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://

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