WHEN a bee or a wasp is spotted, it's only natural for us mere mortals to take flight. None of us want to be stung. And it's also a smart move not to antagonise any unfriendly or stray dogs to avoid them sinking their teeth and tearing us apart.
An army of fire ants or even a lone ant can cause pain and swelling if one is bitten. Some people suffer more from allergic reactions to ant bites.
In Malaysia, there are no antidote for centipedes bites or bee, wasp and jellyfish stings (according to National Poison Centre). Victims are sent to the hospital for symptomatic treatment and supportive care.
There are likely to be antivenom for snakes in most general hospitals, particularly in Kedah (where the incidence of snake bites is higher, probably due to the prevalence of paddy fields).
Here's a quick look at what to do in case you get bitten by some of these creatures.
Dog and cat
With their strong jaws, dogs can crush tissue and tear the skin when they bite someone. The bite can be susceptible to infection. Cats leave puncture wounds because of their thin and sharp teeth. These wounds can reach into joints and bones and introduce bacteria deep into the tissue.
Wash the wound with plenty of soap and warm water to remove dirt, saliva and bacteria. Next, wash with antiseptic solution and apply antibiotic ointment. Cover the wound with gauze or a bandage.
Then, seek medical advice. You may have to take antibiotics to prevent an infection, and a tetanus booster.
If you are bitten by a wild or stray animal that could have rabies, you may need anti-rabies treatment.
The fire ant sting causes red hive-like lesions that burn and itch, and sometimes cause painful pus-filled lesions. Cold packs, pain relievers and antihistamines can relieve discomfort.
Take note that a large number of stings may trigger a toxic or severe life-threatening allergic reaction.
Centipede bites do not occur as frequently as ant, wasp, bee or hornet stings. Large centipede bites can be intensely painful, though rarely fatal. They puncture the skin with their powerful pair of clawed legs located behind the head. They use the legs and claws like syringes to draw venom within the body trunk and inject it into the victim.
The centipede bite can cause pain (like a bee sting), redness and localised swelling. More serious symptoms can be intense itching, local tenderness, headache, swollen lymph glands, dizziness, nausea, palpitations, anxiety and increased blood pressure and local tissue damage.
Wash the bite area with soap and water to minimise infection. Apply ice at 10 minutes interval or a cool wet dressing and a local anesthetic agent for pain relief. Seek medical care if symptoms are serious.
Bee and wasp
Bees and wasps inject venom with their stinger. Sometimes, the stinger may be left in the skin. The venom of bees and wasps is poisonous.
Allergic reaction of the stings can result in serious medical problems and deaths. This occurs in certain people whose immune systems are allergic (overly sensitive) to the venom. When they get stung, their body may overreact to the poison and trigger an allergic reaction in the body.
Whilst multiple stings increase the potential danger in allergic cases, a serious or even fatal allergic reaction can occur from a single sting. In serious cases, most deaths from stings occur within the first hour.
Pull out the (honey) bee stinger quickly to reduce any reaction to its venom. Honey bees leave a stinger in the victim while wasps, yellow jackets and hornets do not.
There will be redness, swelling and pain at the sting site. Although the pain subsides, swelling may last more than a day. Oral antihistamines or calamine lotion will help relieve itching and ice pack, to reduce swelling.
If symptoms worsen or the victim has breathing difficulty, epinephrine is required.
If a victim has been stung more than 10 times, send him to the hospital.
Antihistamines can slow an anaphylactic reaction (a life-threatening allergic reaction) reaction but won't stop it.
The bite can cause stiffness and swelling. The treatment for a puncture (the bite) is a tetanus shot. Watch for possible signs of infection, like red streaks up your arm a few days after the bite.
It can be quite a torture if you accidentally stepped on a sea urchin. Some of them have spines several inches long. They are driven into the skin when one steps or falls on or brushes against the creatures. The hard spines of these echinoids can break and lodge in the skin, causing much pain.
