This is a lecture by Dr. C. James Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
What are Animal Bites?
An animal bite is a wound, caused by the teeth usually results in a break in the skin due to the excessive pressure on body tissue from the bite. It also involves the contusions which can occur without a break in the skin. Bites can be provoked or unprovoked. Other bite attacks may be in fact unprovoked. Animal bites mostly cause a serious infections and even death.
Animal bites include injuries not only from the teeth of reptiles, mammals but fish and amphibians. Arthropods can also bite and leave injuries. Cat and human bites can carry a higher risk of infection. If the bitten animal has an identifiable owner, ask whether it is vaccinated currently against rabies. If it is a stray animal, call the police.
This pptx is on recognition of different snakes, snake bite management particularly in children. At the end of the slide show you will definitely able to recognize and manage snake bites.
Scorpions are a common arthropod found all over the world.
If threatened, a scorpion may use its long, flexible tail to sting a potential predator.
Frequently, people unknowingly come into contact with these species and experience the painful sensation of envenomation
snake poisoning with variety of snakes and identification features, conservative treatment.Antitoxin treatment with a note on the drugs used to treat antitoxin reactions, Venom composition and venom classification, types of snakes and features. snake bite treatment at different levels of healthcare systems in India.
What are Animal Bites?
An animal bite is a wound, caused by the teeth usually results in a break in the skin due to the excessive pressure on body tissue from the bite. It also involves the contusions which can occur without a break in the skin. Bites can be provoked or unprovoked. Other bite attacks may be in fact unprovoked. Animal bites mostly cause a serious infections and even death.
Animal bites include injuries not only from the teeth of reptiles, mammals but fish and amphibians. Arthropods can also bite and leave injuries. Cat and human bites can carry a higher risk of infection. If the bitten animal has an identifiable owner, ask whether it is vaccinated currently against rabies. If it is a stray animal, call the police.
This pptx is on recognition of different snakes, snake bite management particularly in children. At the end of the slide show you will definitely able to recognize and manage snake bites.
Scorpions are a common arthropod found all over the world.
If threatened, a scorpion may use its long, flexible tail to sting a potential predator.
Frequently, people unknowingly come into contact with these species and experience the painful sensation of envenomation
snake poisoning with variety of snakes and identification features, conservative treatment.Antitoxin treatment with a note on the drugs used to treat antitoxin reactions, Venom composition and venom classification, types of snakes and features. snake bite treatment at different levels of healthcare systems in India.
Versión PDF de la presentación PowerPoint elaborada por el BiolGustavo Reati (CZA, FCEFyN, UNC) y Dr. Andrés Barnes (Hospital Rawson), en Córdoba (Argentina).
Presentación sobre escorpiones o alacranes, elaborada por el Biol. Gustavo Reati (Centro de Zoología Aplicada - Fac.CEFyN, UNC) y el Dr. Andrés Barnes (Hospital Rawson) (Córdoba, Argentina).
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is the Immune System Lesson PowerPoint which is one small part of my Human Body Systems Unit from www.sciencepowerpoint.com . This portion of the unit also includes parasites, HIV, AIDS, and STD's. These are posted on slideshare. Please visit the Human Body Systems Unit to learn more.
This is a lecture by Dr. Peter Moyer from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Peter Moyer from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: Basics of Toxicology: Resident TrainingOpen.Michigan
This is a lecture by Dr. Patrick Carter from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: Status Epilepticus (SE): Resident TrainingOpen.Michigan
This is a lecture by Dr. C. James Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Ghana Grab Bag Pediatric Quiz- Resident TrainingOpen.Michigan
This is a lecture by Hannah Smith, MD and Ruth S. Hwu, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC - Parasitic Infections - for NursesOpen.Michigan
This is a lecture by Katherine A Perry from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Oral and Facial Infections- Resident TrainingOpen.Michigan
This is a lecture by Dr. Shannon Langston from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. James Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Slideshow is from the University of Michigan Medical
School's M1 Immunology sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M1Immunology
Like all technologies, biotechnology offers the potential of enormous benefit but also potential risks. Biotechnology could help address many global problems, such as climate change, an aging society, food security, energy security and infectious diseases, to name just a few.human health and animal health and welfare and increasing livestock productivity. Biotechnology improves the food we eat - meat, milk and eggs. Biotechnology can improve an animal's impact on the environment. And biotechnology enhances ability to detect, treat and prevent diseases.
