Bites Treatment

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Poisonous Snakes of North America:

Pit vipers vs non-venous Snakes:                                            Venous:

           Rattlesnake                                     Copperhead                                Water Moccasins

Coral Snakes (not a pit viper but a small, shy, timid, but powerful neurotoxin; bites are rare and deaths rarer). Usually seen in southern northeast:

Do's

• Call 911

• Keep individual calm

• Remove restrictive clothing

• Clean and disinfect

• Place bite site below level of heart

  • Monitor for anaphylaxis (i.e., shock, change in mental status, difficulty breathing - see

Don'ts

• Do not tourniquet

  • Do not cut and suck

  • Do not apply ice

• Do not give aspirin or advil (anti-inflammatories)

References:

• • Wilderness First Aid, Frank Hubbell, DO, TMC Books, 3rd Ed., 2014

  • First Aid and Medicine, Duff and Gormly, 11th Ed, 2011

  • Backcountry First Aid and Extended Care, Buck Tilton, Falcon Guides, 5th Ed, 2007

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Ticks:

Summary: Ticks are common in the U.S. and some are capable of transmitting disease. In the north east, Lyme disease is of concern. Ticks are carried by mice (during the nympha stage) and deer (in the adult stage). The cause of the disease is an organism called Borrelia burgdorferi which lies in the gut of the tick. The tick must be present and feeding for over 24 hours to transmit the disease. Luckily, only about 1 in 4 carry the organism and transmission is low. But we don't have that information about the specific deer tick that has bitten us. If the tick is not imbedded in the skin, it can not transmit the disease. If embedded, follow the below information.

Identification: The deer tick tends to be smaller without the coloration of the dog tick (which does not transmit the disease). The biggest problem are the nymph, an immature deer tick, because of it's small size and it makes it difficult to find when checking for ticks after a day hike or camping.

What to do after being bitten by a tick1: 

• • Use fine tweezers to grasp the tick as close to the skin surface as possible.

  • Pull backwards gently but firmly, using an even, steady pressure. Do not jerk or twist.

  • Do not squeeze, crush, or puncture the body of the tick, since its bodily fluids may contain infection-causing organisms.

  • After removing the tick, wash the skin and hands thoroughly with soap and water.

  • If any mouth parts of the tick remain in the skin, these should be left alone; they will be expelled on their own. Attempts to remove these parts may result in significant skin trauma.

The Infectious Diseases Society of America (IDSA) recommends preventive treatment with antibiotics only in people who meet ALL of the following criteria2:

• • Attached tick identified as an adult or nympha I. scapularis (deer) tick (see picture 1 in addendum below).3,4

  • Tick is estimated to have been attached for equal or greater then 36 hours (based upon how engorged the tick appears or the amount of time since outdoor exposure).

  • The antibiotic can be given within 72 hours of tick removal.

  • The local rate of tick infection with B. burgdorferi is greater then 20 percent (known to occur in parts of New England, parts of the mid-Atlantic states, and parts of Minnesota and Wisconsin).

  • The person can take antibiotics, usually doxycycline (not pregnant, greater then 8 years old).

Note 1: All the above criteria must be met according to the IDSA, however, I personally feel this criteria is to strict.5 The presence of a bulls eye rash, acute symptoms (see monitoring below) following outdoor activity or late symptoms require medical attention and Lyme disease should be a consideration.

Monitoring: Monitor the area for rash, Erythema Migrans (EM) (see picture 2 in addendum), which often times has a blanching or "bull's eye" center. However, only 50% of individuals will develop such a rash (and individuals who do see such a rash, many do not recall being bitten by a tick). Symptoms are vary variable. Early symptoms include fever, joint or muscle pain, fatigue and weakness. Late symptoms include severe headaches, painful arthritis and swelling of joints, cardiac abnormalities, and central nervous system (CNS) involvement leading to cognitive (mental) disorders.6,7

Note 2. The diagnosis is a clinical one with lab tests only as supporting evidence.8 Many in the medical field rely on the laboratory test for Lyme. In my experience, The test is often negative early on (less then 4 weeks), and I've seen classic later symptoms with a negative test. Many physicians claim you can only get Lyme once and when you have a negative test, you do not have Lyme, both of which I disagree. It is well know that late symptoms may recur even after treatment.

