AUSTRALIAN RESUSCITATION COUNCIL GUIDELINE 9.4.2 ENVENOMATION - SPIDER BITE

INTRODUCTION

The bites of many different Australian spiders may cause pain but only bites from some Funnel-web spiders are an immediate threat to life.

If serious symptoms or signs develop from any spider bite, transport the victim to hospital.

FUNNEL-WEB SPIDERS

A bite from a large (> 2cm), dark-coloured spider, especially in the regions of Sydney, Blue Mountains, central, northern, southern highlands or south coast of NSW, or south-eastern Queensland, should be considered as a dangerous bite and immediate treatment given (1,2).

RECOGNITION

Symptoms and signs of Funnel Web spider bite may include:

  • pain at the bite site, but little local reaction
  • tingling around the mouth
  • profuse sweating
  • copious secretion of saliva
  • abdominal pain
  • muscular twitching
  • breathing difficulty.
  • confusion leading to unconsciousness

Note: Life threatening effects may occur within 10 minutes.

MANAGEMENT

The rescuer should:

  • call an ambulance
  • apply Pressure Immobilisation Technique immediately (see Guideline 9.4.8)

If the victim is unresponsive and not breathing normally, follow ANZCOR Guideline 8: Cardiopulmonary Resuscitation.

Note

Antivenom is available for treatment of Funnel-web spider envenomation.

[CLASS A, LOE IV]

RED-BACK SPIDER

This spider (approximately 1cm body length) has a characteristic red, orange or pale stripe on its back. A bite may threaten the life of a child, but apart from pain, is rarely serious for an adult 1.

RECOGNITION

Symptoms and signs may include:

  • immediate pain at the bite site which becomes hot, red and swollen
  • intense local pain which increases and spreads
  • nausea, vomiting and abdominal pain
  • profuse sweating, especially at the bite site
  • swollen tender glands in the groin or armpit of the envenomated limb.
Notes:

Local pain develops rapidly at the bite site and may become widespread, but the venom acts slowly so a serious illness is unlikely in less than 3 hours. Pain can be treated with antivenom3,4,8 (Class A, LOE II) in a hospital where resuscitation facilities are available. A related species, the Cupboard Spider (resembles the red-back spider without the stripe) may be treated with the Red-back spider antivenom (1,5).( Class B, LOE IV)

MANAGEMENT

The rescuer should:

  • keep the victim under constant observation
  • apply an ice or cold compress to lessen the pain (for periods of no longer than 20mins)
  • transport the victim to a medical facility, preferably by ambulance, if the victim is a young child or collapse occurs or pain is severe.
Note:

The Pressure Immobilisation Technique is not used because the venom acts slowly and any attempt to retard its movement tends to increase local pain. Antivenom is available for Red- back spider envenomation.

[CLASS A, LOE IV]

WHITE-TAILED SPIDER BITE

Although the bite of the White-tailed spider may cause severe inflammation(4), it has caused, contrary to popular opinion, very few cases of severe local tissue destruction.1, 6 Other causes of necrotic ulcers should be sought especially when a spider has not been seen.(7)

The Pressure Immobilisation Technique should not be used.

[CLASS A; Expert Consensus Opinion]

OTHER AUSTRALIAN SPIDER BITES

All other spider bites should be treated symptomatically (Apply ice or cold compress to lessen the pain.)

[CLASS A; Expert Consensus Opinion]

REFERENCES

  1. Sutherland SK, Tibballs J. Australian Animal Toxins, Oxford University Press, Melbourne. 2001
  2. Isbister GK, Gray MR, Balit CR et al. Funnel-web spider bite: a systematic review of recorded clinical cases. Med J Aust 2005; 182: 407-11.
  3. Ellis RM, Sprivulis PC, Jelinek GA, et al. A double-blind, randomized trial of intravenous versus intramuscular antivenom for Red-back spider envenoming. Emerg Med Aus 2005; 17: 152-156.4.
  4. Isbister GK, Brown SGA, Miller M. et al. A randomised controlled trial of intramuscular vs. intravenous antivenom for lactrodectism- the RAVE study. Q J Med 2008; 101: 557- 565.
  5. Isbister GK, Gray MR. Effects of envenoming by comb-footed spiders of the genera Steatoda and Achaearanea (family Theridiidae: Araneae) in Australia. J Toxicol – Clin Toxicol 2003; 41: 809-819.
  6. Isbister GK, Gray MR. White-tail spider bite: a prospective study of 130 definite bites by Lampona species. MJA 2003;179: 199- 203
  7. Pincus SJ, Winkel KD, Hawdon GM, Sutherland SK. Acute and recurrent skin ulceration after spider bite. Med J Aust 1999; 171: 99-102.
  8. Isbister GK, Page CB, Buckley NA, et al. Randomized Controlled Trial of Intravenous Antivenom Versus Placebo for Latrodectism: The Second Redback Antivenom Evaluation (RAVE-II) Study. Annals of Emergency Medicine 2014; in press.

FURTHER READING

ANZCOR Guideline 8: Cardiopulmonary Resuscitation

ANZCOR Guideline 9.4.8: Pressure Immobilisation Technique

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