GEMC: Aspirated and Ingested Foreign Bodies: Resident TrainingOpen.Michigan
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Alternatives to animal studies in Pharmaceutical research has been explained on the basis of replacement, reduction and refinement. Also newer pre-clinical animal models like use of genetically modified animals were presented.
From the event "Synthetic Biology: Science, Policy, and Ethics."
Sponsored by the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School.
For more information, visit our website at http://petrieflom.law.harvard.edu/events/details/synthetic-biology.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Jim Holliman, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Alterations in Body Temperature: The Adult Patient with a Fever- Reside...Open.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Rapid Sequence Intubation & Emergency Airway Support in the Pediatric E...Open.Michigan
This is a lecture by Michele Nypaver, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Disorders of the Pleura, Mediastinum, and Chest Wall- Resident TrainingOpen.Michigan
This is a lecture by Andrew Barnosky, DO from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Dental Emergencies and Common Dental Blocks- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Arthritis and Arthrocentesis- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Bursitis, Tendonitis, Fibromyalgia, and RSD- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Right Upper Quadrant Ultrasound- Resident TrainingOpen.Michigan
This is a lecture by Jeff Holmes from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: Nursing Process and Linkage between Theory and PracticeOpen.Michigan
This is a lecture by Jeremy Lapham from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
2014 gemc-nursing-lapham-general survey and patient care managementOpen.Michigan
This is a lecture by Dr. Jeremy Lapham from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Jessica Holly from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: The Role of Radiography in the Initial Evaluation of C-Spine TraumaOpen.Michigan
This is a lecture by Dr. Stephen Hartsell from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
MATATAG CURRICULUM: ASSESSING THE READINESS OF ELEM. PUBLIC SCHOOL TEACHERS I...NelTorrente
In this research, it concludes that while the readiness of teachers in Caloocan City to implement the MATATAG Curriculum is generally positive, targeted efforts in professional development, resource distribution, support networks, and comprehensive preparation can address the existing gaps and ensure successful curriculum implementation.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
How to Build a Module in Odoo 17 Using the Scaffold Method
GEMC - Insect Stings and Spider Bites- Resident Training
1. Project: Ghana Emergency Medicine Collaborative
Document Title: Insect Stings and Spider Bites
Author(s): C. James Holliman (Penn State University), MD, FACEP, 2012
License: Unless otherwise noted, this material is made available under the
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or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please
speak to your physician if you have questions about your medical condition.
Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.
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3. Insect Stings and
Spider Bites
C. James Holliman, M.D., F.A.C.E.P.
Professor of Emergency Medicine
Director, Center for International Emergency Medicine
M. S. Hershey Medical Center
Penn State University
Hershey, PA, U.S.A.
3
4. Newspaper article on spread of the African origin
“killer bees” into California
Newspaper article from the LA Daily News. January 2, 1996
4
6. Newspaper article on “killer bee” attack in Texas
Newspaper article from the LA Daily News. January 2, 1996
6
7. Commonest Insect Stings in the U.S.
§ Hymenoptera (bees, wasps, ants) :
§ 30 to 50 deaths in U.S. per year from
allergic reactions
§ Diptera (flies)
§ Bed bugs, kissing bugs, lice, fleas,
midges (“no-see-ums”)
7
8. Wasps
Honeybees
Phalinn Ooi (flickr 1, 2)
Hornets
beckymaldonado (flickr), William Warby (flickr)
Fire Ants
John (flickr), Brent Myers (flickr)
EOL Group (flickr 1, 2)
Yellowjackets
Bob Peterson (flickr 1, 2)
8
9. Honeybee leaving
imbedded stinger
Honey bees are the only hymenoptera
with a strongly barbed sting. When a
honey bee stings a person, it cannot
pull the barbed stinger back out. The
stinger should be removed as quickly
as possible; a delay of a few seconds
leads to more venom being injected.
