74. Datta G, Tu AT. Structure and other chemical characterizations of gila toxin, a lethal toxin from lizard venom. J Pept Res. 1997;50:443-50. 75. Mochca-Morales J, Martin BM, Possani LD. Isolation and characterization of helothermine, a novel toxin from Heloderma Horridum horridum (Mexican beaded lizard) venom. Toxicon. 1990;28(3):299-309. 76. French R, Brooks D, Ruha AM, Shirazi F, Chase P, Boesen K, Walter F. Gila monster ( Heloderma suspectum) envenomation: descriptive analysis of calls to United States Poison Centers with focus on Arizona cases. Clin Toxicol. 2015;53(1):60-70. 77. Preston CA. Hypotension, myocardial infarction, and coagulopathy following Gila monster bite. J Emerg Med. 1989;7(1):37-40. 78. Hooker KR, Caravati EM. Gila monster envenomation. Ann Emerg Med. 1994;24(4):731-5. 79. Strimple PD, Tomassoni AJ, Otten EJ, Bahner D. Report on envenomation by a Gila monster ( Heloderma suspectum ) with a discussion of venom apparatus, clinical findings, and treatment. Wilderness Environ Med. 1997;8(2):111-6. 80. Akahoshi M, Song CH, Piliponsky AM, Metz M, Guzzetta A, Åbrink M, Schlenner SM, Feyerabend TB, Rodewald HR, Pejler G, Tsai M. Mast cell chymase reduces the toxicity of Gila monster venom, scorpion venom, and vasoactive intestinal polypeptide in mice. J Clin Investig. 2011;121(10):4180-91. 81. Bush SP, Cohen JP, Greene S. Widow spider envenomations. Medscape Drugs & Diseases. Updated May 28, 2020. https://emedicine.medscape.com/article/772196-overview. Accessed January 3, 2023 82. Erdur B, Turkcuer I, Bukiran A, Kuru O, Varol I. Uncommon cardiovascular manifestations after a Latrodectus bite. Am J Emerg Med. 2007;25(2):232-5. 83. Kose A, Bozkurt S, Lok U, Zengınol M, Yıldırım C, Gunay N, Kose B. Presumptive Latrodectus
F (abʹ) 2 versus placebo in the treatment of latrodectism: a randomized, double-blind, placebo-controlled, clinical trial. Ann Emerg Med. 2019;74(3):439-49. 88. Greene S, Tucci V. Is that skin lesion an infection or an envenomation? In: Mattu A, Chanmugam AS, Swadron SP, Woolridge D, Winters M, eds. Avoiding Common Errors in the Emergency Department. Philadelphia: Wolters Kluwer; 2017. 89. Wright SW, Wrenn KD, Murray L, Seger D. Clinical presentation and outcome of brown recluse spider bite. Ann Emerg Med. 1997;30(1):28-32. 90. Curry SC, Vance MV, Ryan PJ, et al. Envenomation by the scorpion Centruroides sculpturatus. J Toxicol Clin Toxicol. 1983–84; 21: 417-49.
bite with ileus and myocardial involvement. Wilderness Environ Med. 2010;21(3):271-2. 84. Quan D, Ruha AM. Priapism associated with Latrodectus mactans envenomation. Am J Emerg Med. 2009;(6):759.e1-2. 85. Cohen J, Bush S. Case report: compartment syndrome after a suspected black widow spider bite. Ann Emerg Med. 2005;45(4):414-6 86. Monte AA, Bucher-Bartelson B, Heard KJ. A US perspective of symptomatic Latrodectus spp. envenomation and treatment: a National Poison Data System review. Ann Pharmacoterapy. 2011;5(12):1491-8. 87. Dart RC, Bush SP, Heard K, Arnold TC, Sutter M, Campagne D, Holstege CP, Seifert SA, Lo JC, Quan D, Borron S. The efficacy of antivenin latrodectus (Black Widow) equine immune 91. Coorg V, Levitan RD, Gerkin RD, Muenzer J, Ruha AM. Clinical presentation and outcomes associated with different treatment modalities for pediatric bark scorpion envenomation. J Med Toxicol. 2017;13(1):66-70. 92. Eagleman DM. Envenomation by the asp caterpillar ( Megalopyge opercularis ). Clin Toxicol. 2008;46(3):201-5. 93. Greene SC, Carey JM. Puss caterpillar envenomation: erucism mimicking appendicitis in a young child. Pediatr Emerg Care. 2020;36(12):e732-4. 94. Bush SP, King BO, Norris RL, Stockwell SA. Centipede envenomation. Wilderness Environ Med. 2001;12(2):93-9. 95. Kizer KW, McKinney HE, Auerback PS. Scorpaenidae envenomation: a five-year poison center experience. JAMA. 1985;253:807. 96. Scoggin CH. Catfish stings. JAMA. 1975;231(2):176-7. 97. Russell FE. Stingray injuries: a review and discussion of their treatment. Am J Clin Pathol. 1953;64: 382. 