by David Page
■ Remove venom from bite site. Make 1/4-inch-long by 1/4- to 1/2inch-deep incisions over each fang bite. Apply suction—by mouth, if necessary, as long as there are no cuts inside the mouth.
■ Neutralize the venom. Antivenom is available, which is administered intravenously in successively larger doses depending on the degree of venom deposit, from none for grade 0 to 50cc or more for grades 3 and 4.
■ Treat the general side effects. Give IV fluids and blood products for shock, dialysis for kidney failure, special drugs to maintain adequate blood pressure and antibiotics to prevent infection. All of this is done in the hospital.
These feared injuries vary from relatively minor lacerations to big bites with extensive tissue and blood loss and the need for complex reconstructive surgery. And like other animals, the shark's mouth harbors unique bacteria that can cause infection.
The majority of shark attacks occur in the late summer and early fall when bathers are active and sharks move down the coasts from colder northern waters. With multiple rows of sharp teeth and a torpedo body of awesome proportions, particularly in such species as the great white, the shark plays a central role in humankind's wealth of myth. Anchored in elements of fact, shark lore often outstrips reality, and Peter Benchley's Jaws tapped into man's deepest fears. It was disquieting to wade into the ocean for a long time after reading that book and viewing Spielberg's haunting film.
Doctor G.H. Burgess has described four kinds of shark attacks according to degree of injury and presumed intent:
1. Hit-and-run. These attacks by smaller sharks inflict smaller wounds and occur in shallow waters where there are swimmers thrashing about in the surf. Presumably mistaking the bather for a meal, the shark somehow senses its mistake, releases the victim and leaves.
2. Bump-and-bite. These assualts are just what they sound like: a shark sizing up the situation by bumping the intended victim, presumably testing the potential morsel. Larger sharks, such as the tiger and bull, use this technique in deep water on divers, and the resulting wounds are horrific, sometimes resulting in death.
3. Sneak. Sneak attacks are, like bump-and-bite assaults, somehow related to feeding or a reaction to a territorial imperative. They cause serious damage. The shark may attack over and over and hold on to its victim, and the wounds therefore tend to be vicious.
4. Provoked. A provoked attack may occur when—it's hard to believe someone would actually do this—divers attempt to chase or film sharks. Or a bather may unintentionally annoy a shark not knowing the fish is in the vicinity. Severe wounds result, but these attacks represent only a small percentage of all shark attacks.
The type of wound depends on the size of the shark, the aggressiveness of the attack and the body part bitten. Abdominal wounds may enter the cavity and expose viscera. Limb attacks may lacerate large amounts of soft tissue, crush muscle, tear tendons and expose bone. Traumatic amputation is possible. On the other hand, smaller sharks may bump, bite and leave little more than a row of indentations from their teeth.
Horse Bites
Horse bites result in either crush or laceration types of soft tissue injury. Unlike the case when an arm or leg is crushed under a collapsing building when large amounts of tissue debris are released into the bloodstream, a horse bite only causes damage to local tissue. At worst, severe contusions, lacerations and, at times, broken bones occur.
The attack comes when the rider turns her back or when someone approaches a horse that has been mistreated.
Consider that a horse's teeth are designed to tear out grass (the front teeth are tearing, cutting in design) or grind up grass (the back teeth crush). Unless your character was wearing thick clothes over the bite site, some sort of injury will occur. If you must have your concert pianist lose a digit, contrive to have his sponsor's favorite stallion chomp it off just before the fox hunt. Feeding one's mount places the fingers in danger as the horse may see more food than is being presented and may include part of the hand in its mouth. Palming the apple or sugar cube will keep
Hospital Treatment of Any Bad Bite
■ Give IV fluid replacement and blood products as needed to treat for shock.
■ Give intravenous antibiotics.
■ Debride, or clean up, the wound. When possible, surgeon attempts to close as much of the defect as possible.
