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Human and animal bites and venomous stings

Gauteng Department of Health, Emergency Medical Services, Trauma Unit, Johannesburg Hospital and University of the Witwatersrand, Johannesburg, South Africa, macfarlaneca{at}ems.gpg.co.za

CJ van Loggerenberg

Medical Rescue International, Emergency Medical Services, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa

Human and animal bites and venomous stings demand careful handling. Immediate resuscitation may be necessary. Severe tissue damage from larger animals frequently requires urgent haemorrhage control, followed by debridement. Subsequent reconstruction is commonly necessary. Smaller bites, and particularly human bites, may easily be underestimated, and can have significant infective sequellae, with particular attention being paid to the potential finger joint injury. Surgical exploration is frequently indicated, debridement, irrigation and antimicrobial therapy being required. Viral transmission, as well as bacterial infection, can result from bites.

With regard to envenomation, often a great deal of time and effort is directed at identifying the offending animal and focusing on a specific toxin. It is important to ensure effective general resuscitation first. Thereafter, specific antivenom and antianaphylaxis measures may be taken.

A description of the three common envenomation symptom complexes -cyto-complex, neuro-complex and haemo-complex - is presented, along with some causative sources. Principles of resuscitation, wound care and general treatment measures are indicated, and then appropriate specific treatments are recommended.

Bites and envenomations vary in different parts of the world and it is important that emergency departments develop appropriate protocols relevant to their locations. Common poisonous animal sources should be identified and symptom complexes anticipated. Specific antivenom therapy, appropriate to the area, should be available. However, the general principles of resuscitation and wound care have pride of place.

Key Words: bites • stings • envenomation • resuscitation • surgical exploration • antivenom

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