Page 115 - PJ MED OPS Handbook 8th Ed

DISPOSITION:
1. Urgent evacuation if evidence of severe envenomation (cardiovascular collapse, anaphy-
laxis, paralysis, ascending edema of limb).
2. Evacuation not required if signs and symptoms do not indicate severe envenomation after
24 hours of observation.

Insect/Arthropod Envenomation

SPECIAL CONSIDERATIONS – Insect/Arthropod Bite:
1. In cases of suspected black widow spider bites, consider other causes for acute abdominal
pain.

HYMENOPTERA (BEE, WASP, HORNET)
Signs and Symptoms:
1. Pain
2. Swelling/edema
3. Puncture site(s) from stinger or fangs
4. Warmth
5. Erythema
6. Signs of anaphylaxis

Management:
1. If signs and symptoms of anaphylaxis present, treat per Anaphylaxis Protocol
2. Remove stinger by scraping from side
3. Apply ice or cold water
4. Apply topical 1% hydrocortisone cream
5. Apply topical lidocaine
6. Ibuprofen 800mg PO tid × 7 days
7. Diphenhydramine (Benadryl) 25–50mg q6hr PRN PO/IV
ARTHROPOD (Spider)
1. Black Widow (Red hour glass on back)
a. Signs and Symptoms:
i) Pinching bite followed by local swelling and burning
ii) Large muscle group spasms/tremors
iii) Abdominal pain and/or rigidity within 60 minutes
iv) Nausea and vomiting
v) Diaphoresis
vi) Hypertension
vii) Tachycardia
Black Widow

Chapter 8. Tactical Medical Emergency Protocols (TMEPs) n 113