Chapter 27 Plant and Animal Emergencies
Objectives 27.1 Compare and contrast poison, toxin, and venom. 27.2 List and describe common toxic plants encountered in wilderness settings. 27.3 Describe how plants can be harmful to humans. 27.4 List and describe various land and marine creatures that may be harmful to humans. continued
Objectives 27.5 Describe and demonstrate how to assess a patient that has been injured following an encounter with a toxic plant, an animal, or some marine life. 27.6 Describe and demonstrate how to manage an exposure to topical toxins. 27.7 Describe and demonstrate the proper management of wounds caused by animals, including reptiles, insects, and spiders.
Topics Anatomy and Physiology Adverse Effects and Emergencies from Common Plants Spider, Insect, and Animal Injuries Assessment Management Chapter Summary
Case Presentation You step out of the wilderness aid station and notice a 22-year-old male, with a small limp, complaining of pain in his leg as ambulatory personnel help him down the trail entrance. He says he felt a sharp pain, and noticed a dark brown snake slithering away. He has two puncture holes in his calf above his boot.
Anatomy and Physiology Epidermis Waterproof protective barrier to invading organisms Dermis Contains the hair follicles, blood capillaries, sweat glands and nerve endings Hypodermis Contains many small blood vessels continued
Anatomy and Physiology continued
Anatomy and Physiology Organs with a high vascular supply (i.e., major internal organs) absorb toxins rapidly. Organs with a low vascular supply (i.e., the extremities) increase the potential for infection. continued
Anatomy and Physiology Note distinction between toxin and poison: Toxin: from a living creature Poison: from either a living creature or non-living substance Venom is a toxin or poison specific to a certain animal (snake, spider, scorpion, etc.)
Plants Toxic to the Skin Poison Ivy Description Habitat Toxic part Toxic effects continued
Plants Toxic to the Skin Poison sumac Description Habitat Toxic part Toxic effects continued
Plants Toxic to the Skin Poison oak Description Habitat Toxic part Toxic effects
Plants Toxic to the Skin Stinging nettle Description Habitat Toxic part Toxic effects Copyright Dorling Kindersley Media Library
Plants Toxic to Ingestion Monkshood Description Habitat Toxic part Toxic effects continued Copyright Clive Bournsel / Dorling Kindersley Media Library
Plants Toxic to Ingestion Autumn Crocus Description Habitat Toxic part Toxic effects Copyright Roger Smith / Dorling Kindersley Media Library continued
Plants Toxic to Ingestion Lily of the Valley Description Habitat Toxic part Toxic effects continued Copyright Demi Brown / Dorling Kindersley Media Library
Plants Toxic to Ingestion Foxglove Description Habitat Toxic part Toxic effects continued Copyright Dorling Kindersley Media Library
Plants Toxic to Ingestion Castor Oil Plant Description Habitat Toxic part Toxic effects continued Copyright Steve Gorton / Dorling Kindersley Media Library
Plants Toxic to Ingestion Yew Description Habitat Toxic part Toxic effects continued Copyright Roger Smith / Dorling Kindersley Media Library
Plants Toxic to Ingestion Pokeweed Description Habitat Toxic part Toxic effects continued Copyright Andrea Lawson / Dorling Kindersley Media Library
Plants Toxic to Ingestion Rhododendron Description Habitat Toxic part Toxic effects continued Copyright John Glove / Dorling Kindersley Media Library
Plants Toxic to Ingestion Jimson Weed Description Habitat Toxic part Toxic effects Copyright Steve Gorton / Dorling Kindersley Media Library continued
Plants Toxic to Ingestion Water Hemlock Belladonna Description Habitat Toxic part Toxic effects
Poisonous Mushrooms Amanita Description Habitat Toxic part Toxic effects continued Copyright Neil Fletcher / Dorling Kindersley Media Library
Poisonous Mushrooms False morels Description Habitat Toxic part Toxic effects Copyright Leighton Moses / Dorling Kindersley Media Library continued
Poisonous Mushrooms Little brown mushrooms Description Habitat Toxic part Toxic effects Copyright Neil Fletcher / Dorling Kindersley Media Library continued
Poisonous Mushrooms Jack-o-Lantern Green-Spored Lepiota Description Habitat Toxic part Toxic effects Copyright Neil Fletcher / Dorling Kindersley Media Library
