treatment of venomous bites and stings

[Jhanananda]

Over the decades of treating various venomous bites and stings I have found simply soaking the effected body part in water with about 1tbl spoon of salt or baking soda will eliminate the pain, and reduce the swelling, in a few minutes of soaking.  This of course depends upon the venom.

Ants, bees, wasps, and many other stinging insects typically employ formic acid as the venom.  Formic acid is easily neutralized in the presence of salt or baking soda.

However, other poisons used by venomous insects and reptiles can be other poisons, that can be quite insidious to treat.  Often the other poisons employed by venomous insects and reptiles is a digestive enzyme, which can literally digest your flesh.

Saturday night I was bitten by something that was at the bottom of my bed.  The sting was about 4 times as painful as a bee sting, and the pain lingered for quite some time.  Since I am in Arizona, and living in a van, and the brown recluse spider is common here, and is commonly found in bed, then I believe i was bitten by a brown recluse spider.

brown recluse spider
The brown recluse, Loxosceles reclusa, Sicariidae (formerly placed in a family "Loxoscelidae") is a spider with a venomous bite.

Brown recluse spiders are usually between 6 and 20 millimetres (0.24 and 0.79 in), but may grow larger. While typically light to medium brown, they range in color from whitish to dark brown or blackish gray. The cephalothorax and abdomen are not necessarily the same color. These spiders usually have markings on the dorsal side of their cephalothorax, with a black line coming from it that looks like a violin with the neck of the violin pointing to the rear of the spider, resulting in the nicknames fiddleback spider, brown fiddler, or violin spider.

Behavior

A brown recluse's stance on a flat surface is usually with all legs radially extended. When alarmed it may lower its body, withdraw the forward two legs straight rearward into a defensive position, withdraw the rearmost pair of legs into a position for lunging forward, and stand motionless with pedipalps raised. The pedipalps in mature specimens are dark and quite prominent and are normally held horizontally forward. When threatened it usually flees, seemingly to avoid a conflict, and if detained may further avoid contact with quick horizontal rotating movements or even resort to assuming a lifeless pose (playing dead). The spider does not usually jump unless touched brusquely, and even then its avoidance movement is more of a horizontal lunge rather than a vaulting of itself entirely off the surface. When running, the brown recluse does not leave a silk line behind, which would make it more easily tracked when it is being pursued. Movement at virtually any speed is an evenly paced gait with legs extended. When missing a leg or two it appears to favor this same gait, although (presumably when a leg has been injured) it may move and stand at rest with one leg slightly withdrawn. During travel it stops naturally and periodically when renewing its internal hydraulic blood pressure that, like most spiders, it requires to renew strength in its legs.

Habitat
Brown recluse spiders build asymmetrical (irregular) webs that frequently include a shelter consisting of disorderly thread. They frequently build their webs in woodpiles and sheds, closets, garages, plenum spaces, cellars, and other places that are dry and generally undisturbed. When dwelling in human residences they seem to favor cardboard, possibly because it mimics the rotting tree bark which they inhabit naturally. They have also been encountered in shoes, inside dressers, in bed sheets of infrequently used beds, in clothes stacked or piled or left lying on the floor, inside work gloves, behind baseboards and pictures, in toilets, and near sources of warmth when ambient temperatures are lower than usual. Human-recluse contact often occurs when such isolated spaces are disturbed and the spider feels threatened. Unlike most web weavers, they leave these lairs at night to hunt. Males move around more when hunting than the females, which tend to remain nearer to their webs. The spider will hunt for firebrats, crickets, cockroaches, and other soft-bodied insects.

Distribution
The range lies roughly south of a line from southeastern Nebraska through southern Iowa, Illinois, and Indiana to southwestern Ohio. In the southern states, it is native from central Texas to western Georgia and north to Kentucky.[3][4]

Despite rumors to the contrary, the brown recluse spider has not established itself in California or anywhere outside its native range.

In contradiction of this premise, brown recluse spider bites have been reported in Arizona for decades.

