[Dailydrool] spider bites

[Randee White]

I don't chime in very often but from previous and personal experience, brown recluse spiders shouldn't be messed with.  I have taken care of several people who have self treated spider bites and who have subsequently lost fingers, toes, or large chunks of skin because the venom had caused such widespread tissue destruction.  The brown recluse venom is extremely poisonous, even more potent than that of a rattlesnake. The venom of the brown recluse is toxic to cells and tissues.  Infection can even spread through the body and areas of tissue destruction can occur far from the site of the bite.  
	* This venom is a collection of enzymes. One of the specific enzymes, once released into the victim's skin, causes destruction of local cell membranes, which disrupts the integrity of tissues leading to local breakdown of skin, fat, and blood vessels. This process leads to eventual tissue death (necrosis) in areas immediately surrounding the bite site. 

	* The venom also induces in its victim an immune response. The victim's immune system releases inflammatory agents that recruit signal specific disease-fighting white blood cells to the area of injury. In severe cases, however, these same inflammatory agents can themselves cause injury. These secondary effects of the venom can produce these more significant side effects of the spider bite: destruction of red blood cells, low platelet count, blood clots in the capillaries and loss of ability to form clots where needed, acute renal failure (kidney damage), coma, death.
Brown recluse spider bites often go unnoticed initially because they are usually painless bites. Occasionally, some minor burning that feels like a bee sting is noticed at the time of the bite. Symptoms usually develop two to eight hours after a bite. Keep in mind that most bites cause little tissue destruction. Victims may experience these symptoms:  severe pain at bite site after about four hours,  severe itching, nausea, vomiting, fever, and myalgias (muscle pain).
	* Initially the bite site is mildly red and upon close inspection may reveal fang marks. Most commonly, the bite site will become firm and heal with little scaring over the next few days or weeks. Occasionally, the local reaction will be more severe with erythema and blistering, sometimes leading to a blue discoloration, and ultimately leading to a necrotic lesion and scarring. Signs that may be present include:  blistering (common), necrosis (death) of skin and subcutaneous fat (less common), and severe destructive necrotic lesions with deep wide borders rare).
If you think you or someone you know has been bitten by a brown recluse spider, then the individual should be seen by a doctor that day. If possible, bring the spider in question to the doctor's office. Identification of the spider is very helpful in making the correct diagnosis.  If the patient is unable to be seen by a doctor that day, he or she should seek care at a hospital's Emergency Department.
 
Home first aid care is simple. This self-care should not replace a visit to a doctor or emergency department.  After a spider bite: apply ice to decrease pain and swelling.  Elevate area if possible above the level of the heart.  Wash the area thoroughly with cool water and mild soap.  Avoid any strenuous activity because this can spread the spider's venom in the skin.  Use acetaminophen (Tylenol) for pain relief.
	* Do not perform any of the following techniques:  Do not apply any heat to the area. This will accelerate tissue destruction.  Do not apply any steroid creams to the area such as hydrocortisone cream. Do not attempt to remove the spider venom with suction devices or cut out the affected tissue. Do not apply a tourniquet to the extremity involved.
After initial evaluation, the doctor may provide the following treatment:  Tetanus immunization, Pain medication, Antibiotics if signs of infection are present in the wound, Antihistamines such as diphenhydramine (Benadryl) for itch relief
	* The patient will need to follow-up with a doctor because most wounds will need to be checked daily for at least three to four days. Necrotic lesions will need close follow-up. The doctor may carefully remove dead tissue in necrotic areas to reduce the chance of developing secondary bacterial infections.
Randee and the White House Gang


      
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