Emergency medicine clinics of North America
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Native US snakes that produce clinically significant envenomation can be divided into 2 groups, crotalids and elapids. The crotalids include rattlesnakes, cottonmouths, and copperheads. Crotalid envenomation can result in significant local tissue damage as well as thrombocytopenia and coagulopathy. ⋯ Native US elapids are all coral snakes that possess neurotoxic venom that can cause weakness, respiratory paralysis, and rarely death. Treatment of both types of envenomation revolves around general supportive care and antivenom administration when indicated. Previously advocated treatments, such as tourniquets, venom extraction, and bite site excision are not recommended.
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Arthropods (phylum Arthopoda) account for a higher percentage of morbidity and mortality to humans than do mammalian bites, snake bites, or marine envenomation. They are ubiquitous in domestic dwellings, caves, and campsites and in wilderness settings such as deserts, forests, and lakes. Although arthropods are most intrusive during warmer months, many are active throughout the winter, particularly indoors. ⋯ Encounters with humans are generally defensive, accidental, or reactive. An individual stung by an insect or bitten by an arachnid may experience pain and local swelling, an anaphylactic reaction, or life-threatening toxicity. This review discusses the clinical presentation and latest treatment recommendations for bites and stings from spiders, scorpions, bees, ants, ticks and centipedes of North America.
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Decompression sickness and arterial gas embolism, collectively known as decompression illness (DCI), are rare but serious afflictions that can result from compressed gas diving exposures. Risk is primarily determined by the pressure-time profile but is influenced by several factors. ⋯ Many conditions must be considered in the differential diagnosis. High-fraction oxygen breathing provides first aid but definitive treatment of DCI is hyperbaric oxygen.