From: scd@atria.com Sun Jun  5 05:05:22 EDT 1994
Newsgroups: rec.gardens
From: scd@atria.com (Steve Daukas)
Subject: Bites/Stings/Allergic reactions...
Summary: Information post about allergic reactions, bites and stings
Keywords: allergic reactions, bites, stings
Date: Tue, 31 May 1994 14:15:46 GMT
Lines: 870

This post is long (about 900 lines)!  There is an intro and two section 
beyond dealing with specific bites/stings and what to do about them.

I decided to post this information after seeing posts about treatments that 
were not entirely accurate, or after reading discussions about bee stings 
where people were recommending taking lots of over-the-counter meds (a few
months ago).
-
OK.  Let me start by saying a few words.  This post is informational only. 
I am not a physician.  I have lots of experience at the various levels of EMT 
(Emergency Medical Technician).  I have taught in the past (both medical and 
rescue), have "worked" on a pharmacology text (soon to be published), and have 
been a volunteer on various rescue squads since 1979 (I have been a rescue 
squad commander and have held the rank of Lieutennant in charge of training). 
Currently, I am not active in EMS, (as a result of moving into an area that 
doesn't have many volunteer organizations), but I still hold many of my 
certifications and licenses and am nationally registered with the Dept. of 
Transportation (the governing body of EMS in the US).  My current licenses
are valid in those states that recognize the National Registry of Emergency 
Medical Technicians.  OK - enough of the Resume!  ;-)

My information comes from a variety of texts, many dealing specifically with
prehospital care, and my experiences.  I do not claim that this information
is accurate for all jurisdictions in this country.  In fact, some of what
I present is illegal in certain areas (even for EMT-Paramedics).  Again, its 
for those who are curious...

After some soul-searching, I decided to include descriptions of some of the
advanced treatments often used for various conditions. These descriptions are
clearly marked.  I was hesitant to include these descriptions because they
are advanced, meaning you can do more harm than good if you do it wrong, but
in the end I thought it would be OK as most people wouldn't be able to do them 
for lack of equipment or people would try based on some "treatments" that are 
based on "hollywood" and are only partially correct and if performed as shown
on TV are, by definition, wrong.

Advanced treatment requires medical training and certification!  This includes 
CPR and other procedures described.  As stated above, this info is provided as 
a matter of information and to give an indication as to how serious certain 
events are given the treatments used by individuals such as EMTs and others.  
DO NOT ATTEMPT these treatments!!

-

A word about tourniquets...  Tourniquets are used to stop both venus and arterial
blood flow to a limb.  There is NEVER and reason to use a tourniquest for bites
or stings, unless the limb is bleeding severely and it can't be stopped (e.g,
the person will die from blood loss).  Constricting band are used to stop venus 
blood flow only.  When properly used, there will still be a pulse in the wrist or
foot, for example.  The use of the constriction band for bites is very controversial 
in EMS, some areas still do not allow their use.  Don't use anything like these
devices unless your on the top of Mt. Everest and an MD tells you to do it!

ALWAYS call for help BEFORE doing anything!

Oe final note to this intro:  NEVER eat or drink anything if there is any question
of a serious medical condition, such as an allergic reaction.  Never eat "herbal
remedies" or take chicken soup!  I have had one pateint die on me because she ate
a common flowering plant used to make a heart med (she knew quite a bit about 
medicinal flora).  Having "food" in your belly can complicate treatments at the ER,
especially if there is any medicinal value to what you have eaten!  Having you
stomach pumped will delay proper treatment (they will pump it.)  In the case of
a severe allergic reaction, I am not aware of any "household" remedy that will stop
someone from going into anaphylactic shock and passing away.


The next two sections...

Section 1 provides background on allergic reactions

Section 2 deals with basic information and treatment of certain common 
bites/stings.

-

Section 1 - Alleric Reactions
=============================

Concepts and Terminology (boring, but useful)
---------------------------------------------

To understand what takes place during an allergic reaction and in
anaphylaxis, several concepts and terms need to de defined:

The imune response is designed to guard the body against dangerous
foreign substances such as infection and antigens.  In the normal
imune response, the protective cells of the body recognise the
dangerous intruders, and destroy them.  The allergic reaction or
response, on the other hand, is an _oversensitive_ and harmful
response against a foreign body.  

Immunity is the body's natural protective state of being resistant
to poisons and foreign substances.

An antigen is a foreign substance that induces the formation of
antibodies.  Antigens are such things as bacteria or viruses.

An antibody is a protective protein substance formed in the body
as a result of contact with a foreign antigen.  

When antigens and antibodies interact in the body, an immune
response develops.  This response can cause allergies and
anaphylaxis. 

An allergy is an abnormal and individual hypersensitivity
to substances that are ordinarily harmless.

An allergen is an antigen that the body is oversensitive to.

Sensitisation is the process of exposure to an allergen and 
then results in the production of antibodies.  An important 
fact to note is that an allergic reaction cannot occur with 
the first contact with a potential antigen because antibodies 
have not yet formed.  

Anaphylaxis means without protection (literally).  It is an
acute generalised allergic reaction that occurs within minutes to 
hours after the body has been exposed to an allergen.  Anaphylaxis
is a serious medical condition that can lead to death in minutes.

