Search for tag: "bites"

Interviewer: Poisonous spider bites, what should you do if you get bitten? That's next on The Scope.

Announcer: This is "From the Frontlines" with emergency room physician, Dr. Troy Madsen on The Scope.

Interviewer: Dr. Madsen, you know, for whatever reason, spiders will instill a bit of fear into a lot of people, right? Nobody wants to get bitten by a spider but realistically, it's just kind of the poisonous ones you have to look out for.

Dr. Madsen: That's right. It is. You know, we often have people come to the ER saying they've been bitten by a spider, they aren't sure if they have but they may have an infection or an abscess. In those cases, honestly, I don't know if they've ever been bitten by one, but you're exactly right. It's really just the poisonous spiders that we really worry about in terms of more serious symptoms and more concerning things.

Interviewer: All right. So a regular spider bite probably nothing to worry about unless you do start seeing an abscess or some infection then you would want to get that treated. But what are we talking about poisonous spiders? I understand there are two essentially in the United States. You've got the brown recluse and you got the black widow.

Dr. Madsen: That's right.

Interviewer: If I get bitten by either one of those, is that a big deal?

Dr. Madsen: Probably not a huge deal. Let's say that right off.

Interviewer: Because I was terrified of black widows as a kid.

Dr. Madsen: Oh, me too. And see, I'm just scared to death of those things, thinking if they bit you, you were going to die.

Interviewer: Yeah, yeah.

Dr. Madsen: That's not the case. I guess we could talk about black widows first because when I think about it as a kid, seeing a black widow spider, when your friends told you they had a black widow spider in the window, well, it was just like, "Wow, stay away. That is just so scary."

Interviewer: That's right.

Dr. Madsen: Impending death. That's not the case. If a black widow spider bites you, it's one of these things where it just makes you feel really miserable and kind of the classic thing is someone may come to the ER and maybe they know they've gotten bitten by a black widow spider, maybe not, but they just have tons of abdominal pain and you push on their abdomen and it's very rigid, almost like something where you would think they had like some sort of a severe infection in their abdomen, but that's classically what it causes. It causes nausea, vomiting. People just feel awful.

It's the sort of thing where I'll give some fluids, some nausea medication. They often require pain medication or something just to calm down their nerves because they're so tense from it. But then it goes away. It might take a couple days, but it's not going to kill you.

Interviewer: So if you're out in the wilderness on your own, you didn't have medical attention, you would feel pretty cruddy for a couple of days.

Dr. Madsen: You would.

Interviewer: That's the biggest. And then dehydration probably the biggest danger.

Dr. Madsen: Exactly.

Interviewer: If you're nauseous and throwing up. Would you throw up from a black widow spider?

Dr. Madsen: Absolutely.

Interviewer: Nauseous. Okay.

Dr. Madsen: Yeah, and it's one of those things it's like let's say you get food poisoning or you get some sort of viral illness. It's the same sort of thing where if you're otherwise healthy, probably not a big deal, you're going to feel awful, but you're going to get over it. But if you have other issues like maybe heart disease, diabetes, issues where you're already maybe having some health issues and then you throw in that dehydration along with it, that could cause some bigger problems, so that might be a reason where you need some medical attention for that.

Interviewer: All right. What about the brown recluse spider? Here in Utah, people say they get bitten by them. This is like the ongoing debate, right?

Dr. Madsen: Yup.

Interviewer: Like one person will say, "Yeah, they're absolutely in Utah." But a lot of other people will say, "No, they're not."

Dr. Madsen: That's right. And from everything I understand they're not in Utah. And I agree. I have people come to the ER who would swear they have been bitten by a brown recluse spider and who knows? I can't say they have or they haven't. Maybe it traveled here on a moving van from Alabama. Who knows? But these are primarily in the Southeastern U.S. We have a spider in Utah called the hobo spider that is brown and looks like a brown recluse spider, so that might cause some confusion. But the hobo spider doesn't cause the problems that the brown recluse causes. And it can maybe cause local infections, some issues there.