Prevention:

• • Where protective clothing hiking in tall grass, heavy underbrush, very thickly wooded areas.

  • Do a tick check after each day hike, looking closely for the tiny nymph.

  • Do a tick check morning and evening when camping.

Addendum:

Deer tick vs dog tick

References:

• 1. Patient information: What to do after a tick bite to prevent Lyme disease (Beyond the Basics)   Linden Hu, MD, Professor of Medicine, Tufts University School of Medicine

  2. Infectious Diseases Society of America practice guidelines for clinical assessment, treatment and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis.   Infectious Diseases Society of America (IDSA, Dec lst, 2006)

  3. Tick Identification   From tickinfo.com

  4. How to Identify a Deer Tick   From wikiHow

  5. Why We Protest Against The IDSA   From Lymedisease.org (formally CALDA)

  6. Lyme Disease   From the American Lyme Disease Foundation

  7. Arthritis and Lyme Disease   From WebMD

  8. A GUIDE: THE DIAGNOSTIC DILEMMA OF LYME DISEASE   From the Lyme Research Alliance re: test reliability.

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Poisonous Spiders of North East America:

3,000 species of spiders have been described in North America. Of the spiders found in North America, only the Brown Recluse Spider (Loxosceles reclusa) and the Black Widow (Latrodectus) species are considered really dangerous and an average of 4 people die from venomous spider bites a year in the USA.

Brown Recluse: The brown recluse is found from the Atlantic to the Pacific but is more common in the central U.S. It measures from 6 to 18 mm (1/4 to 3/4 inch) in body length.

Symptoms: Individuals react differently to the bite; some people may not be aware of the bite for two or three hours, while others may have an immediate painful reaction. A stinging sensation is usually followed by intense pain. Within eight hours, a small puss filled blister usually rises, and a large area around the bite becomes red and swollen. An ulcer may and often develops. The ulcer will usually stop growing within 10 days, and full healing may take months.

Treatment: Treat with rest, ice and elevation. Seek immediate medical attention if:

• Severe pain

• Abdominal cramping

• A growing ulcer at the bite site (may require debridement and antibiotics)

Black Widow:The Black Widow Spider is notorious at being among the most venomous spiders in the world and it's venom can be fatal. However, less than 1% of all people bitten by this spider run the risk of dying, and most of them are saved with the use of an effective anti venin, which was developed in 1956. The very young or very old individuals are at the greatest risk.

This species occurs throughout North America, from Canada to Mexico, and in the West Indies. Black Widows measure about 1.2 cm (1/2 inch) in body length. The female is normally shiny black, with a yellowish orange to red hourglass (sometimes just a dot) marking on the underside of the abdomen. Black Widow Spiders need some kind of a shelter and can often be seen in small crevices or in woodpiles, rubble piles, under stones, in hollow stumps, in sheds and garages. Indoors they are sometimes found in undisturbed, cluttered areas in basements and crawl spaces. They build strong retreats close to the ground but might also spread their webs over plants.

Symptoms: Pain around the bite area usually within an hour but can spread to the abdomen, back or chest, abdominal cramping (sometime severe), and sweating around the area the bite area or entire limb. Additional symptoms can include:

• Headache

• Chills

• Nausea, Vomiting

• Difficulty in respiration

• Profuse perspiration

• delirium

• Hypertension

Treatment: The Black Widow Spider is notorious at being one of the most venomous spiders in the world and it's venom could be fatal. However, less than 1% of all people bitten by this spider run the risk of dying, and most of them are saved with the use of an effective antivenin, which was developed in 1956. The very young or very old individuals are at the greatest risk. More typically, recovery is complete in 1 to 5 days. All patients should seek immediate medical attention.   

  References:

• 1. North America's most venomous spider   Google site dedicated to all the venomous, poisonous, or otherwise potentially dangerous animals on Earth

  2. Spider bites   by the Mayo Clinic Staff

  3. Spiders: Brown Recluse, Black Widow, and Other Common Spiders   Oklahoma Cooperative Extension Service

  4. Black Widow Spider Bite   From EmedicineHealth

  5. Bad Bug Slide Show: Identifying Bugs and Their Bites, WebMD 

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