Difference between revisions of "Spider bites"

(Black Widow)
Line 19: Line 19:
 
#Abx are indicated only if signs of infection exist; secondary infections are uncommon
 
#Abx are indicated only if signs of infection exist; secondary infections are uncommon
  
==Black Widow==
+
== Black Widow ==
===Clinical Features===
+
=== Clinical Features ===
#Local
+
#Local  
##Pinprick sensation; then increasing local pain that may spread to entire extremity
+
##Pinprick sensation; then increasing local pain that may spread to entire extremity  
##Erythema appears 20-60 min after the bite
+
##Erythema appears 20-60 min after the bite  
 
##Pain begins to abate after several hours and disappears by 2-3d
 
##Pain begins to abate after several hours and disappears by 2-3d
#Systemic
+
#Systemic  
##Muscle cramp-like spasms in large muscle groups (although exam rarely reveals rigidity)
+
##Muscle cramp-like spasms in large muscle groups (although exam rarely reveals rigidity)  
##Pain becomes generalized
+
##Pain becomes generalized  
 
###Severe abdominal wall musculature pain and cramping is well described
 
###Severe abdominal wall musculature pain and cramping is well described
##Headache, nausea/vomiting, diaphoresis, photophobia, dyspnea
+
##Headache, nausea/vomiting, diaphoresis, photophobia, dyspnea  
 
##A-fib, myocarditis, priapism, and death are rare
 
##A-fib, myocarditis, priapism, and death are rare
  
===Treatment===
+
=== Treatment ===
#Pain and muscle spasms
+
#Pain and muscle spasms  
 
##Opiods and benzos
 
##Opiods and benzos
#Systemic illness
+
#Systemic illness  
##Antivenom
+
##Antivenom  
###Consider for:
+
###Consider for:  
####Children
+
####Children  
####Pregnant women
+
####Pregnant women  
 
####Elderly
 
####Elderly
  
===Disposition===
+
=== Disposition ===
#Consider admission for:
+
#Consider admission for:  
##Symptoms of moderate envenomation
+
##Symptoms of moderate envenomation  
##Pregnant women
+
##Pregnant women  
##Children
+
##Children  
 
##Pts w/ preexisting cardiovascular disease or HTN
 
##Pts w/ preexisting cardiovascular disease or HTN
  

Revision as of 01:03, 30 October 2011

Brown Recluse

Clinical Features

  1. Bite is initially painless
  2. Mild reaction
    1. Most common
    2. Mild erythematous lesion that later becomes firm and heals without scar
  3. Severe reaction
    1. Begins w/ mild-severe pain several hrs after bite accompanied by erythema and swelling
    2. Hemorrhagic blister then forms surrounded by vasoconstriction-induced blanched skin
    3. By day 3 or 4 hemorrhagic area may become ecchymotic
      1. Leads to "red, white, and blue" sign (erythema, blanching, ecchymosis)
    4. By end of first week ecchymotic area may become necrotic w/ eschar formation
  4. Systemic effects
    1. Rare
    2. Occur predominantly in children 24-72hr after the bite
      1. Include nausea/vomiting, fever, arthralgias, thrombocytopenia, rhabdo, renal failure

Treatment

  1. Local wound care
  2. Abx are indicated only if signs of infection exist; secondary infections are uncommon

Black Widow

Clinical Features

  1. Local
    1. Pinprick sensation; then increasing local pain that may spread to entire extremity
    2. Erythema appears 20-60 min after the bite
    3. Pain begins to abate after several hours and disappears by 2-3d
  2. Systemic
    1. Muscle cramp-like spasms in large muscle groups (although exam rarely reveals rigidity)
    2. Pain becomes generalized
      1. Severe abdominal wall musculature pain and cramping is well described
    3. Headache, nausea/vomiting, diaphoresis, photophobia, dyspnea
    4. A-fib, myocarditis, priapism, and death are rare

Treatment

  1. Pain and muscle spasms
    1. Opiods and benzos
  2. Systemic illness
    1. Antivenom
      1. Consider for:
        1. Children
        2. Pregnant women
        3. Elderly

Disposition

  1. Consider admission for:
    1. Symptoms of moderate envenomation
    2. Pregnant women
    3. Children
    4. Pts w/ preexisting cardiovascular disease or HTN

Tarantula

Clinical Features

  1. Abdominal hairs may be flicked a short distance when threatened
    1. Rarely penetrate human skin but can imbed deeply into conjunctiva and cornea
  2. Bites can be painful but systemic symptoms other than fever are unusual

Management

  1. Red eye and pain after handling a tarantula necessitates an ocular exam
    1. Hairs may be difficult to detect on slit lamp
  2. Treatment is surgical removal of hairs and topical steroids

See Also

Bites and Stings

Source

  • Tintinalli
  • Rosen's