Page 88 |
Previous | 95 of 1025 | Next |
|
|
small (250x250 max)
medium (500x500 max)
Large
Extra Large
large ( > 500x500)
Full Resolution
|
Loading content ...
the very young or the elderly or odierwise previously debilitated patients.* Deadi probably is die result of cardiac or respiratory failure. Odier dian a good history, diere are, of course, no diagnostic tools to help with the diagnosis of a black widow bite. Tests should be ordered only to rule out odier disorders diat mimic this spider bite. It may be difficult to get a good history from very young victims who are preverbal. It is unfortunate diat you cannot ask the malefactor herself, the lady spider. There should be some reason why diis female arthropod has earned her common appellation�the black widow. Only rarely does the female consume her mate after copulation. She eats him only if she can catch him. If he stays to have a cigareue he is doomed. If, on die other hand, he takes advantage of her slighdy befuddled post-coital state and makes a quick exit, he will probably be safe. No after-glow for you dude. Run for your life, you eight-legged wimp. Go eat a fiy! Treating the Bite Treatment of a black-widow spider bite is not ideal and remains conu-oversial. It is usual and customary to use muscle relaxants, such as mediocarbamol and benzodiazepines, 10% calcium gluconate given intravenously and, in some patients, specific antivenin." Because the primarily padiophysiologic aberration following an envenomation is motor end-plate stimulation and muscle rigidity, it is no surprise diat the use of muscle relaxants is a time-honored recommendation. Some authorities recommend opioids such as morphine or meperidine, eidier alone or widi benzodiazepines to relieve muscle pain and cramping. The use of calcium gluconate^* has many champions and, although the exact mechanism of action is unknown, some believe diat it replenishes calcium stores in die sarcoplasmic reticulum of muscles which have been depleted of calcium by die repetitive neuromuscular stimulation. Much of die controversy in the deat-ment of black widow spider bite centers around whedier to use antivenin or not." Theantivenin is prepared from the serum of horses immunized againstLa/rodecmj venom. It probably acts by binding die venom, preventing die toxin from interfering with normal synaptic membrane function. Of course, you must give die patient a skin test before using diis product. Serum sickness, anaphylaxis, and deadi are possibilities if the patient is sensitized to horse serum. The great majority of Latrodectus envenomations are self-limited and respond to symptomatic U-eatment. Antivenin should probably be reserved only for patients at risk of deadi because diere is a 9% incidence of anaphylactic reactions in patients with negative skin tests, an 80% incidence in patients widi positive skin tests, and as high as a 36% risk of serum sickness." The very young and the very old may be at least considered as candidates for antivenin if their condition warrants. A final caution: avoid die use of antivenin in patients receiving a beta-blocker; it increases dieir risk of anaphylaxis. A recent review by Clark, et al'^ evaluated dierapy in 163 patients who had a black widow spider bite widi positive identification of the spider or a visible envenomation site ("target lesion"). The investigators' conclusions are interesting: Calcium gluconate was inferior to a parenteral opioid-benzodiazepine combination in relieving pain in significant envenomations. Furthermore, they suggest antivenin is more effective than calcium gluconate in reheving pain after serious envenomation. They were not impressed that calcium gluconate offered symptomatic pain relief. The audiors favored inti-avenous morphine and benzodiazepines to achieve freedom from pain in a great majority of dieir patients. Deja Vu All Over Again? And on die subject of drugs, one hears rumblings diese days, however faint, diat the "su-eet" variety should be"legalized." Supporters say diat diis would eliminate the criminal purveyors by getting rid of the profit motive. Opponents point to data diat show that legalizing alcohol (a far greater disaster in terms of deadi and disease dian narcotics or cocaine) may have been a big mistake for our counuy. Golly, could diere be a backlash? Could Prohibition return? Could my beloved fadier come back for just one day to see history repeat? He would be so pleased, so nostalgic, so willing to repeat his version of die St. Valentine's Day Massacre. It could be deja vu all over again. ? References 1 Arnold RE. WhatTo Do About Bites and Sungs of Venomous Animals. New York: Macmillan Publishing Co., 1993, pp. 17-20. 2 Mofenson HC, Caraccio TR. Spider bites aren't an itsy-bitsy problem in kids. ContempPed 1993;10:18. 3 Spider-widow or Hour-glass. Poisindex, Micromedex Inc. 1993;78. 4 Binder LS. Acute arthropod envenomadon. Med Toxicol Adverse Drug 1989; 4:163. 5 Edlich RF, Rodeheaver GT. et al. Management of venomous spider bites. Curr Concepts Trauma Care 1985;7:17. 6 Kobemick M. Black widow spider bites. Am Fam Phys 1984;29:241. 7 Baba A, Cooper JR. The acUon of black widow spider venom in synaptosomes. J Neurochem 1980;34:1369. 8 Moss HS, Binder LS. A retrospecuve review of black widow spider envenomation. Ann Emerg Med 1987; 16:188. 9 Allen C. Arachnid envenomations. Emer Clin N Am 1992; 10:280. 10 Russell FE. Of bites and sdngs. Emerg Med 1983;6:142-56. 11 Spait DW, Dart RC, et al. Skin tesung, (abs). Ann Emerg Med 1988;17:389. 12 Clark RF, Wediem-Kestner S, et al. Clinical review and treatment of black widow spider envenomations. Ann Emerg Med 1992:21:782. 88 NCMJ / February 1994, Volume 55 Number 2
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-Present] |
Document Title | North Carolina Medical Journal [1940-Present] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1994 |
Identifier | NCHH-17-055 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 55 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-055.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-055 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Description
Fixed Title * | Page 88 |
Document Title | North Carolina Medical Journal [1940-Present] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1994 |
