General Approach to All Patients

Bites and Envenomations

Basic Life Support

  • Irrigate/Cleanse wound with 0.9% NaCl (remove any large debris)
  • Remove stinger if wasp or bee (if easily removed)
  • Mark initial edematous area with pen and note time
  • Immobilize affected part and remove distal jewelery
  • Attempt to identify what caused bite and bring to Emergency Department if dead (use caution when handling animals)

Advanced Life Support

  • For signs of allergic reaction or anaphylaxis, refer to the appropriate Allergic Reactions protocol, page 16
  • For Black Widow spider or Scorpion envenomations with severe muscle spasms
    • Midazolam (Versed) 5 mg IM or intranasal via MAD OR 2.5 mg slow IV
  • For patients with severe pain if systolic blood pressure ≥ 120 mmHg:
    • Fentanyl (Sublimaze) 1 mcg/kg (maximum 50 mcg) slow IV; repeat once after 5 minutes as needed (maximum 100 mcg total dose) OR 100 mcg intranasal via MAD (divide dose equally between nostrils)
      • Preferentially use intranasal delivery via MAD for those where IV access may be difficult to obtain in a timely fashion or not indicated for chief complaint