But the brown recluse, really the big thing with that is it causes a lot of skin breakdown where it bites. So unlike the black widow that causes a lot more symptoms like nausea, vomiting, a lot of symptoms all through the body, the big issue with these brown recluse bites, and I saw this when I worked back in Ohio, is it causes lots of skin breakdown, but quite honestly, there's not a ton we can do for that. Sometimes, with these areas, you know, you can see an area maybe a few inches wide where it just eats away at the skin, takes several weeks to really see this progress.

Some of these cases, people eventually require a skin graft to treat that area, but it's also one of these things where if you're rush to the ER, maybe we could try on an antibiotic. I mean it's questionable. Is there stuff that really prevents this? I haven't seen anything convincing. But you can try stuff. Maybe it helps, maybe it doesn't.

Interviewer: All right. And again, is it a painful thing so maybe some pain medication would be a good idea and stuff like that?

Dr. Madsen: Yeah, maybe some pain medication, you know. Again, we see lots of people who swear they've been bitten. Who knows if they really have?

Interviewer: All right. So I think we all have already covered the treatment. Brown recluse not necessarily a lot you can do in the short term.

Dr. Madsen: Not right off. I mean, if you're absolutely convinced and you know it's a brown recluse, maybe get checked out, maybe we can try something.

Interviewer: Got you. If you see your skin starting to disintegrate, then you know it wasn't a hobo spider.

Dr. Madsen: That's right.

Interviewer: And then for the black widow, abdominal pain the thing to watch out for there or the thing that you would treat is if there was actually throwing up to make sure that you stay hydrated.

Dr. Madsen: Exactly. Or if you're just in so much pain you can't tolerate it, you may need some pain medication.

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Interviewer: What is the thing you should be worried about if you end up with a dog bite? We're going to talk about dog bites next on The Scope.

Dr. Troy Madsen's an emergency room physician at University of Utah health care. And if you get bitten by a dog, what do you need to know? Dr. Madsen, go.

Dr. Madsen: So the biggest thing we think about with dog bites are infection. That's probably the first thing that comes to mind for me in any kind of bite dog, cat, whatever, but in particular with dog bites. So when I see someone with a dog bite, first of all, I'm looking at the wound itself. Are they moving their hand okay? Let's say they got bitten on their hand or on their forearm. Do all the tendons seem like they're intact? Can they feel? Are the nerves working okay? Is the blood flowing okay, making sure there's no damage to any of the vessels there? So anything I would do it any sort of laceration, that's what I'm doing with the dog bite.

But the big thing, I think, about say someone falls and cuts their arm or cuts their arm with a knife or something like that versus a dog bite would be the infection risk because dogs, like any other animal including humans, have lots of germs in their mouth. So typically what I'm thinking about there is getting the wound cleaned out really well, making sure it's washed out really well. And then often with these bites I'll put people on antibiotics. So I think if you're bitten by a dog that's the big thing you're thinking about is, number, one getting this cleaned out really well. Number two, was it a fairly deep wound or something where maybe you should be on antibiotics for a few days to prevent an infection there.

Interviewer: All right, so if you take a look at it and it's a deep wound then it's a no brainer, you probably should go to the ER?

Dr. Madsen: You really should.

Interviewer: The instant care would they be able to handle something like?

Dr. Madsen: Instant care would be fine.

Interviewer: They'll be able handle that as well and get that stitched up. But if it's just kind of a minor bite, they kind of broke the skin a little bit, then you need to watch out for infection.

Dr. Madsen: You do. And I think if it's a minor bite in those situations, if it were me, I would just wash it out really well.

Interviewer: Soap and water?

Dr. Madsen: Sure. You can use some soap and so might kind of might hurt. Quite honestly, if you just run the tap, just get a lukewarm water going, put your arm or whatever affected body part of was put it under there, let it just run for five or ten minutes, just wash that out really well, that's really going to do the job. And you can avoid putting a lot of soap on there, causing a lot of pain. I think just getting lots of water running through it, just flushing it out is going to be effective, and you know you can try some antibiotic ointment on there as well. But I think the big thing to watch for there is any signs of infection where it starts to get red, swollen, getting drainage from the wound, then absolutely in that situation, you need to get to an urgent care or an ER, get in and get on some antibiotics.

