Author: Michael Hunt, MD
- Use the mnemonic NOT RECLUSE to rule out a brown recluse spider bite:
- Numerous bites (recluse spiders will bite once)
- Occurence (recluse bites between April- October)
- Timing (recluse spiders are… get this… reclusive)
- Red (recluse bites are white/pale)
- Elevated (recluse bites are flat)
- Chronic (recluse bites are acute)
- Large (recluse wounds are small)
- Ulceration, early (recluse bites ulcerate between 7-14 days)
- Swollen (recluse bites are flat)
- Exudative (recluse bites are dry)
Stoecker WV, Vetter RS, Dyer JA. NOT RECLUSE-A Mnemonic Device to Avoid False Diagnoses of Brown Recluse Spider Bites. JAMA Dermatol. 2017 May 1;153(5):377-378. doi: 10.1001/jamadermatol.2016.5665. PubMed PMID: 28199453.
Author: John Winkler, MD
- Tall flowering plant with phototoxic sap
- Direct skin contact with the sap can cause the skin to become photosensitive
- Severe blisters and even burns can result
Diebel, Matthew (18 June 2018). “Giant Hogweed, a Plant That Can Cause Burns and Blindness, Found in Virginia”. USA Today.
- Snake bites commonly occur between April and October.
- Rattlesnake bites are the most common.
- Venom contains proteins/enzymes that cause local inflammation, coagulopathy, and systemic effects (hypotension, angioedema, renal failure, etc.) along with neurotoxins may cause fasciculations, ptosis, drooling, or hyporeflexia.
- Mark site for swelling.
- Monitor progression.
- Elevate and immobilize injured limb and treat pain.
- Check basic labs including coagulation studies, and update tetanus.
- Antidote is CroFab and use if patient has systemic symptoms. Anaphylaxis is a known complication of CroFab
- Avoid: ice, tourniquets, and incision and drainage.
Hifumi T et. al.. Venomous snake bites: clinical diagnosis and treatment. J Intensive Care. 2015 Apr 1;3(1):16. doi: 10.1186/s40560-015-0081-8.
Warrell DA. Snake bite. Lancet. 2010. 375(9708):77-88. doi: 10.1016/S0140-6736(09)61754-2.
Warrell DA. Envenoming and injuries by venomous and nonvenomous reptiles worldwide. In: Wilderness Medicine, 6th Edition, Auerbach PS (Ed), Elsevier Mosby, Philadelphia 2012. p.1040.
Author: John Winkler, M.D.
- Photokeratitis is a UV burn of the sclera and cornea, which can cause blindness.
- UV light causes eyelid swelling with diffuse scarring of the eye (widespread, punctate uptake of fluorescein dye). While this can eventually heal, it is incredibly painful.
- Snow reflects light underneath sunglasses, so wrap-around goggles are the best form of prevention.
- This can happen to welders, sunbathers or any other person with prolonged UV light exposure.
Author: John Winkler, M.D.
Dr. Winkler shares his knowledge of wilderness medicine and provides insight on how to prevent and treat conditions such as hypothermia, frostbite and sun blindness. More importantly, he gives us tips on how to stay safe while doing our favorite wintertime activities!