Spider Bite

For starters, I’ll say this… I/we frequently don’t believe you. Even if you actually saw the spider rearing its head, when you head to the ER it’s probably best just to say “feels like something bit me.”

There are two interesting spiders in the US, the brown recluse and the black widow. The first causes lesions that are remarkably awful. I’ve only seen a handful of these and mostly back in St. Louis. On the other hand, the toxin from the black widow can actually cause severe belly pain. These seemed more prevalent back in New Mexico.

However, spiders in SLO are like the people, generally pretty gentle. The majority of our spiders are busy bodies that just want what we want… dead mosquitoes. (Vanessa believes otherwise.)

All that said, here are the buzzwords for suspected spider bites.

Red Flags:

• Fevers
• Abdominal pain
• Multiple painful lesions
• Rapid expansion
• Red streaks
• Swollen lymph nodes
• Draining pus
• Skin ulcer development
• Immunocompromise (Cancer, chronic steroids, elderly, etc.)
• “I coincidentally also inject heroin.”

Happy Words

• Itchy
• Localized to one small lesion
• “I didn’t see the spider.”
• “It’s getting better already.”
• “I hate spiders.” (Insectist!)

In the ER we see if there is an abscess to drain. We look for signs of systemic infection. If we suspect bacterial infection we likely treat with antibiotics. If we suspect brown recluse bite, then we call internists, toxicologists, ID docs and maybe eventually plastic surgeons. These bites are rare and folks get excited.

For black widow bites, an antivenom exists, but I have yet to use it. During my residency I remember talk of someone using it once.

Essentially, we treat spider bites based on the buzz words with main goals being to limit infection and discomfort. All that said, the story is entirely different down under. In Australia, your killer instincts are spot on Vanessa.

Read about the funnel-web spider if you suffer from narcolepsy.
“The final stages of severe envenomation include dilation of the pupils (often fixed), uncontrolled generalized muscle twitching, unconsciousness, elevated intracranial pressure and death.” Crickey! Australian funnel-web spider

P.S. Surely some of you in SLO have your stories and will side with Vanessa. Please be gentle.

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