Wednesday, June 29, 2011

The ER "Spider Bite"

So for you comrades-in-arms may I present to you the all time over-call from triage-land. I know the triage nurses are obliged to write down the essence of why a patient is in the ER, but "spider bite"... Come on! They are NEVER spider bites.

They are NEVER Black Widow Bites (the symptoms of which, reportedly, one time, about sixty years ago, confused some surgical resident enough convince him to remove the patient's appendix--- *pinky swear*). The hallmark of these bites is PAIN, and tetanic muscle contractions in the area around the bite.... Here's the scary little critter....


Never seen a patient bitten by one. Never.

And don't talk to me about the Brown Recluse.... Everyone and their uncle, especially down here in God's country, has seen some email containing pictures of a supposed Brown Recluse bite victim who looks like the Elephant Man due to MASSIVE TISSUE NECROSIS. And here's one of the critters right here...


Notice the marking on the thorax which give it it's more common name, the 'Fiddle-back' spider. Now if you HAPPEN to get bitten by one of these you COULD, possibly, get a bad reaction, and there's very little to do as the venom causes tissue necrosis, but no one is ever bitten by one of these. For the thousandth time people... all you people who have some little bump or swelling or pone or risin' it was, as the Lord is my protector, almost certainly a mosquito, because NONE OF YOU HAVE EVER BROUGHT ME ONE IN A JAR, NOT A LIVE ONE OR A DEAD ONE AND NONE OF YOU ACTUALLY SAW A SPIDER BITE YOU FOR ALL THAT IS HOLY!

So really, all of you who think you were bitten by a spider and want to come to the ER, stay home, you were not, because if you were, you would look like this....


And this just never happens... Except to this patient today who came in telling triage he thought he had a spider bite. *slinking away*

30 comments:

  1. Ugh. That looks like shit. How do you treat that?

    -MS1 (MS2)

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  2. a lot like frostbite... you let it define itself... let all the injury happen, keep it clean... and then skin graft it.

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  3. I remember reading about neutralizing spider toxin with electricity, several years ago. I don't know if it ever proved out or not....

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  4. Allright, I know everyones waiting for one of my amusing anecdotes so without further adieux....
    There was this flaming Internal Medicine Attending(aren't they all) Who carried a Fag Bag, I mean Man Purse on rounds.
    We couldn't give him the Matthew Shepard treatment, cause it was 1986, and nobody knew who Matthew Shepard was, but one day "Some Dude" slipped an extremely realistic rubber snake in Dr. Flaming's purse.
    The thought was he'd go into his purse for some lube, I mean some poppers, and when he saw the coiled Serphent he'd scream, and everyone would point and laugh.
    Of course you know the rest of the story...
    Massive MI right there in the ICU...
    actually it was the one day he DIDN'T go to his purse for a breath mint, he didn't even mention the Snake the next day...
    Waste of $2.99 if you ask me...

    Frank

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  5. dear anon,
    the electricity thing had to do with snake bites and it proved not nearly as useful as leaching. frank, your brain is wired special-like. you claim to hate the French but keep saying adeiux, which is, i guess the pleural of adieu, like, 'good by ya'll' in your native tongue. and the rubber snake deal, this wasn't a certain Navy doc in San Diego was it? i mean we had one out there who, way before 'don't ask don't tell', was known to hum Ethel Merman tunes on rounds.

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  6. Frank reminds me of another Navy doc..

    http://cdrsalamander.blogspot.com/2007/05/new-usna-sex-scandle.html


    -MS1

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  7. MS1: ya gotta problem with a creepy Navy Pediatrician who video taped young naval academy midshipmen/women havin sex in his own home????

    9-11: Nah, this was in Sunny LA(Lower Alabama)and Dr. Loose Sphincter was a mangey refugee from N'ahwlins(New Orleans)come to Alabama for the better schools/more tolerant social mores...Seriously, who moves TO Alabama if they have a choice??

    Frank

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  8. The proper term for female mids is "dubs. " WUBAs is acceptable as well.

    -ms1

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  9. I have seen a proven Black Widow bite. The critter crawled inside of Junior's bib overhauls and bit him 3 times before he killed it and brought in the carcass.

    Big ol' red hourglass on the abdomen all right. 3 bites across the abdomen that looked like mosquito bites and a redneck with every muscle in his body in spasm. You could bounce quarters off his bubba-belly. Hard as granite.

    I had to get the State troopers to bring the anti-venin from Birmingham, but within 15 minutes of injection, Junior was markedly better. Admitted him overnight, and by morning he was ready to hit the road home.

