Wessel's tiger ornamental tarantula bite envenomation: A case report and venom analysis.

Tarantulas are commonly kept as pets and bites from some species can cause severe symptoms. Here we describe a case of a patient with transient atrial fibrillation (afib) and painful muscle cramps requiring hospitalization for pain management after being bitten by a Poecilotheria tigrinawesseli (Wessel's Tiger Ornamental) spider. He was discharged with a cardiac event monitor and outpatient cardiology follow-up. The event monitor documented transient afib which decreased in frequency then resolved halfway through the three-week monitoring period. In conclusion, tarantula envenomation is usually mild with local pain and edema most reported. However, bites by some species, such as P. tigrinawesseli may have local and more systemic, long-lasting effects.

Study of Factors Contributing to Scorpion Envenomation in Arizona.

INTRODUCTION: Arizona has the highest incidence of scorpion envenomation reported to US poison control centers (PCCs). Most cases reported are from a residence, but specific details are limited. METHODS: Specialists at Arizona's two PCCs prospectively completed the Factors of Envenomation in Arizona Residences Survey (FEARS) for residential scorpion exposures reported during 4-week periods in the summer and winter. Based on these results, a second questionnaire, FEARS-2, targeting indoor residential exposures was then administered. RESULTS: Among 382 FEARS responses, no significant differences were found between summer and winter exposures, except for rainfall in the previous 24 hours. Scorpions had previously been seen in 81.8% of exposures, and 29.4% reported a previous envenomation at the residence. Most exposures occurred indoors (86.5%) and in a bedroom (42.5%), where the scorpion was in the bed in 54.7% of cases. Among all stings in a bed, 72.7% occurred while sleeping. Children were stung more often in a family room (38.6% vs. 14.5%; p < .00001) and by a scorpion on the floor (53.5% vs. 35.0%; p = .0014). Distal extremities were stung most often, particularly the foot (34.5%), with most being while barefoot (81.9%). CONCLUSION: A variety of characteristics and associations involving residential scorpion envenomations were identified. These details can be used to guide public education and primary prevention efforts to help decrease residential scorpion exposures.

Human Plant Exposures Reported to a Regional (Southwestern) Poison Control Center Over 8 Years.

BACKGROUND: There is little published data about human plant exposures reported to US poison control centers (PCCs). METHODS: A retrospective chart review of all reported plant exposures to a single regional PCC between January 1, 2003 and December 31, 2010 was done to understand better the characteristics of plant exposure cases. Specific generic plant codes were used to identify cases. Recorded variables included patient demographics, plant involved, exposure variables, symptoms, management site, treatments, and outcome. Univariate and multivariate regression was used to identify outcome predictors. RESULTS: A total of 6492 charts met inclusion criteria. The average age was 16.6 years (2 months-94 years); 52.4% were male. The most common exposure reason was unintentional (98%), and the majority (92.4%) occurred at the patient's home. Ingestions (58.3%) and dermal exposures (34.3%) accounted for most cases. Cactus (27.5%), oleander (12.5%), Lantana (5.7%), and Bougainvillea (3.8%) were most commonly involved. Symptoms developed in 47.1% of patients, and were more likely to occur following Datura (66.7%), and Morning Glory or Milkweed (25% each) exposures. Almost 94% of patients were managed onsite (home) and only 5.2% involved evaluation in a health care facility (HCF). Only 37 (0.6%) patients required hospital admission, and 2.9% of cases resulted in more than minimal effects. Exposures resulting in more than minimal clinical effects were predicted by several variables: abnormal vital signs (OR = 35.62), abnormal labs (OR = 14.87), and management at a HCF (OR = 7.37). Hospital admissions were increased for patients already at a HCF (OR = 54.01), abnormal vital signs (OR = 23.28), and intentional exposures (OR = 14.7). CONCLUSION: Plant exposures reported to our poison control center were typically unintentional ingestions occurring at home. Most patients were managed onsite and few developed significant symptoms.

A retrospective review of 911 calls to a regional poison control center.

BACKGROUND: There is little data as to what extent national Emergency Medical Services (EMS; 911) utilize poison control centers (PCCs). A review of data from our PCC was done to better understand this relationship and to identify potential improvements in patient care and health care savings. METHODS: Retrospective chart review of a single PCC to identify calls originating from 911 sources over a 4-year study period (1/1/08-12/31/11). Recorded variables included the origin of call to the PCC, intent of exposure, symptoms, management site, hospital admission, and death. Odds ratios (OR) were developed using multiple logistic regressions to identify risk factors for EMS dispatch, management site, and the need for hospital admission. RESULTS: A total of 7556 charts were identified; 4382 (58%) met inclusion criteria. Most calls (63.3%) involved accidental exposures and 31% were self-harm or misuse. A total of 2517 (57.4%) patients had symptoms and 2044 (50.8%) were transported to an Emergency Department (ED). Over 38% of calls (n = 1696) were handled primarily by the PCC and did not result in EMS dispatch; only 6.5% of cases (n = 287) with initial PCC involvement resulted in crew dispatch. There were 955 (21.8%) cases that resulted in admission, and five deaths. The OR for being transported to an ED was 45.4 (95% confidence interval [CI]: 30.2-68.4) when the crew was dispatched by the PCC. Hospital admission was predicted by intent for self-harm (OR 5.0; 95% CI: 4.1-6.2) and the presence of symptoms (OR 2.43; 95% CI: 1.9-3.0). The ORs for several other predictive variables are also reported. CONCLUSIONS: When 911 providers contact a PCC about poisoning-related emergencies, a history of intentional exposure and the presence of symptoms each predicted EMS dispatch by the PCC, patient transport to an ED, and hospital admission. Early involvement of a PCC may prevent the need for EMS activation or patient transfer to a health care facility.

A Survey of Primary Care Offices: Triage of Poisoning Calls without a Poison Control Center.

Poison control centers hold great potential for saving health care resources particularly by preventing unnecessary medical utilization. We developed a four-question survey with three poisoning-related scenarios, based on common calls to our poison center, and one question regarding after-hours calls. We identified primary care provider offices in our poison center's region from an internet search. We contacted these offices via telephone and asked to speak to an office manager or someone responsible for triaging patient phone queries. Using a scripted form, trained investigators questioned 100 consecutive primary care provider offices on how they would handle these poisoning-related calls if there was no poison center to refer their patients to. Results of our survey suggest that 82.5% of poisoning-related calls to primary care offices would be referred to 911 or an emergency department if there was no poison center. These results further support the role that poison centers play in patient care and health care utilization.