Bites and Stings and Things

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Bites and Stings and Things

• David A. Meurer, MD
• University of Florida College of Medicine
• Department of Emergency Medicine

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Otherwise known as . . .
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Dx Arthropod Attack

• Hymenoptera-bees, wasps, hornets, fire ants

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Dx Arthropod Attack

• Hymenoptera-bees, wasps, hornets, fire ants
• Spiders-black widow, brown recluse, and others

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Dx Arthropod Attack

• Hymenoptera-bees, wasps, hornets, fire ants
• Spiders-black widow, brown recluse, and others
• Stinging Caterpillars

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Dx Arthropod Attack

• Hymenoptera-bees, wasps, hornets, fire ants
• Spiders-black widow, brown recluse, and others
• Stinging Caterpillars
• Scorpions

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Hymenoptera
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Hymenoptera

• Bees

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Hymenoptera

• Bees
• Wasps, Hornets, and Velvet Ants

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Hymenoptera

• Bees
• Wasps, Hornets, and Velvet Ants
• Fire Ants

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Hymenoptera Venoms
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Hymenoptera Venoms

• Bees
• Histamine
• Phospholipase A
• Hyaluronidase
• Melittin
• Acid Phosphatase
• Allergin C (di-phenylpyramine)

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Hymenoptera Venoms

• Bees
• Honeybees

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Hymenoptera Venoms

• Bees
• Honeybees
• Bumble bees

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Hymenoptera Venoms

• Bees
• Honeybees
• Bumble bees
• African killer bees

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Killer Bee Migration
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Hymenoptera Venoms

• Bees
• Wasps and Velvet Ants
• Bee venom plus seratonin and kinnins

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Hymenoptera Venoms

• Bees
• Wasps and Velvet Ants
• Hornets
• Wasp venom
• plus aceylcholine

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Hymenoptera Venoms

• Fire Ants
• Piperdine alkaloids
• Low protein

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Imported Fire Ant Distribution
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Hymenoptera Reactions
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Hymenoptera Reactions

• Local Reactions

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Hymenoptera Reactions

• Local Reactions
• Toxic Reactions

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Hymenoptera Reactions

• Local Reactions
• Toxic Reactions
• Systemic/Anaphylactic Reactions

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Hymenoptera Reactions

• Local Reactions
• Toxic Reactions
• Systemic/Anaphylactic Reactions
• Delayed Reactions

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Hymenoptera Reactions

• Local Reactions
• Toxic Reactions
• Systemic/Anaphylactic Reactions
• Delayed Reactions
• Unusual Reactions

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Treatment of Hymenoptera Stings
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Treatment of Hymenoptera Stings

• Local Reactions

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Treatment of Hymenoptera Stings

• Local Reactions
• Systemic Reactions

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Spiders
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Spiders

• Black Widow

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Other Widow Spiders

• Red Widow

• Brown Widow

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Spiders

• Black Widow
• Neurotoxin

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Spiders

• Black Widow
• Neurotoxin
• Wound Appearance

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Spiders

• Black Widow
• Neurotoxin
• Wound Appearance
• Local vs. Systemic Effects

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Clarks Grading Scale for Widow Spider
Envenomations
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Spiders

• Black Widow
• Neurotoxin
• Wound Appearance
• Local vs. Systemic Effects
• Labs Abdominal Labs
• CBC
• UA/UCG
• CPK

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Spiders

• Black Widow
• Neurotoxin
• Wound Appearance
• Local vs. Systemic Effects
• Labs
• Treatment

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Spiders

• Brown Recluse

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Distribution of Brown Recluse
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(No Transcript)
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Spiders

• Brown Recluse
• Digestive Venom

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Spiders

• Brown Recluse
• Digestive Venom
• Wound Appearance

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Spiders

• Brown Recluse
• Digestive Venom
• Wound Appearance
• Local vs. Systemic Effects

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Spiders

• Brown Recluse
• Digestive Venom
• Wound Appearance
• Local vs. Systemic Effects
• Labs CBC, BMP, Coags

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Spiders

• Brown Recluse
• Digestive Venom
• Wound Appearance
• Local vs. Systemic Effects
• Labs CBC, BMP, Coags
• Treatment

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Spiders

• Other Spiders

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Spiders

• Other Spiders
• U.S.