Other definitions include:

edema - 		swelling
stridor -		harsh sounding breathing
dyspnea -		shortness of breath
cyanosis -		bluish colour
syncope -		temporary loss of consciouness
tachycardia -		very fast heart beat
bradycardia -		very slow heart beat
accessory muscles - 	muscles used to help breath. located in neck, chest
hypotension - 		low blood pressure
hypertension - 		high blood pressure
sign -			objective evidence, such as edema
symptom - 		subjective evidence, such as nasuea
Sx -			signs and symptoms
pulmonary edema -	fluid/blood build-up in the lungs (pink frothy 
                        mucus coughed up while breathing)
transport -		CALL 911 or equivalent



Common Allergens
----------------

Allergen groups include drugs, insect venom, food, and pollen.
The causative agent may be injected, ingested, absorbed through
the skin or mucus membranes, or inhaled.  Inhaled substances
rarely cause allergic reactions.

Insect stings/bites fall into the injection category.  The allergic
reaction is different from the toxic effects of the venom.

The insect order Hymenopter is the most common allergen. The
four prominent members include the bumblebee, honeybee, white-
faced hornet, and the yellow jacket.  About 8 in 1000 are
allergic to stinging insects and half of these are severe.
This order has whats called "cross-sensitivity" meaning a bite
from one may lead to an allergic reaction to a bite from another.

Ants, dear flies, ticks, and mosquitoes can all cause an allergic
reaction.



Pathophysiology
---------------

In a simple anaphylactic reaction, the antigen-antibody interaction
causes mild alleric signs and symptoms (Sx) limited to usually one or
two body systems and without systemic cardiovascular effects.  In an
anaphylactic reaction, however, the antigen-antibody reaction is
severe.  This reaction takes place on the surface of mast cells and
basophils (types of white blood cells) and signals the release of
several chemicals, primarily histamine.  Other chemicals include
serotonin, bradykinin, and SRS-A (slow reacting substance of
anaphylaxis).

These chemicals cause three primary reactions: capillary dialation,
increased capillary permeability, and smooth muscle spasm.  As these
substances travel around the body, the following Sx can be seen:

Skin			flushing, edema, itching, hives, rash, a
			feeling of warmth
Eyes			itching, tearing, edema
Nose			congestion, itching, sneezing
Upper Airway		pharyngeal or laryngeal spasm, hoarsness,
			stridor, bronchospasm, tightness in the neck
Lower Airwar		Dyspnea, wheezing, use of accessory muscles to breath,
			cyanosis, pulmonary edema
Cardiovascular		tachycardia, irregular pulse, weak pulse, hypotension
Gastrointestinal	nasuea, vomiting, diarrhea, abdominal cramps
Neurogenic		Anxiety, dizziness, syncope, weakness, seizure,
			headache

A person may experience these Sx within seconds after exposure, or the
reaction may be delayed for several hours.  The initial Sx usually occur
in the Skin.  The primary rule for determining severity is simple:  the
sooner the onset of Sx after exposure, the more severe the reaction.
Injected antigens can produce Sx immediately, but usually this happens
after 5 minutes to as much as thirty minutes later.  Injested antigens
usually cause a reaction in about 2 hours.

The effect on the cardiovascular system progresses as follows:

 -  caplillary beds dialate (located in skin and internal organs)
 -  increase in capillary permeability (fluid leaks out)
 -  blood pools in capillary beds (especially the skin)
 -  decreased amount of blood returns to heart
 -  decreased cardiac output
 -  early stages of hypovolemic shock (low blood volume)

The effect on the airway is simply this: the airway constricts (usually
from swelling) and spasms resulting in decreased airflow into the lungs 
and a reduced oxygenation of the blood.  Loss of the airway is the primary 
concern.

Commonly used drugs include epinephrin (adrenalin) and diphenhydramine.
Others are used in the prehospital setting as well.

Epinephrin counteracts the effects of histamine and the other chemicals
by vasoconstriction, bronchial dialation, and restoration of the tone and
permeability of the blood vessels.  Epinephrin's major side effect is the
development of cardiac irritability.  IV administration of Epinephrin can
cause serious arrhythmias.  This drug is short acting and may be needed
every 15 minutes.

Diphenhydramine is an antihistamine that antogonizes the adverse effects
of histamine and prevents further release of histamine.  This drugs is not
used on pregnent patients.  The major side efect is a dry mouth and caridac 
arrhythmias.



Section 2
=========

Patient Assessment
------------------

The victim of a bite will usually be agitated.  Try to calm them and
determine what happened, where, how long ago, and what the culprit
might have been (determine if it walked, flew, swam, etc.).

Determine if the threat is still nearby and move from the area if
this is the case.  If the culprit is dead, collect it carefully
and put it into a container that can be handled safely.

If the victim has no Sx, don't leave them alone - monitor them for
at least four hours.  (Clearly, I'm not talking about a mosquito bite
here.)

If itching, a feeling of warmth, tightness in the throat or chest,
or a rash appear (usually the first signs) summon help immediately.
Knowing when the bite took place will help determine how severe the
condition is - remember the sooner Sx folow the bite, the more severe
the reaction.  If the situation worsens, concern yourself with maintaining 
an airway.

