INJECTED POISONS AND ENVENOMATIONS

Injection of venom by stings and bites from various insects and arthropods, while not normally life-threatening, can cause acute allergic reaction that can be fatal. Poisons may also be injected by snakes and marine animals.

Bee, Wasp, and Fire Ant Stings
Stings from bees, wasps, and ants account for more poisonings than stings from any other insect group. Fortunately, they rarely result in death. The vast majority of stings cause a minor local reaction at the injection site, with pain, redness, itching, and swelling. These symptoms usually fade after a short time. A small percentage of these stings can cause an allergic victim severe anaphylactic reactions, presenting with itching, swelling, weakness, headache, difficulty breathing, and abdominal cramps. Shock may follow quickly, and death may occur.

The following first aid measures are recommended for all but minor, local reactions to bites or stings:

1. Closely monitor vital signs (and the whole patient), and remove all rings, bracelets, and watches.

2. Remove stingers without squeezing additional venom (remaining in poison sacs attached to stingers) into the victim. To do this, scrape along the skin with a dull knife (as if you were shaving the person). The dull blade will catch the stinger and pull it out.

3. Place an ice cube or analgesic-corticosteroid cream or lotion over the wound site to relieve pain. Do NOT use "tobacco juice," saliva, or other concoctions.

4. For severe allergic reactions (generalized itching or swelling, breathing difficulty, feeling faint or clammy, unstable pulse or blood pressure), immediately give the victim a subcutaneous injection of 1:1000 aqueous solution of epinephrine. Dosage is 0.5 cc for adults and ranges from 0.1 to 0.3 cc for children.

5. Patients with severe allergic reactions should be evacuated immediately to a medical facility.

Scorpion Stings
About 40 species of scorpions (fig. 5-2) exist in America. Centruroides exilicauda may cause severe effects. Most dangerous species are found from North Africa to India. Scorpion stings vary in severity, depending on the species of the scorpion and the amount of poison actually injected. They cause severe pain in the affected area.

Mild reactions may include local swelling, skin discoloration, swollen lymph nodes near the sting area, itching, paresthesias ("pins and needles," numbness), and even nausea and vomiting. The duration of symptoms is less than 24 hours.

The following first aid treatment should be given for scorpion stings:

1. Place ice over the sting site (cool the area for up to 2 hours). Do NOT use tobacco juice, saliva, or other concoctions.

2. Elevate the affected limb to approximately heart level.

3. Give acetaminophen for minor pain.
4. Calcium gluconate, 10 ml of 10 percent solution, may be given intravenously to relieve muscle spasms.

5. Valium may be used to control excitability and convulsions.

6. An antivenom is available for severe bites by Centruroides exilicauda (also called "bark scorpion," it is the scorpion found in Mexico and the American southwest). It is available from the Antivenom Production Laboratory, Arizona State University, Tempe, Arizona 85281, phone (602) 965-6443 or (602) 965-1457, and from Poison Control in Phoenix, phone (602) 253-3334.

CAUTION: Morphine and meperidine hydrochloride may worsen the respiratory depression from the venom of Centruroides exilicauda.

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