Secondary infection follows if the spines are left in. One has to tediously extract every one of the spines for relief.
Treatment of any injury caused by a sea urchin should be conducted by a physician because attempts to remove spines yourself can cause the spines to fracture within your skin. Embedded pedicellaria (tiny forceps-shaped growths of a sea urchin) can still pump toxin into the human body. Sometimes surgery is necessary to remove deeply embedded spines. Tetanus shots are usually administered to prevent an infection at the puncture or bite site. Corticosteroids help curb itching around the wound while hydrocortisone can help decrease inflammation.
Swimmers sometime get stung by jellyfish and the pain can be stinging, sometimes life-threatening. A sting by venomous types of jellyfish such as a box jellyfish purportedly can cause death in minutes.
The tentacles of jellyfish are covered with sacs filled with venom. Other than the pain, there may be itching, rash and raised welts.
Progressive effects may include nausea, vomiting, diarrhoea, lymph node swelling, abdominal pain, numbness/tingling and muscle spasms.
Severe reactions from the stings can lead to difficulty in breathing, coma and death.
Peeing on the jellyfish sting site is a common suggestion by swimmers who swear that it works for pain relief. But then, it does not work for everyone because urine does not always have enough acid to neutralise the venom.
Rub sand on the sting area quickly until it does not feel slimy. Do not rinse the sting with fresh water (unless it is the sting of a man of war, a jelly-like marine invertebrate, which has a different type of venom).
You can also rinse away any remaining jellyfish tentacles using hot water if possible (or salt water). Fresh water may worsen the stinging pain.
Remove tentacles with a glove (not bare hands), stick or tweezers. The tentacles can still sting after they've been ripped from the jellyfish.
In case of poisoning ...
The National Poison Centre is the only centre in the country that serves health professionals and the public on chemical safety and poisoning related information, including venomous bites.
What is the role of the National Poison Centre (NPC) and what part does it play in emergency cases such as poisoning or bites by poisonous creatures and insects?
Adilah Mohamed Ariff, senior pharmacist and head of Service Call Centre Unit at the National Poison Centre, Universiti Sains Malaysia, Penang, gives us more insight about the centre's services.
Does the National Poison Centre provide antivenom to state hospitals to treat cases involving bites by poisonous creatures (venomous snakes) and insects (wasps, jellyfish stings)?
The National Poison Centre does not stock/develop/import any antivenom, but it facilitates enquiries on availability of antivenom in Malaysian hospitals.
We have a database on the availability of antivenom based on information provided by pharmacists in local hospitals.
Hospitals do not import antivenom directly but purchase them from local pharmaceutical companies licensed by the Health Ministry to import the antivenom from manufacturers.
In the absence of antivenom, an anti-tetanus jab ALONE is not sufficient because both have different functions. Antivenom neutralise venom while anti-tetanus jab prevents and treats tetanus, (a.k.a. lockjaw), a serious bacterial infection.
In Malaysia, what are the typical (common) poisonous snake bites?
Based on epidemiological studies in Malaysia, the Malayan pit viper, cobra, shore pit viper and Wagler's pit viper are the four commonest species of snakes associated with snake bite envenomation.
However, there are also many cases where the snake was unknown as victims can't see the features clearly.
It's important to see as much as possible the physical appearance of the snake even though we can't identify it by name. Remember the shape of the head and the colour of the body as these details may be helpful to identify the possible type of the snake and to differentiate between the venomous and non-venomous snake.
Identification of the snake may help to save the bite victim's life as appropriate antivenom can be given immediately.
There are three common families of venomous snakes in Malaysia:
- Elapidae family – cobra, King cobra, kraits, coral snakes.
- Crotalidae family – Malayan pit viper, shore pit viper.
- Hydrophidae family – most of the sea snakes.
What should be done in an emergency?
1. Phone or send for medical assistance.
2. Reassure the the victim who may be very anxious and encourage him/her to remain calm.
3. Have the victim remain as still as possible. Do not attempt to catch or kill the snake.
4. Immobilise the bitten limb with a splint or sling because movement or muscular contraction increases absorption of venom into blood and lymphatics.