The airway is the primary concern.  The simple rule of ABC is used;
Airway, Breathing, Circulation.  The basic techniques tought for CPR are
whats used to establish and maintain an open (patent) airway and to
ensure circulation.

Establish basic vitals:  A pulse in the wrist means a BP sufficient for
total body profusion, but it will not tell you if the patient is in
shock or not.  An very week pluse in the wrist means the person is very
likely in shock and is very likely in bad shape!  One way to ascertain 
if the person is on the way to shock is by pinching the bed of a fingernail
until it goes white and then releasing.  If it takes more than 2 seconds 
for the normal pink colour to return, this is an ominous sign.  (Obviously,
nail polish must first be removed.) 

Determine LOC (level of consciousness).  If the person seems "drunk" or
"sleepy", you must seek treatment.  If the person is abnormally agitated
or even verbally abusive, this is a sign of a change in mentation, an
early indicator of neurogenic involvement.

If you suspect a severe reaction and the airway is failing, judgement
is called for.  Don't wait for transport unless it is very close at hand.
If you live in a rural or lightly suburban area, use the phone to inform the 
dispatcher what is going on and that you feel as though you should take the 
victim to the ER and what route will be used.  Ask them to intercept you along 
the way.  Follow your instincts, BUT ALWAYS FOLLOW THE DISPATCHER'S 
INSTRUCTIONS!  In any case, you should explain the situation and ask for an 
"ALS" response, that is, an Advanced Life Support response.  

The victim of other vectors may exhibit similar Sx.  The same basic treatments 
apply.




Specific Treatments
-------------------
Snakebite (Pit Vipors)
----------------------

There are posionous snakes in every state except Alaska, Hawaii and Maine.
Of the 120 species in the US, about 20 are posionous.  Of the bites that
do take place, about 55% are from rattlesnakes, 34% from copperheads, 10%
from water moccasins, and 1% from coral snakes.

Sx generally occur immediately, but only about one-third of all bites
manifest Sx.  When no Sx present themselves, probably no venom was
injected.

Nonpoisonous bites are not considered an emergency.  Poisonous bites
contain some of the most complex toxins known; venoms can affect the
central nervous system, brain, heart, kidneys, and blood.

Signs that indicate a poisonous bite include:

   One or two distinct puncture wounds (fang marks).  Nonposionous bites 
   usually leave a series of shallow, small puncture wounds.  The coral 
   snake is one exception.  This snake leavs a semicircular marking from its 
   teeth.  A row of punctures does not rule out a posionous bite, but fang 
   marks _always_ confirms a posionous bite.
   
   The patient experiences severe burning and pain almost immediately, but 
   always within 4 hours of the bite.

   The wound begins to swell and discolour usually immediately, but always
   within 4 hours.

Most posionous snakes have the following characteristics:

  Large fangs 
  Elliptical pupils - nonposionous snakes have round pupils
  Presence of a pit - a heat sensitive organ - between the eyes
  A variety of blotches on a brightly coloured skin, including pink, yellow,
    olive, tan, grey, red, or brown.
  A triangular head that is larger than the neck.

The one exception to all this is the coral snake.  It has round pupils, no
fangs, and a small head.  Because its mouth is so small and teeth are short, 
most bites are on the finger or toes.  Coral snakes are generally small and
have rings of red, yellow and black; the red and yellow touch each other.

The seriousness of the bite can be determined by assessing several items:

1 - Age, size and health of the victim.  Bites are most dangerous in 
    children and the elderly.

2 - Depth, location, and number of bites.  A single glancing blow is
    less dangerous than multiple wounds.  Bites on the head or torso
    are usually fatal, as is a bite that punctures a blood vessle.

3 - Duration of the bite.  Was it a quick hit or did the snake hold on.

4 - Clothing.  A bite that hits the skin directly is worse than one that
    went through clothing.

5 - Maturity of the snake.  The older, the more dangerous.

6 - Condition of the fangs and venom sacs.  (Not recommended for 
    inspection by untrained professional.)

7 - How angry the snake was.  The more agitated, the more venom.




What to do when you go to help:
-------------------------------

BE CAREFUL!!!  Snakes will often be found within a twenty foot radius
of the area in which the bite occured!

The priorities of emergency care for snakebite are to limit the spread of 
venom and to transport ASAP!

If the victim was bit by a pit vipor (rattlesnake, copperhead, or 
cottonmouth), proceed as follows:

Look for Sx...

   Immediate and severe burning pain, swelling.  The entire extremity
   swells within 8 to 36 hours.  (As a rule, no burning/pain, no venom.)

   Purplish discoloration within 2 to 3 hours.

   Numbness and possible blistering around the bite within a few hours.

   Nausea and vomiting.

   Rapid heartbeat (tachycardia), low blood pressure (hypotension),
   weakness and syncope (fainting).

   Numbness and tingling of the tounge and mouth.

   Excessive sweating (diaphoretic)

   Fever and chills.

   Muscular twitching.

   Convulsions.

   Dimmed vision.

   Headache.

Priorities for treatment are:

   1.  Move the person away from the site.  If you can do so
       without endangering yourself, kill the snake and transport
       it with the victim.

   2.  Lie the person down and keep them quiet.

   3.  Keep the extremity below the level of the heart and immobilize 
       it in a position of function.  Remove jewelry.

