Mammalian

• Human: Eikenella corrodens
• Dog/Cat: Pasteurella multocida

Athropod

• Hymenoptra (bee, wasp, hornet, ant)
  • Venom: histamine reaction, anaphylaxis
  • Symptoms
    • Local: pain, swelling, pruritus
    • Toxic (<48h): multiple bits, N/V, syncope, HA
    • Anaphylaxis: minutes
    • Delayed (10-14d): serum sickness, fever, arthralgia, malaise
  • Management
    • Remove stinger
    • Wash, ice, anti-histamine, analgesia

• Brown recluse (violin pattern)
  • Location: Midwest, wood pile
  • Symptoms: initially painless, cytotoxic venom may cause necrosis
  • Management: supportive, Tdap, delayed debridement if necrotic
• Black widow (red hourglass)
  • Venom: neurotoxic, ACh, NE
  • Symptoms: painful, erythema, muscle contractions (“acute abdomen”), localized diaphoresis from ACh release
  • Management: analgesia, benzodiazepines, antivenom for refractory pain (may cause anaphylaxis)

Snake

• Crotalid (rattlesnake, copperhead, cottonmouth, collectively “pit vipers”)
  • Venom: cytotoxic, hemorrhagic
  • Symptoms: erythema/edema (ecchymoisis/bullae), nausea/vomiting, metallic taste
  • Labs: DIC
  • Management
    • Immobilization (no tourniquet)
    • Local wound care, Tdap
    • CBC, INR, fibrinogen (q2h)
    • Antivenom (Crofab 4-6 vials): given until symptoms or laboratory abnormalities arrest
    • Compartment syndrome: avoid surgery
• Elapidae (coral snake, “red on yellow”)
  • Venom: neurotoxic, delayed 10-12h
  • Symptoms: no significant local reaction, bulbar palsies, respiratory depression
  • Management: no antivenom, supportive care, intubation

Cnidaria (jellyfish)

• Symptoms: local pain, erythema, pruritus
• Management: 5% acetic acid, alcohol, remove stinger
  • Antivenom for box jellyfish

Stingray

• Symptoms: local pain, edema
• Management: Local wound care, Tdap, hot water immersion, antibiotics for Vibrio (cephalexin with doxycycline)

Vibrio vulnificus

• Symptoms: necrotizing fasciitis, in cirrhotic primary septicemia after ingesting shellfish