98. Fenner PJ, Williamson JA, Skinner RA. Fatal and nonfatal stingray envenomation. Med J Aust. 1989;151:621. 99. Wound necrosis caused by the venom of stingrays. Med J Aust. 1985;141:854. 100. Cevik J, Hunter-Smith DJ, Rozen WM. Infections following stingray attacks: A case series and literature review of antimicrobial resistance and treatment. Travel Med Infect Dis. 2022:102312. 101. Cegolon L, Heymann WC, Lange JH, Mastrangelo G. Jellyfish stings and their management: a review. Mar Drugs . 2013;11(2):523-50 102. Li L, McGee RG, Isbister G, Webster AC. Interventions for the symptoms and signs resulting from jellyfish stings. Cochrane Database Syst Rev . 2013;12:CD009688 COMMON ENVENOMATIONS: SNAKES, LIZARDS, MARINE LIFE, AND ARTHROPODS Final Examination Questions Select the best answer for each question and mark your answers on the Final Examination Answer Sheet found on page 123, or complete your test online at EliteLearning.com/Book 21. Which the following is most characteristic of a coral snake
26. Which the following findings is most consistent with an Arizona bark scorpion ( Centruroides sculpturatus ) envenomation? a. Hypofibrinogenemia. b. Necrosis at the envenomation site. c. Opsoclonus. d. Tissue swelling. 27. Which the following statements regarding marine envenomation is correct? a. Antivenom is available for Portuguese man-o’-war ( Physalia physalis ) envenomations. b. Hot water immersion relieves the pain of most marine envenomations. c. Irrigation of jellyfish stings with cold sterile water should immediately follow ABC. d. Urine neutralizes most marine venoms. 28. Which of the following is most likely following a sting from the pus caterpillar (Megalopyge opercularis)? a. Hematologic laboratory abnormalities. b. Nausea and vomiting. c. Paralysis. d. Severe pain at the envenomation site. 29. Which of the following venomous lizards is native to the U.S.? a. Gila monster. b. Iguana. c. Komodo dragon. d. Mexican beaded lizard. 30. Which of the following statements regarding hymenoptera envenomation is most accurate? a. Allergic reactions are uncommon in envenomations involving fewer than 10 stings. b. Epinephrine should be administered prophylactically to all patients in case they develop an allergic reaction. c. It is essential to remove the stingers as soon as the patient arrives in the emergency department. d. The LD50 is estimated to be between 20 and 40 stings per kilogram.
envenomation? a. Ecchymosis. b. Painful paresthesias. c. Significant tissue swelling. d. Thrombocytopenia. 22. Which of the following statements regarding snakebite management is correct? a. Antibiotics should be started in the emergency department to prevent infection. b. Fasciotomy is the first-line treatment for suspected compartment syndrome. c. One of the indications for antivenom is progressive local swelling and tenderness that crosses a major joint. d. There is no evidence that antivenom improves outcomes for copperhead envenomations. 23. Which the following statements regarding antivenom is correct? a. It is only indicated for systemic toxicity or abnormal hematologic laboratory results. b. Once the patient is treated with antivenom, they must not ever receive it again. c. Serum sickness is observed in nearly 100% of patients treated with either Anavip or CroFab. d. The incidence of acute adverse reactions to CroFab (ovine-derived FabAV) is between 1.4% and 10%. 24. Which of the following is most characteristic of recluse spider envenomation? a. Hemolysis. b. Hypertension. c. Profound diaphoresis. d. Severe pain. 25. Which of the following statements regarding widow spider envenomation is correct? a. Although antivenom is available, its use is not recommended because of the high incidence of adverse reactions. b. Antibiotics should be started in the emergency department to prevent infection. c. Hypotension is commonly observed. d. Pain is often severe and frequently requires parenteral opioids.
Course Code: RPTTX03CE
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Book Code: RPTTX2024
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