Part 3
The material presented in this appendix was prepared by Lt Col John C. Moseley, USAF, MC, Dermatologist, Wilford Hall USAF Medical Center, Lackland AFB, Texas.
BLACK WIDOW SPIDER
REACTIONS
_IMMEDIATE:_ Pinprick sensation from the bite
_LOCAL:_ Dull numbing pain; two red puncture marks at bite site. Pain peaks at 1-3 hours and persists 12-48 hours
_REGIONAL:_
1. Severe muscular pain and spasm 2. Rigid boardlike abdomen 3. Tightness in chest and pain on inspiration
_GENERAL:_
1. Rigidity and spasm of all large muscle groups; excruciating abdominal pain 2. Convulsions, paralysis 3. Shock
_DEATHS:_ 4-5% of untreated cases due to neurotoxic effect of the venom
TREATMENT
_LOCAL FIRST AID:_ Ineffective and unnecessary
_SYSTEMIC:_
1. Antivenin—1 vial IM (carefully follow package insert instructions) after testing for horse-serum sensitivity 2. Calcium gluconate—10 ml of 10% solution given IV immediately and prn to control muscle pain 3. Muscle relaxants—Give continuously over 8-16-hr period to relieve intensity of muscle spasm and pain 4. Treat for shock as necessary (Chart 2)
BROWN RECLUSE SPIDER
REACTIONS
_IMMEDIATE:_ Very little pain, if any
_LOCAL:_
1. 2-8 Hours—Mild to severe pain with redness and vesiculation at bite site, followed by ischemia 2. 3-4 Days—Star-shaped firm area of deep-purple color with necrosis 3. 7-14 Days—Central area of depression and ulceration 4. 21 Days—Healing and scar formation. May not heal sufficiently and may require skin grafting
_SYSTEMIC:_
1. Fever, chills, nausea, vomiting, weakness, joint pain 2. Morbilliform or petechial generalized eruption 3. Occasionally serious hematological disturbances—hemolytic anemia, thrombocytopenia
_DEATHS:_ Reported; usually in children, due to renal failure and hematological abnormalities.
TREATMENT
_LOCAL FIRST AID:_ None effective or necessary
_LOCAL:_ Within 4 hours of the bite, locally excise bite site
_SYSTEMIC:_
1. Systemic corticosteroids is the treatment of choice and must be administered immediately—methylprednisolone (Depo-Medrol) 80 mg IM, followed by prednisone 60 mg a day for 3 days and gradually tapered over a 10-14-day course of therapy 2. Heparin therapy may reduce the disseminated intravascular coagulation phenomenon 3. Analgesics for pain
CENTIPEDES
REACTIONS
_IMMEDIATE:_ Pain, often intense
_LOCAL:_ 1-4 hours—A two-puncture wound at the site with redness, swelling, and a burning aching pain that subsides in 4-5 hours
_REGIONAL:_ Rare—Purpura of an entire limb
_ANAPHYLAXIS AND DEATH:_ None reported in the United States
TREATMENT
_LOCAL FIRST AID:_
1. Wash with soap and water 2. Apply ammonia in 10% solution 3. Apply cool wet dressings of a saturated magnesium sulfate solution
_SYSTEMIC:_ Analgesics for pain
TRUE BUGS (KISSING BUGS)
REACTIONS
_IMMEDIATE:_ Usually no sensation, occasionally mild pain
_LOCAL:_ (Four distinct reactions depending on degree of sensitivity):
1. Papule with a central punctum 2. Small vesicles grouped around bite site with swelling and little redness 3. Giant urticarial lesion with central punctum and surrounding brawny edema 4. Hemorrhagic nodular-to-bullous lesions on hands and feet—the characteristic “kissing bug bites”
_ANAPHYLACTIC SHOCK:_ Rare, but reported
_DEATHS:_ None reported
TREATMENT
_LOCAL FIRST AID:_ Wash with soap and water
_SYSTEMIC:_ Oral antihistamines (Chart 1)
ANTS
REACTIONS
_IMMEDIATE:_ Fierce burning pain lasting minutes