   4.  Wash the wound area with alcohol, soap and COOL water, hydrogen peroxide.
       Do not scrub or tear the tissue.  Irrigate the area with saline or 
       clean cool water.

   5.  Transport ASAP!

   6.  NEVER EVER apply ice to the bite area!  Ice can cause tissue damage,
       gangrene, or rebound vasodialation when the ice is removed!

   ADVANCED TREATMENT

   NOTE:  The following descrption is provided in order to dispell the 
          "hollywood" treatment of how to deal with a snake bite.

   7.  Find the fang marks.  Wrap _flat_, soft rubber tubing that is at least
       3/4" wide around the extremity two to four inches both above and below
       the fang marks.  The tubing should be tight enough to stop blood flow
       through the veins, but not stop arterial blood flow.  You should be
       able to put two fingers between the skin and constriction band.  There
       should still be a distal pulse.  _Never_ place these bands on either
       side of a joint, or around the neck, head, or torso.  Loosen these
       bands if swelling takes place.

       --DISCLAIMER--  Many EMS jurisdictions do no allow for this procedure,
       even by trained personnel.
 
   8.  --DISCLAIMER--  Only if you are more than 30 minutes from medical
       treatment and only if directed to do so by a physician...

       Incise and suction the fang marks.  Only do so if on an extremity
       and with a sterile instrument.

       Locate the fang marks.  Pinch the skin up between the thumb and 
       forefinger to avoid hitting a vein.  Make longitudinal (vertical) cut 
       marks through each fang mark, only deep enough to go just below the skin.
       Incision should be parallel to each other, 1/8" to 1/4" long and made 
       in the direction of the fang entry.  NEVER make an X or cross the cuts!

       Apply suction to the wound directly over the incisions.  You can "milk"
       the incision with your fingers if necessary.  Suction with your mouth
       only as a last resort and only as directed by a physician!  Only use your
       mouth if you have no wounds in your mouth.

       NOTE - because venom spreads so rapidly, incising and suctioning is of
              no value unless it is done withing 5 minutes of the bite.

       --DISCLAIMER--  Many EMS jurisdictions do no allow for this procedure,
       even by trained personnel.
       
   9.  Use basic life support procedures as appropriate.  Treat for shock,
       Keep the victim warm and lying down, with legs elevated (unless bite
       is on leg).  Be prepared to perform CPR.  Apply O2 at 2 to 4 L/min.



Snakebite (coral snake)
-----------------------

Coral snakes - and other neurotoxic snakes like the cobra, mamba, sea snake,
and krait - are the most posionous of all.

Instead of having fangs, the coral snake has several pairs of short, groved,
fang-like teeth in its upper jaw.  It chews its victims instead of striking
with a clean blow.  The venom is absorbed very quickly and is disseminated
throughout the body.

There is generally little or no pain involved with the bite.  The bite leaves
one or more tiny scratch marks in the area of the bite.

One to eight hours after the bite, the victim will experience blurred vision,
drooping eyelids, slurred speech, increased salivation and sweating, and 
drowsiness.  As time passes, nasuea, vomiting, difficulty of breathing, 
paralysis, convulsions, shock and coma may ensue.  Depending on the size of 
the victim, total CNS (central nervous system) shutdown can occur in as little 
as 10 minutes.

Treatment is similar to that of the Pit Vipor, with a few important differences:

!.  Transport the victim immediately.
2.  Transport the victim immediately.
3.  Transport the victim immediately.
4.  Flush the bite area with WARM soapy water.  Use several quarts.
5.  NEVER incise the bite.  NEVER use constricting bands.




Black Widow Spider Bite
-----------------------

Habitat background:

The female black widow spider is characterized by a shiny black body, thin legs,
and a crimson red marking on its abdomen, usually in the shape of an hourglass 
or two red triangles.  Do not be confused by appearances, however.  Of the five 
species in the US, only three are black, and not all have the characteristic red
marking.

The female is one of the largest spiders in the US.  Males generally do not 
bite; females bite only when hungry, agitated, or protecting the egg sack.  
Contrary to folklore, the black widow spider is not aggressive.  In fact, many 
bites occur when a finger or hand enters the web and is mistaken as prey.

Black widow spiders, as is true for most spiders, are usually found in dry, 
secluded dimly lit areas.  The spider is known for its extremely strong, 
funnel-shaped web.  More than 80% of all bite victims are adult men.

Venom:

Black Widow Spider bites are among the leading cause of death from _spider_ 
bites in the US.  The venom - 14 times more toxic than rattlesnake venom, is a 
neurotoxin that causes little pronounced local reaction, bites results in pain 
and spasm in the large muscle groups (which are the abdomen, upper leg, 
buttocks, etc.) within thirty minutes to three hours.  Severe bites will affect 
the respiratory system and can result in respiratory failure, coma, and death.

Those at the highest risk for developing severe bites are children under 16, the
elderly over 60, and people with chronic illness and anyone with hypertension.