Bite
Main article: Loxoscelism

As suggested by its specific epithet reclusa (recluse), the brown recluse spider is rarely aggressive, and bites from the species are uncommon. In 2001, more than 2,000 brown recluse spiders were removed from a heavily infested home in Kansas, yet the four residents who had lived there for years were never harmed by the spiders, despite many encounters with them.[14][15] The spider usually bites only when pressed against the skin, such as when tangled within clothes, towels, bedding, inside work gloves, etc. Many human victims report having been bitten after putting on clothes that had not been worn recently, or had been left for many days undisturbed on the floor. However, the fangs of the brown recluse are so tiny they are unable to penetrate most fabric.[16]

The bite frequently is not felt initially and may not be immediately painful, but it can be serious. The brown recluse bears a potentially deadly hemotoxic venom. Most bites are minor with no necrosis. However, a small number of brown recluse bites do produce severe dermonecrotic lesions (i.e. necrosis); an even smaller number produce severe cutaneous (skin) or viscerocutaneous (systemic) symptoms. In one study of clinically diagnosed brown recluse bites, skin necrosis occurred 37% of the time, while systemic illness occurred 14% of the time.[17] In these cases, the bites produced a range of symptoms common to many members of the Loxosceles genus known as loxoscelism, which may be cutaneous and viscerocutaneous. In very rare cases, bites can even cause hemolysis—the bursting of red blood cells.[18]

Around 49% of brown recluse bites do not result in necrosis or systemic effects. When both types of loxoscelism do result, systemic effects may occur before necrosis, as the venom spreads throughout the body in minutes. Children, the elderly, and the debilitatingly ill may be more susceptible to systemic loxoscelism. The systemic symptoms most commonly experienced include nausea, vomiting, fever, rashes, and muscle and joint pain. Rarely, such bites can result in hemolysis, thrombocytopenia, disseminated intravascular coagulation, organ damage, and even death.[19] Most fatalities are in children under the age of seven[20] or those with a weak immune system.

This does not match my symptomatology

While the majority of brown recluse spider bites do not result in any symptoms, cutaneous symptoms occur more frequently than systemic symptoms. In such instances, the bite forms a necrotizing ulcer that destroys soft tissue and may take months to heal, leaving deep scars. These bites usually become painful and itchy within 2 to 8 hours. Pain and other local effects worsen 12 to 36 hours after the bite, and the necrosis develops over the next few days.[21] Over time, the wound may grow to as large as 25 cm (10 inches). The damaged tissue becomes gangrenous and eventually sloughs away.

This does describe my symptomatology.

Misdiagnosis

It is estimated that 80% of reported brown recluse bites have been misdiagnosed.[4] There is now an ELISA-based test for brown recluse venom that can determine whether a wound is a brown recluse bite, although it is not commercially available and not in routine clinical use. Clinical diagnoses often use Occam's razor principle in diagnosing bites based on what spiders the patient likely encountered and previous similar diagnoses.[4][17][22]

There are numerous documented infectious and noninfectious conditions that produce wounds that have been initially misdiagnosed as recluse bites by medical professionals, including:

    Pyoderma gangrenosum
    Infection by Staphylococcus
    Infection by Streptococcus
    Herpes
    Diabetic ulcers
    Fungal infection
    Chemical burns

   

    Toxicodendron dermatitis
    Squamous cell carcinoma
    Localized vasculitis
    Syphilis
    Toxic epidermal necrolysis
    Sporotrichosis
    Lyme disease[23]

Many of these conditions are far more common and more likely to be the source of necrotic wounds, even in areas where brown recluse spiders actually occur.[4] The most important of these is methicillin-resistant Staphylococcus aureus (MRSA), a bacterium whose necrotic lesions are very similar to those induced by recluse bites, and which can be lethal if left untreated.[24] Misdiagnosis of MRSA as spider bites is extremely common (nearly 30% of patients with MRSA reported that they initially suspected a spider bite), and can have fatal consequences.[25]

