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Funnel Web Spider Envenomation Treatment & Management

  • Author: Joe Alcock, MD, MS; Chief Editor: Joe Alcock, MD, MS  more...
 
Updated: Feb 13, 2014
 

Prehospital Care

See the list below:

  • If possible and when expedient and safe, the spider should be killed and collected for identification.
  • A pressure immobilization bandage identical to that applied in the management of Australian snakebite should be applied immediately.[8] The dressing prevents migration of venom via lymphatics to the central circulation. Simultaneous immobilization (with a splint and/or sling) diminishes the muscle-pump effect on lymphatics and venous flow. Tourniquets are to be avoided.
  • Pressure immobilization must be maintained until the patient arrives at a hospital where antivenom is available.
  • Supportive care, including cardiac and respiratory life support, should be performed as necessary and according to the advanced cardiac life support (ACLS) protocol.
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Emergency Department Care

See the list below:

  • Most bites do not result in severe envenomation, although local pain at the site of the bite is common. When severe envenomation occurs, resuscitation measures and antivenin therapy should be instituted as necessary.
  • Funnel-web spider antivenom (CSL, Melbourne) is prepared by hyperimmunizing rabbits with the venom of A robustus. It has been effective in treating victims of a variety of species of Australian funnel-web spiders
    • Antivenom has been highly successful in the treatment of A robustus envenomation. Complete resolution of symptoms has occurred in 97% of patients treated with antivenom after confirmed funnel-web spider bites. Antivenom has been used successfully in pregnant women, breastfeeding women, and children.
    • Anaphylaxis is a risk when giving antivenom. In a recent review, adverse effects consistent with anaphylaxis occurred in 2 patients of 75 treated with antivenom. One patient of the 75 developed serum sickness within 7 days of administration of antivenom.[1]
  • Premedication with an antihistamine and steroid to prevent anaphylaxis may be considered. However, premedication with epinephrine is contraindicated because of elevated catecholamine levels induced by the venom. Administration of epinephrine is appropriate if anaphylaxis occurs.
    • Antivenom should be given in the ED or intensive care unit with close monitoring by medical and nursing staff. The initial dose of antivenom is 2 bottles intravenously, but most cases require 4 or more bottles.
    • Antivenom is indicated if any of the following are present:
      • Muscle fasciculation
      • Marked salivation or lacrimation
      • Piloerection
      • Significant tachycardia
      • Hypertension in a previously normotensive patient
      • Hypotension or shock
      • Dyspnea
      • Disorientation
      • Confusion
      • Depressed level of consciousness
  • As with any bite, ensure that tetanus immunization status is up to date.
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Consultations

See the list below:

  • Referral to an intensive care specialist may be necessary in cases of moderate-to-severe envenomation.
  • Advice from an experienced toxicologist practicing in an endemic area (eg, Sydney, Newcastle) should be sought in all funnel-web spider bites.
  • The New South Wales Poisons Information Centre has toxicologists available 24 hours a day.
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Contributor Information and Disclosures
Author

Joe Alcock, MD, MS Associate Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center

Joe Alcock, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Matthew M Rice, MD, JD, FACEP Senior Vice President, Chief Medical Officer, Northwest Emergency Physicians of TeamHealth; Assistant Clinical Professor of Medicine, University of Washington School of Medicine Pending Approval

Matthew M Rice, MD, JD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, Society for Academic Emergency Medicine, Washington State Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Joe Alcock, MD, MS Associate Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center

Joe Alcock, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Robert L Norris, MD Professor, Department of Emergency Medicine, Stanford University Medical Center

Robert L Norris, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, International Society of Toxinology, American Medical Association, California Medical Association, Wilderness Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Simon G A Brown, MBBS, PhD, FACEM, to the development and writing of this article.

References
  1. Isbister GK, Gray MR, Balit CR, Raven RJ, Stokes BJ, Porges K, et al. Funnel-web spider bite: a systematic review of recorded clinical cases. Med J Aust. 2005 Apr 18. 182(8):407-411. [Medline]. [Full Text].

  2. Isbister GK, Fan HW. Spider bite. Lancet. 2011 Dec 10. 378(9808):2039-47. [Medline].

  3. Isbister GK, Gray MR. Bites by Australian mygalomorph spiders (Araneae, Mygalomorphae), including funnel-web spiders (Atracinae) and mouse spiders (Actinopodidae: Missulena spp). Toxicon. 2004. 43(2):133-40. [Medline].

  4. Pineda SS, Wilson D, Mattick JS, King GF. The lethal toxin from Australian funnel-web spiders is encoded by an intronless gene. PLoS One. 2012. 7(8):e43699. [Medline]. [Full Text].

  5. Graudins A, Wilson D, Alewood PF, Broady KW, Nicholson GM. Cross-reactivity of Sydney funnel-web spider antivenom: neutralization of the in vitro toxicity of other Australian funnel-web (Atrax and Hadronyche) spider venoms. Toxicon. 2002 Mar. 40(3):259-66. [Medline].

  6. Isbister GK, Gray MR. A prospective study of 750 definite spider bites, with expert spider identification. QJM. 2002 Nov. 95(11):723-31. [Medline].

  7. Fisher MM, Carr GA, McGuinness R, Warden JC. Atrax robustus envenomation. Anaesth Intensive Care. 1980 Nov. 8(4):410-20. [Medline].

  8. Sutherland SK, Duncan AW. New first-aid measures for envenomation: with special reference to bites by the Sydney funnel-web spider (Atrax robustus). Med J Aust. 1980 Apr 19. 1(8):378-9. [Medline].

  9. Dieckmann J, Prebble J, McDonogh A, Sara A, Fisher M. Efficacy of funnel-web spider antivenom in human envenomation by Hadronyche species. Med J Aust. 1989 Dec 4-18. 151(11-12):706-7. [Medline].

  10. Harrington AP, Raven RJ, Bowe PC, Hawdon GM, Winkel KD. Funnel-web spider (Hadronyche infensa) envenomations in coastal south-east Queensland. Med J Aust Med J Aust. 1999 Dec 6-20. 171(11-12):651-3. [Medline]. [Full Text].

  11. Howarth DM, Southee AE, Whyte IM. Lymphatic flow rates and first-aid in simulated peripheral snake or spider envenomation. Med J Aust. 1994 Dec 5-19. 161(11-12):695-700. [Medline].

  12. Sutherland SK. The Sydney funnel-web spider (Atrax robustus). 3. A review of some clinical records of human envenomation. Med J Aust. 1972. 2:642-6.

  13. Sutherland SK, Duncan AW, Tibballs J. Local inactivation of funnel-web spider (Atrax robustus) venom by first- aid measures: potentially lifesaving part of treatment. Med J Aust. 1980 Oct 18. 2(8):435-7. [Medline].

  14. White J, Cardoso JL, Fan HW. Clinical toxicology of spider bites. Handbook of Clinical Toxicology of Animal Venoms and Poisons. CRC Press; 1995. 272-83.

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The Sydney funnel-web spider, Atrax robustus. Male (left) and female (right). Photograph courtesy of the Australian Venom Research Unit, Department of Pharmacology, University of Melbourne, Australia.
Female funnel-web spider. Image courtesy of Glenn DuBois, CEO, http://www.termite.com/spider-identification.html.
Male funnel-web spider. Image courtesy of Glenn DuBois, CEO, http://www.termite.com/spider-identification.html.
 
 
 
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