Bites and stings — snake, spider, centipede and scorpion

For animal and human bites — see Animal or human bites

Snakebites — land and sea

Only effective antivenom ​is CSL land or sea snake antivenom​

Do not

  • Do not let person move — take transport to person
  • Do not wash bite ​site — hospital has test to find out kind of snake from venom left on skin
  • Do not give antivenom out bush — unless advised by doctor

Do first

Most important thing — stop spread of venom from bite site

  • If unconscious or collapsed — DRS ABC
  • Medical consult
  • Lie person down, keep as calm and still as possible
  • Apply pressure bandage and immobilisation
    • Start at toes or fingers and work up. If bite on trunk or head — just bandage bite ​site
    • Use firmest bandage you have. Elastic is much better than crepe
    • Apply bandage as firmly as possible to the limb. You should not be able to easily slide a finger between the bandage and the skin
    • Use 15cm wide bandage for leg
    • Splint bitten arm or leg to stop it moving
    • Immobilise whole person — use stretcher if available

Check

  • Calculate age-appropriate REWS
    • Adult — AVPU, RR, O2 sats, pulse, BP, Temp
    • Child (less than 13 years) — AVPU, respiratory distress, RR, O2 sats, pulse, central capillary refill time, Temp
  • Weight, BGL
  • U/A for blood and protein — save urine for venom identification
  • Coma scale score, ptosis (drooping eyelid), ​lack of ophthalmoplegia (eye movement)​
    • Repeat every hour — more often if person getting worse ​
  • Immunisation status — tetanus

Do

  • Put in IV cannula — oozing around site may indicate envenoming
  • Take blood for UEC​, CK

Redback spider bite

Not life threatening but can cause significant pain

Do not

  • Do not put on tourniquet or pressure bandage — will make pain ​worse

Ask

  • Pain at bite site​
    • Increasing over minutes to hours
    • Lasts more than 24 hours
  • Pain radiating from bite site to close limb, trunk, local lymph nodes
  • Feeling unwell​, lethargy​, headache ​
  • Abdominal pain​, nausea​, vomiting ​
  • Increased sweating
  • Priapism (painful erection) in boys
  • May present as intractable crying in an infant

Check

  • Calculate age-appropriate REWS
    • Adult — AVPU, RR, O2 sats, pulse, BP, Temp
    • Child (less than 13 years) — AVPU, respiratory distress, RR, O2 sats, pulse, central capillary refill time, Temp
  • Weight, BGL
  • Head-to-toe exam — signs and symptoms usually obvious in 1–6 hours if going to happen
  • Bite site may not be obvious
  • If these signs/symptoms — think of bite, even if no clear story
    • Sweating around bite site or strange patterns of regional sweating (eg sweating below both knees)
    • May have abdominal pain and/or chest pain
    • Child — irritable and agitated
  • Immunisation status — tetanus

Do

  • Cold pack (do not put ice directly on bite) OR hot pack/water may help with pain ​
  • Give pain relief
  • If still pain or severe pain — medical consult including possible role for antivenom especially in children 

Centipede or scorpion sting

May be very painful but usually only lasts 6–12 hours

  • Centipede bites — may be a lot of redness​ ​and swelling, allergic reactions can occur
  • Scorpion bite/sting — may be no mark​

Check

  • Immunisation status — tetanus​

Do

  • Wash bite and apply antiseptic
  • Cold pack (do not put ice directly on bite) OR hot pack/water may help with pain ​
  • Give pain relief, if needed
  • Monitor for 4 hours for systemic toxicity, rare (eg vomiting​, headache​, sweating, hypertension)