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Spiders

• Other Spiders
• U.S.
• Exotics

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Stinging Caterpillars
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Stinging Caterpillars

• Puss caterpillar/Wooly slug

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Stinging Caterpillars

• Puss caterpillar/Wooly slug
• Io Moth caterpillar

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Stinging Caterpillars

• Puss caterpillar/Wooly slug
• Io Moth caterpillar
• Saddleback
• caterpillar

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Stinging Caterpillars

• Venom mechanism

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Stinging Caterpillars

• Venom mechanism
• Clinical Presentations

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Stinging Caterpillars

• Venom mechanism
• Clinical Presentations
• Treatment

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Scorpions
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Scorpions

• Local to Florida

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Scorpions

• Bark scorpion (Centroides sculpturatus/C.exilicaud
  a)

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Scorpions

• Bark scorpion Symptoms and Grading of
  envenomation

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Scorpions

• Bark scorpion (Centroides sculpturatus/C.exilicaud
  a)
• Symptoms and Grading of envenomation
• Treatment
• Grade 1 or 2
• Grade 3 w/o respiratory symptoms
• Grade 3 w/ respiratory symptoms or Grade 4

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Scorpions

• Exotic

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Dx Reptile Revenge
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Dx Reptile Revenge

• Crotalidae (Pit vipers) rattlers, cottonmouth,
  copperheads

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Dx Reptile Revenge

• Crotalidae (Pit vipers) rattlers, cottonmouth,
  copperheads
• Elapidae-coral snake

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Dx Reptile Revenge

• Crotalidae-Pit vipers-rattlers, cottonmouth,
  copperheads
• Elapidae-coral snake
• Exotic Snakes and Lizards

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Dx Reptile Revenge

• Crotalidae-Pit vipers-rattlers, cottonmouth,
  copperheads
• Elapidae-coral
• Exotic Snakes and Lizards
• Venomous Lizards

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Pit Vipers
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Pit Vipers

• Identification

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Pit Vipers

• Identification
• Venom

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Pit Vipers

• Identification
• Venom
• Symptoms and Grading of Envenomation

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Pit Vipers

• Identification
• Venom
• Symptoms and Grading of Envenomation
• Treatment

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Crotalid Treatment Flowchart
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Pit Vipers

• Identification
• Venom
• Symptoms and Grading of Envenomation
• Treatment
• ? need to identify the snake

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Crotalid Antivenom

• Wyeth
• Equine
• E/W Diamondback, Tropical Rattler, Fer-de-Lance
• Dose
• 5-10 vials vs. 10-20 vials
• Repeat q 30-120 min as needed

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Crotalid Antivenom

• Wyeth
• Equine
• E/W Diamondback, Tropical Rattler, Fer-de-Lance
• Dose
• 5-10 vials vs. 10-20 vials
• Repeat q 30-120 min as needed
• CroFab
• Ovine Fab Fragments
• E/W Diamondback, Mojave Rattler, Water Moccasin
• Dose
• 4-6 vials, may repeat _at_ 1hour.
• Maintenance 2 vials q 6 hours x 3 (18 hours)

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Coral Snakes
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Coral Snakes
Scarlet snake

• Identification

Scarlet King Snake
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Coral Snakes

• Identification
• Venom

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Coral Snakes

• Identification
• Venom
• Symptoms

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Coral Snakes

• Identification
• Venom
• Symptoms
• Treatment

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Reptile Revenge Exotic Stuff

• Nonvenomous snakes and lizards
• Venomous exotic snakes
• Venomous lizards(Not exotic-unless you live in
  Fl.)

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Nonvenomous Snakes and Lizards
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Venomous Exotic Snakes

• 1-(520)-626-6016 U Az PCC Tuscon

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Venomous Lizards
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Dx Mammal Mastication

• Awww RATs!

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Dx Mammal Mastication

• Rabies
• Antibiotics
• Tetanus
• s

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Dx Mammal Mastication

• Rabies

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Dx Mammal Mastication

• Rabies
• Wound Care

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Dx Mammal Mastication

• Rabies
• Wound Care
• Prophylaxis

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Dx Mammal Mastication

• Rabies
• Wound Care
• Prophylaxis

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Dx Mammal Mastication

• Antibiotics
• 50 infected dog bites/57 infected cat bites
• Aerobes and anaerobes 56
• aerobes alone 36
• anaerobes alone 1
• No growth 7

New England Journal of Medicine Volume 34085-92
January 14, 1999 Number 2
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Dx Mammal Mastication

• Antibiotics
• 50 infected dog bites/57 infected cat bites
• Pasteurella sp. most frequent isolates
• dog bites (50 percent) Pasteurella canis
• cat bites (75 percent). P. multocida multocida
• P. multocida septica
• Aerobes streptococci, staphylococci, moraxella,
  and neisseria.
• Anaerobes included fusobacterium, bacteroides

New England Journal of Medicine Volume 34085-92
January 14, 1999 Number 2
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Dx Mammal Mastication

• Antibiotics
• ß-lactam antibiotic with a ß-lactamase inhibitor
• Second-generation cephalosporin with anaerobic
• activity
• combination therapy with either penicillin and a
  first-generation cephalosporin OR clindamycin and
  a fluoroquinolone
• New England Journal of Medicine
• Volume 34085-92 January 14, 1999 Number 2

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Dx Mammal Mastication

• Tetanus

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Dx Arthropod Attack Reptile Revenge
Mammal Mastication

• Any Questions?

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The End