Reported cases of brown recluse bites occur primarily in Arkansas, Colorado, Kansas, Missouri, Nebraska, Oklahoma, and Texas. There have been many reports of brown recluse bites in California—though a few related species may be found there, none of these are known to bite humans.[5] To date, the reports of bites from areas outside of the spider's native range have been either unverified, or, if verified, the spiders have been moved to those locations by travelers or commerce. Many arachnologists believe that a large number of bites attributed to the brown recluse in the West Coast are either from other spider species or not spider bites at all. For example, the venom of the hobo spider, a common European species established in the northwestern United States and southern British Columbia, has been reported to produce similar symptoms as the brown recluse bite when injected into laboratory rabbits. However, the toxicity of hobo spider venom has been called into question as actual bites have not been shown to cause necrosis, and no such occurrences have ever been reported where the spider is native.[26]

Numerous other spiders have been associated with necrotic bites in medical literature. Other recluse species, such as the desert recluse (found in the deserts of southwestern United States), are reported to have caused necrotic bite wounds, though only rarely.[27] The hobo spider and the yellow sac spider have also been reported to cause necrotic bites. However, the bites from these spiders are not known to produce the severe symptoms that can follow from a recluse spider bite, and the level of danger posed by these has been called into question.[28][29] So far, no known necrotoxins have been isolated from the venom of any of these spiders, and some arachnologists have disputed the accuracy of spider identifications carried out by bite victims, family members, medical responders, and other non-experts in arachnology. There have been several studies questioning the danger posed by some of these spiders. In these studies, scientists examined case studies of bites in which the spider in question was identified by an expert, and found that the incidence of necrotic injury diminished significantly when "questionable" identifications were excluded from the sample set.[30][31] (For a comparison of the toxicity of several kinds of spider bites, see the list of spiders having medically significant venom.)

brown recluse (continued)
Bite treatment

First aid involves the application of an ice pack to control inflammation and prompt medical care. If it can be easily captured, the spider should be brought with the patient in a clear, tightly closed container so it may be identified.

Routine treatment should include immobilization of the affected limb, application of ice, local wound care, and tetanus prophylaxis. Many other therapies have been used with varying degrees of success, including hyperbaric oxygen, dapsone, antihistamines (e.g., cyproheptadine), antibiotics, dextran, glucocorticoids, vasodilators, heparin, nitroglycerin, electric shock, curettage, surgical excision, and antivenom.[32][33] None of these treatments have been subjected to randomized controlled trials to conclusively show benefit. In almost all cases, bites are self-limited and typically heal without any medical intervention.[4]

Outpatient palliative care following discharge often consists of a weak or moderate strength opioid (e.g. codeine or tramadol, respectively) depending on pain scores, an anti-inflammatory agent (e.g. naproxen, cortisone), and an antispasmodic (e.g. cyclobenzaprine, diazepam), for a few days to a week. If the pain and/or spasms have not resolved by this time, a second medical evaluation is generally advised, and differential diagnoses may be considered. Occasionally, an antibiotic is prescribed as well.

Cases of brown recluse venom travelling along a limb through a vein or artery are rare, but the resulting tissue mortification can affect an area as large as several inches and in extreme cases require excising of the wound.
Specific treatments

In presumed cases of recluse bites, dapsone is often used for the treatment of necrosis, but controlled clinical trials have yet to demonstrate efficacy.[34] However, dapsone may be effective in treating many "spider bites" because many such cases are actually misdiagnosed microbial infections.[35] There have been conflicting reports about its efficacy in treating brown recluse bites, and some have suggested it should no longer be used routinely, if at all.[36]

Wound infection is rare. Antibiotics are not recommended unless there is a credible diagnosis of infection.[37]

Studies have shown that surgical intervention is ineffective and may worsen outcome. Excision may delay wound healing, cause abscesses, and lead to scarring.[38]

Purportedly application of nitroglycerin stopped necrosis.[39] However, one scientific animal study found no benefit in preventing necrosis, with the study's results showing it increased inflammation and caused symptoms of systemic envenoming. The authors concluded the results of the study did not support the use of topical nitroglycerin in brown recluse envenoming. [40]

Antivenom is available in South America for the venom of related species of recluse spiders. However, the bites, often being painless, usually do not present symptoms until 24 or more hours after the event, possibly limiting the effect of this intervention.[41]

[Jhanananda]