5. Apply a pressure bandage to the envenomed limb. If the bite is to the trunk, apply firm pressure to the bitten area.
The only universally accepted bandage technique is recognised as "pressure immobilisation bandage (PIB)".
This technique is done by putting splint and bandage with a "not so light and not so hard" pressure. However, if the type of snake is unknown or the rescuer is not familiar with PIB, simply help the patient to remain still as much as possible while seeking medical assistance.
Pressure immobilisation method may prevent or delay the development of life-threatening paralysis from cobra, king cobra, kraits and sea snake bites.
Ideally, an elastic, stretchy crepe bandage about 10 cm wide and 4.5 metres long should be bound firmly around the entire bitten limb, starting distally around fingers or toes and moving proximally, to include a rigid splint too. It should not be too tight that the peripheral pulse is occluded or that a finger cannot easily slip between its layers.
Important: Pressure immobilisation is recommended for bites by neurotoxic elapid snakes including sea snakes, but should not be used for bites by vipers whose venoms cause local necrosis.
6. Remove any items or clothing which may constrict the bitten limb if it swells (rings, bracelets, watches, footwear, etc).
7. Avoid any interference with the bite wound as this may introduce infection, increase absorption of the venom and increase local bleeding. If there is any bleeding on the bite site, hold a clean cloth/cotton on the area for about 5 minutes until the blood stop.
8. Where possible, help should be brought to the patient rather than moving the patient.
1. Do not apply any traditional or even modern topical cream/lotion/ointment.
2. Do not tie or apply tourniquet at any part of the limb because it may cause venom to deposit in one area, causing more complications like compartmental syndrome and/or disability.
3. Do not incise the bite site.
4. Do not suck the venom with any method.
5. Do not apply hard pressure on the bitten area.
7. Do not give the victim anything to eat or drink, especially consumable alcohol that may accelerate absorption of venom.
8. Do not administer stimulants or pain medications to the victim, unless specifically directed by a physician.
What if a person is bitten by a cobra on the neck?
The same emergency measures can be taken as a bite on other parts of the body; minimise movement and seek medical assistance as soon as possible.
Are there cases of tarantula or other poisonous animal bites?
To date, no tarantula bite cases have been referred to the NPC. However, other unknown type of spider bite cases have been referred as well as bites by scorpion, centipede, bee, wasp, ant, and marine poisonous creatures like jellyfish, puffer fish, catfish, red snapper and red tide (harmful algal bloom).
Based on an unpublished study in 1999-2001, the actual number of cases admitted to government hospitals due to animal toxins exposure outnumber poisoning cases involving chemical agents.
However, very few animal bites cases were referred to NPC.
What is the role of the National Poison Centre with regards to assistance given to public, private hospitals and the public?
Its Drug and Poison Information Services (DPIS) is available to the public and health professionals 24 hours a day, seven days a week. E-mail enquiries are also entertained from time to time. NPC can be consulted on:
- Acute and chronic poisoning involving drugs and medicals products, pesticides, household products, industrial chemicals and natural toxins.
- Misuse and abuse of medicines/drugs.
- Drug-related problems, including adverse reactions.
Currently, the DPIS is fully utilised by health professionals from government health facilities, with an increasing number of poisoning cases referred for enquiries every year. Enquiries from private hospitals and the public are still very few since not many poisoning cases are admitted to private hospitals and most Malaysians will normally send poisoned patients to hospitals rather than call the NPC beforehand.
NPC also assists health professionals and public in dealing with poisoning cases through prevention, education and training programmes. Laboratory analysis is also available for them to identify poison in products or biological sample.
Malaysia's National Poison Centre 24-hours Drug and Poison Information Service – (Monday-Fridays: 8.10am–5.10pm): 04-657 0099 or 1800-88-8099; after-office hours (weekends & public holidays): 012-430 9499