Part 11

DEATHS: Occasional; due to neurotoxic species

TREATMENT

LOCAL FIRST AID:

1. Apply ice packs 2. Apply tourniquet if possible and as near sting site as possible. Loosen briefly every 10-15 minutes WARNING: Do not use morphine or opiates since they increase toxic effects

SYSTEMIC:

1. Specific antivenin available for many dangerous species; administered early, may be lifesaving 2. Calcium gluconate—10 ml of 10% solution IV immediately and prn to control muscle pain 3. Phenobarbital—30-60 mg orally for sedation and control of convulsions 4. Treat for shock as necessary (Chart 1)

URTICATING CATERPILLARS

REACTIONS

IMMEDIATE: Severe burning pain

LOCAL:

1. Numbness and swelling of area inflicted with severe radiating pain 2. Possible double row of parallel red punctuate marks forming a gridlike tract along the path of the caterpillar 3. Swelling of regional lymph nodes 4. Late foreign-body reaction to unremoved spines

SYSTEMIC:

1. Nausea, vomiting, fever 2. Headaches 3. Shock and convulsions (rare)

DEATHS: None reported

TREATMENT

LOCAL FIRST AID:

1. Repeated stripping using adhesive or cellophane tape to remove spines 2. Apply ice packs 3. Apply baking soda and water paste

SYSTEMIC:

1. For severe pain give meperidine hydrochloride (Demerol, 50-100 mg PO or IM), morphine sulfate (0.25 subcutaneous), codeine phosphate (0.5 g PO) NOTE: Aspirin is generally not effective 2. Shock (Chart 2)

CHART 1 ANTIHISTAMINES

GROUP TRADE NAME AVERAGE ORAL BASE SEDATION GENERIC NAMES ADULT CHILD

Ethanolamines diphenhydramine•HCl Benadryl 50 mg q 4-6h 25 mg q 4-6h ++++ diphenhydramine Dramamine 50 mg q 4h 25 mg q 4h ++++ theophyllinate Ethylenediamine tripelennamine Pyribenzamine 50 mg q 4-6h 25 mg q 4-6h +++ Alkylamines chlorpheniramine maleate Chlor-Trimeton 4 mg q 6h 2 mg q 6h ++ brompheniramine maleate Dimetane 8 mg q 6h 4 mg q 6h + triprolidine•HCl Actidil 2.5 mg q 8h 1.25 mg q 8h ++ Cyclizines hydroxyzine•HCl Atarax 25-100 mg q 10-25 mg q + 6h 6h Miscellaneous cyproheptadine•HCl Periactin 4 mg q 6h 2 mg q 6h +++ promethazine Phenergan 25-50 mg q 12.5-25 mg ++++ 6-8h q 6-8h

Chart 2 Treatment of Anaphylaxis—Shock

IMMEDIATE TREATMENT MILD REACTION TREATMENT SEVERE REACTION TREATMENT REACTION: Conjunctivitis, Rhinitis, Urticaria, Pruritus, Erythema

Epinephrine•HCl 0.3 ml Diphenhydramine•HCl 50 mg (1:1,000) IM PO q 6h Diphenhydramine•HCl 50 mg PO

REACTION: Laryngeal edema

Epinephrine•HCl 0.3 ml Diphenhydramine•HCl 50 mg Oxygen (1:1,000) IM q 6h IM or PO Diphenhydramine•HCl 50 mg Diphenhydramine•HCl 50 mg Ephedrine sulfate 25 mg q q 6h IV 6h Ephedrine sulfate 25 mg q 6h Monitor blood gases Hydrocortisone Tracheostomy

REACTION: Bronchospasm