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Emergency Medicine > Bites and Stings > Flashcards

Bites and Stings Flashcards

1
Q

What is the ORDER of stinging insects?

A

Hymenoptera

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2
Q

Fire ants are part of the ____ family

A

Wingless Formicidae

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3
Q

Bees are part of the ____ family

A

Apidae
Bees = Apids

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4
Q

Wasps are part of the ___ family

A

Vespid

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5
Q

when a wasp (vespid) stings you, does its barbs stay in your skin?

A

NO

bee (apid) barbs do stay in your skin and need rmved

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6
Q

The major cause of allergic rxns to insect stings in the US are ______

A

Yellow jackets (vespids)

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7
Q

What is the most allergenic part of vespid (wasp) venom?

A
  • Antigen 5 protein
  • Phospholipase
  • Hyaluronidases
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8
Q

Which insect bites and anchors itself into the person and stings repeatedly as it rotates its body in an arc around the bite, producing a characteristic central bite partially encircled with a red sting line?

A

FIRE ANTS

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9
Q

Which insect venom has hemolytic, cytolytic, antimicrobial, and insecticidal properties?

A

FIRE ANTS

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10
Q

Which insect bite looks like tiny little bee stings that go away and leaves you with little pustules?

A

FIRE ANTS

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11
Q

How to remove a stinger?

A

Scraping method with edge of something flat/sharp

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12
Q

2ndary infections are MC with which insect bites?

A

Ants
Yellow Jackets who rummage garbage

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13
Q

What can you give to a pt who was stung by an insect and is now very itchy?

A

High potency topical steroid (Fluocinonide or Clobetasol)

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14
Q

A spider bite from a _____ is initially painless and then develops into tissue necrosis and hemorrhagic blisters?

A

Brown Recluse

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15
Q

Brown Recluse Bite Trmnt

______ is the only effective option once there is evidence of skin necrosis

A

Anti-venom

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16
Q

Steps for general wound managemet

A
  1. clean bite with mild soap & water
  2. apply cold packs, do not freeze wound
  3. elevate or keep in neutral position
  4. pain meds (NSAIDs)
  5. +/- Prophylactic Tetanus shot
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17
Q

A spider bite from a ____ causes an immediate sharp/stinging sensation. Dull/Numbing pain out of proportion to clinical signs

A

Black Widow

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18
Q

A _____ spider bite releases alpha-Latrotoxin, triggering release of Ach and NorEpi

A

Black Widow

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19
Q

Black Widow Spide Bite Trmnt

Give ____ for muscle spasms

A

Benzodiazepines

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20
Q

A patient was stung by a Scorpion and now has a HIGH Creatinine Kinase (CK). Concern for?

A

Rhabdomyolysis

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21
Q

WU for Scorpion Sting

A
  • Hemolysis -> CBC
  • Rhabdomyolysis -> Creatinine Kinase (CK)
  • Pancreatitis -> Lipase (Amylase not v specific)
  • Arrhythmias -> EKG
22
Q

Corals, Cobras, and Mambas are part of the ______ family of snakes

23
Q

Rattlesnakes, Copperheads, and Cottonmouths are part of the ____ family of snakes

Type of snake

24
Q

Which SS do Elapids (Corals, Cobras, Mambas) cause?

  • Neurotoxic/Parayltic?
  • Coagulopathies?
A

Neurotoxic/Paralytic

Neurotoxic: Irreversibly binds to Ach receptor -> ascending paralysis -> blurred vision, ptosis, incr salivation, resp distress, euphoria, weakness, lethargy

25
Q

Which SS do Vipers (Rattlesnakes, Copperheads, Cottonmouths) produce?