■ If a fracture is present, fix the broken bones first, often with internal fixation with metal rods, then repair the soft tissue damage.
■ Start rehabilitation immediately.
the fingers away from the horse's muzzle as he maneuvers the delicacy between his impressive pearlies.
Ears are another exposed body part known to be a horse's occasional target. The result may be a mangled or amputated lobe. After disciplining her unruly mount, your character's ear may tempt the ornery steed when her back's turned. Noses have been bitten off by horses. Plastic surgery is needed to reattach any part—assuming it's not too badly mangled.
Or a shoulder might tempt the stallion. The result is often a nasty bruise or laceration, depending on the clothing worn. Veterinarians have been known to suffer from serious forearm bites while treating a horse. These injuries range from severe soft tissue damage, including the severing of flexor and extensor tendons of the forearm, to a fracture of either forearm bone or both.
Finally, some horses have the temerity to pick up their owner by the collar. A horse can bite the back of the collar of a riding jacket or the hood of a sweatshirt and half choke the person by lifting him off the ground.
Stings
Unless you live in a bubble, you've undoubtedly been stung by an insect. Mosquitoes, black flies, ants and other smaller insects inflict annoying bites that carry virtually no risk to life or limb. This isn't true of some larger insects and spiders. Depending on where your story takes place, you may wish to give someone a short-term illness—perhaps a sickness that isn't easily diagnosed by the doctors in your scene—that stems from an innocuous insect bite.
Here are a few examples.
Although several types of spiders live in the United States, only two may cause serious problems for your homegrown characters.
The brown recluse spider doesn't spin a web, lives in the dark recesses of wood piles and other dry, dark places, and comes out at night to feed. It may be recognized by the brown violin-shaped area on its back. Only a quarter to a half inch in size, this little pest can inflict a nasty wound which on occasion causes a flulike illness or even general bleeding problems. The brown recluse can be found in the Midwest and the South.
Treatment by a doctor includes supportive measures, but the wound may require surgical excision. After a few hours, the bite site appears to have a central black dot of dead tissue, but this can progress in rare cases to a more extensive zone of necrosis (dead tissue). If the victim is bitten on the thigh or butttock where there's more fatty tissue, the amount of resulting dead tissue increases.
The black widow spider is found all over the United States, except in Alaska, and has either two red dots or a red hourglass mark on its belly. The female is larger than the male, whom she will kill if he disturbs her web when she has young. Hence the name. At any rate, this aggressive spider produces what is called a neurotoxin, a substance that causes stimulation of the nervous system producing chest and belly pain. You can imagine how this might mimic either a heart attack or an abdominal catastrophe.
The hymenoptera are a group of well-known arthropods that are responsible for more deaths in the United States than all of the snake bites combined. Wasps, bees, hornets and fire ants inflict painful wounds, which, if numerous, cause nausea and vomiting and a general sense of illness. Sensitivity to the venom results in an anaphylactic reaction, an allergic response to the poison that squeezes off the victim's airway, knocks down the blood pressure and can cause death if not immediately treated.
Kits are available that contain vials of adrenaline and antihistamines that may be used in an emergency. Local care for most stings inc
ludes ice packs, elevation and rest.
Centipedes, those multisegmented ugly crawlers, can inflict a painful bite, which causes swelling and occasionally an infection.
Although most of the scorpions found in the United States cause only painful bites, the kinds of scorpions in some parts of the world are poisonous. Scorpion bites in Brazil carry over a 10 percent mortality rate. Israel, North Africa and Mexico also have poisonous scorpions. It is said the venom causes a massive outpouring of the body's own adrenaline, as if your character's survival mechanisms got turned on to maximum and left there. The victim dies of cardiac failure because the heart is literally whipped to death.
About that botfly.
