Bites and Stings

Question 1

What is the ORDER of stinging insects?

Answer 1

Hymenoptera

Question 2

Fire ants are part of the ____ family

Answer 2

Wingless Formicidae

Question 3

Bees are part of the ____ family

Answer 3

Apidae
Bees = Apids

Question 4

Wasps are part of the ___ family

Answer 4

Vespid

Question 5

when a wasp (vespid) stings you, does its barbs stay in your skin?

Answer 5

NO

bee (apid) barbs do stay in your skin and need rmved

Question 6

The major cause of allergic rxns to insect stings in the US are ______

Answer 6

Yellow jackets (vespids)

Question 7

What is the most allergenic part of vespid (wasp) venom?

Answer 7

• Antigen 5 protein
• Phospholipase
• Hyaluronidases

Question 8

Which insect bites and anchors itself into the person and stings repeatedly as it rotates its body in an arc around the bite, producing a characteristic central bite partially encircled with a red sting line?

Answer 8

FIRE ANTS

Question 9

Which insect venom has hemolytic, cytolytic, antimicrobial, and insecticidal properties?

Answer 9

FIRE ANTS

Question 10

Which insect bite looks like tiny little bee stings that go away and leaves you with little pustules?

Answer 10

FIRE ANTS

Question 11

How to remove a stinger?

Answer 11

Scraping method with edge of something flat/sharp

Question 12

2ndary infections are MC with which insect bites?

Answer 12

Ants
Yellow Jackets who rummage garbage

Question 13

What can you give to a pt who was stung by an insect and is now very itchy?

Answer 13

High potency topical steroid (Fluocinonide or Clobetasol)

Question 14

A spider bite from a _____ is initially painless and then develops into tissue necrosis and hemorrhagic blisters?

Answer 14

Brown Recluse

Question 15

Brown Recluse Bite Trmnt

______ is the only effective option once there is evidence of skin necrosis

Answer 15

Anti-venom

Question 16

Steps for general wound managemet

Answer 16

1. clean bite with mild soap & water
2. apply cold packs, do not freeze wound
3. elevate or keep in neutral position
4. pain meds (NSAIDs)
5. +/- Prophylactic Tetanus shot

Question 17

A spider bite from a ____ causes an immediate sharp/stinging sensation. Dull/Numbing pain out of proportion to clinical signs

Answer 17

Black Widow

Question 18

A _____ spider bite releases alpha-Latrotoxin, triggering release of Ach and NorEpi

Answer 18

Black Widow

Question 19

Black Widow Spide Bite Trmnt

Give ____ for muscle spasms

Answer 19

Benzodiazepines

Question 20

A patient was stung by a Scorpion and now has a HIGH Creatinine Kinase (CK). Concern for?

Answer 20

Rhabdomyolysis

Question 21

WU for Scorpion Sting

Answer 21

• Hemolysis -> CBC
• Rhabdomyolysis -> Creatinine Kinase (CK)
• Pancreatitis -> Lipase (Amylase not v specific)
• Arrhythmias -> EKG

Question 22

Corals, Cobras, and Mambas are part of the ______ family of snakes

Answer 22

Elapidae

Question 23

Rattlesnakes, Copperheads, and Cottonmouths are part of the ____ family of snakes

Type of snake

Answer 23

Viper

Question 24

Which SS do Elapids (Corals, Cobras, Mambas) cause?

• Neurotoxic/Parayltic?
• Coagulopathies?

Answer 24

Neurotoxic/Paralytic

Neurotoxic: Irreversibly binds to Ach receptor -> ascending paralysis -> blurred vision, ptosis, incr salivation, resp distress, euphoria, weakness, lethargy

Question 25

Which SS do Vipers (Rattlesnakes, Copperheads, Cottonmouths) produce? - Neurotoxic/paralysis? - Myotoxic/Coagulopathies?

