Pediatric emergency medicine trisk 2008 2008
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Laboratory data, including cerebrospinal fluid, are usually normal, but
lymphocytic pleocytosis has been reported.
Management. Management is based on general supportive care and a diligent
search for the tick. Tick removal is curative. Ticks should be removed using blunt
forceps or tweezers. The tick should be grasped as close to the skin surface as
possible and pulled upward with a steady even pressure. A twisting or jerking
motion may cause the mouthparts to break off. Do not squeeze or crush the body
of the tick because this may introduce infective agents. After the tick is removed,
the bite site should be cleaned. Once the tick is removed, the paralysis is rapidly
reversible without apparent sequelae.
Centipedes and Millipedes
Centipedes (class Myriapoda order Chilopoda) are venomous, biting with jaws
that act like stinging pincers. Bites can be extremely painful; however, the toxin is
relatively innocuous, causing only local reaction. Treatment consists of injection
of local anesthetic at the wound site and local wound care.
American millipedes (order Diplopoda) are generally harmless.
Insects
The insects (class Insecta) constitute the largest number of animal species.
Hymenoptera is the most important order of the class and includes bees, wasps,
hornets, yellow jackets, and ants ( Fig. 90.19 ). Hymenoptera is responsible for
50% of human deaths from venomous bites and stings. A variety of toxic
reactions are seen but the most common is allergic. Ants are discussed separately
due to differences in venom composition and rate of systemic reactions.
Bee, Hornet, Yellow Jacket, Wasp. Clinical recognition. Clinically, the stings of
bees and wasps differ because the barbed stinger of the bee remains in the
victim’s skin, whereas the wasp may sting multiple times. The venoms of the bee,
hornet, yellow jacket, and wasp contain protein antigens that can elicit an
immunoglobulin E antibody response. Venoms contain various biogenic amines,
phospholipase, phosphatase, and hyaluronidase. Because of the similarity of the
venoms, cross-reactivity can occur. A single sting by a hymenopteran insect can
lead to death from anaphylaxis, and multiple stings can cause serious harm
through the deleterious effects of large doses of venom released. Local reaction to
a sting results in pain, erythema, and swelling that may involve the whole limb
and persist for up to a week.
