MANUAL MINORS
Bites and stings are common occurrences in the emergency department, requiring prompt and effective management due to their potential to cause infections, allergic reactions, or even severe envenomations.
From an emergency physician’s perspective, a thorough evaluation and appropriate treatment are crucial to minimise complications and improve patient outcomes.
Initial Assessment
Rapid Medical History:
Type of Agent: Identifying the animal or insect responsible for the bite or sting is essential as it influences treatment and prognosis.
Time of Exposure: Knowing how much time has passed since the bite or sting helps assess the risk of infection or systemic reactions.
Health History: Includes allergy history, tetanus vaccination status, and any medical condition that could complicate treatment, such as immunosuppression.
Physical Examination:
Inspection: Evaluate the wound for signs of infection, necrosis, or envenomation. Look for active bleeding, foreign bodies (e.g., teeth, stingers), and the extent of swelling.
Vital Signs: Monitor blood pressure, heart rate, and respiratory rate, and assess for systemic symptoms like fever, breathing difficulty, or neurological signs.
Types of Bites and Stings
Type of Bite/Sting | Complications | Management |
|---|---|---|
Domestic Animal Bites | Infection from bacteria (Pasteurella, Capnocytophaga), tetanus risk. | Deep wound cleaning, debridement if necessary, prophylactic antibiotics, tetanus vaccine if indicated. |
Human Bites | High infection rate due to oral flora (Streptococcus, Staphylococcus aureus), especially in hands. | Cleaning and debridement, broad-spectrum antibiotics, consider tetanus vaccination. |
Wild Animal Bites | Risk of severe infections and rabies. | Rabies prophylaxis (immunoglobulin and vaccine), deep wound cleaning, antibiotics if signs of infection, observation. |
Insect Stings (Bees, Wasps, Ants) | Mild local reactions to anaphylaxis in allergic individuals. | Remove stinger if present, apply cold compresses, administer antihistamines and corticosteroids, epinephrine in anaphylaxis, advanced life support if needed. |
Spider Bites (Black Widow, Brown Recluse) | Severe systemic symptoms (black widow), local necrosis (brown recluse). | Wound cleaning, symptomatic management with analgesics and muscle relaxants, consider antivenom and hospitalisation in severe cases. |
Marine Animal Stings/Bites (Jellyfish, Sea Urchins, Venomous Fish) | Severe local reactions, necrosis, systemic envenomation in rare cases. | Rinse with salt water or vinegar (jellyfish), remove spines, pain management, antivenom, and hospitalisation for severe envenomations. |
General Management in the Emergency Department
Wound Cleaning and Debridement: All wounds must be properly cleaned to prevent infections. In some cases, debridement is necessary to remove dead or contaminated tissue.
Prophylactic Antibiotics: Consider especially for high-risk bites (cat bites, human bites, or bites to areas like the hands and face).
Immunisation: Administer a tetanus vaccine if needed and rabies prophylaxis for wild animal bites.
Symptomatic Treatment: Includes pain management, antihistamines to control inflammation, and, in cases of severe allergic reactions, adrenaline and other treatments for anaphylactic shock.
Observation and Follow-up: Some patients may need extended observation in the emergency department, especially those at risk of developing severe complications like deep infection or anaphylaxis.
Referral: Complex cases, such as severe envenomations or bites affecting deep structures, may require referral to intensive care or a specialist (e.g., surgery or maxillofacial surgery).
Patient Disposition
Discharge: For minor injuries without signs of complications, the patient may be discharged with instructions for follow-up and home care, including warning signs for return.
Hospitalisation: Required for severe cases, including deep infections, severe allergic reactions, and systemic envenomations that do not respond to initial emergency treatment.
Comments