The lecture has been given on Feb. 13th, 2011 by Dr. Mohammad Shaikhani.

1. Bites & Stings

5. Clinical features & assessment Friends and relatives will frequently bring the snake with the patient; it should be handled as little as possible since it may only be injured rather than dead. The amount of venom injected via a bite is highly variable, depending on the length of time since the snake last ate and on its aggression. The pattern of clinical features is shown in Figure 9.9. Snake venom detection kits are available in some countries. The venom is detected from a dry swab of the bite site using monoclonal antibody techniques. The 20-minute whole blood-clotting test is a useful bedside tool in remote areas; a 2-3 ml sample of venous blood from the victim is left undisturbed at ambient temperature for at least 20 minutes. The vessel containing the blood is then tipped once and may be compared with a normal control. If it has not clotted, there is haemostatic disturbance from systemic envenoming. All patients should have a full blood count, urea and electrolytes, liver function tests, creatine kinase, troponins and an ECG performed. Friends and relatives will frequently bring the snake with the patient; it should be handled as little as possible since it may only be injured rather than dead. The amount of venom injected via a bite is highly variable, depending on the length of time since the snake last ate and on its aggression. The pattern of clinical features is shown in Figure 9.9. Snake venom detection kits are available in some countries. The venom is detected from a dry swab of the bite site using monoclonal antibody techniques. The 20-minute whole blood-clotting test is a useful bedside tool in remote areas; a 2-3 ml sample of venous blood from the victim is left undisturbed at ambient temperature for at least 20 minutes. The vessel containing the blood is then tipped once and may be compared with a normal control. If it has not clotted, there is haemostatic disturbance from systemic envenoming. All patients should have a full blood count, urea and electrolytes, liver function tests, creatine kinase, troponins and an ECG performed. Friends and relatives will frequently bring the snake with the patient; it should be handled as little as possible since it may only be injured rather than dead. The amount of venom injected via a bite is highly variable, depending on the length of time since the snake last ate and on its aggression. The pattern of clinical features is shown in Figure 9.9. Snake venom detection kits are available in some countries. The venom is detected from a dry swab of the bite site using monoclonal antibody techniques. The 20-minute whole blood-clotting test is a useful bedside tool in remote areas; a 2-3 ml sample of venous blood from the victim is left undisturbed at ambient temperature for at least 20 minutes. The vessel containing the blood is then tipped once and may be compared with a normal control. If it has not clotted, there is haemostatic disturbance from systemic envenoming. All patients should have a full blood count, urea and electrolytes, liver function tests, creatine kinase, troponins and an ECG performed.

6. Clinical features & assessment Friends and relatives will frequently bring the snake with the patient; it should be handled as little as possible since it may only be injured rather than dead. The amount of venom injected via a bite is highly variable, depending on the length of time since the snake last ate and on its aggression. The pattern of clinical features is shown in Figure 9.9. Snake venom detection kits are available in some countries. The venom is detected from a dry swab of the bite site using monoclonal antibody techniques. The 20-minute whole blood-clotting test is a useful bedside tool in remote areas; a 2-3 ml sample of venous blood from the victim is left undisturbed at ambient temperature for at least 20 minutes. The vessel containing the blood is then tipped once and may be compared with a normal control. If it has not clotted, there is haemostatic disturbance from systemic envenoming. All patients should have a full blood count, urea and electrolytes, liver function tests, creatine kinase, troponins and an ECG performed. Friends and relatives will frequently bring the snake with the patient; it should be handled as little as possible since it may only be injured rather than dead. The amount of venom injected via a bite is highly variable, depending on the length of time since the snake last ate and on its aggression. The pattern of clinical features is shown in Figure 9.9. Snake venom detection kits are available in some countries. The venom is detected from a dry swab of the bite site using monoclonal antibody techniques. The 20-minute whole blood-clotting test is a useful bedside tool in remote areas; a 2-3 ml sample of venous blood from the victim is left undisturbed at ambient temperature for at least 20 minutes. The vessel containing the blood is then tipped once and may be compared with a normal control. If it has not clotted, there is haemostatic disturbance from systemic envenoming. All patients should have a full blood count, urea and electrolytes, liver function tests, creatine kinase, troponins and an ECG performed. Friends and relatives will frequently bring the snake with the patient; it should be handled as little as possible since it may only be injured rather than dead. The amount of venom injected via a bite is highly variable, depending on the length of time since the snake last ate and on its aggression. The pattern of clinical features is shown in Figure 9.9. Snake venom detection kits are available in some countries. The venom is detected from a dry swab of the bite site using monoclonal antibody techniques. The 20-minute whole blood-clotting test is a useful bedside tool in remote areas; a 2-3 ml sample of venous blood from the victim is left undisturbed at ambient temperature for at least 20 minutes. The vessel containing the blood is then tipped once and may be compared with a normal control. If it has not clotted, there is haemostatic disturbance from systemic envenoming. All patients should have a full blood count, urea and electrolytes, liver function tests, creatine kinase, troponins and an ECG performed.

