Season 1 | Episode 1
Description: Knowing whether that red bump is a serious issue or merely an irritation can be difficult. Dr. Gerald O'Malley shares the importance of identifying bites and stings in order to get the right treatment. Join us as we debunk common myths related to spider bites, snake bites, jellyfish stings, and more.
>> Dr. Gerald O’Malley: The snake, of course, bit him on the mouth, his mouth started to swell up, so he got the bright idea of trying to run electricity through it; and so, he and his buddy hooked jumper cables up to his mouth and then the other end to a car battery and then [explosive sound], and then as you can imagine he didn’t do very well.
>> Narrator: Welcome to the Medical Myth Buster podcast where we set the record straight on today’s most talked about medical topics and questions. On every episode, you’ll hear stories from the frontlines of medical care to help dispel common myths and answer the questions you’ve been itching to ask your doctor. Remember, you can always find more information on this week’s topic and hundreds of others on MerckManuals.com. Now, here’s your host, Editor-in-Chief of the Merck Manuals, Dr. Robert Porter.
>> Dr. Robert Porter: Welcome to the Medical Myths podcast. I’m your host, Dr. Rob Porter, Editor-in-Chief of the Merck Manuals. On this episode, we welcome my old friend and colleague Dr. Gerald O’Malley. Gerry is a professor of emergency medicine at the Sydney Kimmel School of Medicine at Thomas Jefferson University. He is also the director of toxicology at Branstad Regional Medical Center in Myrtle Beach, SC. He’s been a practicing emergency physician for about what 20 years, Gerry?
>> Dr. O’Malley: Well, since you were my attendee way back in the day, yeah, it’s been about 22 years.
>> Dr. Porter: Ah, making me feel young like you always do. Anyway, today we’re going to be talking about one of the most searched terms in the Merck Manuals: Bites and Stings. And that’s a pretty big topic so I thought we would stick with things we see here in North America. And that reminds me of one night I was working in the ER, and a chap came in, he had a glass jar with him, and it was in a paper bag, and he said “don’t open the jar yet, but it’s my snake, and she just bit me on the thumb! I thought she might be pregnant and I wanted to see how many eggs she had in her tummy.” And so, he did, in fact, have a bite on his thumb, and he says: “Well Doc, I know I’m supposed to cut it open and suck the venom out, but I was too scared to!” So, Dr. O’Malley, should he have done that?
>> Dr. O’Malley: No, he should not have, and I hope he didn’t expect you to do that!
>> Dr. Porter: He did! He suggested that.
>> Dr. O’Malley: No, we, generally, as toxicologists we generally recommend don’t start cutting and sucking because you will probably start cutting things that you need, like arteries and nerves and tendons and stuff, so frankly, the only two tools or devices that you need if you are bitten by a snake are a cellphone and set of car keys to either call 911 and get a ride to the hospital, or even Uber could take you to a hospital. So, for I think most civilians and people who are accidentally envenomated or bitten, just get yourself to a hospital, or call for help.
>> Dr. Porter: Now you mention envenomated vs. bitten, is there a difference? I mean if a poisonous snake bites you don’t you get a good dose of venom?
>> Dr. O’Malley: Not necessarily. It’s unclear the actual percentage of snake bites result in envenomation. I’ve heard estimates of anywhere from 25% to 50% of actual bites by a poisonous snake results in an envenomation. The older the snake is, the more they can control how much venom they can inject into you and most snakes they just want to get away. So if they see you, and most people are generally larger than the snake, then the snake is just not interested in biting you and injuring you, they just want to get away from you so they bite you without injecting any venom into you just so they can get away.
>> Dr. Porter: Wow, smart snake. So how can people themselves tell whether they’ve been envenomated or not?
>> Dr. O’Malley: You can’t, a lot of times physicians have trouble determining whether or not an individual has been bitten. Typically, if you are bitten by a snake and you show up at an emergency room, you can plan on being there for at least 6 or 8 hours. Just so the doctors can run some tests and observe you over a period of time to figure out whether or not you’ve actually been envenomated.
>> Dr. Porter: Ok so, if it’s a little hard to tell early on what about putting a tourniquet around the bite? Is that a myth or medicine?
