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<< Bites and Stings – Snakes, Spiders, and Scorpions in the United States

Risk Management

1. "I thought that fasciotomy was indicated for rattlesnake bites."

Fasciotomy is not indicated for the majority of snakebites, since true compartment syndrome is rare. Unnecessary fasciotomy worsens outcome and results in a disfiguring scar and, possibly, loss of function.

2. "I thought a two hour observation period was long enough for an elapid snakebite."

The neuromuscular weakness resulting from coral snakebites is typically delayed by several hours. An inadequate observation period can result in disastrous consequences, including death by respiratory failure.

3. "I thought the new CroFab® antivenom didn't cause any hypersensitivity reactions."

Although the newer CroFab® antivenom has been documented to result in fewer hypersensitivity reactions than the older product, the potential for life threatening reactions and serum sickness is still present. Patients must be adequately monitored for these reactions.

4. "I thought one dose of CroFab® was all that was needed to treat rattlesnake bites."

Because of the more rapid clearance of the smaller Fab fragments when patients are treated with CroFab®, recurrence of crotaline toxicity often occurs. Repeat dosing of CroFab® is therefore required in many cases.

5. "Don't all rattlesnake bites need antivenom?"

Up to 25% of crotaline snakebites result in no toxicity (so-called "dry bites"). No antivenom is required for such asymptomatic bites, or for those with minimal local swelling with no progression and no systemic toxicity.
6. "I didn't know that scorpion stings could be so severe in kids."

The severity of Centruroides exilicauda scorpion envenomations is greatest in small children who receive a larger dose of venom per kilogram than an adult. Small children therefore require more vigilant monitoring and treatment.

7. "I was so busy treating the other aspects of the envenomation that I forgot the tetanus prophylaxis."

Although it is easy to focus on treating the more impressive toxicities of these envenomations, it is important not to forget important basic principles of wound care, such as tetanus prophylaxis.

8. "Isn't Latrodectus antivenom the first line of therapy for black widow spider envenomations?"

Many patients with black widow spider bites who are experiencing muscle pain and cramping can be adequately managed with intravenous opioids and benzodiazepines. Although Latrodectus antivenom is effective in reversing toxicity, it exposes the patient to the risk of hypersensitivity reactions.

9. "Aren't dapsone, aggressive surgical excision, and electrotherapy accepted therapies for brown recluse spider bites?"

These therapies are of unproven benefit for brown recluse spider envenomation and may actually worsen outcome. Good basic wound care is the most important aspect of treatment.

10. "I didn't think that brown recluse spider bites were that big of a deal."

It is important to be aware that brown recluse spider bites can result in severe systemic toxicity and significant delayed dermatonecrosis. The patient must be advised that close follow-up of the wound is mandatory to monitor for complications and the possible need for plastic surgery referral.

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Last Modified: 08/17/2017
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