Interviewer: Some redness is normal though right after a bite like that?

Dr. Madsen: Some redness, yes, but I expect usually the redness is going to go down within 24 hours. If it's getting bigger after 24 hours, that's a sign of infection.

Interviewer: And get that taken care of immediately.

Dr. Madsen: Exactly.

Interviewer: All right. So if it's a dog that's known to you then I think we've covered it. But if it's a dog that's not known to you, then you've got people worried about rabies.

Dr. Madsen: So the big thing to know is if you know the dog, if it's your dog, if their shots are up to date, you can observe the dog after the bite, you don't need to rush in and get rabies shots. If it's a dog where this is some random dog, and you don't know whose dog it is and you don't know where the dog went, you need to think about rabies, and that's something to go to the ER for or an urgent care could handle this as well to look at getting the rabies vaccine to prevent rabies.

Interviewer: When a dog that's not known to you attacks you, would they be showing symptoms and signs of rabies? Or could they be asymptomatic, not showing those symptoms and signs and still have rabies?

Dr. Madsen: They could. It's hard to say and it may not be florid rabies where it's classically you know you hear foaming at the mouth as rabid dog. But just any time you're bitten by a dog and you just cannot track that dog afterwards or you just don't know if they've had their shots, you need really need to get the rabies vaccine in that situation.

Interviewer: And don't wait for, "I'll just see how I feel."

Dr. Madsen: Yes, don't wait to see if you get rabies and wait for that because there's not much you can do once you have rabies.

Interviewer: Is there anything else to keep in mind when it comes to a dog bite?

Dr. Madsen: I think the big things again are watch for infection, and use your judgment in terms of getting to the ER to get on antibiotics depending if this is a larger wound versus something you could just wash out treat at home. Again, always think about rabies if you don't know the dog, you don't know whose dog it is, get in, get the rabies vaccine.

updated: August 19, 2020
originally published: August 19, 2016

Interviewer: You get bitten by a non-poisonous snake, ER or not? That's next on The Scope.

Announcer: Is it bad enough to go to the emergency room? Or isn't it? You're listening to "ER or Not" on The Scope.

Interviewer: It's the game where you get to decide whether or not you would go to the ER and then we find out the correct answer from Dr. Troy Madsen, emergency room physician at University of Utah Health Care. ER or not today, you are bitten by a non-poisonous snake. Is that a reason to go to the ER?

Dr. Madsen: Non-poisonous snakes, first of all, you want to know that it is a non-poisonous snake. So in Utah, we're thinking primarily about rattlesnakes being the poisonous snake here of concern. So if you know it's not a rattlesnake, if it's a little garden snake that was in your yard, you picked it up, it bit your finger, not necessarily a reason to go to the ER.

Interviewer: Okay.

Dr. Madsen: But there is kind of one little caveat here, with this. With any bite, and we always think about it with snakebites, you have to think about tetanus. Something we have to think about with any laceration, anything like that. So if you can tell yourself, "Okay. I know I had a tetanus booster. It's been within the last 10 years. I'm covered there." In terms of the bite itself, everything's moving okay, it's not like it affected any tendons, nerves, nothing like that, it's not a real deep bite, it's probably something you can just wash out at home and not go to the ER.

Interviewer: What about infection? Is that a worry in a snakebite as well? I know it's a worry with a lot of other bites.

Dr. Madsen: It is for a lot of other bites. And again, certainly, infection is something that you think about with snakebites. But if someone comes to the ER, they've got a couple little fang marks on their finger from a snakebite, and it looks clean, it's not like a real dirty wound where they were working in the garden and their hands were real dirty and then the snakebite pushed a bunch of dirt into their finger, I'm not really going to start that person on an antibiotic for that.

Interviewer: Fascinating. So like getting bit by a dog, more worry of infection than getting bitten by a snake?

