Archives for December 18, 2005

Black Widows

Everyone in Fort Worth who has an abscess was ‘bitten by a spider’. It’s a given that this will be the explanation, and it makes sense (people want to explain things, especially if it’s on their body and hurts).

Sometimes, it really is a spider bite, and occasionally they bring it in:

These folks don’t have an abscess, by the way, they haven’t had time for that to develop. They’re either worried about what could happen, or they have the actual Latrodectism, or symptoms of envenomation.

Here’s a nice table, lifted from the Texas Department of Health’s Venomous Spider page:

General Black Widow Spider Envenomization Symptoms

  • abdominal cramping
  • abdominal rigidity
  • convulsions
  • headache
  • lesion at site of bite
  • nausea
  • pain
  • profuse sweating
  • tremors
  • unconsciousness
  • vomiting

The ‘profuse sweating’ I haven’t seen, and wonder if they misunderstood one of the unique clinical features of the black widow envenomation: localized perspiration around the site of the bite, only. It’s a nice teaching point, though the patient never seems to appreciate how interesting it is.

There are a range of treatments for this, and it’s very very rarely fatal (I found one reference that said less than 1%, but that’s just a guess, as even if it’s a real number from a study it’s only studying people with known bites). I personally have had about 5 patients with Latrodectism, and they’re truly miserable and appreciative when you make the symptoms a lot better.

(I have a friend who had this, and after 20mg of IV valium was still having severe abdominal wall cramping. He then got the antivenin, and says 10 minutes later his cramping was essentially gone. He was then kept in the hospital for the next 18 hours because he was so sedated from the valium).

If bitten by one, just come on in to the ED, we’ll treat you without the spider.

Oh, and I can’t resist reproducing this table, from the TDH website just below the Black widow one, for Brown Recluse:

General Brown Recluse Spider Envenomization Symptoms

  • chills
  • fever
  • nausea
  • necrosis at the bite site
  • nothing
  • red white and blue lesion at the bite site
  • restlessness
  • weakness


We have a Winner!

Okay, thanks for all the entries to my silly caption contest, they were truly terrific.


The Winner: GoatWhacker, for the caption:
If you experience a carrot lasting greater than four hours, it is important to seek medical attention.

Honorable Mentions:
Too bad his wife is frigid by SarahW


Mr. Snowman suddenly heard the sound of a snowblower off in the distance by dribear.

Thanks for the entertainment, players!