Spider bite
A spider bite, also known as arachnidism, is an injury resulting from the bite of a spider. The effects of most bites are not serious.[1] Most bites result in mild symptoms around the area of the bite.[1] Rarely they may produce a necrotic skin wound or severe pain.[2]:455

Most spiders do not cause bites that are of importance.[1] For a bite to be significant, substantial envenomation is required. Bites from the widow spiders involve a neurotoxic venom which produces a condition known as latrodectism.[3] Symptoms may include: pain which may be at the bite or involve the chest and abdomen, sweating, muscle cramps and vomiting among others.[1] Bites from the recluse spiders cause the condition loxoscelism, in which local necrosis of the surrounding skin and widespread breakdown of red blood cells may occur.[4] Headaches, vomiting and a mild fever may also occur.[4] Other spiders that can cause significant bites include: the Australian funnel web spiders[5] and the South American wandering spider.[1]

Efforts to prevent bites include clearing clutter and the use of pesticides.[1] Most spider bites are managed with supportive care such as NSAIDs (including ibuprofen) for pain and antihistamines for itchiness.[6] Opioids may be used if the pain is severe.[6] While an antivenom exists for black widow spider venom it is associated with anaphylaxis and therefore not commonly used in the United States.[6] Antivenom against funnel web spider venom improves outcomes.[1] Surgery may be required to repair the area of injured skin from some recluse bites.[6]

Spider bites may be overdiagnosed or misdiagnosed.[1] Historically a number of conditions were attributed to spider bites. In the Middle Ages a condition claimed to arise from spider bites was tarantism, where people danced wildly.[7] While necrosis has been attributed to the bites of a number of spiders, good evidence only supports this for recluse spiders.[1]

Signs and symptoms
Almost all spiders are venomous, but not all spider bites result in the injection of venom. Pain from non-venomous, so-called "dry bites" typically lasts for 5 to 60 minutes while pain from envenomating spider bites may last for longer than 24 hours.[8] Bleeding also may occur with a bite. Signs of a bacterial infection due to a spider bite occur infrequently (0.9%).[8]

A study of 750 definite spider bites in Australia indicated that 6% of spider bites cause significant effects, the vast majority of these being redback spider bites causing significant pain lasting more than 24 hours.[9] Activation of the sympathetic nervous system can lead to sweating, high blood pressure and gooseflesh.[10]

Most recluse spider bites are minor with little or no necrosis. However, a small number of bites produce necrotic skin lesions. First pain and tenderness at the site begin. The redness changes over 2 to 3 days to a bluish sinking patch of dead skin—the hallmark of necrosis. The wound heals slowly over months but usually completely.[11] and, rarely, widespread symptoms, including profound anemia. Rarely the bite may also produce the systemic condition with occasional fatalities.

Cause
Spiders do not feed on humans and typically bites occur as a defense mechanism.[13] This can occur with from unintentional contact or trapping of the spider.[13] Most spiders have fangs too small to penetrate human skin.[14] Most bites by species large enough for their bites to be noticeable will have no serious medical consequences.[15]

Medically significant spider venoms include various combinations and concentrations of necrotic agents, neurotoxins, and pharmacologically active compounds such as serotonin. Worldwide only two spider venoms have impact on humans—those of the widow and recluse spiders. Unlike snake and scorpion envenomation,[16] widow and recluse species bites rarely have fatal consequences. However, isolated spider families have a lethal neurotoxic venom: the wandering spider in Brazil and the funnel web in Australia. However, due to limited contact of humans with these spiders, deaths have always been rare, and since the introduction of anti-venom in Australia, there have been no funnel web related deaths.[17]

Pathophysiology
Main article: Pathophysiology of spider bites

A primary concern of the bite of a spider is the effect of its venom. A spider envenomation occurs whenever a spider injects venom into the skin. Not all spider bites involve injection of venom, and the amount of venom injected can vary based on the type of spider and the circumstances of the encounter. The mechanical injury from a spider bite is not a serious concern for humans. However, it is generally the toxicity of spider venom that poses the most risk to human beings; several spiders are known to have venom that can cause injury to humans in the amounts that a spider could inject when biting. While venoms are by definition toxic substances, most spiders do not have venom that is directly toxic (in the quantities delivered) to require medical attention and, of those that do, severity is typically mild.

