Bites and Stings

The Lymphatic System

The Lymphatic System is a network of vessels, nodes, ducts, and organs that produce and transport lymph fluid. The lymphatic system plays a large part in the following:

• Removing fluid from tissues
• Production of immune cells, such as lymphocytes
• Absorbs fat from the intestines

The lymphatic system does not have a pump like the circulatory system, but rather it utilizes muscle movement in order to transport fluids. The lymphatic system is predominantly responsible also for the transportation of venom from snake bites. This is why it is critical to keep the casualty as still as possible and immobilise the bitten limb. Muscle contractions cause increased lymph movement and hence help spread the venom.

Bites and Stings

Bites and stings from certain creatures can be potentially dangerous, and Australia has no shortage of such creatures. There are many different varieties of snakes, spiders and jellyfish which carry venom that can cause pain and swelling, and in extreme cases, death (most commonly through neurotoxic muscle paralysis causing breathing failure).

The most common cause of death from snake bites is collapse with cardiac arrest. This can occur within 10-60 minutes of a bite with envenomation, and often before the casualty reaches a hospital.

Other insect bites can be potentially fatal when a person is allergic to the insect, such as with bee stings.

Snake Bites

Signs and Symptoms

The bite site may be painless and without visible marks. Signs and symptoms of a snake bite may include:

• Paired puncture marks, but can be single or parallel scratches on the skin
• Headache
• Altered mental status – including confusion, irritation, or even unconsciousness
• Abdominal pain, nausea and/or vomiting
• Double or blurred vision, or drooping eyelids
• Respiratory weakness or respiratory arrest
• Difficulty in breathing, speaking or swallowing
• Limb weakness, muscle paralysis
• In the bitten limb, swollen & tender glands (armpit/groin)

Management

You should take care to firstly rest the casualty, and reassure them as best as possible while you investigate for a possible snake bite. If found, follow the pressure immobilisation technique immediately and seek emergency medical assistance.

Pressure Immobilisation Technique (PIT)

• The bandage should be firm and tight (i.e. tight enough to prevent easily sliding a finger between the bandage and the skin) but not uncomfortable or painful
• Next, bandage the entire limb (using an additional bandage or the same bandage if long enough)
• Start distally (furthest from the body) and work proximally (closer to the body) to reduce swelling
• Once the limb is bandaged, use a splint to restrict any movement of the limb (i.e. a stick or pole, or if an upper limb, use a sling)
• Keep the casualty as still as possible and ideally, bring assistance to them rather than attempt to move them
• If the casualty becomes unresponsive, commence CPR

Pressure Immobilisation Technique (PIT) Video

DO NOT:

🗵 Do not cut, suck or treat the bitten area

🗵 Do not wash the bitten area

🗵 Do not apply an arterial tourniquet

The Pressure Immobilisation Technique is recommended for the following bites and stings:

• All venomous snakes
• Funnel-web spiders
• Blue-ringed octopus and cone shell

Remember: As a first aider, we don’t fix or diagnose, we only preserve life until more advanced care can be provided.

Spider Bites

Of the numerous species of spiders found in Australia, only two are capable of causing death; the funnel web and the red back spider (for a child).

It can be difficult to identify a funnel web, so any bite from a big, black spider should be considered potentially dangerous.

Red Back Spider

Signs and Symptoms

• When bitten, instant pain at the bite site
  o Bite site becomes swollen red and hot
• Strong pain which spreads and increases
• Abdominal pain, nausea and/or vomiting
• Profuse sweating, particularly at the site of the bite
• In the bitten limb, swollen & tender glands (armpit or groin)

Red Back Spider: Treatment (Cold compress)

• Apply a cold compress to the affected area to help reduce swelling and pain for periods of 20 minutes
• Rest the casualty and monitor
• These are generally not fatal however the casualty should be directed to obtain a medical opinion
• If pain is persistent, or the casualty experiences headache, nausea, vomiting, or an altered level of consciousness, then they should be taken to the hospital, or call 000 for an ambulance

Note: Do not apply the Pressure Immobilisation Technique (PIT) as the venom acts slowly.

Stings

Most stings should be treated with ice. If the casualty is allergic to the sting, there is a risk of anaphylaxis, which is a medical emergency. If an anaphylactic reaction occurs, follow the Anaphylaxis Guideline and DRS ABCD. Contact 000 immediately.

Bee Sting: Treatment (Cold compress)

• Never pull or squeeze the sting out as more venom will be injected. Try to scrape it sideways away from the entry point.
• Apply cold compress to the affected area to help reduce swelling and pain for periods of 20 minutes (do not apply ice to the eye area).
• If the person has an allergy to bee stings, they can fall into a life-threatening state of anaphylactic shock. The only treatment is an injection of adrenaline. Seek medical attention immediately

Most stings should be treated with ice. If the casualty is allergic to the sting, there is a risk of anaphylaxis, which is a medical emergency. If an anaphylactic reaction occurs, follow the Anaphylaxis Guideline and DRS ABCD. Contact 000 immediately.