_LOCAL:_ (Fire Ants)
Minutes—Wheal formation 2-4 Hours—Clear fluid-filled vesicles 8-10 Hours—Cloudy fluid-filled vesicles 12-24 Hours—Umbilicated pustules on a red base, with pain and tenderness 3-8 Days—Lesions resolve; may leave scars
_SYSTEMIC:_ Due to allergic sensitization; severity and speed of onset related to degree of sensitivity. May see wheezing, urticaria, abdominal cramps, generalized edema, nausea, vomiting, dizziness, confusion, shock
_ANAPHYLAXIS AND DEATH:_ Rare, but reported
TREATMENT
_LOCAL FIRST AID:_
1. Wash sites with soap and water 2. Apply ice packs or cold compresses 3. Apply baking soda and water paste
_SYSTEMIC:_
1. Epinephrine (1:1,000) subcutaneous injection (0.2-0.5 ml in adults and 0.1-0.3 in children). Repeat in 5-10 min if necessary 2. Antihistamine (Benadryl, 50 mg IM)—Adult 3. Oral antihistamines (Chart 1) 4. Treat for shock as necessary (Chart 2)
BEES AND WASPS
REACTIONS
_IMMEDIATE:_ Pain
_LOCAL:_ Within 1-4 hours—Appearance and subsidence of wheal and red flare; may see intense local swelling in region of sting
_SYSTEMIC:_
1. Mild reaction—Generalized urticaria, itching, malaise, anxiety 2. Moderate reaction—Any of the above plus generalized edema, tightness in the chest, wheezing, abdominal pain, nausea, vomiting, dizziness 3. Severe reaction—Any of the above plus labored breathing, difficulty in swallowing, hoarseness or thickened speech, marked weakness, confusion, feeling of impending disaster 4. Shock—Cyanosis, fall in BP, collapse, incontinence, unconsciousness 5. Delayed serum-sickness-like reaction (10-14 days after sting)—Fever, lymphadenopathy, malaise, headache, urticaria, polyarthritis
_ANAPHYLAXIS AND SUDDEN DEATH:_ Many cases reported, usually in adults
TREATMENT
_LOCAL FIRST AID:_
1. Remove bee stinger from sting site by gently scraping with fingernail or blade to prevent further venom injection from attached venom sac 2. Wash site with soap and water 3. Apply ice packs or ammonia in 10% solution 4. Apply baking soda and water paste 5. Elevate and rest involved limb
_SYSTEMIC:_
1. Epinephrine (1:1,000) subcutaneous injection (0.2-0.5 ml in adults and 0.1-0.3 ml in children). Repeat in 5-10 min if necessary 2. Analgesics (ASA, Tylenol) for pain 3. Antihistamines (Chart 1)—Useful only for urticarial and pruritic reactions 4. Treat for shock as necessary (Chart 2)
_LONG-TERM MANAGEMENT:_ (for hypersensitive patients)
1. Medic-alert tag or bracelet 2. Emergency treatment kit and instructions for use 3. Program for desensitization
SCORPIONS
REACTIONS
_IMMEDIATE:_ Severe sharp pain
_LOCAL:_
1. Dangerous neurotoxic species—Pins-and-needles sensation with no local swelling or discoloration (found in Arizona only) 2. Comparatively harmless species (not neurotoxic)—Local swelling and discoloration at sting site
_SYSTEMIC_ (neurotoxic species only—within 1-3 hours):
1. Hypoesthesia and numbness or drowsiness 2. Itching of nose and throat 3. Impaired speech and tightness of jaw muscles 4. Restlessness and muscle twitching 5. Muscle spasms with pain, nausea, vomiting, incontinence, convulsions 6. Respiratory and/or circulatory distress
_ANAPHYLAXIS:_ Rare, but reported with non-neurotoxic species
_DEATHS:_ Occasional; due to neurotoxic species
TREATMENT
_LOCAL FIRST AID:_
1. Apply ice packs 2. Apply tourniquet if possible and as near sting site as possible. Loosen briefly every 10-15 minutes WARNING: Do _not_ use morphine or opiates since they increase toxic effects