Answer 25

Myotoxic/Coagulopathies ## Footnote Myotoxic: direct cellular injury -> alters balance of coagulation system -> Coagulopathies -> tender lymph nodes as venom spreads thru lymph system

Question 26

# Snake Bite Presentation Initially -> ______ Later -> _______

Answer 26

Initially -> **EDEMA** Later -> **HYPOVOLEMIA (SHOCK)**

Question 27

MC venomous snake family in the US

Answer 27

Vipers

Question 28

2 MC venomous snakes in Indiana

Answer 28

Copperhead Cottonmouth

Question 29

Coral snakes are found in ___ states of US

Answer 29

Southern

Question 30

Antivenom can cause an allx rxn if allx to ____ or ____

Answer 30

sheep horses

Question 31

# Snake bite trmnt When should you suck out the venom and apply tournequet with ice?

Answer 31

NEVER LIKE EVER EVER ## Footnote applying pressure may cause arterial insufficiency and necrosis

Question 32

# Venomous or Non-venomous snake?

Answer 32

Venomous

Question 33

Which venomous snake looks like a non-venomous snake?

Answer 33

Coral Snake

Question 34

Which venomous snake looks like a non-venomous snake?

Answer 34

Coral Snake

Question 35

Mammalian bites can transmit mouth flora including which 5 bac?

Answer 35

1. Staph aureus 2. Group A Strep 3. Klebsiella 4. Enterococci 5. Prevotella

Question 36

# Dog or Cat bite? Pathogen: **Pasturella Multocida** More likely to cause **INFX**>tissue injury Can cause **Septic Arthritis or Osteomyelitis**

Answer 36

Cat

Question 37

# Dog or Cat bite? Pathogen **Capnocytophaga Canimorsus** More likely to cause **TISSUE INJURY**>Infx Can cause **Gangrene-> Sepsis**

Answer 37

Dog

Question 38

Human Bites on children >___cm diameter should be concern for child abuse

Answer 38

>2.5cm = Child Abuse

Question 39

The MC human bite is called the "______ bite"

Answer 39

**"_FIGHT BITE_"** affects 3rd and 4th metacarpal from punching someone in the mouth

Question 40

The organism ***Eikenella corrodens*** can cause culture negative ______

Answer 40

Endocarditis ## Footnote May also lead to septic arthritis or osteomyelitis

Question 41

Which mammalian bites SHOULD NEVER be closed?

Answer 41

Human Cat ## Footnote clean dog bites can be closed

Question 42

Criteria to close a mammalian bite

Answer 42

1. Not infx 2. <24hrs old 3. not on hand/foot 4. healthy immune system

Question 43

When to give Prophylactic Tetanus Shot? | based on their tetanus shot Hx

Answer 43

* Less than 3 full doses * last dose unknown * >5yrs out

Question 44

ABX for mammalian bite?

Answer 44

Amoxicillin-Clavulanate (Augmentin) ## Footnote **_PCN Allx_** Doxy Bactrim (Trimethoprim / Sulfamethoxazole) Fluoroquinolone + Metronidazole or Clindamycin

Question 45

Domestic animals can have rabies. Which wild animals may also have it?

Answer 45

Foxes Skunks Racoons Bats

Question 46

# Rabies Vaccine If not previously Vacc -> give ______ If previously Vacc -> give _______

Answer 46

Un-Vaccinated -> IVIG + Rabies Vacc Previously Vaccinated -> Rabies Vacc only ## Footnote IVIG = IV Immunoglobulins?

Question 47

# What caused this stinging pattern? * Lesions initially appear as small, linear, papular eruptions that develop rapidly in one or several discontinuous lines, at times surrounded by a raised erythematous zone * Local intense pain + itchy * Papules -> vesiculation -> pustulation -> hemorrhage -> desquamatization

Answer 47

Jellyfish sting (Cnidaria)

Question 48

Jellyfish sting Tx

Answer 48

* Remove tentacles * Non-tropical waters and coral stings -> seawater rinse * Tropical waters -> vinegar rinse followed by seawater rinse * Pain (usually short lived) -> baking soda 50:50 slurry, soak in warm water, NSAIDs * Peeing on sting has no known efficacy

Question 49

How to rinse off after beingn stung by a jellyfish in tropical water?

Answer 49

Vinegar rinse + seawater rinse ## Footnote DO NOT rinse with freshwater bc it can activate undischarge nematocysts! Vinegar helps neutralize the venom

Question 50

You need to rinse off with vinegar prior to sewater if you're stung by a jellyfish in ______ waters - Non-tropical? - Tropical?

Answer 50

Tropical waters = Vinegar + seawater