In Mexico and Central and South America, there are lots of insects to make your character's skin crawl. One such fascinating creature is the botfly, a not-so-little insect I met in the office when a colleague returned from Central America. After vacationing in Costa Rica, the physician developed what looked like boils weeks after returning to the United States. Medical reports describe a variety of clinical findings which include:
• A crawling sensation in the skin
• A swollen area draining pus like a boil
• A bump with a pore and something white moving inside
The botfly is about the size of a bumblebee and lays its eggs on other insects that then deposit them on the host—that's your character. Larvae hatch from the eggs and crawl into the host's skin where they form a cavity with a pore through which to breathe. Later, the larvae burrow deeper into the fat and muscle, giving the "crawling" sensation, and mature in six to eight weeks. Remaining in human flesh for as long as three months, the larvae grow until they're over an inch long!
The larvae enter the skin most often on the scalp, face, arms and legs. But, and here's the good news for the writer, they have been discovered in the eyelids, genitals and tongue. How's that for juicy plot possibilities? Treatment employs any method of cutting off the insect's oxygen supply and includes covering the pore with petroleum jelly, beeswax, pork fat or chloroform in olive oil. When the larvae emerge, you pick them off. They can also be excised under local anesthesia (1% Xylocaine) when the host becomes frantic and screams, "Get them outta me!"
The horror of it all.
Sea Life "Bites"
Ocean critters can raise your character's ire and damage the body just when your scene is serene and breathtaking, say, on a coral reef.
A Portuguese man-of-war is a common jellyfish that consists of a balloonlike sail and dangling tentacles, which are armed and potentially extremely dangerous. Special cysts (nematocyst), or cells, contain a curled hair, which fires out of the cell like a harpoon when the cell is brushed. It deposits venom into the swimmer's skin or any unsuspecting individual who walks a littered beach barefooted after a storm.
The sting may cause mild irritation of the skin or full-thickness skin death and ulceration. Mild nausea may occur or more severe symptoms of vomiting, muscle and joint pain, dizziness, loss of balance, seizures and respiratory failure. Other jellyfish, sea wasps, mollusks, etc., may cause similar symptoms. Treatment varies from local wound care to intensive medical support with special medications in the sophisticated ICU setting and cardiac and respiratory support.
Coral cuts are painful and may progress to tissue loss and ulceration. The wounds should be cleaned with hydrogen peroxide and then protected.
Animal Defenses
Although many animals possess relatively benign self-defense techniques to fend off predators inhabiting their environments, some species have cultivated punishing reprisals. The more sophisticated the animal, the more directed the attack. The less brainy, the less calculated the damage.
Sea urchins and jellyfish don't cogitate much about threats to their welfare, and the indiscriminate volleys of stings from the dangling tentacles know no anger. Reptiles and lower mammals defend themselves when cornered or when a life-threatening attack seems imminent. Humans, wired for thought and reflex, often retaliate when threatened and all too often carry out premeditated body trauma.
Although humankind didn't invent the ambush, we have certainly refined it.
Bites, particularly human attacks, are despicable precisely because they replace eloquence with a guttural assault. Saliva substitutes for language. Bared fangs replace a smile.
To injure a favorite character or to instantly characterize a despised villain, the bite is as good—or as horrible—as it gets.
Are there other types of bites?
Use your imagination.
Alfred Hitchcock exercised his whimsical inventiveness once with a flock of ravenous birds. But don't forget alligators, grizzly bears, wild boar, rhinos and bats. They say cougar attacks are up in California. What animals populate your fictional world? If it's got a mouth, it can bite.
The youngster in the back seat of the sedan writhed like a speared fish. Moaning and thrashing against the vinyl seat, he seemed unaware that he was pinned down by an oak branch driven through his chest. Moments earlier, the car had slithered off the dirt road, plunged down an embankment and crunched into the massive oak tree with low lying limbs. A dead branch had smashed through the windshield missing the two drunk boys in the front seat and spearing the kid riding in the back.
Less than an hour later, using a chain saw, the paramedics cut the branch off a foot from the terrified boy's blood-soaked denim shirt and loaded him and the branch into the waiting ambulance.
