Lesson Outlines
Chapter 19
Lesson 19: Bites and Stings
Lesson Objectives
After completing this lesson, participants should be able to:
 Explain what rabies is.
 Describe the care for an animal bite.
 Describe the care for a human bite.
 Discuss how to care for a pit viper bite.
 Discuss how to care for a coral snake bite.
 Discuss how to care for a nonpoisonous snakebite.
 Describe how to care for insect bites and stings.
 Describe how to care for a black widow spider bite.
 Describe how to care for a brown recluse spider bite.
 Describe how to care for a tarantula bite and embedded tarantula hairs.
 Describe how to care for a common aggressive house spider (hobo spider) bite.
 Describe how to care for a scorpion sting.
 Describe how to care for a centipede bite.
 Describe how to care for a mosquito bite.
 Describe how to care for an embedded tick.
 Describe how to care for a shark bite.
 Describe how to care for barracuda and moray eel bites.
 Describe how to care for marine animal injuries.
 Describe how to care for a stingray puncture.
Points
Animal Bites
 It is estimated that one of every two Americans will be bitten at some time by an
animal or by another person.
 Dogs are responsible for about 80% of animal bite injuries.
o Most are minor
 Bacteria can enter through bite wound.
 Cat bites have higher rate of infection.
 Ferrets are especially likely to bite.
 Children and older people are at greater risk.
Rabies
 Virus found in warm-blooded animals, spread through saliva
 An animal should be considered potentially rabid if it:
o Attacked without provocation
o Acted strangely or out of character
o Is a high risk species
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Report animal bites to the police or animal control
Animal control should capture or confine for observation
Recognizing an Animal Bite
 Puncture wound
 Tissue/skin crushed
 Open wound on fingers, knuckles, or hand
 Animal present
Care for an Animal Bite
 Flush with soap and water under pressure.
 Avoid scrubbing.
 Control bleeding and cover the wound with sterile dressing.
 Seek medical care for cleaning, tetanus shot, or rabies care.
Human Bites
 After dogs and cats, most likely bit is from human.
 Infection can occur.
 Most occur during acts of violence.
 Most common location is hand.
 Recognizing human bites
 Two types:
o True bites—from fights or abuse
o Clenched-in fist injury—cutting a fist on teeth
Care for Human Bites
 Wash with soap and water.
 Avoid scrubbing.
 Flush with running water under pressure.
 Control bleeding with direct pressure
 Cover with sterile dressing.
o Do not close wound.
 Seek medical care for cleaning, tetanus shot, sutures.
Snakebites
 Death from snakebites rarely occurs.
 If death does occur, it occurs in the first 48 hours after the bite.
 Only four snake species in the United States are poisonous.
o Rattlesnake (pit viper)
o Water moccasin (pit viper)
o Copperhead (pit viper)
o Coral snake
 Rattlesnake, water moccasin, coral snake are pit vipers.
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o Triangular, flat heads wider than necks
o Elliptical pupils
o Heat-sensitive pit between eye and nostril on each side
Adult snakebites are more serious.
Pit Vipers
 Found in all states but Alaska, Maine, Hawaii
 Most bites are on extremities.
 Alcohol intoxication is a factor
 Diamondback rattlesnake bites especially deadly
o Antivenin must be given
Recognizing Pit Viper Bites
 Severe, burning pain
 One or two small puncture wounds (fang marks)
 Swelling
 Discoloration and blood-filled blisters
 Nausea, vomiting, sweating, and weakness
Care for Pit Viper Bites
 Get victim away from the snake.
 Keep the victim calm and limit movement.
 Wash area with soap and water
 Stabilize bitten extremity like you would a fracture.
 Seek medical care.
Coral Snake Bites
 The coral snake is America’s most venomous snake.
 It tends to hang on or chew rather than strike and release.
 Symptoms begin 1 to 5 hours after bite.
Recognizing Coral Snake Bites
 Minimal pain
 Sagging or drooping upper eyelids
 Weakness
 Pricking, tingling skin
 Double vision
 Difficulty swallowing
 Sweating
 Abnormal flow of saliva
Care for Coral Snake Bites
 Keep victim calm.
 Gently clean with soap and water.
 Apply mild pressure and bandage.
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Seek medical care for antivenin.
Nonpoisonous Snake Bites
 Nonvenomous snakes inflict the most bites.
 Some so-called nonpoisonous snakes have venom.
 Can cause painful local reactions
Recognizing Nonpoisonous Snake Bites
 Mild to moderate pinch
 Horseshoe-shaped bite marks
 Bleeding
 Mild itching
Care for Nonpoisonous Snake Bites
 Gently clean with soap and water.
 Care is the same as for minor wound
 Seek medical care.
Insect Stings
 Severe allergic reactions to insect stings can be life-threatening.