13. SNAKE BITES

14. SNAKE BITES

20. SCORPION STINGS: Management

21. SCORPION STINGS: Management

22. Spidar venom: All spiders produce venom and are capable of biting humans. Although spider bites in general may be capable of producing allergic systemic reactions, only the bite of the Widow Spiders and the Recluse spiders produce serious wounds and may be be potentially life threatening.

23. Field Safety Awareness Insects

27. Field Safety Awareness Insects [“Venomous Arthropods”, Public Health Pesticide Applicator Training Manual, University of Florida and American Mosquito Control Association, at http://vector.ifas.ufl.edu/ and “Forest Pests of North America: A Guide For Foresters in the South”, Terry S. Price, University of Georgia, Warnell School of Forest Resources at http://www.forestpests.org/publichealth/ ] Field Safety Awareness Fire Ants Fire ant stings appear initially as a red wheal attended by severe burning and itching. The wheal progresses to a clear blister, then to a cloudy necrotic pustule. Breaking the pustule offers the opportunity for secondary infection. Multiple Fire Ant Stings, Murray S. Blum, The University of Georgia, 0001006, University of Georgia Insect Images. Single Early Fire An,t Sting, Jerry A. Payne, USDA ARS, 0001001, University of Georgia Insect Images. Fire ant stings should always be washed with soap and water and treated with antihistamine and antibiotic creams to prevent itching & infection.

28. Field Safety Awareness Insects [“Venomous Arthropods”, Public Health Pesticide Applicator Training Manual, University of Florida and American Mosquito Control Association, at http://vector.ifas.ufl.edu/ and “Forest Pests of North America: A Guide For Foresters in the South”, Terry S. Price, University of Georgia, Warnell School of Forest Resources at http://www.forestpests.org/publichealth/ ] Field Safety Awareness Stinging Caterpillars Puss Caterpillar, Lacy L. Hyche, Auburn University, 1430162, University of Georgia Insect Images. Saddleback Caterpillar, Clemson University - USDA Cooperative Extension Slide Series, 1233068, University of Georgia Insect Images. Io Moth Caterpillar, Clemson University - USDA Cooperative Extension Slide Series, 1233031, University of Georgia Insect Images. White Marked Tussock Moth Caterpillar, John H. Ghent, USDA Forest Service, 0488007, University of Georgia Insect Images. Hag Moth Caterpillar, Jerry A. Payne, USDA ARS, 0001030, University of Georgia Insect Images. Spiny Oak Slug, Jerry A. Payne, USDA ARS, 1227101, University of Georgia Insect Images.

29. Key Point Review Stinging insects include bees, wasps, hornets, yellow jackets, fire ants, and stinging caterpillars. These stinging insects are present in areas where division officers must work on a regular basis. Stinging insects may be debilitating if multiple stings are received, or severe allergic and/or other systemic reactions may occur. Allergic reactions to insect stings may be fatal . Bee’s leave stingers in the wound. The stingers must be removed immediately to prevent additional venom from being pumped into the wound. Wasps, fire ants and caterpillars may sting repeatedly. Bee and wasp venom contains chemicals that cause strong allergic reactions and histamine production in the wound area. Fire ant toxin produces less histamine but greater necrotic effects.

30. Key Point Review A poultice or wet table salt applied to a bee or wasp sting is effective in preventing inflammation. Multiple stings should receive an application of wet table salt and immediate medical attention . All sting victims should be watched closely for signs of allergic and/or other systemic reactions. Obtain immediate medical assistance if systemic effects are noted. Biting flies include mosquitoes, tabanid flies and biting midges. Mosquitoes are ubiquitous & are implicated in the vector transmission of Eastern Equine Encephalitis, St. Louis Encephalitis, West Nile Virus and other diseases between animals and man.

31. Key Point Review Tabanid flies are blood-sucking nuisance insects that are also capable of transmitting diseases. The bites are painful and produce strong itching. Tabanid flies breed in moist soils with high organic contents. They include horse flies, deer flies, yellow flies, stable flies and similar insects. They are sometime so numerous that extraordinary physical protection is required to work in areas infested with tabanid flies. Wash tabanid fly bites with soap and water. Treat with anti-itch creams. Use insect repellants that contain DEET (N, N diethyl- m -toluamide) Tabanid flies are sometimes so numerous that extraordinary protective measures such as the use of “bee-keeper” netting, gloves w/taped sleeves, and pants tucked into boots are required to accomplish any effective work.

32. Key Point Review Biting midges are also known as “no-see-ums” or “sand gnats”. They are very small biting flies that breed in damp soils with lots of organic matter. Biting midges are often so numerous they can literally cover skin surfaces! The most effective biting midge bite prevention is effective clothing; long sleeves, pants legs, head gear, even gloves. Use of an insect repellant containing DEET is also necessary, but physical barriers are the most effective deterrent.