Bites Tags - Differential Diagnosis of https://ddxof.com/tag/bites/ A systematic approach to the evaluation and management of various complaints. Wed, 24 Jan 2018 21:46:18 +0000 en-US hourly 1 https://wordpress.org/?v=6.9.1 https://ddxof.com/wp-content/uploads/2017/08/cropped-ddxof@1x-1-32x32.png Bites Tags - Differential Diagnosis of https://ddxof.com/tag/bites/ 32 32 46076767 Bites https://ddxof.com/bites/ Mon, 20 Feb 2017 08:00:01 +0000 http://ddxof.com/?p=1854 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... Continue reading →

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]]> 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

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