Signs and Symptoms (Sx):

The most common sign of a Black Widow Spider bite is high blood pressure.
The most common symptoms are flushing, sweating, and grimacing of the face 
within ten minutes to two hours.  Other Sx include:

	A pinprick sensation at the bite site, becomming a dull ache within
	30 to 40 minutes

	Pain and spasms in the shoulders, back, chest, and abdominal muscles
	within 30 minutes to 3 hours

	Rigid, boardlike abdomen

	Restlessness and anxiety
	
	Fever

	Rash

	Headache

	Nausea or vomiting

The symptoms generally last from 24 to 48 hours.  The headache and general
weakness, however, may last for several months.

Treatment (Tx):

Prehospital care is generally not effective in the long-term treatment of
the bite.  The goal is general wound care and transport.  General treatment 
consists of:

	Administer care for shock

	Apply a cold compress to the bite area - do not use ice!

	Do not allow scratching of the would and do not clean the
	wound, simply cover it with a loose dressing. 

	Transport as quickly as possible

Black Widow anitvenoms are risky and are reserved for high risk patients.
Nevertheless, you should try to find the spider and bring it with you so
that positive identification can be made.  ID can be made even if the
spider is crushed.



Brown Recluse Spider (aka fidler)
---------------------------------

This spider is generally brown, but can range in color from yellow to chocolat
brown.  The characteristic marking is a brown violin-shaped marking on the upper
back.  The bite of this spider is a serious medical condition.

The bite in non-healing and necrotic.  It requires surgical intervention and
skin grafting to repair.

Most victims will never know they were bitten until several hours after it
takess place.  The following Sx will result:

   The bite becomes a bluish area with a white periphery, gradually becomming
   surrounded with a red halo (a "bulls-eye" pattern).

   Within 24 hours, the following will develope:
	fever
	joint pain
	nasuea and vomiting
	chills

  Within 7 to 10 days, the bite becomes a large ulcer.

Treatment:

1. Administer care for shock
2. Administer O2 and artificial ventillation if needed
3. Transport ASAP
4. Positively identify the culprit, but be careful!
5. Surgical Intervention Required




Ticks
-----

Ticks often carry Rocky Mountain Spotted Fever and prolonged attachment of a
female tick can mimic Sx of Polio.  10% of victims die.

Sx include nasuea and vomiting, abdominal pain, headache, generalised weakness,
flaccid paralysis, and respiratory failure.

Treatment:

1. Transport ASAP.  If transport is delayed...

2. paint the tick with ether, gasoline, or nail polish, or coat it
   with petrolium jelly.

3. Wait for the tick to back out on its own.

ADVANCED TREATMENT

4. If the tick doesn't back out, carefully scrape the tick away
   from the skin.

5. If the head of the tick remains in the skin, cover and transport
   for surgical removal.

6. provide BLS during transport.




Other Insects
-------------

See the next section on insect stings


Insect Stings
-------------

The normal reaction to an insect sting is a sharp "stinging" pain
(thats how a sting got its name) followed immediately by an itchy, 
swollen, painful wheal.  Swelling may persist for several days, but 
usually subsides withing 24 hours.

Redness, tenderness, and swelling at or around the bite site, even if
severe, in the absence of other Sx, is considered to be a local reaction.
Local reactions are rearely serious or life-threatening and can be
treated successfully with a cold compress.

An allergic reaction, however, is a serious matter.  Stings may cause
death (on the average) within 10 minutes of the sting, but almost always
within one hour.

As noted earlier, the culprits most responsible are a group of the
hymenoptera, the insects with membranous (partially see through) wings.  This 
group consists of the honeybee, the wasp, the hornet, and the yellow jacket.  
Stings from wasps and bees are more common than all other insect bites combined.

When someone falls victim to one of these little culprits, it is important
to determine what kind of insect inflicted the sting...

Honeybees leave the stinger and sac behind embedded in the skin.  Hornets
and Wasps do not.  Hornets like trees and shrubs. Yellow jackets stay close 
to the ground and often nest in the ground.  Hornets build their nests
close to the ground.  Wasps love high places, like attics and eaves.  Honey
bees cluster around flowers and flowering shrubs, including clover.

Signs and symptoms of anaphylaxis:

   Faintness, dizziness, generalised itching, hives
   flushing, generalised swelling including the eyelids, lips and tongue,
   upper airway obstruction (sounds like a seal bark),
   difficulty swallowing, shortness of breath, wheezing or stridor,
   labored breathing, abdominal cramps, confusion, syncope,
   convulsions, low blood pressure/shock.

Some people will have these symptoms delayed for as much as two weeks!
In these cases, the Sx are:  rash, fever, joint pain, neurological problems,
and secondary infections.

What to do:

-  Lower the affected limb below the heart and in a position of function

-  Get the person's medical history, including any medications being taken

-  If there is a history of asthma or heart disease, transport ASAP.

-  Keep the person warm.  Lie them down and elevate the legs and lower
   the head (DO NOT ELEVATE the leg if it is the site of the bite).

-  Transport the victim as soon as possible (e.g., call 911)

-  Make certain the victim is under observation for at least 24 hours.
   If any Sx appear, transport immediately.

-  Inhalation products and antihistime products WILL NOT WORK.  Nothing
   should be taken by mouth.

ADVANCED TREATMENT

-  If the stinger is still in the skin, remove the stinger by GENTLY scraping
   against it with your fingernail, with the edge of a knife, or with a credit
   card.  NEVER use "tweezers."  Be careful not to squeeze the stinger, you will
   inject additional venom into the area.  Make certain you also remove the sac
   as it is capable of secreting venom even without the stinger attached.

