Emergency Management for All Pts

• Follow standard protocol for supporting ABCs.
• Carefully remove any remaining, visible venom apparatus.*
• Keep Pt warm and calm, and avoid excessive movement.
• Apply cold compress**/sterile dressing to affected area.
• Remove rings and constricting jewelry from affected area.
• Immobilize extremity with loose splint to restrict movement.
• Keep affected area below level of heart.
• Attempt to identify insect or animal for correct antidote.
• Manage allergic reaction/anaphylaxis (see Allergic Reaction: Anaphylaxis).

Arachnid (Spiders) and Scorpions

Black widow

• Classic presentation: Abdominal rigidity and pain, HA, dizziness, shoulder and backache, n/v, sweating, and salivation.
• Increased morbidity and mortality in very young children and the elderly.

Brown recluse

• Spider identified by a violin-shaped pattern on back.
• Tell-tale sign: Reddish ulcer surrounded by a whitish blue "bull's-eye."
• Other than an inconspicuous bite mark, s/s usually won't show for 24 hr.

Scorpion

• Bark scorpion (southwestern United States) is the only lethal species in the U.S.
• Anticipate shock-support ABCs.

Hymenoptera (Bees, Wasps, and Ants)

• ^*Remove stingers by scraping only!Avoid tweezers, because squeezing venom sac will only inject more venom.
• If Pt has Epi-Pen, assist with administration.

Snake Envenomation

• Anticipate shock-support ABCs.
• Avoid practices such as tourniquets or excision and suction.
• ^**Do not use cold compresses or ice on affected area.

Marine Animals

Jelly Fish/Sea Anemones (Tentacles)

• Carefully remove visible tentacles or spines. Irrigate skin with 5% acetic acid (household vinegar), isopropanol, or seawater. Do not use freshwater.

Sea Urchin/Sea Cucumber/Stingray (Barbs and Spines)

• Carefully remove spines if possible and immerse affected area in water as warm as Pt can tolerate without scalding (<110°F/42°C).