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General treatment principles for envenomation


First aid for envenomation involves:

  • Preventing further envenomation
  • Managing pain
  • Administering CPR, as necessary



Preventing further envenomation

Pressure immobilisation bandage

Pressure immobilisation bandaging delays absorption of venom from the affected area, thereby delaying the onset of symptoms. Pressure immobilisation bandaging is appropriate for bites from all sea and land snakes, cone shells, funnel-web spiders and the blue-ringed octopus. Pressure immobilisation bandaging slows down the venom travelling through the lymphatic system. The process for applying a pressure immobilisation bandage is detailed in chapter 14. Do not let the casualty move around once the bandage is applied. Splinting is then necessary to prevent movement as per chapter 14.

Vinegar

Vinegar is used for a minimum of 30 seconds to prevent further stinging from tentacles that may remain on the skin after a Chironex box jellyfish sting.  Vinegar may prevent further discharge of stinging cells after stings from Irukandji, Morbakka or Carybdea jellyfish. Vinegar does not reduce pain and does not reverse the effects of venom already injected. Vinegar should be used on all tropical jellyfish stings.  Encourage the casualty to keep the stung area still, as movement quickens absorption of the injected venom.

Pain management

Cold treatment

Cold treatment is used for localised skin pain from bites and stings (redback spider, centipedes, bees etc) and many non-tropical jellyfish stings. If a sting covers a large area, and particularly if the casualty is cold or wet, using cold therapy over a large area may cause hypothermia. In these cases, ice massage is recommended: tear the top 1–2 cm off an icy-cup (frozen water in a cardboard cup) or hold a small block of ice with a glove or cloth. Rub the ice over the affected area

Heat treatment

Heat stops pain in the majority of penetrating spine injuries from venomous fish (e.g. stonefish, stingray, puffer fish, lionfish, etc), and sea urchins.

Hot water treatment is also recommended for bluebottle (phylasia) stings. Place the affected limb in water as hot as can be tolerated (about 43oC), after first checking the temperature, or having the casualty check it with an unaffected limb, to avoid scalds. Leave the affected limb in water until the pain subsides. If the pain persists for long periods of time, seek medical aid.  Call Triple Zero (000) for an ambulance.

If it is a penetrating injury, i.e. a barb or spine, seek medical aid to have the barb or spine removed.