>> Dr. O’Malley: Its probably more of a myth. Some toxicologists like to recommend applying a light constricting band on the extremity because you would slow down the spread of the venom through the lymphatic system. The problem is that once the swelling begins, those loose, constricting bands can rapidly become tourniquets and tourniquets cut off blood supply, and that’s never a good thing. So, we generally recommend no tourniquets, no rubber bands, no tied-up bandanas or anything- just avoid doing it. The same thing with cold, with ice, for a while there, people were recommending immersion of the injury extremity into cold water or ice. You’re actually complicating things because if there is an envenomation and have tissue that’s being injured well, now you’re just going to make that even worse by adding a thermal injury onto it. So, again, get out your cellphone, call for help, or get in your car and get to a hospital. That’s probably the best recommendation I think we can give.
>> Dr. Porter: Alright, so I guess if ice isn’t any good then this last extremity I’ve heard really is bad. I’ve heard applying an electric shock to the bite might help?
>> Dr. O’Malley: I don’t know where that came from, there was theory flying around among snake people that if you were to run electricity over an envenomated area you would somehow denature the proteins.
>> Dr. Porter: Break them down in other words?
>> Dr. O’Malley: Right, and inactivate the venom, that is a very, very bad idea and the guy who taught me toxicology Dr. Rick Dart from the University of Colorado and the Rocky Mountains Poison Center he published a case in the Animals Emergency Medicine years ago about a guy who was trying to kiss a snake and of course the snake didn’t want to kiss him…
>> Dr. Porter: Might have been a friend of the patient I had!
>> Dr. O’Malley: The snake, of course, bit him on the mouth, and his mouth started to swell up, so he had the bright idea of trying to run electricity through it; so, he the bright idea of he and his buddy got jumper cables and attached them to his mouth and the other end to a car battery and kaboom! As you can imagine, he didn’t do very well. So, yeah, electricity, ice, tourniquets- it's all bad.
>> Dr. Porter: What else do we need to know?
>> Dr. O’Malley: There’s an old boy scout saying when looking at coral snakes…
>> Dr. Porter: Oh yeah, red on yellow kill a fellow; red on black, venom lack- I think that’s right.
>> Dr. O’Malley: Exactly, that’s the way the story goes- my take on that would be red on yellow, leave it alone, red on black leave it alone!
>> Dr. Porter: I think that’s the best advice, the snake will be happier, you’ll be happier, and we in the ER will be happier that we don’t have another snake bite to take care of. So, good, a lot of myths we were able to dispel about snake bites, but now let’s talk about what’s actually the most commonly searched topic on merckmanuals.com, about bites- and that’s spider bites. And I can say back in my clinical day, that was such a common thing, all the time people were coming in complaining of spider bites. Was that in your experience too?
>> Dr. O’Malley: I can’t remember a single shift I’ve worked in the past 22 years in which somebody didn’t come in with a pimple, convinced it was a lethal spider bite.
>> Dr. Porter: How many of those do you think actually were spider bites, looking back on it?
>> Dr. O’Malley: None. Well, I shouldn’t say none
>> Dr. Porter: Very few probably?
>> Dr. O’Malley: Yes, very few.
>> Dr. Porter: a few percent. What kind of things might be mistaken for spider bites?
>> Dr. O’Malley: A pimple. Another type of insect bite, an infection.
>> Dr. Porter: Now we talked about recognizing snakes and how hard that is, how about spiders? I know sometimes people would come in and see me with a spider bite and they’ll bring me what they want me to identify and its not only not a spider it’s like a piece of lint or something- can you tell?
>> Dr. O’Malley: No, I can’t tell. People will wake up with like a pain in their neck or their scalp or on their shoulder and they may as they get out of bed, realize there is a crushed insect in the pillow. So naturally, the thought is “I’ve just been bitten by a spider, and if I don’t start crawling on walls and shooting webs out of my wrists then I better run to the ER quickly” and they do and they very often bring in this smushed insect, and I have no idea what it is.
>> Dr. Porter: So, if we can’t tell from looking at the insect or from the person’s description, what do we really pay attention to when someone comes in with a possible bite?
>> Dr. O’Malley: That’s a great question since it’s very difficult to examine an insect or a spider and determine whether or not it’s venomous- even for professionals. Toxicologists, often do, we don’t spend as much time worrying about the poison- we spend all the time worrying about the patient.
