Insect Stings and Bites

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ENVENOMATION BY INSECTS

  • Bees &  Wasps: Usually benign, but may provoke either laryngeal oedema or anaphylactic shock.
  • Spiders & Scorpions: The majority of spiders are benign. If a truly toxic species is thought to be responsible apply first aid and supportive measures as for snake bite (see Section below)

SNAKE BITES

Venom diffuses mainly via the lymphatics, not via Blood vessels, tourniquets are thus of little use

First Aid Treatment 

  • Clean the wound with Cetrimide + Chlorhexidine solution 15% + 1.5% diluted 1 in 20 with water

Alternatively

  • Clean with Hydrogen Peroxide Solution 3%
  • Apply film constant pressure to the site of the bite
  • Apply a crepe bandage firmly to the entire limb
  • Immobilize the patient for 12 hours observation
  • Give reassurance

Note: Not all patients with snakebite should be given Anti-venom Administration of Snake Antivenom

  • Ensure that the Anti-Venom solution is clear
  • Give 0.5 ml of Adrenaline 1/1000 subcutaneously if needed
  • Give 100 ml of the Polyvalent Antivenom as an iv infusion, diluted in 300 ml of Normal Saline
  • Children:
    • Dilute in 0.4 ml/kg of saline
    • Give the infusion slowly for the first 15 minutes (most reactions occur within this period)
    • Thereafter increase the rate gradually until the whole infusion is completed within 1 hour

If there is a history of allergy:

  • The patient may still need to be given Anti-venom because of systemic poisoning, but take particular care

If a reaction occurs:

  • Hydrocortisone may need to be administered in addition to Adrenaline
  • Give an antihistamine:
    • Give Promethazine 25 mg 24 hourly           
  • If there is no clinical improvement by the end of the infusion:  
    • Repeat the same dose as above

Note: Reserve Polyvalent Snake Anti – venom (anti-snakebite serum) for patients with one or more of these signs and symptoms:

  • Hypotension
  • Vomiting
  • Neurotoxicity
  • Haemotoxicity

SUPPORTIVE THERAPY

Give reassurance - most snake bites are not dangerous

  • Treat shock if any

Children > 6 months:

  • manage in accordance to ABCCCD approach
  • give adequate analgesia
  • give maintainance IV fluids
  • Give Tetanus Toxoid Vaccination. If patient is developing signs of tetanus:
    • Give Tetanus Antitoxin (ATS) 1,500 IU s/c or IM
  • Only give antibiotics if evidence of necrosis, no indication for prophylactic antibiotics
  • Eventually excise sloughs and graft skin early
    • If evidence of compartment syndrome refer to the surgical team for fasciotomy