 Honeybees and some yellow jackets have barbed stingers that embed in skin.
o Stingers leave venom, continue to release after the bee leaves
 Wasp, yellow jacket, hornet, and fire ant stingers not barbed
o Can sting multiple times
 Mostly self-limited, local reactions
 Swelling/redness might peak 2-3 days after sting
 Life-threatening symptoms: nausea, vomiting, wheezing, fever, drippy nose
 Anaphylactic symptoms: difficulty speaking, tightness in throat/chest, shortness
of breath, chest pain
 Sting can be fatal in minutes if the victim is severely allergic.
Recognizing Insect Stings
 Pain, redness, itching, swelling
 Worrisome symptoms
o Hives, swelling of lips or tongue, tickle in throat, wheezing
 Life-threatening symptoms
o Blue/gray skin color, seizures, unresponsiveness, inability to breathe
 Range of symptoms can vary
 Stings to mouth or eye are more dangerous.
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Lesson Outlines
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Care for Insect Stings
 Remove stinger and venom sac.
 Wash with soap and water.
 Apply ice.
 Give aspirin (adults), acetaminophen, or ibuprofen.
 Consider topical steroid or antihistamine.
 Observe victim for 30 minutes.
 Assist with prescribed epinephrine kit if reaction is severe.
 Call 9-1-1 for signs of severe allergic reaction.
Spider and Insect Bites
 Only a few spiders produce significant poisoning.
 Most bites are from female spiders.
 Little immediate pain, difficult to diagnose
Black Widow Spiders
 Can also be brown or gray
 Females are large; up to 2-inch leg span
 Venom contains neurotoxin
 Causes severe muscle pain, cramping
Recognizing Black Widow Spider Bites
 Sharp pinprick, then dull pain
 Two fang marks
 Very severe pain
 Bite on lower body
o Muscle stiffness, abdominal cramps
 Bite on upper body
o Muscle stiffness/pain in shoulders, back, chest
 Headache, chills, fever, sweating, dizziness, nausea, vomiting
Care for Black Widow Spider Bites
 Catch spider if possible.
 Clean with soap and water or rubbing alcohol.
 Apply ice.
 Give aspiring (adults), ibuprofen, or acetaminophen.
 Monitor breathing.
 Seek medical care.
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Brown Recluse Spiders
 Violin-shaped figure on back
 Males and females are venomous.
Recognizing Brown Recluse Spider Bites
 Local reaction, mild to severe pain at bite site
 Redness, swelling, itching
 Blister forms, becomes red, bursts
o Bull’s-eye pattern
o Scab forms, falls off and leaves crater
o Process recurs, leaving larger crater
 Fever, weakness, vomiting, joint pain, rash
 Stomach cramps, nausea, vomiting
Care for Brown Recluse Spider Bites
 Catch spider if possible.
 Clean with soap and water or rubbing alcohol.
 Apply ice.
 Give aspirin (adults), ibuprofen, or acetaminophen.
 Seek medical care.
Tarantulas
 Bite only when provoked or roughly handled
 Will scratch its abdomen with its legs when upset
 Hairs flick onto person’s skin
 Bite pain ranges from almost painless to deep throbbing pain lasting up to 1 hour.
Recognizing Tarantula Bites and Embedded Hairs
 Pain—aching or stinging
 Hairs cause itching, inflammation that can last several weeks
Care for Tarantula Bites and Embedded Hairs
 Tarantula bite
o Catch spider if possible.
o Clean with soap and water or rubbing alcohol.
o Apply ice.
o Give aspirin (adults), ibuprofen, or acetaminophen.
o Seek medical care.
 Embedded tarantula hairs
o Remove hairs with sticky tape.
o Wash with soap and water.
o Apply hydrocortisone cream.
o Give aspirin (adults), ibuprofen, or acetaminophen.
o Give antihistamine.
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Lesson Outlines
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Common Aggressive House Spider
 Also called the hobo spider
 Most common large spider in Pacific Northwest
Recognizing Common Aggressive House Spider Bites
 Redness, blisters
 Later: gangrene (dead tissue)
 Headache, visual problems, weakness
Care for Common Aggressive House Spider Bites
 Catch spider if possible.
 Clean with soap and water or rubbing alcohol.
 Apply ice.
 Give aspirin (adults), ibuprofen, or acetaminophen.
 Seek medical care.
Scorpion Stings
 Look like miniature lobsters
 Bark scorpion is only threatening to humans.
o Primarily found in Arizona
 Severe cases usually only in children
 Death is rare.
 Ensure airway and breathing
Recognizing Scorpion Stings
 Local immediate pain and burning, followed by numbness and tingling
 No swelling or blanching
 Tapping finger over site causes pain.
 Can cause paralysis, spasms in legs/arms, facial twitching
 Severe reactions: fast heart rate, salivation, breathing distress
Care for a Scorpion Sting
 Monitor breathing.