>> Dr. Porter: Well that sounds sensible.
>> Dr. O’Malley: Yeah so what symptoms are the patients presenting with- is there swelling? Is there pain? Are their vital signs abnormal? Is their blood pressure low? Are they having an altered mental state? Are they acting bizarrely?
>> Dr. Porter: So, they’re going to have some symptoms, and really aren’t going to feel well?
>> Dr. O’Malley: Exactly, muscle cramps, pretty severe pain. The black widow spider bite, if it were to bite you and envenomate you, you’re going to know about it. It’s not something that will just sort of sneak up on you later on, and it’s one of the few things that we can actually treat in the emergency department.
>> Dr. Porter: Oh, what do we have to do for black widow spiders?
>> Dr. O’Malley: There’s an antivenom that’s avaliable for Black Widow spider bites, it’s tricky and it really should not be administered by someone who is not a toxicologist.
>> Dr. Porter: So, I shouldn’t be pulling that out on my own without giving you a call then is what you’re saying?
>> Dr. O’Malley: Just as the older snake antivenom were very tricky, the black widow antivenom could cause more problems than it solves.
>> Dr. Porter: So, what are some other myths about spiders that you’ve heard?
>> Dr. O’Malley: Oh, I think theres all sort of myths about spiders laying eggs under your skin and itty-bitty baby spiders. A week later, I heard a myth that you’re never more than 3 feet away from a spider anywhere if you’re in the wilds of Wyoming or the middle of Manhattan, there is a spider close by; spiders crawl into your mouth at night; that you consume eight spiders a year in the food you eat. I think most of those are myths with no real scientific evidence at all to support any of those things. But ill never forget the first time I looked into a woman’s ear and saw a little spider in tehre happily moving around in her ear canal. I made sure not to let her know it was a spider until after I had gotten out of her ear because I didn’t think she would handle it too well.
>> Dr. Porter: So just like the snake, its not so much what kind of spider it is as what’s going on with you. Are you having symptoms from the bite? Its painful you’re feeling sick all over- that’s the most important thing, right?
>> Dr. O’Malley: Exactly, I would agree with that, if you don’t feel well for whatever reason and you think your symptoms might be due to a spider bite, or a snake bite, or some other kind of insect bite then that is what the ER is for. Go to the ER get checked out by a doctor, it might be a quick trip for reassurance, or it might be something a little more complicated. That’s what we’re here for.
>> Dr. Porter: Thanks, Gerry. We’re gonna take a quick break and we’ll be right back.
>> Commercial: Did you know you can use MerckManuals.com to find in-depth content about hundreds of medical topics including those that may be difficult to spell. Simply browse by using the letter spine search function on our website. It’s the “best first place to go” for easy-to-understand medical content. Now back to Dr. Porter and the Medical Mythbusters podcast.
>> Dr. Porter: We are back with Dr. Gerry O’Malley. Now you mentioned other bits and stings, what’s the most common bite or sting you see in your practice- it’s certainly not spider bites.
>> Dr. O’Malley: Probably bee stings or wasps or yellow jackets depending on the time of year.
>> Dr. Porter: Now those we don’t have too much trouble with people identifying, because I’ve gotten stung and boy, you know right away that you’ve been stung and it swells up. What are the danger signs people should watch out for with a bee sting?
>> O’Malley: Virtually any bee sting or wasp sting or yellow jacket or centipede sting are going to hurt. They are going to sting you, and it is going to hurt. The issue or the concern would be if you were to develop symptoms aside from just pain at the site of the bite. If you were to develop trouble breathing or if you were to get light headed and dizzy or if you felt that your throat was closing up. These types of symptoms should prompt a trip to the emergency department.
>> Dr. Porter: Certainly, a number of people are allergic to bee stings, and they know it, and maybe they carry some medicine. But theres plenty more people out there who have been stung by bees and never had an allergic reaction before, are they safe? Can they know for sure that they will never get an allergic reaction or might they sometimes develop one?
>> Dr. O’Malley: They are not safe. Just because you’ve been bitten before and didn’t develop an allergy does not mean you won’t develop one next time. The venoms of the different insects are similar enough where you could develop an allergic reaction to an insect, even though you’ve been stung before and have not had an allergy.