_SYSTEMIC:_
1. Specific antivenin available for many dangerous species; administered early, may be lifesaving 2. Calcium gluconate—10 ml of 10% solution IV immediately and prn to control muscle pain 3. Phenobarbital—30-60 mg orally for sedation and control of convulsions 4. Treat for shock as necessary (Chart 1)
URTICATING CATERPILLARS
REACTIONS
_IMMEDIATE:_ Severe burning pain
_LOCAL:_
1. Numbness and swelling of area inflicted with severe radiating pain 2. Possible double row of parallel red punctuate marks forming a gridlike tract along the path of the caterpillar 3. Swelling of regional lymph nodes 4. Late foreign-body reaction to unremoved spines
_SYSTEMIC:_
1. Nausea, vomiting, fever 2. Headaches 3. Shock and convulsions (rare)
_DEATHS:_ None reported
TREATMENT
_LOCAL FIRST AID:_
1. Repeated stripping using adhesive or cellophane tape to remove spines 2. Apply ice packs 3. Apply baking soda and water paste
_SYSTEMIC:_
1. For severe pain give meperidine hydrochloride (Demerol, 50-100 mg PO or IM), morphine sulfate (0.25 subcutaneous), codeine phosphate (0.5 g PO) NOTE: Aspirin is generally not effective 2. Shock (Chart 2)
CHART 1 ANTIHISTAMINES
GROUP TRADE NAME AVERAGE ORAL BASE SEDATION GENERIC NAMES ADULT CHILD
Ethanolamines diphenhydramine•HCl Benadryl 50 mg q 4-6h 25 mg q 4-6h ++++ diphenhydramine Dramamine 50 mg q 4h 25 mg q 4h ++++ theophyllinate Ethylenediamine tripelennamine Pyribenzamine 50 mg q 4-6h 25 mg q 4-6h +++ Alkylamines chlorpheniramine maleate Chlor-Trimeton 4 mg q 6h 2 mg q 6h ++ brompheniramine maleate Dimetane 8 mg q 6h 4 mg q 6h + triprolidine•HCl Actidil 2.5 mg q 8h 1.25 mg q 8h ++ Cyclizines hydroxyzine•HCl Atarax 25-100 mg q 10-25 mg q + 6h 6h Miscellaneous cyproheptadine•HCl Periactin 4 mg q 6h 2 mg q 6h +++ promethazine Phenergan 25-50 mg q 12.5-25 mg ++++ 6-8h q 6-8h
Chart 2 Treatment of Anaphylaxis—Shock
IMMEDIATE TREATMENT MILD REACTION TREATMENT SEVERE REACTION TREATMENT REACTION: Conjunctivitis, Rhinitis, Urticaria, Pruritus, Erythema
Epinephrine•HCl 0.3 ml Diphenhydramine•HCl 50 mg (1:1,000) IM PO q 6h Diphenhydramine•HCl 50 mg PO
REACTION: Laryngeal edema
Epinephrine•HCl 0.3 ml Diphenhydramine•HCl 50 mg Oxygen (1:1,000) IM q 6h IM or PO Diphenhydramine•HCl 50 mg Diphenhydramine•HCl 50 mg Ephedrine sulfate 25 mg q q 6h IV 6h Ephedrine sulfate 25 mg q 6h Monitor blood gases Hydrocortisone Tracheostomy
REACTION: Bronchospasm
Epinephrine•HCl 0.3 ml Epinephrine•HCl 0.3 ml Oxygen (1:1,000) IM (1:1,000) IM Aminophylline 500 mg IV q Diphenhydramine•HCl 50 mg Aminophylline 250 mg IV 6h IV over 10-min period of time Hydrocortisone IV fluids Monitor blood gases Observe for respiratory failure
REACTION: Hypotension
Epinephrine•HCl 0.3 ml Metaraminol bitartrate, Oxygen (1:1,000) IM 100 mg in 1,000 ml 5% Metaraminol bitartrate IV Diphenhydramine•HCl 50 mg dextrose in water IV fluids IV
Transcriber’s Notes
—Retained publication information from the printed edition: this eBook is public-domain in the country of publication.
—Corrected a few palpable typos.
—Generated a spine image from elements of the cover image.
—Reformatted several charts for better text flow on narrow screens.
—In the text versions only, text in italics is delimited by _underscores_.
End of Project Gutenberg's Venomous Arthropod Handbook, by Terry L. Biery