Page 125 - 2022 Ranger Medic Handbook

Envenomation – Arthropod
(Spider & Scorpion)
DEFINITION: Toxic envenomations from arthropods are generally not life threatening, but can cause conditions requiring
treatment and potential hospitalization. Most suspected “spider bites” are MRSA abscesses. Assume abscess unless
the spider bite was witnessed.
Black Widow:
S/Sx: Pinching bite followed by local swelling and burning; large muscle group spasms/tremors; abdominal pain and/
or rigidity within 60 minutes (may mimic appendicitis or acute surgical abdomen); nausea and vomiting; diaphoresis;
hypertension; tachycardia.
MANAGEMENT:
1. Treat per Pain Management Protocol (narcotic analgesia).
2. Midazolam 2–5mg IV/IM for relief of muscle spasm.
3. Diphenhydramine 25–50mg q6hr prn PO/IV. SECTION 3
4. In cases of suspected black widow spider bites, consider other causes for acute abdominal pain.
Brown Recluse:
S/Sx: Local pain and ulceration at site within 2–8 hours with surrounding erythema; Hemorrhagic vesicle progressing to
slowly enlarging eschar; fever, chills, nausea, joint pain.
MANAGEMENT:
1. Elevate bite site.
2. Avoid strenuous activity.
3. Treat per Pain Management Protocol (narcotic analgesia).
4. Diphenhydramine 25–50mg q6hr prn PO/IV.
5. Monitor and treat per Cellulitis Protocol.
Scorpion:
S/Sx: Local pain, swelling, and erythema; nausea and vomiting; paresthesia; tongue fasciculations; sympathetic (tachy-
cardia, hypertension, hyperthermia) or parasympathetic (hypotension, bradycardia, hypersalivation, incontinence) over-
drive can develop; seizures; agitation; blurry vision/rotary eye movements.
MANAGEMENT:
1. Treat per Pain Management Protocol.
2. Treat per Nausea and Vomiting Protocol.
3. Supportive care as necessary per appropriate protocol.
4. Diphenhydramine 25–50mg q6hr prn PO/IV.
5. Apply ice or cold water.
DISPOSITION: Urgent evacuation for development of abdominal rigidity, development of systemic signs, or for anaphy-
laxis. Routine evacuation for tissue necrosis of brown recluse bite. Evacuation typically not required for localized insect
stings and scorpion bites.
Envenomation – Insect, Hymenoptera
(Bee, Wasp, Hornet)
DEFINITION: Toxic envenomations from bees, wasps, and hornets are all capable of causing life-threatening anaphy-
laxis, especially in personnel with known hypersensitivity. Personnel with known reactions should maintain their own
epinephrine administration kit (Epi-Pen).
S/Sx: Pain; swelling/edema; puncture site(s) from stinger or fangs; warmth; erythema; signs of anaphylaxis
MANAGEMENT: If signs and symptoms of anaphylaxis present, treat per Anaphylaxis Protocol.
Hymenoptera (Bee, Wasp, Hornet):
1. Remove stinger by scraping from side.
2. Apply ice or cold water.
3. Apply topical 1% hydrocortisone cream.
4. Apply topical lidocaine.
5. Ibuprofen 800mg PO tid × 7 days.
6. Diphenhydramine 25–50mg q6hr prn PO/IV.
DISPOSITION: Urgent evacuation for development of systemic signs or for anaphylaxis. Evacuation typically not re-
quired for localized insect stings and scorpion bites.
SPECIAL CONSIDERATIONS: Tactical medics must always be aware of unit personnel with known insect hypersensitivities.

2022 RANGER MEDIC HANDBOOK 111