Identifier | NCHH-17-055-0098 |
Form General | Periodicals |
Page Type | all; article |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | ncmed551994janmay_0098.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 55 |
Issue Number | 2 |
Page Number | 88 |
Health Discipline | Medicine |
Full Text | the very young or the elderly or odierwise previously debilitated patients.* Deadi probably is die result of cardiac or respiratory failure. Odier dian a good history, diere are, of course, no diagnostic tools to help with the diagnosis of a black widow bite. Tests should be ordered only to rule out odier disorders diat mimic this spider bite. It may be difficult to get a good history from very young victims who are preverbal. It is unfortunate diat you cannot ask the malefactor herself, the lady spider. There should be some reason why diis female arthropod has earned her common appellation�the black widow. Only rarely does the female consume her mate after copulation. She eats him only if she can catch him. If he stays to have a cigareue he is doomed. If, on die other hand, he takes advantage of her slighdy befuddled post-coital state and makes a quick exit, he will probably be safe. No after-glow for you dude. Run for your life, you eight-legged wimp. Go eat a fiy! Treating the Bite Treatment of a black-widow spider bite is not ideal and remains conu-oversial. It is usual and customary to use muscle relaxants, such as mediocarbamol and benzodiazepines, 10% calcium gluconate given intravenously and, in some patients, specific antivenin." Because the primarily padiophysiologic aberration following an envenomation is motor end-plate stimulation and muscle rigidity, it is no surprise diat the use of muscle relaxants is a time-honored recommendation. Some authorities recommend opioids such as morphine or meperidine, eidier alone or widi benzodiazepines to relieve muscle pain and cramping. The use of calcium gluconate^* has many champions and, although the exact mechanism of action is unknown, some believe diat it replenishes calcium stores in die sarcoplasmic reticulum of muscles which have been depleted of calcium by die repetitive neuromuscular stimulation. Much of die controversy in the deat-ment of black widow spider bite centers around whedier to use antivenin or not." Theantivenin is prepared from the serum of horses immunized againstLa/rodecmj venom. It probably acts by binding die venom, preventing die toxin from interfering with normal synaptic membrane function. Of course, you must give die patient a skin test before using diis product. Serum sickness, anaphylaxis, and deadi are possibilities if the patient is sensitized to horse serum. The great majority of Latrodectus envenomations are self-limited and respond to symptomatic U-eatment. Antivenin should probably be reserved only for patients at risk of deadi because diere is a 9% incidence of anaphylactic reactions in patients with negative skin tests, an 80% incidence in patients widi positive skin tests, and as high as a 36% risk of serum sickness." The very young and the very old may be at least considered as candidates for antivenin if their condition warrants. A final caution: avoid die use of antivenin in patients receiving a beta-blocker; it increases dieir risk of anaphylaxis. A recent review by Clark, et al'^ evaluated dierapy in 163 patients who had a black widow spider bite widi positive identification of the spider or a visible envenomation site ("target lesion"). The investigators' conclusions are interesting: Calcium gluconate was inferior to a parenteral opioid-benzodiazepine combination in relieving pain in significant envenomations. Furthermore, they suggest antivenin is more effective than calcium gluconate in reheving pain after serious envenomation. They were not impressed that calcium gluconate offered symptomatic pain relief. The audiors favored inti-avenous morphine and benzodiazepines to achieve freedom from pain in a great majority of dieir patients. Deja Vu All Over Again? And on die subject of drugs, one hears rumblings diese days, however faint, diat the "su-eet" variety should be"legalized." Supporters say diat diis would eliminate the criminal purveyors by getting rid of the profit motive. Opponents point to data diat show that legalizing alcohol (a far greater disaster in terms of deadi and disease dian narcotics or cocaine) may have been a big mistake for our counuy. Golly, could diere be a backlash? Could Prohibition return? Could my beloved fadier come back for just one day to see history repeat? He would be so pleased, so nostalgic, so willing to repeat his version of die St. Valentine's Day Massacre. It could be deja vu all over again. ? References 1 Arnold RE. WhatTo Do About Bites and Sungs of Venomous Animals. New York: Macmillan Publishing Co., 1993, pp. 17-20. 2 Mofenson HC, Caraccio TR. Spider bites aren't an itsy-bitsy problem in kids. ContempPed 1993;10:18. 3 Spider-widow or Hour-glass. Poisindex, Micromedex Inc. 1993;78. 4 Binder LS. Acute arthropod envenomadon. Med Toxicol Adverse Drug 1989; 4:163. 5 Edlich RF, Rodeheaver GT. et al. Management of venomous spider bites. Curr Concepts Trauma Care 1985;7:17. 6 Kobemick M. Black widow spider bites. Am Fam Phys 1984;29:241. 7 Baba A, Cooper JR. The acUon of black widow spider venom in synaptosomes. J Neurochem 1980;34:1369. 8 Moss HS, Binder LS. A retrospecuve review of black widow spider envenomation. Ann Emerg Med 1987; 16:188. 9 Allen C. Arachnid envenomations. Emer Clin N Am 1992; 10:280. 10 Russell FE. Of bites and sdngs. Emerg Med 1983;6:142-56. 11 Spait DW, Dart RC, et al. Skin tesung, (abs). Ann Emerg Med 1988;17:389. 12 Clark RF, Wediem-Kestner S, et al. Clinical review and treatment of black widow spider envenomations. Ann Emerg Med 1992:21:782. 88 NCMJ / February 1994, Volume 55 Number 2 |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-055.pdf |
Document Sort | all; nchh-17 |
Article Title | Will The Defendant Please Rise? Black Widow Spider Poisoning |
Article Author | Ronald B. Mack, Md |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-055 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Tags
Comments
Post a Comment for Page 88