Envenomation Flashcards
What is the order of insects that includes ants, bees and wasps?
Hymenoptera
(a) A local reaction is the most common reaction. It consists of a small red patch that burns and itches.
(b) The generalized reaction consists of diffuse red skin, hives, swelling of lips and tongue, wheezing, abdominal cramps and diarrhea.
(c) Stings to the mouth and throat are more serious, as they may cause airway swelling.
(d) Victims of multiple stings often experience:
1) Vomiting
2) Diarrhea
3) Dyspnea
4) Hypotension
5) Tachycardia
6) Syncope
7) Skin infections
Hymenoptera Sting
In advanced stages of toxicity, the victim experiences
1) Increased muscle activity with hyperkalemia
2) Acute tubular necrosis
3) Renal failure
4) Pancreatitis
5) Coagulopathy
6) Heart attack
7) Stroke
Hymenoptera Sting
Treatment of Hymenoptera Sting
(a) Remove the stinger
(b) Wash the site with soap and water.
(c) Place a cold compress or ice on the site to reduce inflammation.
(d) Give oral analgesics as needed for pain relief.
(e) Topical steroid cream can be helpful for swelling, as are oral antihistamines
How should you remove a stinger
1) Scrape away the stinger in a horizontal fashion.
2) Try not to grasp the stinger sac.
3) However, if one is unable to remove the stinger in a horizontal fashion, it is most important to remove it as soon as possible by any available means
Medications for Hymenoptera Sting
(1 Loratadine (Claritin) - 10mg orally once daily
(2 Desloratadine (Clarinex) - 5mg once daily
(3 Fexofenadine (Allegra) – 60mg twice daily or 120 mg once daily
(4 Cetirizine (Zyrtec) - 10 mg orally once daily
(5 Brompheniramine (Dimetapp) or chlorpheniramine (Chlor-Trimeton) - 4mg orally every 6-8 hours, or 8-12 mg orally every 8-12 hours as a sustained release tablet
(6 Clemastine - 1.34-2.68 mg orally twice daily
If hives occur with wheezing and respiratory difficulty after a stinger, what should be given immediately
Epinephrine
What can help with wheezing after stinger
Beta agonist inhalers (e.g., albuterol)
What other medications should be used when epinephrine is used
oral steroids and antihistamines
Ticks transmit many diseases, including
(a) Lyme Disease
(b) Rocky Mountain spotted fever (RMSF)
(c) Relapsing fever
(d) Colorado tick fever
(e) Ehrlichiosis
(f) Babesiosis
(g) Tularemia
(h) Southern Tick-Associated Rash Illness (STARI)
A non-infectious ascending paralysis similar to Guillain- Barre syndrome, may occur within five days after the tick attaches. Removal of the tick is
curative.
Tick paralysis
Where are ticks found
- areas replete with weeds, shrubs, and trails
- They will often be found at forest boundaries where deer and other mammals reside
- will sit on low-hanging shrubs with legs outstretched until an animal passes
Tick treatment
1) Use thin-tipped tweezers or forceps to grasp the tick as close to the skin surface as possible.
2) Pull the tick straight upward with steady even pressure.
(b) Wash the bite with soap and water, then wash hands after the tick has been removed.
(c) Watch for local infection and symptoms of tick-borne illness (incubation period 3 to
30 days), especially headache, fever, and rash.
Lyme Disease, RMSF, Tularemia, or Ehrlichiosis is suspected, which medications should be initiated
- doxycycline
Treatment for other tick-borne illnesses that are not Lyme Disease, RMSF, Tularemia, or Ehrlichiosis
Supportive
Do nots of tick removal
1) Do not use petroleum jelly
2) Do not use fingernail polish
3) Do not use rubbing alcohol
4) Do not use a hot match
5) Do not use gasoline
6) Do not grab the rear end of the tick. This expels gastric contents and
increases the chances of infection
7) Do not twist or jerk the tick, as this will most likely cause incomplete removal of the tick
Neurotoxins cause respiratory paralysis
(a) Signs and Symptoms: ptosis, dysphagia, diplopia, and respiratory arrest via diaphragmatic paralysis
Neurotoxic (coral snake)
Cause tissue destruction by digestion and hemorrhage due to hemolysis and destruction of the endothelial lining of
the blood vessels.
Cytolytic (rattlesnakes, other pit vipers)
Name the snake:
Red touches black your OK jack. Red touches yellow you’re dead fellow.
Coral snakes
Name the snake:
(a) Triangular head
(b) Keeled scales
(c) Elliptical pupils
(d) Nostrils plus IR pit
(e) Single row of subcaudal scales
Venomous snakes
Name the snake:
(a) Oval shaped head
(b) Round pupil
(c) No IR pit
(d) Double row of subcaudal scales
Nonvenomous snakes
(a) Local pain
(b) Redness
(c) Swelling
(d) Extravasation of blood
(e) Perioral tingling
(f) Metallic taste
(g) Nausea and vomiting
(h) Hypotension
(i) Coagulopathy
Cytolitic snake bite
Treatment of snake bites
(a) Remove from threat, try to ID snake
(b) Immobilize the patient and maintain the bitten part in a neutral position
(c) Remove jewelry
(d) DO NOT apply a tourniquet or attempt to extract venom!!!
(e) Irrigate and clean the bite
(f) Loose dressing if hemotoxic bite, expect swelling
(g) Do not let patient walk, limit exertion
(h) MEDEVAC
Methods to avoid for removing venom
(a) Incision and oral suction
(b) Mechanical suction devices
(c) Cryotherapy
(d) Surgery
(e) Electric shock therapy
(f) Tourniquets
Signs and Symptoms:
1) Generalized muscular pains
2) Muscle spasms,
3) Rigidity
4) Abdominal Pain
Black Widow Spiders
Treatment of Black Widow Spider bite
Pain may be relieved with pain control and muscle relaxants (benzodiazepines and supportive care)
Sign and Symptoms: Causes progressive local necrosis as well as hemolytic reactions (rare). Bite is usually painless
Brown Recluse Spider
Treatment of Brown Recluse Spider bite
1) Pain management for secondary local necrosis and close monitoring initially.
2) Consider antibiotic prophylaxis in field setting
3) Bites occasionally progress to extensive local necrosis and may require excision of the bite site and oral corticosteroids.
(1) Signs and Symptoms:
(a) Muscle cramps
(b) Twitching and jerking
(c) Occasionally hypertension
(d) Convulsions
(e) Pulmonary edema
Scorpion
Treatment of Scorpion
(a) Supportive care is appropriate for North American species.
(b) Always review the threat of local species when operating OCONUS
(c) If severe neurologic or neuromuscular dysfunction consult poison control and discuss further management and anti-venom
(d) Suction oral secretions, airway management, cardiac monitoring, IV opioids preferably fentanyl due to no histamine release, benzo for spasms unless getting anti-venom