  • Neurotoxic/paralysis?
  • Myotoxic/Coagulopathies?
A

Myotoxic/Coagulopathies

Myotoxic: direct cellular injury -> alters balance of coagulation system -> Coagulopathies -> tender lymph nodes as venom spreads thru lymph system

26
Q

Snake Bite Presentation

Initially -> ______
Later -> _______

A

Initially -> EDEMA
Later -> HYPOVOLEMIA (SHOCK)

27
Q

MC venomous snake family in the US

28
Q

2 MC venomous snakes in Indiana

A

Copperhead
Cottonmouth

29
Q

Coral snakes are found in ___ states of US

30
Q

Antivenom can cause an allx rxn if allx to ____ or ____

A

sheep
horses

31
Q

Snake bite trmnt

When should you suck out the venom and apply tournequet with ice?

A

NEVER LIKE EVER EVER

applying pressure may cause arterial insufficiency and necrosis

32
Q

Venomous or Non-venomous snake?

33
Q

Which venomous snake looks like a non-venomous snake?

A

Coral Snake

34
Q

Which venomous snake looks like a non-venomous snake?

A

Coral Snake

35
Q

Mammalian bites can transmit mouth flora including which 5 bac?

A
  1. Staph aureus
  2. Group A Strep
  3. Klebsiella
  4. Enterococci
  5. Prevotella
36
Q

Dog or Cat bite?

Pathogen: Pasturella Multocida
More likely to cause INFX>tissue injury
Can cause Septic Arthritis or Osteomyelitis

37
Q

Dog or Cat bite?

Pathogen Capnocytophaga Canimorsus
More likely to cause TISSUE INJURY>Infx
Can cause Gangrene-> Sepsis

38
Q

Human Bites on children >___cm diameter should be concern for child abuse

A

> 2.5cm = Child Abuse

39
Q

The MC human bite is called the “______ bite”

A

“FIGHT BITE“
affects 3rd and 4th metacarpal from punching someone in the mouth

40
Q

The organism Eikenella corrodens can cause culture negative ______

A

Endocarditis

May also lead to septic arthritis or osteomyelitis

41
Q

Which mammalian bites SHOULD NEVER be closed?

A

Human
Cat

clean dog bites can be closed

42
Q

Criteria to close a mammalian bite

A
  1. Not infx
  2. <24hrs old
  3. not on hand/foot
  4. healthy immune system
43
Q

When to give Prophylactic Tetanus Shot?

based on their tetanus shot Hx

A
  • Less than 3 full doses
  • last dose unknown
  • > 5yrs out
44
Q

ABX for mammalian bite?

A

Amoxicillin-Clavulanate (Augmentin)

PCN Allx
Doxy
Bactrim (Trimethoprim / Sulfamethoxazole)
Fluoroquinolone + Metronidazole or Clindamycin

45
Q

Domestic animals can have rabies. Which wild animals may also have it?

A

Foxes
Skunks
Racoons
Bats

46
Q

Rabies Vaccine

If not previously Vacc -> give ______
If previously Vacc -> give _______

A

Un-Vaccinated -> IVIG + Rabies Vacc
Previously Vaccinated -> Rabies Vacc only

IVIG = IV Immunoglobulins?

47
Q

What caused this stinging pattern?

  • Lesions initially appear as small, linear, papular eruptions that develop rapidly in one or several discontinuous lines, at times surrounded by a raised erythematous zone
  • Local intense pain + itchy
  • Papules -> vesiculation -> pustulation -> hemorrhage -> desquamatization
A

Jellyfish sting (Cnidaria)

48
Q

Jellyfish sting Tx

A
  • Remove tentacles
  • Non-tropical waters and coral stings -> seawater rinse
  • Tropical waters -> vinegar rinse followed by seawater rinse
  • Pain (usually short lived) -> baking soda 50:50 slurry, soak in warm water, NSAIDs
  • Peeing on sting has no known efficacy
49
Q

How to rinse off after beingn stung by a jellyfish in tropical water?

A

Vinegar rinse + seawater rinse

DO NOT rinse with freshwater bc it can activate undischarge nematocysts!
Vinegar helps neutralize the venom

50
Q

You need to rinse off with vinegar prior to sewater if you’re stung by a jellyfish in ______ waters
- Non-tropical?
- Tropical?

A

Tropical waters = Vinegar + seawater

Emergency Medicine (11 decks)

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