Spiders Black Widow Description Habitat Characteristic of Bite Toxic effect continued
Spiders Brown Recluse Description Habitat Characteristic of Bite Toxic effect continued
Spiders Hobo Description Habitat Characteristic of Bite Toxic effect continued
Spiders Wolf Description Habitat Characteristic of Bite Toxic effect Copyright Frank Greenaway / Dorling Kindersley Media Library continued
Spiders Wolf Description Habitat Characteristic of Bite Toxic effect Copyright Jerry Young / Dorling Kindersley Media Library
Scorpions Bark scorpion Description Habitat Characteristic of Bite Toxic effect Copyright Dorling Kindersley Media Library
Ticks Deer tick Description Habitat Characteristic of Bite Disease transmitted Copyright Pfizer Central Research continued
Ticks Deer tick Description Habitat Characteristic of Bite Disease transmitted Copyright Charles Stewart & Associates continued
Ticks Dog tick Description Habitat Characteristic of Bite Disease transmitted Copyright Dorling Kindersley Media Library
Bees, Wasps, Hornets Usually causes pain, swelling, and joint aching
Mosquitoes, Fleas, Biting Flies Localized redness, itching, swelling Can transmit illnesses: Malaria Dengue Fever Yellow Fever Encephalitis West Nile Virus Copyright Frank Greenaway / Dorling Kindersley Media Library
Ants Localized redness, itching, swelling
Reptiles Cold-blooded animals that regulate their body temperature by moving into or out of the sun. Characterized by scales covering their skin. Copyright Stephen Kirk / Dorling Kindersley Media Library
Rattlesnake Description Habitat Characteristic of Bite Toxic effects continued
Rattlesnake
Coral Snake Description Habitat Characteristic of Bite Toxic effects continued
Alligator and Crocodile Description Habitat Characteristic of Bite Toxic effects Copyright Andy Holligan / Dorling Kindersley Media Library
Marine Creatures Shark Description Habitat Method of causing injury Injuries Copyright Frank Greenaway / Dorling Kindersley Media Library continued
Marine Creatures Moray eel Description Habitat Method of causing injury Injuries continued
Marine Creatures Stingray Description Habitat Method of causing injury Injuries continued
Marine Creatures Jellyfish Description Habitat Method of causing injury Injuries continued
Marine Creatures Biting fish Description Habitat Method of causing injury Injuries Copyright Colin Keates, Dorling Kindersley Courtesy of the Natural History Museum, London continued
Marine Creatures Spined fish Description Habitat Method of causing injury Injuries Copyright Steve Gorton / Dorling Kindersley Media Library
Mammals Horse bite Soft tissue damage Broken bones Localized softtissue infections continued
Mammals Dog bite Soft tissue damage Broken bones Localized softtissue infections
Domestic and Wild Dogs, Wolves, Coyotes, and Foxes Beware of Dogs Ready to Bite continued Copyright Dorling Kindersley Media Library
Domestic and Wild Dogs, Wolves, Coyotes, and Foxes Wolf Method of causing injury Injuries
Domestic and Wild Cats Method of causing injury Habitat Injuries Copyright Jerry Young / Dorling Kindersley Media Library
Pack Animals Horses, Mules, Llamas, Alpacas Method of causing injury Injuries
Rodents and Small Animals Method of causing injury Injuries Copyright Frank Greenaway, Dorling Kindersley Courtesy of the Natural Museum, London
Bats Method of causing injury Injuries Copyright Frank Greenaway / Dorling Kindersley Media Library
Moose, Elk, Deer, and Bison Method of causing injury Injuries Copyright Frank Greenaway / Dorling Kindersley Media Library
Bear Method of causing injury Injuries Copyright Christopher and Sally Gabe / Dorling Kindersley Media Library
Case Update A 22-year-old male is in moderate distress and his leg is red and swollen. His pulse is 120 BPM, respiration is 18, BP 110/90. There are no other signs of trauma, no medical problems, he is not taking any medications, and has no known allergies.
Assessment Immediate life threatening situation? Need to assess ABCDs Bite? Plant? Large animal trauma? Allergies: Patient have an Epipen? Bite or fang marks? Copyright Scott Smith
Assessment: Plants and Mushrooms Assess extend of the rash or trauma; monitor over time Monitor vital signs frequently and watch for shock.
