Spider Bites

Ok, folks, time for me to stump speach a little.

First of all, I'm an ER physician.
Next, we see on the order of 5 to 10 people per day in my ED that present with a chief complaint of "possible spider bite". Out of these probably one per month is actually a spider bite. Out of those probably one every 6 months is a brown recluse.

Here's the approach I recommend.
If you notice a sore on your body that is red, hot, tender and looks like a spider bite, it is probably not a spider bite unless you saw the actual spider that bit you and/or felt the bite occur. More than likely what you have is something called CA-MRSA (Community Acquired Methacillin Resistant Staph Aureus) infection. This, moreso than a spider bite actually, needs immediate medical attention. They sometimes require I&D (incision and drainage--cut open to let the pus out) and, in all cases, require antibiotics... And NO, don't use that leftover amoxicillin that's been in the cabinet since you had strep throat 3 years ago...it won't work and will actually promote further resistance of the MRSA. You'll need Bactrim or Clindamycin...don't let the doctor put you on Keflex or anything else, tell him you're worried about MRSA. Nice article HERE


If you're certain it's a spider bite and you have the spider and it's identifiable then you have some options....
Brown Recluse and Black Widows are the only poisonous spiders that cause morbidity in the US. Black Widows have an antivenom, though it's rarely needed. However medical attention is often needed for pain control and muscle spasms. If it's a black widow you can either wait to see if you have symptoms then see a doctor, or start for the doctor immediately and if you don't have symptoms by the time you get there you probably won't develop any. If you do then you can get treatment right away. If you have a history of cardiac disease or other vascular disease and you are having chest pain or severe abdominal pain then you need to call 911 and go to the hospital immediately...those are indications for possible treatment with anti-venom.


If it's a brown recluse you can decide, on your own, what to do. Most of us will look at your bite, give you a random antibiotic, maybe even something fancy like Dapsone...all the while we know it won't do a bit of good. Some major hospitals that have hyperbaric chambers and an aggressive hyperbarics physician will sometimes dive fresh bites as there's some sketchy evidence that it could help. If you hate doctors and/or don't wanna pay the bill to see a doctor then it's perfectly acceptible to watch and wait. Brown recluse bites sometimes get very large and serious and require debridement--cutting away of the damaged tissue. This isn't from infection, it's from the toxin and we don't have an antidote for the toxin. If it's only a moderate size wound then watchful waiting is usually what we prescribe. These always look terrible and, inevitably, someone will put you on antibiotics, "just in case", but they rarely are actually necessary. However, it's reasonable to see a physician fairly early if it becomes clear that the wound will become fairly large and has potential for infection or to need surgical treatment...that way you can be refered and treated appropriately instead of just showing up once the would has gotten severe.


Hope that's not overly wordy.

 

<div class='quotetop'>QUOTE(huskers @ Oct 23 2006, 09:22 PM) [snapback]337142[/snapback]</div>

Death and loss of limb are very very rare. Soft tissue loss is the main problem...it can be very extensive in some cases.

 

<div class='quotetop'>QUOTE(naterprius @ Oct 23 2006, 11:13 PM) [snapback]337186[/snapback]</div>

Don't know for sure, it's one of those things that since it's not really something that's life or limb threatening the cost of producing it, then rarely having it used wouldn't justify the manufacturer's efforts. I seem to recall that a anti-venom has been produced in small quantities by scientists.

Even Black Widow anti-venom is very hard to get and VERY expensive. The last case I had when I used it I had to sign papers I'd never seen before. The pharmacist had to have it couriered from the other local hospital b/c we didn't have it, the she brought it to me directly, wouldn't let the nurse sign for it, only me!

 

<div class='quotetop'>QUOTE(MarinJohn @ Oct 24 2006, 11:16 AM) [snapback]337368[/snapback]</div>

You're welcome, decided to add a couple photos and links to my post since there seems to be some interest.

 

<div class='quotetop'>QUOTE(Pinto Girl @ Oct 24 2006, 03:14 PM) [snapback]337563[/snapback]</div>

Sorry to be nit-picky about that unfortunate story.....
But, while scorpions might be capable of "biting" it would certainly never be enough to cause any human noticable harm. Now, they can "Sting" with the stinger on their tail. That is their means of envenomation. Also, the huge majority of scorpion envenomations are not fatal, but I'm not very familiar with the species of scorpions in Mexico.