Wasp: Treatment (Cold compress)

• Clean the affected area with soap and warm water
• Apply a cold compress to the affected area to help reduce swelling and pain for periods of 20 minutes
• Be alert for signs of anaphylaxis
• Prolonged swelling at the site of the sting may respond to antihistamines – refer to the casualty for further advice

Fire Ants

Fire ants are dangerous, imported pests that could spread to large areas of Australia. They inflict a painful, fiery sting, which can, in rare cases, cause a severe acute allergic reaction (anaphylaxis). (excerpt from https://www.business.qld.gov.au)

Signs and Symptoms

• Fire ants inflict a fiery sting, which causes a small blister to form at the site of each sting after several hours
• Pain, burning and itching at the site
• Swelling of the stung area
• In allergic casualties:
  o onset of wheezing and breathing difficulties
  o facial swelling and hives
  o rapid pulse
  o collapse

Fire Ants: Treatment (Cold compress)

• Calm and reassure the casualty
• Apply a cold compress to the affected area to help reduce swelling and pain for periods of 20 minutes
• Gently wash the affected area with soap and water
• Leave the blisters intact, do not break them
• Rest the casualty and monitor
• Also, monitor the casualty for signs of an allergic reaction
  o If the onset of an allergic reaction:
  – Call Triple Zero (000) for an ambulance
  – Follow anaphylaxis treatment guidelines
  – Follow DRS ABCD and be prepared to perform CPR

Blue Ringed Octopus

Treatment: (PIT)

• Treatment for a Blue Ringed Octopus bite is the same as a snake bite
• Apply the Pressure Immobilisation Technique (PIT) and call 000 for an ambulance
• If the person stops breathing, follow DRS ABCD and commence CPR immediately

Box Jellyfish

The box jellyfish is equipped with millions of stinging cells which extend from the body and have the potential to inflict fatal stings on humans. The box jellyfish can grow up to 38cm across the bell with 60 tentacles up to 15 tentacles at each corner.

In Australia, about 70 deaths in the past 50 years, none for nearly a decade.

Signs and symptoms of someone who has been stung by a Box Jellyfish include:

• Red welts – a variety of skin markings (frosted pattern)
• Tentacles left on skin
• Severe pain around the lymph nodes (armpits, groin etc.)
• Nausea, vomiting, headache
• Sudden cardiac arrest or respiratory distress

Box Jellyfish: Treatment (Vinegar)

• Carefully and safely remove the casualty from the water
• Observe DRS ABCD. Call 000 for an ambulance and be ready to perform CPR
• Flood the affected area with vinegar for 30 seconds to neutralise the tentacles
• If vinegar is not available, pick off any tentacles (this is not harmful to the first aider) and rinse the sting well with seawater
• For pain relief, apply a cold compress
• Rest the casualty, calm and reassure. Keep under observation

Note: Do not apply or allow fresh water directly onto the sting because it may activate and fire off undischarged stinging cells.

Bluebottle Jellyfish

The most common cause of jellyfish stings in Australia are Bluebottles which vary in size, and the severity of the sting is usually based on the amount of contact the tentacle had with the skin.

No fatalities in the Southern Hemisphere have been confirmed from these creatures. Most stings from a Bluebottle are painful.

Signs and Symptoms

• Whip-like, red, wavy line on the skin from the tentacle
• Trails’ of blue ‘tentacles’ adhering to the body or limbs
• A red rash may occur
• Pain and stinging lasting a number of hours
• Allergic reactions are possible

Bluebottle Jellyfish: Treatment (Hot water)

• Rest the casualty, reassure and keep under observation
• Clear away the tentacles using seawater, then pick off any remaining tentacles (not harmful to the first aider)
• Immerse the stung area in hot water for 20 minutes to relieve pain
• The water should be as hot as the casualty can handle it
• Remember, your tolerance to heat may be different from the casualty.
• If hot water fails to relieve the pain, then a try cold compress
• Call 000 if pain persists, the stung area is quite large, or is in a sensitive area such as the eye

Note: Do not rub the area that was stung. Do not treat with vinegar

Cone Shell

The Cone Shell is found in shallow water, sand flats and reefs around Australia. They are brightly coloured shells shaped like ice-cream cone. The sting can ultimately lead to respiratory distress and death

Basic Treatment:

• Treatment for a Cone Shell sting is the same as a snake bite
• Apply the Pressure Immobilisation Technique (PIT) and call 000 for an ambulance
• If the person stops breathing, follow DRS ABCD and commence CPR immediately

Ticks

Ticks can inject a toxin that may cause local skin irritation or a mild allergic reaction, however, most tick bites cause few or no symptoms (generally develop over several days). In susceptible people, (can occur within hours) a tick bite may cause an allergic reaction or even anaphylaxis, which can be life-threatening.

Basic Treatment:

• In the case of a tick bite, if there is no history of tick allergy, immediately remove the tick
• If the victim has a history of tick allergy, the tick must be killed where it is, rather than removed
• If an anaphylactic reaction occurs, follow the Anaphylaxis Guideline
• Follow DRS ABCD. Contact 000 immediately for an ambulance
• Apply a cold compress to the affected area to help reduce swelling and pain for periods of 20 minutes
• Rest the casualty, reassure and keep under observation
• If the casualty has no history of tick allergy, take the casualty to a doctor to remove the tick

To kill the tick where it is:

• For small ticks (larvae & nymphs), use permethrin cream (available at pharmacies)
• For adult ticks, freeze them with an ether-containing spray (available at pharmacies).
• Wait for the tick to drop off or remove it taking the utmost care to not compress the tick (as this will squirt allergen, toxin and possibly infection into you)

Note: Do not use tweezers