-  Apply a commerical cold pack or ice bags to the site to releive pain and
   swelling.  If using ice, DO NOT PLACE THE ICE ON THE WOUND.  Wrap the ice
   in a moist cloth and place the cloth on the wound.  DO NOT allow the ice
   to remain on the wound for more than 15 minutes.

-  If the person begins to have difficulty breathing, apply O2 at 2 to 4 L/min.  
-  If respiration are not adequate, give mouth-to-mouth ventillation.

-  Find the bite site.  Wrap _flat_, soft rubber tubing that is at least
   3/4" wide around the extremity two to four inches above bite.  The 
   tubing should be tight enough to stop blood flow through the veins, 
   but not stop arterial blood flow.  You should be able to put two fingers 
   between the skin and constriction band.  There should still be a distal 
   pulse.  _Never_ place these bands above a joint, or around the neck, head, 
   or torso.  Loosen this band if swelling takes place.

   --DISCLAIMER--  Many EMS jurisdictions do no allow for this procedure,
   even by trained personnel.

MORE ADVANCED TREATMENT
 
-  If you know the person is allergic to stngs, DO NOT WAIT for the Sx
   to occur - delay can be fatal.  If the victim has an insect sting kit,
   assist them in administering the contents of the kit.  Transport the
   person immediately!

   --DISCLAIMER--  Many EMS jurisdictions do no allow for this procedure,
   even by trained personnel.

OK, FROM HERE OUT, I'M DESCRIBING WHAT A EMT-I/A/P MIGHT DO

-  Administer diphenhydramine, 25 to 100 mg IM or IV

-  Frequently asses vitals, LOC, airway

-  If respiratory involvement ensues without shock, administer 0.1 to 0.5
   mg epinephrin 1:1000 subcutaneously.  (This is what is usually in the insect
   sting kit.)  Pediactric dose is 0.01 mg/kg.  Diphenhydramine may be
   given IV in this case.

-  If the victim is in shock, give high flow O2! Hyperventillate the
   patient as ssoon as is possible.  Intubation is required even if the 
   person is conscious, ventillate with a bag-valve-mask if necessary.  
   Adminsiter lactated ringer's or normal saline solution, infusion rate 
   depending on blood pressure.  Administer epinephrin 0.3 to 0.5 mg 1:1000 IV, 
   very slowly. If IV initiation is delayed, give subcutaneously.

-  Administer additional drug therapy as ordered by a physician.  This
   usually includes phenhydramine 25 to 100 mg IV.  Theophylline ethyl-
   enediamine (aminophylline) at a loading dose of 6mg/kg IV infusion,
   diluted in 100 mL D5W or normal saline over a 20 minute period is
   useful for bronchospasm.  The pediatric loading dose is the same, but
   in D5 0.9% NaCl.




Aquatic Bites/Stings
--------------------

There are some basic differences between bites from marine life and those of
land animals.  The venom from aquatic creatures usually cause more extensive 
damage to the tissues.  Second, venoms from marine life can be destroyed with
heat.  So, NEVER EVER EVER USE ICE on this type of bite.  This does not mean
that you should deep-fry the injury either!  Just use something WARM (heat pack,
or water).

Given the amount of tissue damage likely, treat like any other trauma:

   Control bleeding (direct pressure, elevation, pressure points)
   Treat for Shock (lye down, elevate the legs, keep warm)
   Give BLS (Basic Life Support - mouth-to-mouth, etc.)
   Transport ASAP

General treatment for venomous bites includes:

   Transport ASAP (call 911)

   Apply a constricting band above the bite or sting.  Check for a
   pulse in the limb to ensure you havn't made a tournequit.

   Remove any material that sticks to the site on the _surface_ of
   the skin.  Don't use your bare hands!  Use forceps or tweezers.

   Irrigate the wound thoroughly with water.

   If the skin is _unbroaken_, wash the area with a mild agent such as
   Alcoholic Zephiran, strong soap solution, or ammonia.  NEVER SCRUB
   THE WOUND.  Make _certain_ the fluids flow away from both you and
   the patient.  These fluids will induce further reactions!

   Remove stingers and barbs the same way in which you would remove
   a bee stinger.  Be careful not to squeese more venom into the wound.
   If the stinger is barbed and you can't EASILY remove it,  support
   the stinger or barb with gause and bandages such that it can't move.
   Transport for surgical removal.

   Apply heat and maintain the area at a temperature of 110 to 114 degrees F
   for 30 to 40 minutes.  Apply heat for another 30 minutes if Sx reappear.


Specific Treatments:

For tentacle stings from jellyfish, coral, hydras, and anemones:

1  Remove the victim from the water, BE CAREFUL

2  Call 911

3  Pour rubbing alcohol on the affected areas to denature the toxins

4  Sprinkle meat tenderizer on the affected areas to destroy the toxins

5  Sprinkle talcum power on the affected areas

6  Transport ASAP


For puncture wounds like those from a stingray or from spiny fish:

1  Remove the victim from the water, BE CAREFUL

2  Call 911

3  Immobolize the injured part

4  Soak the injured part in hot water for at least 30 minutes,
   chaning the water to maintain temperature (~110 degress F)

5  Transport ASAP


Hope this is informative.