>> Dr. Porter: Tell me about some of the worst bee sting reactions that you’ve been consulted on?
>> O’Malley: There was an article written in one of the trade newspapers about an emergency physician who was riding his bike and a bee flew in his mouth and stung him in the back of the throat. He coughed it up and natraully being an ER doc just he could go home and take some Benadryl, which he did but after about a half hour he realized his throat was indeed beginning to swell and close up, so he got in his car and drove himself to the ER and was observed for several hours and determined to be okay. He was given some seriods and sent home, he went home and slept a few hours and then went in for his overnight shift. We had a 9-year-old girl who was when I was on Okinawa was bitten by something. We aren’t sure what it was, but it was some flying insect, it could have been a bee or a wasp and she developed an acute allergic reaction and came into the ER. That girl aged me ten years in half an hour. Her face swelled up; her eyes swelled shut, her throat began to close. Luckily, I was able to debilitate her. We gave her steroids but then she developed a reaction to the steroids, and she was very sick for a very long time.
>> Dr. Porter: Had she used an EpiPen before she came in?
>> Dr. O’Malley: She had not.
>> Dr. Porter: Do you recommend that for our listeners who are known to be allergic?
>> Dr. O’Malley: Yes. I believe the primary care providers or the pediatricians should actively engage and ask their patients whether they have ever been exposed to an insect bite and had a sever reactions and they should carry an EpiPen. And every nurse, school nurse, should have an epi-pen in their office.
>> Dr. Porter: And the first responders too.
>> Dr. O’Malley: Right.
>> Dr. Porter: Now I’ve practiced my whole career in the southeast PA region, so I’ve seen all sorts of land and air and animal bites and stings, but I’ve never practiced near the ocean or treated a jellyfish sting. But, I understand that you have when you practiced in the Navy and in SC. Now, what about this myth where if you urinate on the jellyfish sting that will help it?
>> Dr. O’Malley: That’s not a myth!
>> Dr. Porter: Really??
>> Dr. O’Malley: Yeah, peeing on a jellyfish sting will make it feel better. There’s nothing magical about the chemistry of the urine, but it’s just that you’re applying a hot liquid to the sting and that will make it feel better. Even more so, peeing on a jellyfish sting at least you aren’t causing any injury. There are myths where like applying vinegar or a meat tenderizer and that could actually cause injury to the exposed area.
>> Dr. Porter: So that’s not a myth about the urine that’s very interesting to know. What about, I have to say that bystanders supply of urine is somewhat limited in volume- we ought to have something else we can do besides that, is there anything else we can do for jellyfish stings besides that?
>> Dr. O’Malley: Uh, you need to find more hot liquid, like water, that you can submerge you hand or arm or shoulder in. The other thing you can do is get a credit card and run it over the area to dislodge some of the cysts or parts of the jellyfish that are still in your skin.
>> Dr. Porter: That’s the little stinger things
>> Dr. O’Malley: Right, the little stinger things. If you run a credit card over that several times and again, submerge your hand or leg in hot water, and that’s really the best you can do.
>> Dr. Porter: So, if you had to choose three things that people ought to know about bites and stings what would they be?
>> Dr. O’Malley: We live a world that we share with lots and lots of creatures and some of these creatures have bites or venom that they use to bite or sting you. The overwhelming majority of these bites and stings are benign; you can take care of them yourself at home with some soap and water- maybe some ointment or a cool compress or a pain reliever like Ibuprofen or acetaminophen.
>> Dr. Porter: So where can people go to get some information about bites and stings?
>> Dr. O’Malley: They should go to the Merck Manual, number 1, but if they don’t have one handy or can get their computer open then they can call the poison control center at 1-800-222-1222. Dial that number from anywhere in the US, and you’ll be routed to your nearest poison control center, they are open 24/7 and they will be happy to help you make the decision if you should go to the ER or not.
>> Dr. Porter: Well great! Thank you for your time and expertise, and I think I speak for myself and everyone listening that we feel a little more prepared to take the right action in the event of a sting or bite. So, for more information on these and hundreds of other medical topics- visit merckmanuals.com. And remember as we say in the Merck manuals;
>> Dr. O’Malley: Medical Knowledge is Power - Pass it On.
>> Dr. Porter: Thanks a lot and good day.