WFR - Wilderness First Responder Bites, Stings, and Anaphylaxis Questions and Answers — Questions and Answers
Question 1: A hiker is bitten on the ankle by a venomous pit viper. Which of the following actions is contraindicated and should be AVOIDED in the field management of this injury?
- Keeping the patient calm and resting.
- Splinting the affected limb to minimize movement.
- Applying ice packs directly to the bite site to reduce swelling. (Correct answer)
- Marking the leading edge of swelling with a pen and noting the time.
Correct answer: Applying ice packs directly to the bite site to reduce swelling.
Applying ice or cold packs is contraindicated as it can cause localized tissue damage (cryotherapy) and may worsen the effects of cytotoxic venom by concentrating it in one area. The other options are all recommended WFR protocols: keeping the patient calm reduces circulation of venom, splinting immobilizes the limb, and marking swelling tracks venom progression.
Question 2: Which of the following best describes the correct Wilderness First Responder protocol for removing an embedded tick?
- Cover the tick with petroleum jelly or essential oil to make it back out.
- Use fine-tipped tweezers to grasp the tick's body and twist it counter-clockwise.
- Touch the tick with a recently extinguished hot match to shock it into releasing.
- Use fine-tipped tweezers to grasp the tick as close to the skin as possible and pull upward with steady, even pressure. (Correct answer)
Correct answer: Use fine-tipped tweezers to grasp the tick as close to the skin as possible and pull upward with steady, even pressure.
The recommended method is to use fine-tipped tweezers to grasp the tick's head/mouth-parts as close to the skin as possible and pull straight out without twisting or jerking. Methods like smothering it with petroleum jelly, twisting, or using heat are not recommended because they can agitate the tick, potentially causing it to regurgitate infectious fluids into the bite wound.
Question 3: A patient is stung by a wasp and develops hives on their chest and back, complains of a tight throat, and feels dizzy. After administering epinephrine, what is the most appropriate position for this patient while awaiting evacuation?
- Sitting upright to make breathing easier.
- Standing and walking around to improve circulation.
- Lying flat with their legs elevated. (Correct answer)
- In the recovery position on their left side.
Correct answer: Lying flat with their legs elevated.
The patient's dizziness indicates they are likely hypotensive (in shock) as a result of anaphylaxis. Lying flat with legs elevated (the shock position) uses gravity to help return blood to the body's core and brain. While sitting up can help with respiratory distress, the signs of shock take precedence. The patient should NEVER stand or walk.
Question 4: A patient was bitten on the hand by a spider several hours ago. The bite site is red with two small fang marks, but the patient's primary complaint is severe, cramping abdominal pain and muscle rigidity. These systemic symptoms are most characteristic of a bite from which spider?
- Brown Recluse
- Black Widow (Correct answer)
- Hobo Spider
- Wolf Spider
Correct answer: Black Widow
Black widow venom is a potent neurotoxin that causes characteristic systemic symptoms, including severe muscle cramping (often in the abdomen and back), rigidity, nausea, and hypertension. Brown recluse bites are known for causing significant local tissue necrosis, but not the severe systemic muscle cramping described.
Question 5: A patient is stung by a bee and quickly develops a single, large (4-inch diameter), swollen, red, and intensely itchy wheal at the sting site. The patient is breathing normally, denies any throat tightness, and has no other signs or symptoms. This is best classified as:
- A mild local reaction.
- Anaphylactic shock.
- A severe local allergic reaction. (Correct answer)
- A toxic venom reaction.
Correct answer: A severe local allergic reaction.
This is a severe local allergic reaction. Although the reaction is large and uncomfortable, it is confined to the area of the sting. Anaphylaxis is a life-threatening systemic reaction that must involve two or more body systems (e.g., skin and respiratory, or skin and cardiovascular). Since this patient's respiratory and cardiovascular systems are unaffected, it is not anaphylaxis.
Question 6: What is the most appropriate field treatment for a scorpion sting in a North American desert environment when the patient is a healthy adult experiencing only significant localized pain and minor swelling?
- Apply a pressure immobilization bandage to the limb.
- Clean the site, apply a cool compress, and monitor the patient. (Correct answer)
- Use a commercial venom extractor kit over the sting site.
- Immediately evacuate the patient by the fastest means possible.
Correct answer: Clean the site, apply a cool compress, and monitor the patient.
For the vast majority of scorpion stings in North America, which are not life-threatening, treatment is focused on supportive care for local symptoms. This includes cleaning the wound and using cool compresses for pain and swelling. Pressure immobilization is for elapid snakes, not scorpions. Venom extractors are ineffective. Evacuation is only necessary if systemic signs, such as neurological symptoms or respiratory distress, develop.
WFR - Wilderness First Responder Bites, Stings, and Anaphylaxis Questions and Answers
A hiker is bitten on the ankle by a venomous pit viper.
Which of the following actions is contraindicated and should be AVOIDED in the field management of this injury?