Spider venoms work on one of two fundamental principles; they are either neurotoxic (attacking the nervous system) or necrotic (attacking tissues surrounding the bite). In some cases, the venom affects vital organs and systems. The venoms of the widow spiders, Brazilian wandering spider and Australian funnel-web are neurotoxic. Heart muscle damage is an unusual complications of widow venom that may lead to death.[18] Pulmonary edema, fluid acumulation in the lungs, is a feared uncommon complication of funnel-web venom.[17] Recluse and South African sand spider venoms are necrotic. Recluse venom may also cause severe hemolysis (destruction of red blood cells)[19]
Diagnosis

Assumption that a reported injury was caused by a spider is the most common source of false reports, which in some cases have led to misdiagnosis and mistreatment, with potentially life-threatening consequences.[20] Many spider bites are relatively painless but the spider is often trapped and easily found. With neurotoxic envenomation, serious symptoms arise within a few hours.

An affected person may think that a wound is a spider bite when it is actually an infection with methicillin-resistant Staphylococcus aureus (MRSA).[21]

Spider bites are commonly misdiagnosed. Unverified bite reports are frequent and likely represent many other conditions, both infectious and non-infectious, which can be confused with spider bites.[22] Many of these conditions are far more common and more likely to be the source of necrotic wounds.[4]
Management

Most spider bites are harmless, and require no specific treatment. Treatment of bites may depend on the type of spider; thus, capture of the spider—either alive, or in a well-preserved condition, is useful.[23][24]

Treatment of spider bites includes washing the wound with soap and water and ice to reduce inflammation.[25] Analgesics and antihistamines may be used, however antibiotics are not recommended unless there is also a bacterial infection present.[25] Treatment of black widow envenomation seeks to control the pain and nausea that result.

In the case of bites by widow spiders, Australian funnel-web spiders, or Brazilian wandering spiders, medical attention should be sought as in some cases the bites of these spiders develop into a medical emergency.[26][27] Antivenom is available for severe widow and funnel-web envenomation.[1]
Necrosis

In almost all cases, recluse bites are self-limited and typically heal without any medical intervention.[4] Recommendations to limit the extent of damage include elevation and immobilization of the affected limb, application of ice. Both local wound care, and tetanus prophylaxis are simple standards. There is no established treatment for more extensive necrosis. Many therapies have been used including hyperbaric oxygen, dapsone, antihistamines (e.g., cyproheptadine), antibiotics, dextran, glucocorticoids, vasodilators, heparin, nitroglycerin, electric shock, curettage, surgical excision, and antivenom. None of these treatments conclusively show benefit. Studies have shown surgical intervention is ineffective and may worsen outcome. Excision may delay wound healing, cause abscesses, and lead to objectionable scarring.[28]

Dapsone, an antibiotic, is commonly used in the USA and Brazil for the treatment of necrosis. There have been conflicting reports with some supporting its efficacy and others have suggested it should no longer be used routinely, if at all.[29]
Antivenom

Use of antivenom for severe spider bites may be indicated, especially in the case of neurotoxic venoms.[30] Effective antivenoms exist for Latrodectus, Atrax, and Phoneutria venom. In the United States antivenom is intravenous but is used rarely as anaphylactic reaction to the antivenom has resulted in deaths. In Australia, intramuscular antivenom was commonly used, but the use has declined. Doubt has been raised bout the effectiveness of antivenom[31][32] An antivenom for Loxosceles bites is available in South America, and it appears antivenom may be the most promising therapy. However, the recluse antivenom is more effective in experimental animals when given early, patients do not often present until 24 or more hours after the event, possibly limiting the effect of this intervention.[33]

North America

The American Association of Poison Control Centers reported that they received calls regarding nearly 10,000 spider bites in 1994.[14] The spiders of most concern in North America are brown recluse spiders, with nearly 1500 bites in 2013[41] and black widow spiders with 1800 bites.[41] The native habitat of brown recluse spiders is in the southern and central United States, as far north as Iowa. Encounters with brown recluse outside this native region is very rare and bites are thought to be suspect.[4] A dozen major complications were reported in 2013.[41][42]

