BITES and STINGS

dr muhammad isya Firmansyah

SpEm
ENVIROMENTAL EMERGENCY
ϖ Introduction
ϖ First-Aid Priorities
ϖ Animal Bites
ϖ Dog Bites
ϖ Insect Stings
ϖ Injuries by Marine
ϖ Creatures Snake Bites
Most animals will not turn aggressive unless provoked.
Staying away from these wild animals could prevent many
unnecessary injuries.

It is only wise be equipped with a first aid kit when involved

in outdoor activities.

Before attempting a rescue, ensure personal safety before

approaching a victim that is under attack.

Always call medical assistance if you are unable to

handle the situation alone.
1. Ensure personal safety before attempting rescue
2. Assess victim’s condition (e.g. consciousness level)
3. Calm the victim by reassuring victim
4. Treat any visible injuries and minimize any risk of further
injury and infection.

5. Call medical assssitance if you are unable to handle the

injuries alone
6. Identify the injury and the source to assist the medical team
in treating the wounds and anticipating certain symptoms
such as anaphylactic shock.
Animals with sharp teeth can cause deep puncture
wounds and carry germs deep into the tissues and result
in an infection.

Any bite that breaks the skin can cause the victim to
become very vulnerable to infection.
• Canines are born with teeth to hunt and an instinct that
commands it to bite whatever targets it considers as prey.

• These instincts could result in very severe injuries to the

victim.

• Dogs are generally very protective over

-Food
-Territory
-Young

• When threatened, they

will attack to protect them.
• Do not run past a dog

• Do not travel alone in the wild

• Do not approach a dog when it’s eating

• Do not approach a dog when it’s tied up

• Do not snatch anything that belongs to the dog

• Do not pat any stray dog even if it seems pitiful or cute

• Avoid attracting a dog to you with food or sound

• Do not approach a dog when it is nursing its puppies.

• Never force a dog into a corner or threaten it for the fun

of it.
• Treat every dog you do not know with caution.

• Do not throw objects or provoke animals (Dogs

etc…)
• Do not intrude into their territory
1. Control bleeding by
applying direct
pressure and raising
the injured part.
2. Cover the wound with a
sterile dressing or a non
fluffy clean pad
bandaged in place to
control bleeding.

3. Arrange to take or send

the casualty to hospital.
1. Wash the wound
thoroughly with
soap and warm
water in order to
minimize the risk of
infection.
2. Pat the wound dry with clean gauze swabs and
cover with an adhesive dressing or small sterile
dressing.

3. Advise the casualty to see a doctor in case

inoculation (vaccination) is needed. If the wound
is large or deep, arrange to send the casualty to
hospital.
Rabies
A potentially fatal viral infection of the nervous system,
spread in the saliva of infected animals.