Assessment: Spiders and Scorpions Localized soft tissue injury Tissue necrosis Skin color and temperature Monitor for serious infection or tissue necrosis
Assessment: Tick Bites Monitor site for developing rash Monitor vital signs Evidence of fever could mean serious infection
Assessment: Tick Bites Remove tick properly Copyright Joanna Cameron / Dorling Kindersley Media Library
Assessment: Bee Stings Localized inflammation Generalized allergic reaction Monitor vital signs closely Airway
Assessment: Mosquitoes, Insects, and Ant Bites Localized inflammation Mosquitoes can transmit serious illnesses: Fever Cardiovascular instability Neurological instability
Assessment: Snake Bites Snake bites can be fatal Monitor amount of inflammation Signs of abnormal bleeding (i.e. gums or nose) Monitor vital signs for shock
Assessment: Other Reptiles Major tissue damage, fractures, amputations ABCDs Monitor vital signs for shock Treat massive bleeding
Assessment: Mammals ABCDs Assess soft tissue injuries for bleeding Evaluate for internal injuries Head & Spine Monitor vital signs for shock Assess soft tissue injuries for infection
Management Assure scene safety regarding creatures or plant life Observe Standard Precautions Manage ABCD-related problems Call ALS, if needed Assume spine injury if trauma from large animal Urgent evacuation and transport to definitive care
Management: Plant Toxins Skin decontamination Remove obvious resin or plant material Vigorously wash with hot water and soap (including under fingernails) Clean exposed clothing, equipment, and supplies with hot water and soap continued
Management: Plant Toxins Copyright Andy Crawford and Steve Gorton / Dorling Kindersley Media Library
Management: Plant Toxins Remove spines with tweezers Inhaled smoke from fire involving poisonous or toxic plant Transport immediately to medical care
Management: Ingested Plant or Mushroom Toxins Provide supportive care measures If able to identify toxic plant Call 911 (Poison Control) Follow direction of poison control
Management: Insects and Biting Creatures Remove stinger if present continued
Management: Insects and Biting Creatures Clean using soap and water Apply ice Immobilize to prevent spread of venom (spider or scorpion) Supportive care & Transport Epinephrine auto-injector
Management: Snake Bites Plan for rapid evacuation Immobilize affected extremity Place limb at heart-level Avoid heavy physical exertion continued
Management: Snake Bites Do not: suck the poison out Apply tourniquet (unless arterial bleeding) Apply ice
Management: Marine Injuries Animal bite control bleeding & transport Irrigate all wounds with fresh water and apply dressing continued
Management: Marine Injuries Stinging injuries Remove spines; decontaminate Fresh water showers, vinegar, topical isopropyl alcohol can provide pain relief; do not rub area with jellyfish contamination Check with local authorities for frequently encountered species and recommended therapies Diver's Alert Network
Management: Animal Bites Bleeding control & standard wound care Wash injury with sterile or clean water or saline Immobilize suspected fractures Physician evaluation
Management: Large Animal- Related Trauma Treat according to signs and symptoms present Control external bleeding Splint possible fractures Assume spine injury
Case Disposition You are concerned that your patient was bitten by a rattlesnake. Splint his leg while keeping him supine, warm, and calm. His friends help you carry him to the trailhead so that he can avoid exertion. You arrange transport to the closest hospital so that he can be treated with antivenom.
Chapter Summary Most skin rashes from contact with toxic plants are not life threatening. Skin rashes can become infected and should be evaluated by a physician. Minor bites from wild animals are not usually life threatening. continued
Chapter Summary Bites and scratches by certain small wild animals warrant evaluation for rabies. Unexplained altered mental status or severe nausea/vomiting may be associated with ingestion of a plant or mushroom toxin. continued
Chapter Summary When ingestion of a poisonous plant is suspected, obtain a history of what the individual ate. Manage large bites and injuries as you would any traumatic wound. Many stings, whether by insects or marine animals, can be managed with localized treatment. continued
Chapter Summary Observation of signs of systemic involvement requires transport to a medical-care facility. Taking preventative measures to avoid animal bites is the best course of action.