly occur from insect bites/stings. They are usually dangerous only if they affect the air passages (mouth, throat, nose, and so forth), which could interfere with breathing. The bites/stings of bees, wasps, ants, mosquitoes, fleas, and ticks are usually not serious and normally produce mild and localized symptoms. A tarantula’s bite is usually no worse than that of a bee sting. Scorpions are rare and their stings (except for a specific species found only in the Southwest desert) are painful but usually not dangerous.
Serious. Emergency allergic or hypersensitive reactions sometimes result from the stings of bees, wasps, and ants. Many people are allergic to the venom of these particular insects. Bites or stings from these insects may produce more serious reactions, to include generalized itching and hives, weakness, anxiety, headache, breathing difficulties, nausea, vomiting, and diarrhea.  Very serious allergic reactions (called anaphylactic shock) can lead to complete collapse, shock, and even death. Spider bites (particularly from the black widow and brown recluse spiders) can also be serious. Venom from the black widow spider affects the nervous system.  This venom can cause muscle cramps, a rigid, nontender abdomen, breathing difficulties, sweating, nausea, and vomiting. The brown recluse spider generally produces local rather than system-wide problems; however, local tissue damage around the bite can be severe and can lead to an ulcer and even gangrene.
First Aid. There are certain principles that apply regardless of what caused the bite/sting. Some of these are—
WARNING  Insect bites/stings may cause anaphylactic shock (a shock caused by a severe allergic reaction). This is a life-threatening event and a TRUE MEDICAL EMERGENCY.  Be prepared to perform the basic life-support measures and to immediately transport the casualty to a Hospital.

NOTE  Be aware that some allergic or hypersensitive individuals may carry identification or emergency insect bite treatment kits. If the casualty is having an allergic reaction and has such a kit, administer the medication in the kit according to the instructions which accompany the kit.
Types
First Aid Measures
Snake Bite
Brown Recluse Spider
Tarantula Bite
Bee Sting
1  Move victim away from snake
2  Remove all jewelry from affected area, if applicable
3  Reassure victim and keep him quiet
4  Apply constricting band, 1-2 fingerbrredths from the bite. 
   You should be able to insert a finger between the band and skin
a.  Arm or Leg bite.  Place one band above and one band below the bite site
b.  Hand or Foot bite.  Place one band above the wrist or ankle
5.  Immobilize the affected part in a position below the level of the heart
6.  Kill the snake (if possible, without damaging the head or endangering yourself)
     and send it with the victim
7.  Seek medical attention immediately
1   Keep the victim quiet
2   Remove all jewelry from affected part, if applicable
3   Wash the area
4   Apply ice or freeze pack, if available
5   Seek medical attention immediately
1   Wash the area
2   Remove all jewelry from affected part, if applicable
3   Apply ice or freeze pack, if available
4   Apply baking soda, calamine lotion or meat tenderizer (if available)
      to bite site to relieve pain and itching
5   If the site of the bite is on the face, neck (possible airway problems),
      or genital area, or if local reaction seems severe, or if the sting is by
      the dangerous kind of scorpion found in the Southwest United States
      Desert, keep the victim as quiet as possible.  Seek medical assistance.
1   If the stinger is present, remove by scraping with a knife or fingernail. 
      Do not squeeze venom sack; more venom may be injected
2   Remove all jewelry from affected part, if applicable
3   Wash the area
4   Apply ice or freeze pack, if available
5   If allergic signs or symptoms appear, be prepared to perform basic life
      support measures.  Seek medical assistance
Signs & Symptoms
One or two small puncture marks
Pain, redness, and possible swelling
Nausea and vomiting
Disturbed vision
Sweating
Pain at site of sting, possible stinger
Slightly swollen, red and sore skin
Redness & sharp pain
Sweating
Nausea & vomiting
Stomach pain & cramps
Severe muscle pain & spasms
Breathing difficulty
Mild to severe pain
Swelling & tenderness at site
Fever
Chills
Nausea & vomiting
Joint pain
Faint rash
Black Widow Bite
Severe, sharp pain
Swelling
Discoloration
Extreme pain
Tiny blisters
Pain similar to bee sting
Redness
Warm to touch
Ant Bite
Scorpion Sting
Poisonous Plants / Swallowed Poisons
POISON CONTROL CENTER
800-222-1222
The oily sap from the leaves, stem and roots of poison ivy, poison oak and poison sumac irritates the skin of most people.  Once the sap gets on the skin it can spread to other parts of the body and cause a rash with redness, blisters, swelling, itching, burning, fever and headaches.  The severity of the reaction depends on the individual and the extent of the exposure.  The best form of prevention is to learn how to recognize the poisonous plants in your area and to avoid contact with them. 
Learn what poisonous plants look like and stay away from them.  "Leaflets three, let it be"  Might help you remember to avoid plants that have leaflets grouped in threes such as poison ivy.  White berries are another signal of poisonous plants, although not all plants with three leaves or white berries are poisonous.  Wear protective clothing (disposable coveralls, rubber coated or non latex gloves) and take care when handling tools, clothing, and gear that can be contaminated.
The sap of these plants must be on your skin for 10-20 minutes before they start to cause problems.  So, if you think you have touched a poisonous plant, immediately stop to wash the exposed area well with soap and water.  Wipe with rubbing alcohol and apply calamine lotion or other soothing skin treatments.  If the reaction is severe, if the genital area is affected, or if plant parts were chewed or swallowed, seek immediate medical attention. 

The sap also binds to well to clothing, so change clothes.  Keep the outfit you were wearing separate from your other clothing and wash it separately back home. 
A poison is a drug, chemical, or toxic liquid that can cause illness or death if swallowed.  Any drug or medicine can be poisonous it not taken according to a doctors instructions or directions on the label.  Many cosmetics, cleaning products, pesticides, plants, and other household products also contain chemicals that may be harmful if swallowed. 

Call the poison control center if you have a poisoning emergency.  Keep this number handy.
Meanwhile, follow these steps.

1.  Immediately take any poison containers to a telephone.  Call the poison control center or your local emergency response number (if a life threatening condition such as unconsciousness, a change in consciousness, or no breathing is found),  and follow the instructions you are given.

2.  Treat the victim for shock and monitor breathing.
Do not give anything by mouth unless you are told to do so by medical professionals. 

3.  Save any vomit (use a bowl, cookpot, or plastic bag).  It will help a physician identify the poison and give the right treatment. 
Signs & Symptoms
Around the mouth if it is a corrosive poison

Possible vomiting, or later diarrhea

If alcohol poisoning, smell of alcohol on breath and flushed moist face, slurred speech

Victim may be drowsy and may become unconscious

Important

Never give victim anything to drink (including milk and water).

Do not try to make victim vomit as anything that burned going down to her stomach, will burn again coming up.

Do not leave victim alone unless you have to do so to call emergency services.

Take care not to get any of the chemical on yourself.  If you do so, wash it off.

If the victim becomes unconscious.
    Call 911 or local EMS
    Be ready to begin resuscitation.  If you need to give rescue
breaths and there are chemicals on the victims mouth, use a face
mask to protect yourself.
Poison Ivy
Poison Oak
Poison Sumac
Severe Reaction