Pediatric emergency medicine trisk 2011 2011
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Clinical recognition. The fire ant bites with well-developed jaws and then uses
its head as a pivot to inflict multiple stings. There is immediate wheal and flare at
the site. The local reaction varies from 1 to 2 mm, up to 10 cm, depending on the
amount of venom injected. Within 4 hours, a superficial vesicle appears. After 8
to 10 hours, the fluid in the vesicle changes from clear to cloudy (pustule), and
the vesicle becomes umbilicated. After 24 hours, the lesion is surrounded by a
painful erythematous area that persists for 3 to 10 days. Edema, induration, and
pruritus at the site occur in up to 50% of patients. Occasionally, systemic
reactions occur as with other Hymenoptera.
Management. Treatment is symptomatic. Local care includes ice and frequent
cleansing to prevent secondary infection. Topical steroids, antibacterial
medications, and antihistamines do not appear to prevent pustule formation.
Antihistamines are useful for pruritus. Systemic reactions are rare and should be
treated similarly to other Hymenoptera reactions.
TERRESTRIAL VERTEBRATES
Venomous Reptiles
Goals of Emergency Care
Venomous substances are secreted by 15% of the United States’ 120 snake
species. An estimated 7,000 to 8,000 people are bitten annually by venomous
snakes in the United States. Emergency care is directed at providing timely
antivenin therapy and expedient supportive medical care, which has dramatically
reduced mortality and morbidity from poisonous snakebites. Only 10 to 15 deaths
are reported per year, but the morbidity in limb dysfunction and other
complications is undoubtedly much higher. With appropriate therapy, most longterm morbidity can be prevented.
CLINICAL PEARLS AND PITFALLS
Identification of the snake may not be possible, but snakebite victims
should be treated based on clinical symptoms.
Extraction of venom is not usually helpful.
Current Evidence
The pediatric population, especially males aged 5 to 19 years, accounts for a
disproportionately large number of snake-bite victims. The highest incidence
