Page 69 - 2023 SMOG Digital

Environmental

Funnel Web Spider

Envenomation
The lethal component of funnel web spider venom is robustotoxin. It induces an autonomic storm by causing excessive release of
acetylcholine, norepinephrine, and epinephrine. Funnel web spider envenomation causes a biphasic envenomation syndrome. The
first phase includes pain at the bite site, perioral tingling, piloerection, and regional fasciculations which may progress to muscle
spasm. This muscle spasm may involve the face, tongue, and larynx leading to airway compromise. The increased stimulation of
cholinergic and adrenergic systems causes nausea, vomiting, lacrimation, salivation, tachycardia, hypertension, cardiac
dysrhythmias, and acute lung injury. Acute lung injury is the predominate cause of death during the first phase. In the second
phase the symptoms of the first phase resolve and lead to the gradual onset of refractory hypotension, apnea, and cardiac arrest.
Continued from: Universal Patient Care Guideline
Tactical Evacuation Guideline Assess: Airway Guideline
• Airway
Immediately place pressure • Breathing
immobilization using elastic (crepe) • Circulation Consider: Rapid Sequence
bandage applied tightly enough to Intubation
limit lymphatic spread, but not to Address immediate life threats Establish Advanced Airway per
IV/IO Guideline
restrict blood flow. Place IV/IO in non-effected procedure in the following
limb Cardiac Monitor prn sequence:
(Move to next procedure per individual
Airway compromise, Acute YES competencies, contraindications,
Lung Injury or Pulmonary and/or attempt failures)
Edema? • ENDOTRACHEAL INTUBATION
Atropine NO • BIAD
q
0.5mg q3–5min, until • CRICOTHYROIDOTOMY
–
atropinization achieved, Secretions, Salivation,
not to exceed a total of 3mg or YES Lacrimation? Use ARDS Ventilator Management
0.04mg/kg NO
YES
Cardiac Dysrhythmias?
Bradycardia with Pulse Guideline
Cardia Arrest Guideline ENVIRONMENTAL
When appropriate, return to:
Tactical Evacuation Guideline
Tachycardia with Pulse Guideline
Pearls:
• Immediately transport to an MTF with antivenom. Effective funnel web spider antivenom is available
in Australia.
• Anaphylactic reactions should be treated as soon as recognized.
• Local tissue enzymes may inactivate the venom, therefore the use of pressure immobilization
bandage may be helpful in delaying the onset of symptoms, but also may allow for a degree of
inactivation of the venom.
• Ketamine is not recommended as patients may develop tachycardia and have profound
hypertension.
• Benzodiazepines may improve muscle spasms.
• Elevate effected limb to reduce swelling.
• DO NOT cut, suck, electrocute, burn, or use chemicals on the envenomation site.

69