Envenomations

This chapter discusses the type, incidence and management of envenomation caused by a wide variety of terrestrial and marine creatures in North America and Australia including snakes, spiders, scorpions, bees, wasps, ants, jellyfish, octopuses, stinging fish and cone shells. Death from snake bite and scorpion stings world-wide are respectively estimated at 20,000-94,000 and 3,000 per year. While few deaths from envenomation by snakes and other creatures occur in North America and other developed countries such as Australia, serious injury and hospitalizations are not infrequent. Principles of management of snake bite include first-aid, administration of antivenom (antivenin) and intensive supportive treatment. Spider bites are the most frequent type of envenomation, but deaths are rare with the availability of antivenoms. Important spider species in North America are widow spiders and the brown recluse spider, while in Australia important species are funnel-web spiders and the red-back spider. Mortality from anaphylactic reactions to bee, wasp and ant stings in developed countries equals or exceeds that from snake bite. Envenomation by jellyfish is frequent world-wide but mortality is very low except after envenomation by chirodropid species common in the Indo-Pacific region. Immunological responses to jellyfish stings are a relatively unrecognized phenomenon. Injury from species of stinging fish account for many hospitalizations while envenomations by specific octopuses and cone shells occur sporadically.