Historical remedies
Recorded treatment from the 1890s for spider bites in general was rubbing in tobacco juice to the bitten skin,[45] similar to some of the traditional uses of the tobacco plant for various bites and stings from Central and South America.[46] Wild dancing and music was the cure for tarantism—the erotic frenzy believed to arise from the bite of a spider.[47] An antivenom was developed against wolf spiders in Brazil and used for decades. Wolf spiders have since been exonerated—they never caused illness.[48]

[Jhanananda]

After reading these reports I am not convinced that I received a spider bite.  The other option in this region is scorpion bite.

scorpion
Scorpions are predatory arthropod animals of the order Scorpiones within the class Arachnida. They have eight legs[1] and are easily recognised by the pair of grasping pedipalps and the narrow, segmented tail, often carried in a characteristic forward curve over the back, ending with a venomous stinger. Scorpions range in size from 9 mm (Typhlochactas mitchelli) to 20 cm (Hadogenes troglodytes).[2]

The evolutionary history of scorpions goes back to the Silurian era 430 million years ago. They have adapted to a wide range of environmental conditions and can now be found on all continents except Antarctica. Scorpions number about 1750 described species,[3] with 13 extant families recognised to date. Only about 25 of these species are known to have venom capable of killing a human being.[4]:1The taxonomy has undergone changes and is likely to change further, as genetic studies are bringing forth new information.

Scorpion stings are painful but are usually harmless. For stings from species found in the United States, no treatment is normally needed for healthy adults although medical care should be sought for children and for the elderly. Stings from species found elsewhere may require medical attention.[5]

Fluorescence
Scorpions are also known to glow a vibrant blue-green when exposed to certain wavelengths of ultraviolet light such as that produced by a black light, due to the presence of fluorescent chemicals in the cuticle. One fluorescent component is now known to be beta-carboline.[31] A hand-held UV lamp has long been a standard tool for nocturnal field surveys of these animals. Fluorescence occurs as a result of sclerotisation and increases in intensity with each successive instar.[31] This fluorescence may have an active role in scorpion light detection.

Sting and venom

All known scorpion species possess venom and use it primarily to kill or paralyze their prey so that it can be eaten. In general, it is fast-acting, allowing for effective prey capture. However, as a general rule they will kill their prey with brute force if they can, as opposed to using venom. It is also used as a defense against predators. The venom is a mixture of compounds (neurotoxins, enzyme inhibitors, etc.) each not only causing a different effect but possibly also targeting a specific animal. Each compound is made and stored in a pair of glandular sacs and is released in a quantity regulated by the scorpion itself. Of the 1,000+ known species of scorpion, only 25 have venom that is deadly to humans; most of those belong to the family Buthidae (including Leiurus quinquestriatus, Hottentotta, Centruroides and Androctonus).[10][39]
Treatment

First aid for scorpion stings is generally symptomatic. It includes strong analgesia, either systemic (opiates or paracetamol) or locally applied (such as a cold compress). Hypertensive crises are treated with anxiolytics and vasodilators.[40] Scorpion envenomation with high morbidity and mortality is usually due to either excessive autonomic activity and cardiovascular toxic effects or neuromuscular toxic effects. Antivenin is the specific treatment for scorpion envenomation combined with supportive measures including vasodilators in patients with cardiovascular toxic effects and benzodiazepines when there is neuromuscular involvement. Although rare, severe hypersensitivity reactions including anaphylaxis to scorpion antivenin (SAV) are possible.

With this added information I conclude that the bite was most probably scorpion, especially since this region is known for tree scorpions, that tend to fall out of the trees and get into warm places, and I have been parking under trees for shade for months.

The wound did not respond well to soaking the effected part in salt water, so I plan to try an oatmeal poultice, since oatmeal will be served at the Salvation Army free kitchen this morning.  If that does not work, then I will beg some tobacco and try a tobacco poultice.

I will also purchase some batteries for my ultra-violate flash light, which I purchase specifically for the purpose of searching for scorpions in my bedding; and I will use it to search my bedding every night before climbing into my bed.