Page 116 - PJ MED OPS Handbook 8th Ed

b. Management:
i) Treat per Pain Management Protocol (narcotic analgesia)
ii) Midazolam (Versed) 2–5mg PO q6–8hr or 2–5mg IV/IM/IO for relief of muscle spasm
iii) Diphenhydramine (Benadryl) 25–50mg q6hr PRN PO/IV
2. Brown Recluse (notice violin shape on back)
a. Signs and Symptoms:
i) Local pain and ulceration at site within 2–8 hours with
surrounding erythema
ii) Hemorrhagic vesicle progressing to slowly enlarging
eschar
iii) Fever, chills, nausea, joint pain
b. Management:
i) Elevate bite site
ii) Avoid strenuous activity
iii) Treat per Pain Management Protocol (narcotic analgesia) Brown Recluse
iv) Diphenhydramine (Benadryl) 25–50mg q6hr PRN
PO/IV
v) Use an antibiotic appropriate for MRSA if cellulitis exists

SCORPION
Signs and Symptoms:
1. Local pain, swelling, and erythema
2. Nausea and vomiting Brown Recluse Bite
3. Paresthesias
4. Tongue fasciculations
5. Sympathetic (tachycardia, hypertension, hyperthermia) or parasympathetic (hypotension, bra-
dycardia, hypersalivation, incontinence) overdrive can develop
6. Seizures
7. Agitation
8. Blurry vision/Rotary eye movements

Management:
1. Treat per Pain Management Protocol
2. Treat per Nausea and Vomiting Protocol
3. Apply ice packs to bite site
4. Supportive care as necessary
5. Diphenhydramine (Benadryl) 25–50mg q6hr PRN PO/IV
6. Evacuation typically not required for localized insect stings and scorpion bites
7. Urgent evacuation for anaphylaxis, systemic signs, and abdominal rigidity
8. Routine evacuation for tissue necrosis from brown recluse spider bite
9. No evac for localized bites and stings

114 n Pararescue Medical Operations Handbook / 8th Edition