EM · Toxicology and environmental emergencies
Bites and stings
Also known as Mammalian bite · Dog bite · Cat bite · Human bite · Clenched-fist injury · Insect sting · Bee sting · Wasp sting · Stingray injury · Marine puncture wound · Snake bite · Elapid envenomation · Pressure immobilisation bandage · Redback spider bite · Funnel-web spider bite · Latrodectism · Box jellyfish sting · Blue-ringed octopus bite · Stonefish sting · Venom-induced consumption coagulopathy
Bites and stings in the Australasian ED — polymicrobial mammalian bites (median 4 isolates in human bites), bee/wasp stings with anaphylaxis risk, stingray punctures relieved by hot-water immersion, Australian snakebite with VICC, widow/funnel-web spiders, and box jellyfish. Amoxicillin-clavulanate shows excellent in vitro activity; prophylaxis benefits human and hand bites; IM adrenaline is first-line for anaphylaxis; antivenoms exist only for sea snakes, Chironex, and stonefish.
Checked against its sources on 14 Oct 2026
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Target exams
Red flags
- Cat bites, puncture wounds, and hand wounds carry high infection risk — consider prophylaxis; amoxicillin-clavulanate showed excellent in vitro activity against common bite isolates.
- The clenched-fist injury seeds joint, sheath, and bone — explore every wound for tendon, bone, and foreign bodies; refer joint involvement to hand surgery for washout and IV antibiotics.
- Stingray pain: hot-water immersion gives 88% complete relief within 30 min alone — then explore for retained stinger, sheath, or barb, which radiography misses.
- An insect sting can cause anaphylaxis — IM adrenaline is first-line; biphasic reactions occur mostly within 72 h, so observe after resolution.
- Rabies is universally fatal once symptomatic — consider post-exposure prophylaxis for any bat bite (anywhere, including ANZ) and for any dog or monkey bite sustained overseas; irrigate, and seek public-health advice on vaccine and immunoglobulin.
Meet the patient
A 22-year-old man punches someone, opens his hand, and notices a tiny laceration over the knuckle. Hours later the metacarpophalangeal joint is hot, swollen and agonising. It is a clenched-fist injury — the tooth seeds Eikenella (30% of human-bite isolates) plus aerobes and anaerobes into joint and sheath — referred to hand surgery for washout and IV antibiotics, with the wound explored for tendon, bone, and foreign bodies.[1][2]
Hold three patterns at once — mammalian oral flora, heat-labile marine venom, and Hymenoptera hypersensitivity — and the antibiotic, the first aid and the antidote for each bite and sting fall into place.[3]
References26ShowHide
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