- Adapted from Wikipedia
Waugsberg (Wikimedia Commons)
9
10. Kissing Bug
Fernando Otalora Luna (Wikimedia Commons)
Centers for Disease Control and Prevention
(Wikimedia Commons)
10
11. Other Biting Land Arthropods
§ Mites (chiggers, scabies)
§ Ticks
§ Spiders
§ Scorpions
§ Centipedes
11
12. Chigger Bites
After crawling onto their hosts, they
inject digestive enzymes into the skin
that break down skin cells. They do not
actually “bite”, but instead form a hole
in the skin called a stylostome, and
chew up tiny parts of the inner skin,
thus causing severe irritation and
swelling.
- Adapted from Wikipedia
Slturis (Wikimedia Commons)
12
14. Bark Scorpion
Musides (Wikimedia Commons)
The Arizona bark scorpion (Centruroides
sculpturatus) is a small light brown scorpion
common to the southwest United States and
Northern Mexico. It is the most venomous
scorpion in North America, and its venom
can cause severe pain in adult humans.
Temporary dysfunction in the area stung is
common; e.g. a hand or possibly arm can be
immobilized or experience convulsions. It
also may cause the loss of breath for a short
period of time. Due to the extreme pain
induced, many victims describe sensations of
electrical jolts after envenomation.
- Adapted from Wikipedia
14
15. Deathstalker
The deathstalker (Leiurus quinquestriatus) can be found in desert and
scrubland habitats ranging from North Africa through to the Middle East. It is
regarded as a highly dangerous species because its venom is a powerful
mixture of neurotoxins, with a low lethal dose.
- Adapted from Wikipedia
15
János Balázs (flickr)
Matt Reinbold (flickr)
16. Skin reaction from
contact with “Puss
caterpillar”
ClockworkSoul, Wikimedia Commons
“Puss caterpillar”
jeffdelonge, Wikimedia Commons
16
17. Taxonomy of Hymenoptera
Order Hymenoptera
Vespoidea
Vespinae
Yellow Jackets
Hornets
Apoidea
Politinae
Wasps
Formicidae
Apinae
Myrmicinae
Honeybees
Fire Ants
17
19. Types of Reactions to Insect Stings
• Local allergic (most common)
• Exaggerated local reaction (entire limb may swell)
• Generalized allergic → anaphylaxis
• Toxic reaction (usually from at least 50 to several
hundred stings) : mostly GI symptoms (nausea,
vomiting, weakness)
• Delayed : resembles serum sickness
• Local infection : more common from yellow
jacket stings than from other species
• Psychiatric reactions
19
21. Fire Ant Stings
The venom of fire ants is composed of
alkaloids derived from piperidine. The sting
swells into a bump, which can cause much
pain and irritation. The bump often forms into
a white pustule, which can become infected if
scratched, but if left alone will usually flatten
within a few days.
- Adapted from Wikipedia
United States Department of Agriculture (Wikimedia Commons)
21
23. Dangerous Local Reactions from
Insect Stings
• Direct eyeball sting : may cause atrophy
of iris, abscess of lens, perforation of
globe
• Pharyngeal sting : local edema may
cause airway compromise
23
24. Treatment of Local Reactions
• Remove imbedded stinger (honeybees) by
scraping ; not by squeezing (because this
may inject more venom)
• Ice
• Antihistamines
• Tetanus prophylaxis
• Topical steroid cream (optional and
questionably effective)
24
25. Treatment of Anaphylactic (Severe)
Reactions to Insect Stings
Airway management : high flow O2
• IV access : lactated ringers (LR) bolus if hypotensive
• SQ epinephrine 0.01 mg / kg (0.3 mg in adults) ; IV
epinephrine 0.1 mg if severe shock
• IV diphenhydramine 1 mg / kg (50 mg in adults)
• IV steroids (100 to 250 mg hydrocortisone or
methylprednisolone, etc.)