Hepatitis B or C viruses
There is probably only a small risk of hepatitis B or C
viruses being transmitted through a human bite.
Rabies
⚫ Gejala rabies biasanya muncul sekitar 4-12 minggu
setelah pasien tergigit hewan yang terinfeksi
⚫ Gejala awal yang muncul meliputi:
-Demam
-Otot melemah
-Kesemutan
-Sakit kepala
Terdapat gejala lanjutan yang muncul pada
penderita rabies,gejala lanjutan tersebut penanda
kondisi pasien memburuk
Continued...
⚫ Pengamatan dilakukan pada hewan yang menggigit
selama 10-14 hari dengan melihat ada atau tidaknya
gejala rabies pada hewan tersebut tujuannya adalah
menilai perlu atau tidaknya pemberian serum atau
vaksin antirabies.
⚫ Penilaian luka untuk menentukan perlu atau tidaknya
seseorang mendapatkan vaksin atau serum anti rabies
⚫ Luka yang beresiko tinggi adalah yang terletak di
bagian tubuh yang memiliki banyak saraf seperti
leher,kepala, wajah serta ujung jari tangan dan kaki
atau luka tersebut cukup dalam dan jumlahnya lebih
dari 1
Continued...
⚫ Apabila luka yang dialami adalah luka berisiko tinggi
serta hewan yang menggigit tidak dapat di observasi
atau selama observasi hewan menimbulkan gejala
rabies pasien perlu menerima serum atau vaksin.
⚫ Tujuan pemberian vaksin dan serum anti rabies adalah
menetralkan virus rabies yang ada diluka dan didalam
tubuh.
VAKSIN
⚫ Pemberian vaksin anti rabies (VAR) setelah tergigit hewan
yang diduga membawa virus rabies merupakan cara
terbaik agar terhindar dari rabies,fungsi vaksin ini untuk
merangsang antibodi penetral virus rabies.
⚫ Vaksin diberikan sebanyak 4 kali pada orang yang belum
pernah di vaksin dalam periode 21 hari.
⚫ Pada orang yang sudah pernah di vaksin maka
pemberiannya hanya 2 kali dalam periode 3 hari
⚫ Vaksin diberikan melalui suntikan ke otot di sekitar lengan
atas (deltoid) atau paha.
⚫ Setelah pemberian vaksin rabies dapat timbul
ruam,pembengkakan dan sakit pada area yang
disuntik,side effectnya: demam,sakit kepala,muntah,nyeri
otot.
Serum Anti Rabies
⚫ Berfungsi untuk menetralkan virus pada luka
sekaligus memberikan perlindungan selama 7-10 hari
sebelum antibodi yang terbentuk dati vaksin muncul.
⚫ Serum anti rabies diberikan pada orang yang
mengalami luka dengan resiko tinggi.
⚫ Dosis pemberian pada tiap orang berbeda disesuaikan
dengan berat badan pasien ,dosisnya adalah 20 atau
40 IU/kgbb
Pencegahan
⚫ Tetap menerima vaksin sebelum melakukan aktifitas
yang beresiko tinggi menyebabkan tertular virus rabies
meskipun pernah di vaksin.
⚫ Melakukan vaksinasi pada hewan peliharaan seperti
anjing atau kucing.
⚫ Melaporkan hewan liar ke lembaga yang bertanggung
jawab untuk mengawasi hewan liar.
⚫ Mengubur setidaknya sedalam 1 meter atau membakar
hewan yang mati akibat rabies.
⚫ Menghindari kontak langsung dengan hewan liar.
Continued...
⚫ Orang yang memiliki resiko tinggi terpapar virus
seperti staff laboratorium,pengasuh hewan,atau
dokter hewan dianjurkan diberikan vaksin tujuannya
untuk mencegah rabies.
⚫ Vaksin awalnya adalah 3 dosis dalam periode 28 hari
kemudian dapat diberikan dosis tambahan tiap 2-3
tahun apabila orang tersebut memiliki aktifitas yang
beresiko tinggi terpapar rabies.
⚫ Bagi wisatawan yang akan berkunjung ke tempat
wisata yang terdapat hewan liar vaksin diberikan
sebanyak 2 kali dengan jarak pemberian 4 minggu.
• Reassure the casualty.

• Apply constant firm

Bee Sting
pressure, scrape or brush
the sting off with your
fingernail or blunt edge
of an object. (Tweezers
are not recommended as
it may squeeze the
venom sac thus
increasing the venom Bee Sting
released).
•Some people are allergic to stings and can
rapidly develop the serious condition of
anaphylactic shock. Multiple stings can also be
dangerous.

•Stings in the mouth or throat are serious, as

swelling can cause obstruction to the
airway.
• If stung on the fingers or hands, remove any rings
and watches in case of swelling.