Regards,
Steve
--

-
Date: Sat, 21 May 94 20:08 MDT
From: Galatia.9@debug.cuc.ab.ca
Newsgroups: rec.gardens

[text deleted]

For wasp and bee stings, etc, my husband has found the "old wives tale" 
of putting a cut onion on the wound to be true.  Reading several books on 
the matter, I think I know why.  Onion releases sulfer, which is 
antiseptic and anodyne, thus calming the inflammation and pain.  It also 
seems to slow the toxin.  For bee stings, the usual advice is to scrape 
away the stinger and venom sac with a credit card, never fingers or 
tweezers, since the sac can be easily squeezed.  For wasp, hornet and 
yellowjacket stings all you can do is try to ease the pain.  Aloe vera 
gel seems to help here also. 
With all bees, once you get stung, get the hell out of there!  A stinging 
bee, wasp, etc puts out a scent that calls the rest of the hive to war.  
Since wasps, yellowjackets and hornets have much vicious natures than 
honey bees (and much more dangerous venom), getting out of town is even 
more important. 
Keeping wasps, yellowjackets and hornets away from picnics and such is 
relatively easy once you understand that they're carnivorous.  Set a 
piece of meat or fish away from the picnic site for them and they'll 
generally converge on that and leave you alone.   In terms of temper, 
honeybees require a fair bit of provocation to sting, wasps somewhat 
less, yellowjackets get irate if you swat at them, and I've found that 
the less said about hornets, the better ;)  Bumble bee workers don't have 
stingers (and aren't generally inclined to use them anyways), but the 
drones do and they resemble wasps both in manner and appearance.
Never mess with queens of any kind :)
The only colours that most bees-etc seem to disdain are white and beige.  
Anything else might grab attention and no one seems to be able to say for 
sure which colours attract the most.  Perfumes attract bees-etc, but they 
dont seem to like coriander (Tom's of Maine deodorant gets another 
star)   I'm not certain how they feel about lavender or cedar, but at 
least they keep mosquitos away.
Not much help, Im afraid, but thats what I know about them.. I haven't 
been stung.

-==- Ennien

| Ennein & Robin Ashbrook               |                             |
| Internet: Galatia.9@Debug.cuc.ab.ca   |   " To each, their own. "   |
| UUCP: calgary!debug!galatia.9         |                             |


From: Jim.Dixon@f295.n353.z1.fidonet.org (Jim Dixon)
Date: 21 Sep 94 09:36:12 -0500
Newsgroups: alt.sustainable.agriculture
Subject: Yellow-Jackets 1/2
Organization: [Fido] Canadian EarthCare Foundation (604) 769-5097 

Reference Detail
Ministry of Environment, Lands and Parks
Integrated Pest Management Information System
Year Published: 1992 
Reference Type:PAMP     61
Author:Gilkeson, Linda A
Title:Yellowjackets / Safe and Sensible Pest Control Series
Publication:Ministry of Environment, Lands and Parks
Copyright Information:Public Domain
Reference Number:
Abstract
Reference Locations:
Name:Pesticide Management Branch Library
Note:Open to the public; reference only. 8:30-4:30, Mon.-Fri
Reference Authors:
  Name:Gilkeson, Linda A
  Title:Integrated Pest Management Coordinator
  Company: Ministry of Environment, Lands and Parks
Reference Text:YELLOWJACKETS

Most people know and fear the yellow-and-black striped yellowjacket wasps that
are common, uninvited guests to late summer picnics. Their stings are painful
and for those people allergic to insect venom, they are dangerous. Many people
confuse bees, which are fuzzy and only feed on flower nectar,with wasps, which
have shiny bodies and are predators. What most people don't realize is that
yellowjackets capture enormous numbers of flies,caterpillars and other insects
to feed their young. They have been seen bringing in more than 225 flies an
hour to a single nest; one study found that over a three day period, just two
wasps collected 20 grams of imported cabbageworms. It is usually only in late
summer, when their populations are at their peak and wasps are attracted to
plants with ripening fruit or aphid honeydew deposits on the leaves that most
conflicts arise between humans and yellowjackets.  Although they are touchy
defenders of their nests, most stings are a result of accidentally trapping or
pinching a wasp.

> You can avoid being stung by following a few rules:

1. Remove all outdoor food sources attractive to wasps. Feed pets indoors and
keep garbage cans tightly covered and wash cans regularly to remove spilled
food. Bury fallen fruit and table scraps deep in compost piles and don't
compost meat scraps or bones.

2. Watch where you sit or step (don't go barefoot!). Be especially careful to 
 look before reaching into berry bushes or picking fruit. Thirsty wasps are
attracted to moisture so be cautious when sitting on or handling wet beach
towels.

3. Never swat at a yellowjacket hovering around you--it is a good way to ge t
stung. Instead, quietly move away or let the wasp leave of her own accord. The
only exception to this is if you have accidentally disturbed a nest and hear
wild buzzing. In this case protect your face with your hands and RUN!

4. Pick fruit in the early morning or evening while it is cool and most wasps
are still in their nests.

>To reduce yellowjacket problems at picnics and barbeques:

1. Minimize the length of time food is available by keeping it tightly covered
until just before it is to be eaten. Clear away scraps and dirty plates as soon
as the meal is over.

