Envenomation: From 1 Different Sources
The injection of a venom into the tissues by teeth, spines, miniature harpoons (nematocysts) or drills. c.f. bite and sting.
The Crown-of-thorns starfish, known for the considerable damage that it may cause to coral reefs. It seems to occur in epidemics. The spines are venom-tipped, but usually the envenomation leads only to a painful spike wound which may sometimes get infected. Multiple spikes, either in one episode, or many individual stings rarely lead to systemic symptoms, but may lead to hypersensitivity.... acanthaster planci
Absence of visible contraction of the heart, and consequent circulation of the blood, resulting rapidly in death. This may occur after envenomation.... asystole
Animal bites are best treated as puncture wounds and simply washed and dressed. In some cases ANTIBIOTICS may be given to minimise the risk of infection, together with TETANUS toxoid if appropriate. Should RABIES be a possibility, then further treatment must be considered. Bites and stings of venomous reptiles, amphibians, scorpions, snakes, spiders, insects and ?sh may result in clinical effects characteristic of that particular poisoning. In some cases speci?c ANTIVENOM may be administered to reduce morbidity and mortality.
Many snakes are non-venomous (e.g. pythons, garter snakes, king snakes, boa constrictors) but may still in?ict painful bites and cause local swelling. Most venomous snakes belong to the viper and cobra families and are common in Asia, Africa, Australia and South America. Victims of bites may experience various effects including swelling, PARALYSIS of the bitten area, blood-clotting defects, PALPITATION, respiratory di?culty, CONVULSIONS and other neurotoxic and cardiac effects. Victims should be treated as for SHOCK – that is, kept at rest, kept warm, and given oxygen if required but nothing by mouth. The bite site should be immobilised but a TOURNIQUET must not be used. All victims require prompt transfer to a medical facility. When appropriate and available, antivenoms should be administered as soon as possible.
Similar management is appropriate for bites and stings by spiders, scorpions, sea-snakes, venomous ?sh and other marine animals and insects.
Bites and stings in the UK The adder (Vipera berus) is the only venomous snake native to Britain; it is a timid animal that bites only when provoked. Fatal cases are rare, with only 14 deaths recorded in the UK since 1876, the last of these in 1975. Adder bites may result in marked swelling, weakness, collapse, shock, and in severe cases HYPOTENSION, non-speci?c changes in the electrocardiogram and peripheral leucocytosis. Victims of adder bites should be transferred to hospital even if asymptomatic, with the affected limb being immobilised and the bite site left alone. Local incisions, suction, tourniquets, ice packs or permanganate must not be used. Hospital management may include use of a speci?c antivenom, Zagreb®.
The weever ?sh is found in the coastal waters of the British Isles, Europe, the eastern Atlantic, and the Mediterranean Sea. It possesses venomous spines in its dorsal ?n. Stings and envenomation commonly occur when an individual treads on the ?sh. The victim may experience a localised but increasing pain over two hours. As the venom is heat-labile, immersion of the affected area in water at approximately 40 °C or as hot as can be tolerated for 30 minutes should ease the pain. Cold applications will worsen the discomfort. Simple ANALGESICS and ANTIHISTAMINE DRUGS may be given.
Bees, wasps and hornets are insects of the order Hymenoptera and the females possess stinging apparatus at the end of the abdomen. Stings may cause local pain and swelling but rarely cause severe toxicity. Anaphylactic (see ANAPHYLAXIS) reactions can occur in sensitive individuals; these may be fatal. Deaths caused by upper-airway blockage as a result of stings in the mouth or neck regions are reported. In victims of stings, the stinger should be removed as quickly as possible by ?icking, scraping or pulling. The site should be cleaned. Antihistamines and cold applications may bring relief. For anaphylactic reactions ADRENALINE, by intramuscular injection, may be required.... bites and stings
Hormones released by the body under any stressful reaction, or after envenomation (eg Irukandji), that affect the circulatory system, often increasing heart rate and blood pressure.... catecholamines
An excellent analgesic treatment for the skin pain of many envenomations, especially those of jellyfish stings. It is usually less effective than heat for the treatment of stonefish, stingray and other venomous-spined fish envenomations.... cold packs
An effective analgesic for some deeply-injected envenomations including stonefish, stingray and other venomous-spined fish.... heat
An excellent analgesic to stop the skin pain of many envenomations, especially those of jellyfish stings. It is usually less effective than heat for the treatment of stonefish, stingray and other venomous-spined fish envenomations.... ice
Enlargement of the lymph nodes. Swelling of the body lymph glands which is sometimes painful, especially after envenomation. Lymph glands when swollen may be almost anywhere in the body, but are more easilyfelt in the neck, under the arms (axillae) and in the groins.... lymphadenopathy
Tingling and burning in the skin frequently described as “pins and needles”. It is caused by irritation of cutaneous nerves by a variety of causes including trauma and envenomation.... paresthesiae
Fluid in the small air sacs of the lungs, from inefficient pumping by the heart or leakage of fluid from the blood vessels in the lungs (possibly from envenomation). As it prevents air exchange in the lungs it causes hypoxia and may lead to death.... pulmonary oedema
Inefficient functioning of the kidney, leading to death unless acute medical attention is available. Envenomation (especially snake bite) is a common cause, as well as a range of medical conditions, including infection..... renal failure (acute)
Body proteins that act as antibodies. 1. IgG: The immunoglobulin that can be measured in the serum approximately two weeks after a challenge by an antigen. Can cross the placenta from mother to foetus. 2. IgM: The immunoglobulin that can be measured very soon after a challenge by an antigen. The level returns to a non-measurable level very quickly and so this measurement is useful as a test for recent envenomation (or illness). Cannot cross the placenta from mother to foetus. Presence in a neonate therefore indicates infection of the body. 3. IgE: Reaginic antibody; immunoglobulin found in association with allergic or homocytotrophic responses. 4. IgA: Secretory antibody; immunoglobulin found in nonvascular fluids, such as the saliva, bile, aqueous humor, synovial fluide etc.... immunoglobulins
Cessation of breathing, often caused by envenomation (or poisoning).... respiratory arrest
The painful injection of a venom through skin or mucous membranes of a victim. Cf. bite and envenomation.... sting
20% aluminium sulphate solution - useful for itching caused by some insect stings, but less effective (or ineffective) for the skin pain of jellyfish envenomations.... stingose
Violent spasms, muscle contraction (“lock-jaw”) caused by a spore -forming, Gram positive bacillus penetrating the body though a puncture wound, and usually leading to death. The organism occurs in water and mayoccur after envenomation (eg in stingray spine puncture wounds), as well as the more commonly-known soil contamination (eg in war wounds). It may be prevented by vaccination with tetanus toxoid.... tetanus/tetany
The toxin responsible for envenomation in blue-ringed octopus and Japanese Fugu (tetrodotoxic) poisoning from puffer fish ingestion.... tetrodotoxin
A very tight ligature applied over the proximal portion of an extremity (limb) to occlude the artery to prevent blood reaching the distal part of the limb. Useful for severe, uncontrolled arterial bleeding, but dangerous when used for envenomation.... tourniquet
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