Dr. McKeown, Dr. Solomon, and Ms. Mitchell have disclosed that they have no significant relationships with or financial interests in any commercial companies that pertain to this article. There is no commercial support for this activity.

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME). The American College of Emergency Physicians is accredited by the ACCME to provide continuing medical education for physicians.

The American College of Emergency Physicians designates this enduring material for a maximum of 1 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

“Focus On … Critical Decisions: Spider and Insect Envenomation” is approved by the American College of Emergency Physicians for 1 ACEP Category I credit.

Disclaimer

ACEP makes every effort to ensure that contributors to College-sponsored programs are knowledgeable authorities in their fields. Participants are nevertheless advised that the statements and opinions expressed in this article are provided as guidelines and should not be construed as College policy. The material contained herein is not intended to establish policy, procedure, or a standard of care. The views expressed in this article are those of the contributors and not necessarily the opinion or recommendation of ACEP. The College disclaims any liability or responsibility for the consequences of any actions taken in reliance on those statements or opinions.

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References

1. Clark S, Camargo CA Jr. Emergency treatment and prevention of insect-sting anaphylaxis. Curr Opin Allergy Clin Immunol. 2006 Aug;6(4):279-283.
2. Peterson ME. Black widow spider envenomation. Clin Tech Small Anim Pract. 2006;21:187-190.
3. Rauber A. Black widow spider bites. J Toxicol Clin Toxicol. 1983;21:473-485.
4. Clark RF, Wethern-Kestner S, Vance MV, Gerkin R. Clinical presentation and treatment of black widow spider envenomation: a review of 163 cases. Ann Emerg Med. 1992;21:782-787.
5. Vetter RS, Isbister GK. Medical aspects of spider bites. Annu Rev Entomol. 2008;53:409-429.
6. Diaz JH, Leblanc KE. Common spider bites. Am Fam Physician. 2007;75:869-873.
7. Futrell JM. Loxoscelism. Am J Med Sci. 1992;304:261-267.
8. Swanson DL, Vetter RS. Bites of brown recluse spiders and suspected necrotic arachnidism. N Engl J Med. 2005;352:700-707.
9. Furbee RB, Kao LW, Ibrahim D. Brown recluse spider envenomation. Clin Lab Med. 2006;26:211-216.
10. Rash LD, Hodgson WC. Pharmacology and biochemistry of spider venoms. Toxicon. 2002;40:215-254.
11. da Silva P, da Silveira R, Appel MH, et al. Brown spiders and loxoscelism. Toxicon. 2004;44:693-709.
12. Isbister GK, White J. Clinical consequences of spider bites: recent advances in our understanding. Toxicon. 2004;43:477-492.
13. Elston DM. What’s eating you? Tarantulas (Theraphosidae). Cutis. 2002;70:162-163.
14. Hered RW, Spaulding AG, Sanitato JJ, Wander AH. Ophthalmia nodosa caused by tarantula hairs. Ophthalmology. 1988;95:166-169.
15. Kemp SF, deShazo RD, Moffitt JE, et al. Expanding habitat of the imported fire ant (Solenopsis invicta): a public health concern. J Allergy Clin Immunol. 2000;105:683-691.
16. Klotz JH, Pinnas JL, Greenberg L, et al. What’s eating you? Native and imported fire ants. Cutis. 2009;83:17-20.
17. Golden DB. Insect sting anaphylaxis. Immunol Allergy Clin North Am. 2007;27:261-272, vii.
18. Habermann E. Bee and wasp venoms. Science. 1972;177:314-321.
19. Betten DP, Richardson WH, Tong TC, Clark RF. Massive honey bee envenomation-induced rhabdomyolysis in an adolescent. Pediatrics. 2006;117:231-235.
20. Sitprija V. Animal toxins and the kidney. Nat Clin Pract Nephrol. 2008;4:616-627.
21. Sampson HA, Muñoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: summary report—second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. Ann Emerg Med. 2006;47:373-380.

Questionnaire Is Available Online

This educational activity is designed for emergency physicians and should take approx- imately 1 hour to complete. Participants will need an Internet connection through Firefox, Safari or Internet Explorer 6.0 or above to complete this Web-based activity. The CME test and the evaluation form are located online at www.ACEP.org/focuson.