managing spider bites in the ed
DESCRIPTION
Presentation on managing common Australian spider bites in the Emergency DepartmentTRANSCRIPT
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Spider Bites
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Learning Points
Understanding of common Aust spiders.
Recognition of common clinical presentation, & ED management.
Highlight some common misinformation about spider bites.
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Spider’s
Australia is home to 1000’s of different spiders.
The big two are: Red Back and Funnel Web.
White tail gets blamed for everything.
Majority of spider bites cause localised symptoms only.
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Spider Bites
Can be broken into 3 groups:
1. Big Black spider’s – suspect funnel-web!
2. Redback spiders – look for clinical effect.
3. All other spiders - generally minor effects.
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Aussie Spiders!
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Red Back Spider
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Redback Spider
RBS most common envenoming is Aust. 5-10 000 each year.
Clinical features distressing – but not life threatening.
RBS live in dry-dark areas.
Peak bite season January – April.
The women are the problem!
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Consider RBS
Children:
Inconsolable crying
Acute abdomen
Priapism
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Clinical Presentation
Isbister, G. (2006). Spider bite: a current approach to management. Aust Prescriber. 29(6), 156-149.
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Redback Spider
Beware of atypical presentations
Ongoing symptoms weeks-months consider psych!
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Emergency DepartmentManagement.
Pre-hospital:
Reassure, ICE-pack, simple analgesia.
In ED:
2 approaches:
Provide analgesia/antimetics – if Sx resolve D/C.
Antivenom: 2 x 500units of CSL RBS iv over 30min. (monitor for reactions).
Rpt if Sx not improved after 2 hours.
Antivenom effectiveness currently being studied. (RAVE2)
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Funnel-web spider
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Funnel-web spider
Most dangerous spider in Australia.
Comprise 40 species in 2 genera.
Big black spider bite = FWS bite until patient has been observed for 4/24.
Found in QLD and NSW.
The males are the problem
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Clinical Presentation Hx of being bitten by big black spider with fangs.
Localised:
Severe bite site pain with fang marks.
Local erythema & swelling are NOT present.
Systemic:
General: agitation, vomiting, headache, abdo pain.
Autonomic: sweating, salivation, piloerection, lacrimation.
Cardio: HT, tachycardia, hypotension, bradycardia, APO.
Neuro: muscular fasciculation's or spasm, coma.
Children:
Sudden severe illness with inconsolable crying, salivation, vomiting or collapse.
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Emergency Department Management.
Pre-hospital:
Apply PIB- T/F to hospital that has antivenom.
In ED:
Manage in Resus area – full monitoring!
Look out for– resp failure, hypo/hypertension, APO, & coma.
Antivenom: give 2 x 125units of CSL Funnel-web Spider Antivenom – RPT if needed.
Cardiac arrest: Give 4 ampoules undiluted antivenom.
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White Tail Spider
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White-tailed spider
Common spider found around Australia.
Often blamed for causing necrotic arachnidism.
Venom has shown NO definitive toxic components.
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Clinical Presentation
Localised:
Painful bite
3 local reaction can occur:1. Severe local pain <2 hours duration
2. Local pain & a red mark lasting <24hours.
3. Persistent & painful red lesion, which does not break down or ulcerate – may last 5-12 days.
Other features of nausea, malaise, vomiting & headache may occur.
Delayed puritus can occur in up to 20% of cases.
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Differential Diagnosis!
Infection
Diabetic ulcer
Pyoderma gangrenosum
Squamous cell carcinoma
Erythema nodosum
Chemical burn
Localised vasculitis
Factitious injury
Traumatic.
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Emergency DepartmentManagement.
Look for other causes and treat them. Diabetic ulcers Infections (MRSA)
Simple analgesia/antiemetic if required.
Provide reassurance and education!
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Questions
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Take Home Points
Patient’s with signs of envenoming shouldn’t be D/C at night.
Antivenom carries risk and reactions.
Consider analgesia first in RBS.
Look for other cause before blaming the white tail!
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Thank-you