• Wrap a few ice cubes in a towel and apply on the

area for 10-15 minutes to stop the pain and swelling.
Do not apply ice directly on the sting area to prevent
frostbite.
Advise the casualty to see his doctor if the pain and
swelling persist.
• Reassure the casualty. Give the casualty ice to suck or
cold water to sip, to minimize swelling.
ϖ Red, swollen, or warm lump

ϖ Hives

ϖ Rash

ϖ Itching, tingling, numbness, burning, tenderness, pain

ϖ Serious allergic reactions (anaphylaxis) occur when symptoms

spread. These can include difficulty in breathing, dizziness,
nausea, diarrhea, fever, muscle spasms, or loss of
consciousness. Call for emergency medical help right away.
• Use insect repellants

• Wear long pants / T-shirt

• During an attack, cover your face and run in a straight line

as quickly as possible.

• Grab a net, coat, towel, or anything that will give you

momentary relief.

• During your escape, try to find shelter like a house, tent or

car with windows and door closed.
• Avoid other people as they too may come under attack.

• Bees may pursue for up to 400m

• They are slow fliers and most people can outrun a bee.

• be alert for bees coming in and out through cracks in a

wall.

• Stay away once you notice a bee colony. Do not provoke it.
• Using fine-pointed
tweezers, grasp the tick’s
head as close to the
casualty’s skin as
possible.

• Use a slight to-and-fro

action to lever, rather
than pull, the head out.
The mouthparts will be
very firmly embedded in
the skin; try to avoid
breaking the tick and
leaving the buried head
behind.
ϖ
Sea creatures can cause
injury in various ways.

ϖ
Severe poisoning and
occasionally death results
from a severe allergic
reaction (anaphylactic
shock)

ϖ
Paralysis of the chest
 Jellyfis
h
ϖ
Jellyfish stings occur when:
ϖ
people brush against it in the water
ϖ
step on those washed ashore.

ϖ
Jellyfish washed ashore can sting for
weeks.

ϖ
Detached tentacles can also release
• The Portuguese Man-of-War (a type of jellyfish)
is well known for its painful and powerful sting.

• The stings can cause:

– Fever

– Shock

– Heart and lung problems.

• Box Jellyfish (sea wasp) have tentacles containing
thousands of stinging cells.

• Stings occur when people bump into them.

• Tentacles become sticky and adhere tightly to the

skin.

• Venom is released when in contact with human

skin.

• Causes severe pain.

• Sea urchins are found in tropical and
subtropical marine regions.
• Spines of the sea urchins deliver their venom.
• Sting can cause severe burning pain, swelling,
bleeding, itch, nausea, muscle weakness and
difficulty breathing.
• Symptoms can develop immediately and last
up to 6 hours.
• Deep puncture wounds may be seen after a
sting.
• Stingrays are often found buried and feeding in shallow water.

• Stingrays are not aggressive by nature.

• People are usually stung when they step on the stingray.

• The sting causes profuse bleeding, swelling and severe pain that
can last for months. Other symptoms that may develop are
nausea, diarrhea, sweating, muscle cramps, and fits.
• Reassure the casualty and sit him or her down, pour vinegar or
sea water over the injury to disable stinging cells that have not
yet released venom.

• Dust dry powder over the skin around the affected area to
make any remaining stinging cells stick together. Talcum
powder is very good for this. Meat tenderizer, used in barbecue
cooking, is also good as it contains papain, which inactivates
venom.

• Gently brush off the powder with a clean, non-fluffy pad.

1. Gently pull out any
protruding spines. Do
not crush the spines.
2. Soak the affected area
into hot (not scalding)
water for 30-90 minutes
to ease pain. If pain
returns later, try the
heat soaks again.
3. Send the casualty to
hospital.
• Proper footwear

• Be careful when handling marine creatures as they

may have venomous spines and stings

• Keep away from jellyfish

Snake Bites
King Cobra Blue Coral Snake Black Spitting Cobra
• A snake bite is often not a serious injury, but it can be very
frightening.

• Reassurance is vital, for if the casualty keeps still and calm,

the spread of venom may be delayed.

