Terrestrial Envenomations in Pediatric Patients: Identification and Management in the Emergency Department (Trauma CME and Pharmacology CME) -
Publication Date: September 2021 (Volume 18, Number 09)
CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 09/01/2024.
Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 0.5 Trauma CME and 1 Pharmacology CME credits, subject to your state and institutional approval.
Michael Levine, MD, FACEP, FACMT
Associate Professor of Emergency Medicine, University of California, Los Angeles, Los Angeles, CA
Nathan Friedman, MD
Department of Emergency Medicine, University of California, Los Angeles, Los Angeles, CA
Sing-Yi Feng, MD
Associate Professor, Division of Emergency Medicine, Department of Pediatrics, Medical Toxicologist, North Texas Poison Center, University of Texas Southwestern Medical Center, Dallas, TX
Nicole Gerber, MD
Assistant Professor of Clinical Emergency Medicine and Clinical Pediatrics, Department of Emergency Medicine, Division of Pediatric Emergency Medicine, New York-Presbyterian/Weill Cornell Medical Center, New York, NY
The majority of bites and stings from terrestrial animals are not dangerous. However, due to their smaller size, children may be more susceptible to the effects of venom, and they may experience more-severe envenomation effects than adults. This issue reviews the basic epidemiology and underlying pathophysiology of the bites and stings of spiders, bees and wasps, fire ants, scorpions, snakes, and lizards. Clinical presentations are reviewed, and evidence-based recommendations are provided for management of the envenomated patient. While the pathophysiology and much of the presentation and treatment are similar for both children and adults, there can be subtle differences, which will be highlighted in this review.
An 8-year-old boy presents after a rattlesnake bite on his right ankle...
The boy was hiking with his parents when he was bitten by a rattlesnake. He says the pain began almost instantly.
On examination in the ED, he has edema extending from the mid-foot to proximal to the knee. The calf compartments are soft. Ecchymosis is noted as well as oozing from the 2 puncture wounds.
You order laboratory studies and wonder if antivenom administration is warranted.
A 9-year-old girl presents after she felt a “pinch” on her arm while raking leaves...
While en route to the hospital, the girl developed worsening pain at the site and localized sweating over the affected extremity.
In the examination room, the girl is crying, appears to be in great discomfort, and has abdominal cramping. Your examination is notable for a tiny puncture mark surrounded by 2 to 3 cm of erythema over the right arm but minimal edema.
Based on these findings, you are concerned that this is a black widow bite. You recall that there is an antivenom, but you are not sure whether it would be the best choice for this patient.
A 17-month-old boy presents after awakening crying in his crib shortly after midnight...
The boy resides in Arizona and was in his usual state of health when he went to sleep. The parents note that the boy is drooling, flailing all of his extremities, and has “funny” eye movements.
On examination, no bite or sting marks are appreciated.
Based on the findings and the geographical location, you are concerned for scorpion envenomation and wonder how to confirm the diagnosis.
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