Give acetaminophen for pain if delay in hospital
treatment is anticipated.
Antivenom.Antivenom (also called antivenin)
is available for many snakes, and is indicated for
severe envenomations by Viperidae family snakes and
most envenomations by snakes of the other poisonous
families. Antivenom is best given as soon as possible
after an envenomation, but may be of value up to a few
days after a bite.
If possible, antivenom specific to the snake should
be used. Otherwise, a polyspecific antivenom may
be used. READ THE PACKAGE INSERT OF THE
ANTIVENOM FOR VALUABLE INFORMATION.
Epinephrine and diphenhydramine must be available,
as allergic reactions (including anaphylaxis) to
antivenom have occurred (they are often prepared
from horse serum, which some people are allergic to).
Antivenom is diluted (for example, 1:10) and
given at 5 ml/minute IV, and the dose is based on
stopping the progression of signs and symptoms, not
the victims body weight (the childrens dose is the
same as the adult dose). For neurotoxic snakebites, if
there is no improvement in 30 minutes, the dose should
be repeated. For Viperidae (which can cause bleeding
disorders), spontaneous bleeding should stop after
sufficient antivenom is given; continue giving
antivenom until bleeding stops and progression of
swelling is retarded.
Because you may need to
administer antivenom a number of times, one vial may
not be enough to treat a patient.
Antivenom is available via PCCs and hospitals. It
may also be available at zoos and embassies.
The Donts of Snakebite Treatment.The
following are the donts when it comes to treatment
DO NOT use any ice or cooling on the bite.
DO NOT use a tourniquet. Obstructing blood
flow can make local tissue injury much worse.
DO NOT use electric shock.
DO NOT make any cuts or incisions in the
Cuts at the bite site may impede
circulation and promote infection and make
local tissue injury much worse.
DO NOT give victim alcohol or narcotics.
Further information may be obtained on an
emergent basis from a PCC or from Arizona Poison
Control, (520) 626-6016.
Bites, Stings, and Punctures from Sea Animals
A number of sea animals are capable of inflicting
painful wounds by biting, stinging, or puncturing.
Except under rare circumstances, these stings and
puncture wounds are not fatal. Major wounds from
sharks, barracuda, moray eels, and alligators can be
treated by controlling the bleeding, preventing shock,
giving basic life support, splinting the injury, and
transporting the victim to a medical treatment facility.
Minor injuries inflicted by turtles and stinging corals
require only that the wound be thoroughly cleansed
and the injury splinted.
JELLYFISH INJURIES.Other sea animals
inflict injury by means of stinging cells located in
tentacles. This group includes the jellyfish and the
Portuguese man-of-war (fig. 5-5).
(which may be impossible to see, even in relatively
clear water) release poison or tiny stingers through
which poison is injected into the victim. Jellyfish
stings may cause symptoms ranging from minor
irritation (pain and itching) to death. Contact with the
tentacles produces burning pain, a rash with small
hemorrhage in the skin, and, on occasion, shock,
muscular cramping, nausea, vomiting, and respiratory
and cardiac distress. Treatment for minor jellyfish
injuries consists of pouring sea water over the injured
area and then removing the tentacles with a towel or
gloves. Next, pour rubbing alcohol, formalin, vinegar,
meat tenderizer, or diluted ammonia over the affected
area to neutralize any remaining nematocysts (minute
stinging structures). Finally, cover the area with any
dry powder (to which the last nematocysts will
Figure 5-5.Jellyfish and Portuguese Man-of-war.