EMT: Wildlife and Lightning Injuries
This lesson provides an overview of wildlife-related injuries (bites, stings, envenomation's) and lightning strike injuries for EMTs. While these incidents may be less frequent than other trauma calls, they can present unique challenges and immediate life threats. Rapid assessment, supportive care, and knowing when to involve specialized resources are key for effective prehospital management.
Bites, Stings, and Envenomation's (Wildlife)
Injuries from animals, insects, and marine life can range from minor discomfort to severe systemic reactions or local tissue destruction.
Insect Bites and Stings:
Common Reactions: Localized pain, itching, redness, swelling.
Severe Reactions (Anaphylaxis): Life-threatening allergic response, indicated by:
Respiratory distress (wheezing, dyspnea, stridor)
Skin reactions (hives, flushing, angioedema)
Cardiovascular compromise (hypotension, tachycardia)
Gastrointestinal symptoms (nausea, vomiting, abdominal cramps)
Management:
Scene safety (avoid being stung/bitten).
Remove stinger if present (scrape, don't squeeze).
Wash site with soap and water.
Apply cold pack to reduce swelling and pain.
Monitor for anaphylaxis; assist with auto-injector (Epinephrine) if prescribed and per protocol.
High-flow oxygen if respiratory distress.
Rapid transport for severe reactions or if concerns about anaphylaxis.
Spider Bites:
Black Widow Spider: (Neurotoxin)
Symptoms: Immediate pain, muscle cramps (abdomen, back, shoulders), nausea, vomiting, sweating, headache.
Appearance: Red hourglass on abdomen.
Management: Pain management, muscle relaxants (ALS), transport.
Brown Recluse Spider: (Cytotoxin)
Symptoms: Initially mild bite, but over hours to days, a "bullseye" lesion forms, progressing to a necrotic ulcer.
Appearance: Violin-shaped marking on dorsum.
Management: Wound care, pain management, transport.
Snake Bites (Venomous):
Symptoms: Fang marks, localized pain, swelling, ecchymosis, blistering. Systemic symptoms (nausea, vomiting, weakness, abnormal clotting) with pit viper bites. Neurotoxic symptoms (paralysis, respiratory arrest) with coral snake bites.
Management:
Scene safety (do not attempt to capture snake).
Keep patient calm and still.
Immobilize affected extremity below heart level.
Remove constricting items.
Do NOT apply tourniquets, cut the wound, or attempt to suck venom.
Rapid transport to facility with antivenom.
Marine Life Envenomation's:
Jellyfish/Stingrays:
Symptoms: Intense localized pain, redness, swelling, blistering. Systemic reactions possible.
Management (Jellyfish): Rinse with saltwater, remove visible tentacles (wear gloves), immerse in hot water (110-113°F) for pain relief if available and practical.
Management (Stingray): Immerse in hot water.
Transport.
Lightning Strike Injuries
Lightning strikes are rare but can cause devastating multi-system trauma. The immense electrical current and heat can cause cardiac, neurological, and burn injuries.
Types of Lightning Injuries:
Direct Strike: Lightning directly hits the person.
Ground Current: Lightning strikes the ground nearby and the current spreads through the ground to the person.
Side Flash: Lightning strikes an object nearby (e.g., tree) and a portion of the current jumps to the person.
Signs/Symptoms:
Cardiovascular: Cardiac arrest (asystole), arrhythmias. This is the most common immediate cause of death.
Neurological: Loss of consciousness, confusion, seizures, temporary paralysis (keraunoparalysis), permanent neurological deficits.
Burns: Often superficial (feathering/Lichtenberg figures) but can be deep.
Musculoskeletal: Fractures (from falls or muscle contractions).
Ear/Eye: Tympanic membrane rupture, cataracts.
Respiratory: Respiratory arrest (due to CNS impact).
Management:
Lightning strike victims should be triaged in reverse: treat those who appear dead first, as they have the highest potential for successful resuscitation.
Scene Safety: Do NOT become a victim. Ensure the storm has passed and it is safe to approach.
Primary Assessment (ABCs):
CPR: Immediately begin CPR if cardiac arrest is present. Early defibrillation is crucial.
Airway: Ensure patency, manage any airway compromise.
Breathing: Provide ventilatory support if respiratory arrest.
Circulation: Assess for pulse, treat for shock.
Spinal Immobilization: Consider C-spine immobilization due to potential falls or severe muscle contractions.
Burn Management: Cover burns with dry sterile dressings.
Fracture/Trauma Management: Splint obvious fractures.
Rapid Transport: All lightning strike victims require transport for medical evaluation, even if they appear well.
Critical Thinking Questions
You are responding to a patient who was stung by a bee and is now experiencing difficulty breathing and hives. What is the priority intervention for this patient, and why?
Explain why lightning strike victims are triaged differently than typical mass casualty incidents.
A patient has been bitten by a snake. What immediate actions should you avoid, and what is the primary goal of prehospital management?
Describe the key characteristics that differentiate a black widow spider bite from a brown recluse spider bite.
Why is it important to consider spinal immobilization in a patient who has been struck by lightning?