Stings And Bites Flashcards by Demetré Harris

What is the venoms of bees and wasps

Hymenoptera

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What is Hymenoptera from and what is it made from

Bees and wasps

Made of histamine
Melittin: degranualtes basophils and mast cells
Phospholipase and hyaluronidase

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What is the most common response to Hymenoptera

The most common response to a Hymenoptera sting is a transient local reaction.
—Localized itching, pain, erythema, and swelling are common.

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Getting stung in the eye by a bee or wasp can lead to what complications

Eye lid swelling

Anterior capsule cataract

Atrophy of the iris

Lens abcess

Globe perforation

Glaucoma

Refractive changes

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If a pt presents with involuntary muscle spasm and edema without urticaria

Think what?

Bee or wasp sting - Hymenoptera

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What is the typical onset of fatality iwth a wasp or bee sting

Within the 1st hour

In general, the shorter the interval between the sting and the onset of symptoms, the more severe is the reaction!!

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What is the general non anaphylactic treatment for Hymenoptera
(wasp/bee stings)

removal of the stinger by any means

Wash the site

Cold compress may help

Oral analgesics, nsaids, and antihistamines

Elevate the limb as necessary to reduce edema

Corticosteroids are controversial but are still used

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What is the treatment for Hymenoptera (bee stings) anaphylaxis

ABCs 1st

Im Epi 0.3-0.5 1:1000

Aggressive fluids with crystaloids

Anithistamines 1 and 2

+/- steroids

D/c with steroids, antihistamines, and epi pens

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Describe a brown recluse

A pigmented, violin-shaped pattern on the cephalothorax

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What is the venom from a brown recluse

The venom of the brown recluse contains multiple enzymes, including hyaluronidase and sphingomyelinase D, which is the major enzyme responsible for necrosis!!

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Are brown recluse bites painful?

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What is the red white and blue sign of a brown recluse bite

By day 3 or 4, the hemorrhagic area may become ecchymotic, which leads to the “red, white, and blue” sign
(erythema, blanching, and ecchymosis)
»The ecchymosis becomes necrotic, with eschar formation»Significant cosmetic defect requiring skin grafting.

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What is the treatment for a brown recluse bite

Supportive

ABX if signs of infection

+/- dapsone and surgical incision

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What si the f/u for a brown recluse bite

Surgical debridement should be delayed until clear margins are established, often 2 to 3 weeks after the bite. (Not in ED!)

Patients with systemic symptoms following a bite warrant hospitalization.
(hypotension, hypertension, sepsis)

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What is the scientific name for a brown recluse

Loxosceles reclusa

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Describe a Black widows spider

Black with a orange red hourglass

What is the scientifc name for a black widow

latrodectus

What is the most active component of the black widow venom

highly potent venom with the most active component of the venom is
α-latrotoxin

What is the effect of alpha latrotoxin

Acts through both calcium-dependent and calcium-independent pathways leading to receptor stimulation, pore formation, and ultimately massive release of neurotransmitters (predominantly acetylcholine and norepinephrine)

Acetylcholine release accounts for neuromuscular manifestations, and norepinephrine release accounts for the cardiovascular manifestations.

A black widow bites painful ?

Yes

A pt presents with a painful spider bite after cleaning out his wood shed

He know has severe abdominal pain and cramping with HTN and TachyHR
HA, N/V, diaphorsis and photophobia

Think

Latrodectus - black widow

What is the tx appraoch to latrodectus -black widow bites

Supportive measures
+/- IV calcium

Opiods for pain
Benzos for spans

Anti venom

What is the pathophys of a scorpion sting

Most stings cause localized pain at the bite site and can open neuronal sodium channels that cause prolonged and excessive depolarization.

What are the s/s of a scorpion sting

restlessness or uncontrollable jerking of the extremities that appears to be seizure-like activity

Tachycardia, HTN , Pulm edema, and cardio shock

AbnNML oculomotor function
Loss of pharyngeal control uncoordinated RR
Tongue fasciulations

Hypersalivation is common and can threaten the airway

What cranial nerves are effected by scorpion stings

Trigeminal (cranial nerve V) | Facial (cranial nerve VII) Glossopharyngeal (cranial nerve IX)

If a scorpion sting presents with Tachycardia, HTN, and mydriasis What is the tx

Antivenmon and prazosin

If a scorpion sting presents with pulm edema, what is the tx option

Antivenmo Nitro or prazosin Dobutamine

If a scorpion bite presents with HOTN, bradyHR, salivation, sweating, ab pain, and pancreatitis What is the tx ?

Atropine

When should you admit a scorpion sting

Patients with mild, local reaction without systemic reactions may be discharged home with pain control, return precautions and close follow up. Patients with systemic symptoms or cranial nerve impairments may need to be admitted.

What is the effect of crotalinae snake venom

Complex enzyme mixture that causes local tissue injury, systemic vascular damage, hemolysis, fibrinolysis, and neuromuscular dysfunction, resulting in a mixture of local and systemic effects. Crotaline venom quickly alters blood vessel permeability; this leads to loss of plasma and blood into the surrounding tissue, which causes hypovolemia. Crotaline venom activates and consumes fibrinogen and platelets, causing a coagulopathy.

How does Crotalinae Snake venom effect cranial nerves

In some species, specific venom fractions block neuromuscular transmission, which leads to cranial nerve weakness (e.g., ptosis), respiratory failure, and altered sensorium. (GCS what?!)

What are the early S/s or crotalinae snake bites

early symptoms and signs are nausea and vomiting, weakness, oral numbness or tingling of the tongue and mouth, dizziness, and muscle fasciculation.

What are the systemic effects of crotalinae snake venom

Systemic effects include tachypnea, tachycardia, hypotension, and altered level of consciousness. In general, local swelling at the bite site becomes apparent within 15 to 30 minutes. (Wicked fast!)

What are the three possible manifestations of a snake bite

Local injury Hematology abNML Systemic effects The absence of any of these manifestations for a period of 8 to 12 hours following the bite indicates a dry bite.

What is the Tx appraoch to crotalinae snake bites

Antivenom Crotalidae Polyvalent Immune Fab (Ovine) (FabAV) Establish initial control with 4-6 vials and repeat if not met goal If goal of control met Then induce 2-vials at 6-12-18hrs Measure for anaphylaxis before, during and after admin of anti venom Measure limb circumference for compartment syndrome q 30 min Repeat labs q 4 hours Pt may need fluids and or blood or blood products

What is the F/u for a crotalinae snake bite

Observe for 6-8 hours in the ed Can discharge if dry bite without s.s at 8 hours Admit if life threatening S/s or receiving anti venom (general ward)

Describe Elapid snake bites

“Red on yellow, kill a fellow; red on black, venom lack.” Coral snakes

What is the treatment for Elapid Coral Snake bites

Coral snake venom is primarily composed of neurotoxic components- no local injury. Admit potential victims of coral snakebite to the hospital for observation, because venom effects may develop hours after a bite and are not easily reversed. Administer three to five vials of antivenom, Antivenin® (M. fulvius), IV to patients who have definitely been bitten, because it may not be possible to prevent further effects or reverse effects once they develop. Additional doses of coral snake antivenom are reserved for cases in which symptoms or signs of coral snake envenomation appear.