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  10. OK, since I've got my daily Homo-fobic rant out of my system, here's my Spidey-tail...
    My Camp Lejeune batallion aid station, which is sort of like a clinic, except there was no lab or X-ray, and the "Pharmacy" was a closet with an assortment of low bid/expired generic meds, had a clinic Mascot.
    A Big Black-Widder Spider we named "Charlotte", which I thought was because she was a North Carolina Spider, but apparently there's some gay children's book with a Spider named "Charlotte"
    Anyway, Charlotte would make short work of the grasshoppers/beatles we'd feed her, or her favorite, these little green frogs that were probably on the endangered species list.
    And everything was cool until Charlotte had babies...
    Who flitted through the wire covering of her terrarium easier than a truckload of Mexicans crossing the Rio Grande...

    Frank

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  11. Hey ms1- do explain the acronyms!

    Frank, drop me a super secret email and tell the tale of the demise of your awesome blog... Just 'tween us non homos.

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  12. Hey C Joe,
    So they didn't take out his appendix?? Between us then, in decades of work, we have seen TWO serious spider bites. If we were in academia we could apply for a grant.

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  13. Hey 911, I like to help so I'll write the conclusion to the paper you and Frank write when you get your grant:
    Conclusion; Real spider bites are an extremely important consideration in the emergency department, although also very rare. More research is needed.
    Translation: Spider bites are ridiculous to even consider as a real diagnosis, but we sure did like that grant money, please send more.
    I expect a third author credit.
    Dr. J

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  14. So where is DRX?

    You see this is why MDOD has turned into such a homo club. No DRX. I come visit now only to see how my little MS1 is doing.

    -SCRN

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  15. Dr X is OCONUS... and I, for one, am deeply hurt... Kinda like a black-widow spider bite.

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  16. Dr J,
    You must be in academia... I think that counts as thirty hours of research.

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  17. MS1's an MS2 now--which I understand to be absolutely no different from an MS1, maybe a little worse. But I hear I get to flirt with more nurses--is that right, SCRN?

    911:

    WUBA=Woman Used By All.
    "Dub" is the lazy way of saying "Double-U" (W), which is short for WUBA.

    There's other fun ones---Lobster is a favorite--where all the meat's in the tail.

    You can always spot a dub by their traveling to go pick up a nice pint of ben and jerry's (a "dub tub") because they've "had such a harrrrddd day" and "nobody understands how hard it is to be a woman in a man's navy."

    Now you know. I wouldn't throw these terms around the VA, it's a good way to get a lobster boilin, if ya know what I mean.

    And, speaking of what I mean--I sent an email to the mdod gmail account. Don't make me beg.

    --MS1

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  18. Dear MS1,
    Awaiting email... On lookout for WUBAs.

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  19. resent it. check your spam folder?

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  20. not there.... can you spell? here it is...
    mdod.blog@gmail.com

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  21. what kind of operation are you running, 911? I'll try again...

    -ms1

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  22. MS1,

    I still think you are cute, But I fear you might need some tips on how to "get some". Maybe an email to DRX? Just don't want to have my little MS1 (sorry MS2) totally passed over.

    -SCRN (wringing hands with worry)

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  23. 911: I already credited myself 40 hours of research for my contribution and added the reference to my CV.
    Unfortunately I am a lowly pit doc in a community hospital still so it only counts in the ivory tower of my mind.
    Dr. J

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  24. So Dr J,
    How do you still do it? I can't.

    And MS1, no shit, i do not have an email from you in spam or in inbox.

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  25. i have no idea why. if you can shoot me an email at a super-secret account i made--thatd be great.

    its MDOD911@yahoo.com

    -ms1

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  26. i sent a reply. you've probably got every incoming mail blocked if you didnt get it.

    -ms1

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  27. 911 - I've only seen one Black Widow bite, but I've seen quite a number of Brown Recluse bites, with massive systemic complications, since I was ordinarily on the receiving end of anything medically sick from the ED.

    Massive intravascular hemolysis, sepsis, ARDS, airway obstruction due to soft tissue swelling, etc.

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  28. 911: How do I do it? I dunno, It all slides off my back. I'm the shit magnet who always inspires a department full of lunacy and people trying to die but I still have fun. I think of myself like a professional athlete; some days I win, some days I loose, but I always get paid to play.

    PS Are you and MS1 using dial up AOL or something? It's email guys, come-on!!
    Dr. J

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  29. TRUE STORY ALERT:

    I've been bitten by a black widow. Most overrated thing ever. The sucker was hiding in my ski gloves, and bit the hell out of my pinky, though at the time I didn't feel a thing. Put the gloves on, went outside in the cold for a while, finger went all numb, and I since I'm skinny and that's what happens to skinny fingers in the cold, I thought it was just business as usual. Came back inside, and the damn spida fell right out of the glove. When I reheated the digit, however, it started tingling like mad, probably the same feeling Frank gets when one of the neighborhood kids buys a Slip 'n Slide. Went to bed, woke up, and that ol' pinky was sweating like it had jumped into a Guinean maid's mouth whilst I slept. Went to the E.R., and they basically laughed at me. The attending informed me that brown recluse bites are exponentially worse, and I believed him. Thomas Sowell rarely lets his victims live.

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