Disclosures Common Bites and Stings • None David Hartnett, MD Assistant Professor Department of Emergency Medicine The Ohio State University Wexner Medical Center Learning Objectives Impact of bites and stings • Discuss the incidence of bites and stings in the US • 1.5 million ED visits per year • Review management of clinically relevant species • Insects • Mammals • Arachnids • Reptiles • Describe indications and methods of rabies prophylaxis 1 Hymenoptera • Bees, vespids, fire ants • Symptomatic control Insects - 50% • Localized, systemic, and anaphylactic Source: Alvesgaspar - Own work CC BY-SA 3.0, reactions • Stinger removal • Killer Bees Source: James Heilman, MD Own work, CC BY-SA 3.0, Africanized Killer Bees LD50 (mg/kg) Venom (µg) European Honey Bee 2.8 148 Africanized Honey Bee 2.8 156 Cape Honey Bee 3.0 187 LD50 for a 110 lb person Rule of Thumb Honey Bees – 890 Stings 6 stings/lb – survival Yellow Jackets – 3600 stings 8 stings/lb – LD50 Source: James Heilman, MD - Own work CC BY-SA 3.0, Paper wasps – 850 stings 10 stings/lb – Death Source: James Heilman, MD Own work, CC BY-SA 3.0, 2 Bed bugs Mosquito borne illnesses • Behavior • Travel medicine • Chikungunya • Transmission • Dengue • Incidence • Japanese Encephalitis • Malaria • Prevention • Yellow Fever • Zika • Symptom control • Infestation treatment • Endemic to United States Source: CDC • Eastern Equine Encephalitis • St Louis Encephalitis • La Crosse Encephalitis • West Nile La Crosse Virus Encephalitis – West Nile Virus – incidence by Incidence per 100,000 state per 100,000 3 Arachnids - 16% Source: CDC Lyme Disease Rocky Mountain Spotted Fever • Progression • Clinical • Prophylactic Diagnosis Treatment • Doxycycline • Symptomatic Treatment • STARI Source: CDC Source: CDC Source: CDC Source: CDC 4 Other Tick Borne Other Tick Borne Illnesses Illnesses Colorado Tick Fever Babesiosis Tularemia Ehrlichiosis Source: CDC Source: CDC Source: CDC Source: CDC Black Widow Brown Recluse • Localized • Necrotic Reactions Arachnidism- • Systemic hemotoxin Neurotoxin • Local wound care • Treatment – Photograph by Mark • NOT RECLUSE Analgesics, BZD, Chappell of University of antihypertensives California, Riverside. CC BY-SA 2.5 • Antivenin? • Failed Therapies Source: CDC Source: CDC Source: CDC 5 Brown Recluse Centruroides – Arizona bark scorpion • Neurotoxin • Treatment – supportive care Source: CDC • Centruroides immune Fab – Anascorp By Rosa Pineda - Own work, CC BY-SA 3.0, Source: Musides at English Wikipedia, CC BY-SA 3.0, Canine - 26% • Incidence • Infection Risk • Antibiotics Others • Closure 6 Canine Bites Other Mammals - 7% • Humans • Cat Bites • Bats • Raccoons • Possums Rabies Reptiles - 1% • Pre – exposure vaccination Crotalidae Elapidae • Post – exposure treatment • Rattle snakes, • Coral Snake copperheads, • Rabies vaccine – • Neurotoxin cottonmouths 0,3,7,14 days • Coralmyn • Human rabies • Local necrosis and Source: CDC systemic hemotoxin immunoglobulin • CroFab • Previously Vaccinated • Waking up with a bat Source: Norman.benton - Own work CC BY-SA 3.0, Source: Glenn Bartolotti - Own work, CC BY-SA 4.0, Source: CDC 7.