Spiders and
Stingers
A Talk by Chris Nickson
Photo by Stefan
BRO
Master of camouflage
Stonefish Stone
The Itinerary
Redback SpidersFunnelweb Spiders
Box jellyfishIrukandji syndrome
Redback Spider Lactrodectus hasselti
Photo by Eliztyrell
Lactrodectism
Local pain over 10 minSweating & piloerection over 1h
Pain becomes generalisedNonspecific systemic featuresAutonomic features
Usually lasts <1-4 days
Beware Atypical Presentations
Photo by Wocky
Management
Prehospital – Icepack,
paracetamol– no PIB
Resuscitation (rare)Medications– analgesia– antiemetics– antivenom
Redback Antivenom
When? IV or IM?
Photo by Fir002
Antivenom Indications
Severe, refractory local pain
Systemic envenoming
Antivenom Adminstration
2 ampoules (2 x 500 units) IV or IM
+/- Repeat in 2 hours
Is Redback Antivenom Effective?
Photo by Localoptimum
Funnelweb SpiderAtrax sppHadronyche spp
Photo by squil
Clinical Features
Painful biteSystemic features in minority
20 minutes to 2 hour onsetNonspecific features
Specific features– Autonomic– Cardiovascular– Neuromuscular
Management
Prehospital – PIB
Resuscitation Supportive careMedications– +/- Atropine– Antivenom
Observe 4 hours
Struan Sutherland
Life threats
Respiratory failureAcute Pulmonary
OedemaHypertension or shock
ComaPhoto by Mitch_Donavan
Funnelweb Antivenom
Photo by squil
Funnelweb Antivenom
Photo by squil
2+2
Whitetail SpiderLampona sppPhoto by fir002
Necrotic Arachnidism
MYTH
Box JellyfishChironex fleckeri
Box jellyfish worldwide
Fenner PJ, Williamson JA. Worldwide deaths and severe envenomation from jellyfish stings. Med J Aust. 1996 Dec 2-
16;165(11-12):658-61.
Photo from ABC News
Clinical features
Stinger season (Nov-April)Linear cross-hatched weltsAdherent tentaclesSevere pain (8h)Collapse and cardiovascular effectsScarringDelayed hypersensitivity
Management
Prehospital – Analgesia– Vinegar– No PIB
Resuscitation – Hypotension– Dysrhythmias– Cardiac arrest
Analgesia– Ice (hot water?)
Wound careAntivenom
– Arrest: 6 amps– Unstable: 3 amps– Refractory pain: 1
amp
Delayed type hypersensitivity
– Steroid cream
Irukandji SyndromeCarukia barnesi & others
Photo by Lifeinthefastlane.com
“The first Carybdeid was applied to an adult (J.B.), and to a boy, aged nine years (N.B.). A robust young life-saver (C.R.) volunteered to test the second specimen, of similar size to the first.”
Barnes, J. H. (1964). “Cause and Effect in Irukandji Stingings.” Med J Aust 1: 897-.
http://lifeinthefastlane.com/2009/03/jack-barnes-and-the-irukandji-enigma/
Nickson CP, Waugh EB, Jacups SP, Currie BJ. Irukandji syndrome case series from Australia's Tropical Northern Territory. Ann Emerg Med. 2009 Sep;54(3):395-403.
Photo by Bart Currie
Clinical features
Mild sting…Progressive severe painCatecholamine excess syndromeCardiovascular complications– Shock, acute pulmonary
oedema, cardiomyopathy, intracranial hemorrhage
Management
Prehospital – Vinegar, no PIB
ResuscitationMedications– Fentanyl– Promethazine– GTN –magnesium
THE ENDhttp://
lifeinthefastlane.com/education/toxicology/