Dr. Madsen: It is. And for me, it is just because the dog bites are usually deeper. There's usually more tissue involved. I don't know. I can't say I have ever looked to see what the germ content of a dog's mouth versus a snake's mouth is.

Interviewer: There's somebody out there that probably knows.

Dr. Madsen: There probably is, but for me, it's more just the fact that the dog bites are usually a much larger area, usually deeper, usually a lot more tissue involved.

Interviewer: Okay.

Dr. Madsen: That's why with dog bites, I am usually thinking more starting antibiotics to prevent an infection where with snakebites, typically, not such a concern, but something you have to watch out for to make sure nothing develops.

Interviewer: All right. So a non-poisonous snake bite, no need to go to the ER as long as you are sure you've had that tetanus booster within the past 10 years.

Dr. Madsen: Exactly.

Interviewer: Wash it out and just watch it, at that point.

Dr. Madsen: Yeah, wash it out. You can use some antibiotic ointment on it, keep an eye on it, make sure it doesn't develop an infection.

Interviewer: And if you have not had that tetanus shot, urgent care? Can they give you...

Dr. Madsen: Urgent care is fine, yep. You get in to see your doctor within the next day or two, that's fine as well.

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Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: I'm here today with Dr. Mark Eliason. He is an assistant professor of dermatology. Some people are very terrified that a bite might actually be due to a spider such as a brown recluse or a black widow. How often does that occur and if you have been bitten by one of those types of spiders, should you seek medical attention?

Dr. Eliason: Well, first, I should say that they are actually very rare. We do see spider bites that happen, but when they do, you can often see a change. You can actually see the little fang marks on the skin, although that's hard for most people to see. They're very small.

Dr. Miller: Not like a rattlesnake bite?

Dr. Eliason: No, definitely not. They're smaller than that. But they're usually extremely painful right at the site where the bite occurred, and then they’re less so farther away. Most bites that happen from the dangerous spiders like the black widow or the brown recluse or the hobo spider, which sometimes happens here in Utah as well, those can be associated with what we call necrosis, which is skin that starts to die locally. The skin turns a dark purple color. It starts to die a little bit. And usually the problem with these is that people get secondary bacterial infections. It's not so much that the spiders' bite that hurts them. It's the lack of wound care that then leads to further problems.

Dr. Miller: So if you see a spider, and you are bitten by one, you should probably seek some medical attention, or not?

Dr. Eliason: Well, by and large, the spiders, the most prevalent ones that are in this area, particularly the ones that live in homes are very seldom the dangerous ones. Hobo spiders do like to live in certain types of homes. I don't want to make everyone paranoid about that. But they don't like people. They run away from us. They avoid us. They don't sneak out at night and bite.

Dr. Miller: Most spiders do.

Dr. Eliason: Yeah. So with few exceptions, most spider bites could be managed just by washing the area with a topical antibiotic like the bacitracin or polysporin you can get from the store, and then if the area that was bit, that dark red or darkened area doesn't expand, people don't get a fever. Usually, you can just watch those.

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updated: November 27, 2018
originally published: March 24, 2015

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Scot: Halloween's coming up. That means we're going to see an increase of bites no doubt in the ER. Here with Dr. Troy Madsen emergency medicine of the University of Utah Hospital. Do you see more bites like from the werewolves, the vampires and the zombies around Halloween time?

Dr. Troy Madsen: You know, I don't know. I'm working Halloween this year so I'm really curious what I'm going to be seeing that day.

Scot: All joking aside though I thought this would be kind of a fun way to talk about bites.

Dr. Troy Madsen: Yeah.

Scot: You know, so a werewolf could be a dog.

Dr. Troy Madsen: That's probably the best comparison.

Scot: Vampire could be a vampire bat I suppose.

Dr. Troy Madsen: Yeah, yeah. Some sort of bat.

Scot: I don't know what a zombie would be though.

Dr. Troy Madsen: See I'm going to have to compare a zombie to a Komodo dragon just because I imagine the zombie bite is the absolute worst kind of bite you could get.

Scot: Yeah.

