Bites and stings — snake, spider, centipede and scorpion
For animal and human bites — see Animal or human bites
Snakebites — land and sea
Only effective antivenom is CSL land or sea snake antivenom
Do not
- Do not let person move — take transport to person
- Do not wash bite site — hospital has test to find out kind of snake from venom left on skin
- Do not give antivenom out bush — unless advised by doctor
Do first
Most important thing — stop spread of venom from bite site
- If unconscious or collapsed — DRS ABC
- Medical consult
- Lie person down, keep as calm and still as possible
- Apply pressure bandage and immobilisation
- Start at toes or fingers and work up. If bite on trunk or head — just bandage bite site
- Use firmest bandage you have. Elastic is much better than crepe
- Apply bandage as firmly as possible to the limb. You should not be able to easily slide a finger between the bandage and the skin
- Use 15cm wide bandage for leg
- Splint bitten arm or leg to stop it moving
- Immobilise whole person — use stretcher if available
Check
- Calculate age-appropriate REWS
- Adult — AVPU, RR, O2 sats, pulse, BP, Temp
- Child (less than 13 years) — AVPU, respiratory distress, RR, O2 sats, pulse, central capillary refill time, Temp
- Weight, BGL
- U/A for blood and protein — save urine for venom identification
- Coma scale score, ptosis (drooping eyelid), lack of ophthalmoplegia (eye movement)
- Repeat every hour — more often if person getting worse
- Immunisation status — tetanus
Do
- Put in IV cannula — oozing around site may indicate envenoming
- Take blood for UEC, CK
Redback spider bite
Not life threatening but can cause significant pain
Do not
- Do not put on tourniquet or pressure bandage — will make pain worse
Ask
- Pain at bite site
- Increasing over minutes to hours
- Lasts more than 24 hours
- Pain radiating from bite site to close limb, trunk, local lymph nodes
- Feeling unwell, lethargy, headache
- Abdominal pain, nausea, vomiting
- Increased sweating
- Priapism (painful erection) in boys
- May present as intractable crying in an infant
Check
- Calculate age-appropriate REWS
- Adult — AVPU, RR, O2 sats, pulse, BP, Temp
- Child (less than 13 years) — AVPU, respiratory distress, RR, O2 sats, pulse, central capillary refill time, Temp
- Weight, BGL
- Head-to-toe exam — signs and symptoms usually obvious in 1–6 hours if going to happen
- Bite site may not be obvious
- If these signs/symptoms — think of bite, even if no clear story
- Sweating around bite site or strange patterns of regional sweating (eg sweating below both knees)
- May have abdominal pain and/or chest pain
- Child — irritable and agitated
- Immunisation status — tetanus
Do
- Cold pack (do not put ice directly on bite) OR hot pack/water may help with pain
- Give pain relief
- If still pain or severe pain — medical consult including possible role for antivenom especially in children
Centipede or scorpion sting
May be very painful but usually only lasts 6–12 hours
- Centipede bites — may be a lot of redness and swelling, allergic reactions can occur
- Scorpion bite/sting — may be no mark
Check
- Immunisation status — tetanus
Do
- Wash bite and apply antiseptic
- Cold pack (do not put ice directly on bite) OR hot pack/water may help with pain
- Give pain relief, if needed
- Monitor for 4 hours for systemic toxicity, rare (eg vomiting, headache, sweating, hypertension)