• Consider IV dopamine or epinephrine drip if
hypotensive despite fluids
• Inhaled beta aerosol if wheezing (metaproterenol 0.3
25
cc or albuterol 2.5 cc in 3 cc NS)
26. Treatment of Severe Allergic
Reactions (cont.)
• Remove stinger
• Ice to sting site
• Tetanus prophylaxis
• Observe at least 4 to 6 hours
• Discharge on at least 3 day course of
diphenhydramine and 3 to 7 days course of steroids
(weaning dose is optional)
• Referral for desensitization to an allergist
• Consider discharge prescription for epinephrine
injection (“Epi-Pen” or “Ana-Kit”)
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27. Guidelines for Selecting Adult Patients
for Venom Immunotherapy
Reaction
Skin Test / RAST Immunotherapy
Systemic
Positive
Yes
Systemic
Negative
No
Large Local *
Positive or negative
No
Minimal Local *
Positive or negative
No
None **
Positive or negative
No
* Patients
with these types of reactions rarely need skin testing or
RAST.
** Patients with no reactions to stings never need skin testing or RAST.
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29. Discharge and Referral Procedure
Bee avoidance information
Epinephrine prescription
Evaluation by allergist
Waugsberg (Wikimedia Commons)
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30. Constituents of Emergency SelfTreatment Kits
EpiPen Auto-Injector
•
Spring-loaded automatic injector with
•
0.3 ml (0.3 mg) of (1:1,000) aqueous epinephrine
EpiPen Jr. Auto-Injector
•
Spring-loaded automatic injector with
•
0.3 ml (0.15 mg) of (1:2,000) aqueous epinephrine
Ana-Kit
•
Manually operated syringe with
•
0.6 ml (0.6 mg) of (1:1,000) aqueous epinephrine
•
-- delivered as 0.3 ml to a locking point, with the
ability to deliver a second identical dose if necessary
Chlorpheniramine: 2 mg chewable tablets (#4) 30
31. Infections from Insect Stings
• No good studies on infection incidence from
different species
• Infections that do occur are usually due to Strep
• Best rules to follow :
• If sting site red & swollen but mainly pruritic :
treat with PO antihistamines
• If sting site red & swollen but mainly painful :
treat with PO antibiotics
• If sting site red & swollen & pruritic & painful :
treat with both antibiotics & antihistamines
31
33. Brown Recluse Spider Bites
• Often misdiagnosed
• Usually just cause local tissue necrosis → slowly
healing ulcer
• May have systemic symptoms : fever, chills, malaise,
weakness, nausea, emesis, rash : rarely hemolytic
anemia, thrombocytopenia
Rx : Consider local excision ; routine wound care (oral
antibiotics not helpful).
Dapsone (proposed in past as Rx) never actually
shown to be effective.
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41. Black Widow Spider Bites (cont.)
Rx :
• IV fluids if hypotensive
• Narcotics IV
• IV calcium gluconate (10 ml of 10% solution over 5
minutes)
• Methocarbamol (Robaxin) 1 gram IV over 5 minutes
(optional and less effective)
• Tetanus immunization
• Antivenin : only very rarely indicted for an extremely
compromised patient. (Use one vial, reconstitute and
dilute in 100 to 250 cc of D5W and give over ½ to 1
41
hour IV ; similar to use of snake antivenin)
42. Other Dangerous Spiders
Funnel back spiders from Australia
• Bites can be fatal
• Australian antivenin used
Tarantulas
• Usually just cause local tissue reactions
Note that all spiders can inject toxins, but most
have jaws too small to penetrate effectively into
human skin
42
44. Spider Bite Infections
• As for insects, no good studies reported on
infection incidence rates
• Infections are uncommon with black widow
bites
• Infections after brown recluse bites are
usually due to secondary infection (Staph
or Strep) after local tissue necrosis
44
45. Insect Stings and Spider Bites
Summary
• Assess likely species causing the bite or
sting
• Observe patient for allergic or progressive
symptoms and signs if short time frame
from time of injury
• Treat systemic allergic reactions
aggressively and assure proper follow-up
care
45