Dr. Troy Madsen: So if I were to pick one sort of bite out there that's just a horrible bite to have, just nasty that's just going to do you in and make you one of the walking dead it's a Komodo dragon.

Scot: All right, let's talk about bites for a second. Let's say you get bit by a dog for example.

Dr. Troy Madsen: Yeah.

Scot: What's the major concern that somebody should have immediately after that?

Dr. Troy Madsen: So the immediate concern right afterward is, you know, just the bleeding. Making sure you stop the bleeding, hold pressure on there, make sure there are no issues with that. Once that's under control then the next big question is does it need to be repaired? Is this a laceration that needs to be sewn up and if it's a gaping thing, if you've got a lot of tissue coming out of it, if it's on your face, if there are cosmetic issues, that's something that needs to be sewn up.
One of the big things for me in the emergency department is do we need to worry about rabies? Now if this is a dog, let's say a werewolf in this situation-

Scot: It is a werewolf.

Dr. Troy Madsen: It is a werewolf, that's what we're talking about here. Absolutely with a werewolf you would be concerned about rabies. And since, you know, you may not get bitten by a werewolf the next concern would be a dog where you just don't know anything about the dog. Those are the situations where we get concerned and we give the rabies vaccine. We make sure you have a series of shots. It's I think down to four shots now. I think it used to be a few more and you hear all kinds of horror stories about rabies vaccines. I've heard people say, "Well, you have to get it injected into your stomach," which sounds awful. That's absolutely not the case.

Scot: Not the case?

Dr. Troy Madsen: No, it's not.

Scot: It used to be the case?

Dr. Troy Madsen: I don't know, not since I started practicing.

Scot: All right. That's good news.

Dr. Troy Madsen: But maybe years ago because that sounds miserable. But yeah the rabies vaccine is not that bad but we give it as a precaution because if you get rabies you can't cure it. It's a horrible thing and it'll kill you.

Scot: All right bite number two that you might get around Halloween, blah, vampire.

Dr. Troy Madsen: That's right.

Scot: What happens if a vampire bites you?

Dr. Troy Madsen: So a vampire, you know, vampires are bats so I think the best analogy there is a bat bite.

Scot: Okay. Do you see a lot of bat bites?

Dr. Troy Madsen: We don't. I very rarely will see one and you know kind of the weird situation is we'll actually see cases where a person wakes up in their bedroom and there's a bat in the room. And this is really interesting because the US Centers for Disease Control has said, "If you wake up and there's a bat in your room you need to assume you've been bitten."

Scot: They made a statement on this.

Dr. Troy Madsen: They have made a statement.

Scot: Okay.

Dr. Troy Madsen: And it's in their guidelines that you need to have the rabies vaccine. Again, it's getting back to that whole rabies thing and that's our big concern with bat bites.

Scot: The last bite you might get around Halloween time, zombie.

Dr. Troy Madsen: Yeah.

Scot: Be turned into the undead. And you compare that to a Komodo dragon.

Dr. Troy Madsen: Yeah, yeah. Komodo dragons. Obviously we don't see a lot of Komodo dragon bites.

Scot: Sure.

Dr. Troy Madsen: But if I had to draw the best comparison I could to a zombie bite I would say a Komodo dragon.

Scot: And why's that? Yeah.

Dr. Troy Madsen: Because it's just the worst bite you can get. It's amazing how much bacteria Komodo dragons have in their mouths. These locations where they actually have wild Komodo dragons there are reports- I mean that's how they kill animals with just the amount of bacteria in their mouth. I mean there's the force of their bite but they're mouths aren't really that big, but they bite these animals and these animals have severe sepsis, like severe bacterial infections and will often die within hours.
So if we were to ever get someone say from the zoo, if you had like a zoo handler that came in after a bite, man, I would give him every antibiotic I could. I'd have him IV antibiotics, admitted to the hospital, because these things are awful.
So Halloween's coming up. Be safe. Watch out for those werewolves, vampires and zombies. And if you do happen to get bitten, I'll be waiting for you in the ER.

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