The oak spear missed his heart and great vessels but collapsed one lung. A dramatic injury, it was relatively uncomplicated. The trauma surgeons removed the branch in the operating room with routine surgical instruments and with the OR staff standing by with cardiac bypass equipment ready. They were prepared to charge into action had the boy hemorrhaged when the bloody branch was withdrawn from between his ribs.
He didn't.
Impalement Injuries and Mutilation: From Fencing to Fences / 143
Elements of an Impalement Injury
■ Sharp object penetrates the body.
—Full body thickness: impalement object visible at entry and exit wounds
—Partial body thickness: entry wound only
■ Attacking instrument may be in motion. —High velocity (arrow)
—Low velocity (spear, long knife)
■ Sharp object may be fixed in place (fence pale).
■ Victim usually cannot extricate himself from the impaling agent.
■ The resulting injury may be major or trivial even if a major body cavity is penetrated.
■ Often the impaling object must be removed surgically in the operating room with general anesthesia.
■ Chunks of material, e.g., fence, may have to be cut and transported to the hospital still stuck in the victim.
The terror of thinking about impalement injuries comes precisely from a disbelief that such a ghastly wound could occur. We visualize the branch with horror, splintered end puncturing the boy's shirt, pushing torn fabric into his pale flesh where it slashed between his ribs, tearing the muscles and cutting off his breath. And as the victim is removed from the field, his rescuers didn't even remove the impaled object! (The paramedics did the right thing.)
OK, it's a far-out example of impalement. It could never actually happen that way. Not even in the bizarre world of fiction, right?
In fact, it's a true story.
Features off an Impalement Injury
Think of impalement as an uncontrolled injury where the victim gets "stuck like a pig," piked by a sharp object because of focused energy with considerable penetrating power. Of importance is whether the body or the weapon is in motion. A sword may be used to impale someone against a wall; a spear may impale someone against the ground. But the body flung from a balcony becomes impaled on the pointed struts of the pristine white picket fence below.
The features of an impaling injury:
• The skin is lacerated at the point of entry and may be punctured at a point of exit.
; • The chest, abdomen, extremities and neck may be involved.
• Major blood vessels may be cut, but bleeding is minimal at the time of injury because the object presses against the torn vessels and the direct pressure prevents hemorrhage.
• Internal organs may be punctured or lacerated and may leak their contents or bleed.
In a scene from Stephen King's Rose Madder, crazy cop Norman Daniels wrestles in a laundry room with a woman named Pam who struggles to escape his grasp and hits a door.
There was a noise, a meaty sound that was almost a pop like a champagne cork, and then Pam began to flail wildly, her hands beating at the door, her head back at a strange stiff angle, like someone staring intently at the flag during a patriotic ceremony....
... he looked down and saw that Pam's left sneaker was no longer white. Now it was red. Blood was pooling around it; it ran down the door in long drips. . . .
She looked almost nailed to the door, and as Norman stepped forward, he saw that, in a way, she was. There was a coathook on the back of the damned thing. She'd torn free of his hand, plunged forward, and impaled herself. The coathook was buried in her left eye.
What vital structures in the perforated body part are at risk? How does it feel to get pierced by a cold steely point? What parts of the body are most sensitive? Let's think up a few impalements to make your story reek with terror:
• A drunk woman falls forward and impales her eyeball on a toothpick protruding from her martini glass.
• A scuba diver misfires his spear gun into his buddy's thigh, abdomen or scrotum.
• A bow hunter's two-year-old runs out in front of an animal target to pat the "deer" when his father impales his child on the plastic silhouette while practicing for hunting season.
• A recently released psych patient, now homeless, assaults a jogger and nails her to a wooden fence as if she were on a cross.
• Enraged after losing the national championship to a teammate, a member of the university fencing team files down the end of his rapier and runs the champ through the throat in practice.
