page62
to above the knee or from the hand to above the elbow
within 2 hours of
the bite),
an initial
dose of
2 vials
(20 mL) of the antiserum is recommended; if symptoms
of
systemic envenoming
persist
contact
the National
Poisons Information Service.
Adrenaline (epinephrine)
injection must be immediately to hand for treatment of
anaphylactic reactions to the antivenom (for the man-
agement of anaphylaxis,
see section 3.4.3).
Antivenom is
available for
bites
by certain foreign
snakes and spiders,
stings by scorpions and fish.
For
information on identification,
management,
and for
supply in an emergency, telephone the National Poisons
Information Service. Whenever possible the TOXBASE
entry should be read,
and relevant
information col-
lected,
before telephoning the National
Poisons Infor-
mation Service (see p.
32).
Insect stings
Stings from ants,
wasps,
hornets,
and
bees cause local
pain and swelling but
seldom cause
severe direct toxicity unless many stings are inflicted at
the same time.
If
the sting is in the mouth or on the
tongue local
swelling may threaten the upper airway.
The stings from these insects are usually treated by
cleaning the area with a topical
antiseptic.
Bee stings
should be removed as quickly as possible. Anaphylactic
reactions require immediate treatment
with intramus-
cular adrenaline (epinephrine); self-administered intra-
muscular adrenaline (e.g.
EpiPen
c
) is the best first-aid
treatment for patients with severe hypersensitivity.
An
inhaled bronchodilator
should be used for
asthmatic
reactions.
For
the management
of
anaphylaxis,
see
section 3.4.3.
A short course of an oral antihistamine
or
a
topical
corticosteroid
may
help
to
reduce
inflammation and relieve itching.
A vaccine containing
extracts of bee and wasp venom can be used to reduce
the
risk
of
anaphylaxis
and systemic
reactions
in
patients with systemic hypersensitivity to bee or wasp
stings (section 3.4.2).
Marine stings
The severe pain of weeverfish (
Trachi-
nus vipera
)
and Portuguese man-o’-war stings can be
relieved by immersing the stung area immediately in
uncomfortably hot,
but
not
scalding,
water (not
more
than 458 C).
People stung by jellyfish and Portuguese
man-o’-war around the UK coast
should be removed
from the sea as soon as possible.
Adherent
tentacles
should be lifted off
carefully (wearing gloves or using
tweezers) or washed off with seawater.
Alcoholic solu-
tions,
including suntan lotions,
should not be applied
because they can cause further
discharge of
stinging
hairs.
Ice packs will reduce pain and a slurry of baking
soda (sodium bicarbonate),
but
not
vinegar,
may be
useful for treating stings from UK species.
42
Emergency treatment of poisoning
BNF 61
Emergency treatment of poisoning