ER -4- Bites and Stings
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| What group of insects accounts for the greatest number of fatalities | hymenoptera bees, wasps and ants
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| T/F the venom of the Africanized honeybee is more potent than the domestic honey bee | F there venom is the same but they swarm and generally kill by large amounts of stings
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| T/F bee stings cause more allergic reactions than wasp stings | F most allergic reactions reported are from wasp stings
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| T/F a pt with a wasp allergy shouldn't worry about bee stings as there is no cross reactivity with stings | F all hymenoptera share mutual component of venom making cross sensitization a real concern Yellow Jacket venom is the most potent sensitizer
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| What are the s/sx of a toxic rxn to insect sting | nausea, vomiting, diarrhea, light headedness, syncope, HA, Fever, Drowsiness, EDEMA and convulsions can occur leading to possible renal and hepatic failure and disseminated intravascular coagulation
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| What is an anaphylactoid rxn | a severe allergic rxn to an insect sting that presents with itching eyes, facial flushing, generalized urticaria, dry cough, chest/throat constriction, wheezing, dyspnea, cyanosis, abd cramps, diarrhea, N/V, vertigo and stridor
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| What is the tx for an insect sting | remove the stinger, wash sting site, ice pack, oral antihistamine/analgesics (NSAIDS). If a systemic rxn (anaphylaxis) epinephrine, IV Antihistamine, steroids, treat bronchospasm with Beta agonist, IV fluids if they develop hypotension, admit them
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| Venom from a brown recluse causes what type of injury | severe skin necrosis
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| T/F the bite of a brown recluses is extremely painful | F initially it is painless will develop into a mild erythematous lesions which can develop in a necrotic skin lesion
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| If a pt develops necrotic ulcer from a brown recluse bite what should you wait for before debriding the wound | make sure they have clear margins around the wound before debridement
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| What are some common complications of a black widow bite | muscle cramping/spasm, may also develop HTN, HA, N/V, photophobia and dyspnea
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| What is a concern with tarantulas | hairs can be flicked off and get in the eye
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| What diseases are associated with ticks | rocky mt spotted fever, ehrlichiosis, babesiosis, Colorado tick fever, tularemia, encephalitis, Lyme disease, tick borne paralysis,
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| What is a good Ab recommendation in regards to tick bites | prophylactic Ab of doxycycline
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| What is the MOA of pit viper venom | causes local tissue damage and injury and can cause systemic vascular damage, hemolysis, fibrinolysis, neuromuscular dysfunction, venom quickly alters vascular permeability leading to loss of blood and plasma into surrounding tissue,
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| T/F all pit viper bites are venomous | F 25% of bites are dry IE no venom was introduced into the wound
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| How long should you observe a pt before declaring it a dry bit after a pit viper bite and discharging them home | 8hrs minimum as bites may appear benign at first and then develop s/sx
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smaxsmith
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