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.