• Try to get a description of the snake. This will help the

doctor to identify the snake and the correct treatment. Do
not try to catch the snake.
• Notify the police if the snake remains at large.
• A pair of puncture marks.
• Severe pain at the site of the bite.
• Redness and swelling around the bite.
• Nausea and vomiting.
• Difficulty breathing; in extreme cases,
respiration may stop altogether.
• Disturbed vision.
• Increased salivation and sweating.
 CLINICAL MANIFESTATION
LOCAL SYSTEMIC
⚫ Swelling > half bitten • Haemostatic abnormality
limb/48 hours • Neurotoxic signs
• Cardiovascular abnormalities
⚫ Toes especially fingers
• Acute kidney injury
⚫ Rapid extension within a • Myoglobinuria/generalised
few hours rhabdomyolysis/haemolysis
⚫ Enlarged tender • Supporting lab evidence of
systemic envenoming
lymphnode draining the
affected area
(A. Khaldun, 2015)
20 MINUTES WBCT
⚫ Aim : to make sure hemotoxin or not by knowing from
the coagulation.
⚫ How to do?
⚫ Take a glass bottle, DO NOT USE PLASTIC BOTTLE
⚫ Take 2 ml of blood
⚫ Then take that blood into the glass bottle
⚫ Wait for about 20 minutes
⚫ Repeat that test 2 times minimal
⚫ Result :
⚫ After waiting about 20 minutes:
⚫ Clotting (+) : no coagulation disorder (NonHemotoxin)
⚫ Clotting (-) : coagulation disorder (HEMOTOXIN)
Rate Proximal Progression Test
⚫ Aim : to evaluate the edema progression to make a best
next medical treatment.
⚫ How to do?
⚫ Take a tape as a mark to measure the edema
⚫ Make sure the proximal margin of the edema, then take the
distal margin of the tape into the proximal margin of the
edema.
⚫ Note the time when the tape was given (date and time)
⚫ Repeat the evaluation of the edema every 2 hours
⚫ Result : cm/hour
⚫ Example : 10/10/15 ; 09.00 – 11.00 = 4 cm. So we have
evaluated that the edema increase about 2 cm per hour.
1. Lay the casualty down.
Tell the casualty to
keep calm and still.

2. Gently wash the wound

and pat dry with clean
swabs. DIAL 995 FOR
AN AMBULANCE.
3. Lightly compress the limb above the wound with a roller
bandage. Use triangular bandages to immobilize the
affected area to minimize the spread of venom.

4. Position the injured limb below the level of the heart. If

she stops breathing, be ready to resuscitate if needed.
*DO NOT apply a tourniquet, a bandage or ice on the
wound, slash the wound with a knife, or suck the venom.

5. If there is eye irritation, rinse the eye under gently running

cool water for at least 15 minutes. Prevent run-off water
from entering the unaffected eye.
 Lightly compress
Keep the heart above with Roller
the level of wounded bandage
part Leave bite exposed

Tie narrow-fold bandage in

figure-of-eight around feet
• Do not try and chase, provoke, catch or beat up
the snake
• Move away if you spot a snake
 SNAKE ANTIVENOM

MONOVALENT POLYVALENT
Other ANTIVENOM
Probems
⚫ Anaphylactic Reaction/Syok
⚫ Rabies or dosis VAR
Anaphylactic and Adrenaline
Anaphylaxis:manifestation of allergic 2 or more body
systems,examples:skin rash,respiratoty(tachypnoe),cardiovascular(low
blood
Dose: pressure) or gastrointestinal(nausea,vomit,diarrhea)
12thn
keatas&dws:IM 0,5
mg,6-12 thn:IM 0,3 Berikan steroid dan
mg,<6thn:IM 0,15 antihistamine dan Nebuliser
mg..Note the usual hindari pemberian diperkenankan untuk
ampoule is of 1:1000 antihistamin jika <2thn segala usia
concentration with
1ml=1mg
• Most animals and insects do not usually
attack unless injured or provoked
• You must always take sensible precautions before
attempting, for example, to rescue a casualty from
an angry dog or a swarm of bees.
• If you cannot cope alone, get help or call for
ambulance
Haturnuhun