 Gently clean with soap and water or rubbing alcohol.
 Apply ice.
 Give aspirin (adults), ibuprofen, or acetaminophen.
 Seek medical care.
Centipede Bites
 Giant desert centipede is only US centipede dangerous to human.
 Can inject venom through fangs (not legs)
 Venom is relatively weak.
Recognizing Centipede Bites
 Burning pain
 Local inflammation
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Mild swelling of lymph nodes
Giant desert centipede bite: inflammation, swelling, redness lasting 4-12 hours
Swelling and tenderness can last 3 weeks, or disappear and recur
Care for Centipede Bites
 Millipedes (2 pairs of legs per body segment) do not have venom, but can irritate
skin.
o Wash with soap and water.
o Apply cortisone cream or ointment.
 Centipedes (1 pair of legs per body segment):
o Clean with soap and water.
o Apply ice.
o Give aspirin (adults), acetaminophen, or ibuprofen.
o Seek medical care for severe reactions.
Mosquito Bites
 Mosquitoes can carry malaria, yellow fever, dengue fever, and encephalitis.
 No evidence of transmitting HIV or AIDS
 Need blood to lay eggs
 Breed in water
 Most bite at twilight
Care for Mosquito Bites
 Wash with soap and water.
 Apply ice.
 Apply calamine lotion or hydrocortisone ointment.
 Victims with many bites or allergic reaction may take antihistamine or physicianprescribed cortisone.
Embedded Ticks
 Hard ticks familiar from domestic animals
 Soft ticks mainly in western states
 Can carry diseases
 Need blood meal to grow to next stage
 Bites are nearly painless
 Burrows head in skin
 As they feed, their body size increases.
Care for Embedded Ticks
 Remove with tweezers as soon as possible.
 Grasp as close to skin as possible.
o Lift with enough force to tent skin.
o Hold until tick lets go (1 minute).
o Pull tick away from skin.
o Wash with soap and water.
o Apply rubbing alcohol.
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Lesson Outlines
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Apply ice.
Apply calamine lotion.
Watch bite site for rash for one month.
Seek medical care for rash.
Watch for fever, muscle aches, sensitivity to bright light, leg weakness,
and paralysis.
Fire Ants
 Aggressive, can sting repeatedly
 Immediate pain
 Red, swollen area which disappears in 45 minutes
 Blister forms, ruptures in 30-70 hours, can become infected
 Anaphylaxis can occur
 Apply ice.
 Use topical corticosteroid cream.
Marine Animal Injuries
 Most sting in defense, not attack
 Can cause anaphylaxis
 If serious reaction, keep airway open
Sharks
 Very minimal chance of attack
 Leg is most frequently bitten part
 Injuries are similar to boat propeller injuries or chainsaw injuries.
 Immediate bleeding control and shock treatment are essential.
Recognizing a Shark Bite
 Severe bleeding
 Large, open wounds, most often on legs
 Abrasions from contact with sharkskin
Care for a Shark Bite
 Control bleeding.
 Treat for shock.
 Seek medical care.
Barracudas and Moray Eels
 Barracuda bites are rare.
 Moray eels can give multiple puncture wounds.
 Have high infection risk
 First aid for both is identical as for shark bite.
Recognizing Barracuda and Moray Eel Bites
 Barracuda lacerations
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o Similar to shark lacerations
Eel bites
o Severe puncture wounds
o Hold on to victim
o Leave multiple, small puncture wounds
Care for Barracuda and Moray Eel Bites
 Barracuda bite
o Same care as shark bite.
 Eel bite
o Flush wound with water under pressure.
o Control bleeding.
Marine Animals That Sting
 Important to identify specific animal
 Reactions include mild dermatitis to severe reactions
 Portuguese man-of-war sting
o Well-defined linear welts
 Jellyfish sting
o Severe muscle cramping, thin lines of welts in zigzag pattern
 Anemones also sting
Recognizing Marine Animal Injuries
 Stinging
 Severe itching, burning
 Prickling, tingling
 Blisters
 Severe allergic reaction
 Difficulty breathing
 Muscle cramping
 Nausea, vomiting
Care for Marine Animal Injuries
 Apply vinegar or alcohol.
 Scrape off tentacles.
 Reapply vinegar or alcohol, soaking for 15 minutes.
 Monitor breathing.
Stingrays
 Usually peaceful, lie buried in sand or mud
 Wounds occur when victim steps on ray
 Barbed tail thrusts into victim’s leg or foot
 Usually like a laceration
 Venom causes intense burning pain
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Recognizing a Stingray Puncture
 Sudden, intense pain
 Open wound
 Swelling
Care for a Stingray Puncture
 Immerse injured part in hot water for 30-90 minutes.
 Wash with soap and water.
 Irrigate with water under pressure.
 Treat like any puncture wound.
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