Environmental Emergencies 2
Brown Recluse bite usuallyy causes a local skin reaction, some severe enough to require
skin graft.  

Rare systemic effects in younger children.

No significant alteration of necrosis from the venom by steroids, heparin, dapsone, or HBO.

Dapsone should not be used in children due to the risk of methemoglobinemia. Used only in
adult with proven bite.

Antivenom is not yet commercially available.
Brown Recluse Bite
Heat Injuries
Cutaneous Larva Migrans
PIT Viper
Coral Snake
Heat cramps - occur after the work is done, on relaxing, or on taking a cool shower.
                  - abdominal muscle cramps may simulate an acute abdomen.
                  -  victim is highly conditioned and acclimatized.
                  -  adequate fluid replacement but
inadequate salt replacement.

Heat Exhaustion -  2 types, water depletion and salt depletion.
                       - thirst, headache, vomiting, lethargy, cramps
                       - temp around 39.


Heat Stroke - overdressed Infant, Infant in cars, exertion (new athlete), phenothiazine
                - Temp > 41
                - Circulatory Collapse
                - CNS dysfunction
                - rhabdomyolysis and renal failure.
These larvae of nematodes ( hookworm=ankylostoma)  can penetrate intact skin.

Common in tropical regions, especially on beaches, effects butts and feet.

Itchy papules at the entry site with a migratory, raised, erythematous, serpiginous pattern.

Can reach lungs and cause eosinophilic pneumonitis (Löeffler syndrome)

Albendazole or mebendazole can be used for treatment, some times steroids.
There are 2 species of poisonous snakes found in USA - PIT VIPERS and CORAL SNAKE.

Features of PIT Vipers which differentiate them from Non Poisonous Snakes -
(i) Two pits with heat-sensitive organs that assist these poor-visioned reptiles to localize their  
   prey are located on each side of the head, between the eye and nostril;
(ii)
Two pupils are elliptical and vertically oriented;
(iii)
Two curved fangs or hollow maxillary teeth are folded posteriorly against the palate and
    advance forward when the pit viper strikes;
(iv)
Head is relatively more triangular; and
(v)
Scutes, or scales, on the ventral portion caudad to the anal plate continue in a single
    row, whereas nonpoisonous snakes have a cleft, or double row.

PIT Vipers eg. - copper head, diamond back,Rattle Snake, sidewinder and water moccasin.

Cause local and multisystem effects ( CVS, RS, Renal, Neuro, Hematologic)
Rx - CroFab® (Crotalidae Polyvalent Immune Fab) if presents within 12 hours.
Blunt head,  round pupils, ventral caudal scutes, two small maxillary fangs and lacks pits.

Red on yellow, kill a fellow. ( Coral Snake )
Red on black, venom lack. (King Snake, non poisonous)

Coral snakes cause less local effects but disabling
neuro effects

Antivenom is available for eastern coral snake.