2. Serve sweet or alcoholic drinks in covered cups with drinking straws through
the lids so wasps can't get inside and then sting you in the mouth as you
drink. When drinking out of a can, keep the opening covered with your thumb
between sips. 

3. Set up baited yellowjacket traps around the ed
ge of the picnic area or on the end of the table to attract wasps away from the
food to capture them.  Small disposable cardboard traps or reusable ones made
of wood and metal screen are sold at garden centers. They work by attracting
wasps to bait placed under an inverted funnel. When the wasps have had their
fill and instinctively fly upwards toward the light at the end of the funnel,
they are trapped in an enclosed chamber above. In early and mid-summer, 1-2
traps should be enough for most picnics. In August and early September,
however, six or more traps might be necessary. For much of the season, the best
baits are Spam, ham, fish, cat food or meat scraps. La ter in the summer, when
wasps need less protein because they aren't rearing their young, sweet baits
such as jam, honey or rotting fruit are often more attractive.  When the picnic
is over, sink the traps in a bucket of soapy water to kill the wasps. Make very
sure they are dead before cleaning out reusable traps.

>  Removing wasp nests:

Although the number of yellowjackets in late summer invariably prompts many
concerned inquiries on how to control them, usually there is little that can be
done. The wasps will all die in a matter of weeks as fall approaches. Even if a
nearby nest is discovered late in the summer, eliminating it may not have the
desired effect because wasps can fly in from up to a mile away. It is never
advisable to put out poison baits because children and pets may get into them
and because other, beneficial, insects may take the bait and be killed. It is
also a terrible idea to pour gas or kerosene into an underground wasp nest
where it poisons the soil.
If yellowjackets do build a nest in a location likely to cause problems with
people or livestock, the best time to remove it is early in the season, while
it is still small. This is a job for a very careful person or a professional
pest control service. Chemical wasp sprays are available,but if you use them,
consider very carefully where the stream of pesticide that misses the nest will
land. Always use such products according to direction on the label. Remove an
exposed nest that has been sprayed as soon as the wasps are dead. Wear rubber
gloves and dispose of the nest to prevent birds from eating the poisoned larvae
left inside.

>  To remove a hanging wasp nest without using chemicals:

First, it is a good idea to get a helper. To be safe, both of you should we ar
protective clothing from head to foot.  Although a beekeeper's suit with hat
and veil is ideal, you can assemble a similar suit for the occasion from heavy
coveralls, a hat with a wide brim and a length of fine screening. Wear boots
with your pants cuffs pulled outside the boot tops an d seal the cuffs around
the boot top with rubber bands so that wasps can't get up your legs. Wear
gloves and pull your sleeve cuffs over the tops of the gloves and seal them the
same way. Drape the screening over the hat (the brim should keep it away from
your face) and tie it around the neck,over the collar of the coveralls. Make
sure there are no openings around th e collar or base of the veil. You should
wear another layer of clothing underneath the overalls because wasp stingers
are long enough to reach through one layer of cloth.
To remove the nest, approach in the evening or at night when the wasps are all
home and less active because it is cool. Have your helper hold open a large,
heavy bag or a box with a tight lid under the nest while you cut the attaching
stem of the nest as quickly as possible using a long handled pruning hook, or
other tool. When the nest is in the bag or box, close it immediately and seal
shut.  Kill the wasps inside by putting the whole package in a deep freeze for
24 hr. or by directing a wasp spray into the package through a small hole for
several minutes. Don't neglect this last step because wasps can eventually chew
their way out of almost anything.

>  Wasp nests in walls:
Wearing suitable protection as above, spray pyrethrins (fast-acting,short-lived
compounds extracted from pyrethrum daisies) into the opening of the nest at
night. Repeat applications nightly until no more wasps are seen leaving the
hole. Never block up the opening as wasps can chew through wood or follow
wiring to the interior of the house.  In the fall, when the nest is definitely
vacant, caulk or repair the crack to prevent recolonization next year.

>  Underground Wasp nests:
This is a job better left to a  pest control operator, who can dig and vacuum
out the nest, however, you can apply pyrethrins sprays as above or pour several
gallons of boiling water into the nest. Wear protective clothing as described
and be extremely careful not scald yourself with the boiling water.

>  Lifecycle:
In spring, the mated queen wasp crawls out of her overwintering shelter,fills
herself on flower nectar and insects and then builds a nest in a hole in the
ground, inside a wall cavity, or hanging from a branch or the eaves of a
building.  She chews up plant fibers and weathered wood to make a grey papery
pulp for the first egg cells. The queen rears this first brood herself,
foraging for food and feeding the larvae. In about a month these larvae become
adult worker-daughters and take over cleaning, building and feeding chores for
the next generation.  The wasp population grows and the nest expands all season
as the workers add new layers of cells. In late summer the queen stops laying
eggs and the last of the brood matures. Among the last generation in late
summer are both queens and males that develop i n special cells. When they
emerge, they mate and the queen crawls away into a hiding place under bark, in
an old stump or under litter to spend the win ter. The workers and males all
die before winter, the nest falls apart and is not reused next year.

Jim

