Biomedical subjects
T P Forks
Publications and source records attributed to T P Forks.
Evaluation and treatment of poisonous snakebites.
Snakebite victims should be transported immediately to the nearest emergency department. Incision and suction are contraindicated unless performed by experienced personnel within five minutes of the bite, or unless transport of the patient to definitive medical care will take more than 30 minutes. Cryotherapy is contraindicated. All bites should be graded for severity of envenomation. The wound should be cleaned and broad-spectrum antibiotics administered. Tetanus status should be determined and tetanus toxoid administered if necessary. Antivenin is indicated in certain mild cases and in all moderate and severe cases of envenomation. Patients with a mild case of envenomation may require up to five vials of antivenin; patients with moderate bites may require 10 to 15 vials, and patients with severe bites may require 15 to 20 vials. Antivenin is effective only when administered intravenously; skin testing to predict the possibility of anaphylactic reaction is mandatory before administration. Diphenhydramine and epinephrine should be readily available in case of anaphylaxis. Fasciotomy is only indicated in rare cases involving elevated intracompartment pressures.
Brown recluse spider bites.
BACKGROUND: Brown recluse spider bites are a serious medical problem in the southeastern United States. Although most bites are asymptomatic, envenomation can result in a constellation of systemic symptoms referred to as loxoscelism. Patients can also develop necrotic skin ulcers (necrotic arachnidism). These ulcers are often difficult to heal and can require skin grafting or amputation of the bitten appendage. METHODS: A search of the literature was performed using the search words "spider envenomation," "brown recluse spider bites," and "arachnid envenomation." RESULTS AND CONCLUSIONS: Most brown recluse spider bites are asymptomatic. All bites should be thoroughly cleansed and tetanus status updated as needed. Patients who develop systemic symptoms require hospitalization. Surgical excision of skin lesions is indicated only for lesions that have stabilized and are no longer enlarging. Steroids are indicated in bites that are associated with severe skin lesions, loxoscelism, and in small children. Dapsone should be used only in adult patients who experience necrotic arachnidism and who have been screened for glucose-6-phosphate dehydrogenase deficiency. Topical nitroglycerin can be of value in decreasing the enlargement of necrotic skin ulcers.