ENVENOMATIONS - Medicine for Mountaineering and Other Wilderness Activities - page 506

blisterrupturesandtheinvolvedskinturnsdarkbrownorblack.Eventuallytheblack,dead
tissue drops away, leaving a crater that heals with scarring.
A few individuals have skin losses large enough to require grafts to cover the defect.
Generalized symptoms may appear within thirty-six hours of the bite and include chills
and fever, nausea and vomiting, joint pain, and a skin rash or hives. With severe reactions,
destruction of red blood cells (hemolysis) and platelets (thrombocytopenia), resulting in a
significant anemia and bleeding tendency, has been described. Rare fatalities have been re-
ported in children, but the website for the Department of Entomology of the University of
California Riverside claims that bites by brown recluse spiders have never been documen-
ted for such individuals ( http://spiders.ucr.edu/dermatol.html ) .
Routine care should include elevation and immobilization of the affected limb, applica-
tion of ice, local wound care, tetanus prophylaxis, and other supportive care as needed. No
effective, specific therapy for brown recluse bites has been established, particularly in wil-
derness situations where appropriate injectable medications would rarely be carried. Ac-
cording to a review in the New England Journal of Medicine in 2005, reported therapies
have included hyperbaric oxygen, dapsone, antihistamines, antibiotics, dextran, glucocor-
ticoids,vasodilators,heparin,nitroglycerin,electricshock,curettage,surgicalexcision,and
antivenom. None have been subjected to controlled, randomized trials; many are costly,
painful, or potentially toxic.
Scorpion Stings
Scorpions are invertebrates found throughout most of the United States, but the species
lethal for humans, the bark scorpion ( Centruroides ), is limited to Arizona, New Mexico,
Texas, southern California, and northern Mexico. In this area scorpions are a significant
problem. Sixty-nine deaths resulted from scorpion stings in Arizona between 1929 and
1954. During the same period, only twenty deaths resulted from venomous snakebites.
With improved medical management of the complications of scorpion stings, no deaths
have occurred in Arizona for well over twenty years.
These eight-legged arachnids range in length from three to eight inches (7.5 to 20 cm)
and have a rather plump body, thin tail with a stinger at the end, and large pincers, They
are found mostly in dry climates under rocks and logs; buried in the sand; in collections of
lumber, bricks, or brush; and in the attics, walls, or understructures of houses or deserted
buildings. The problems with scorpions in Arizona are clearly related to their tendency to
live in the vicinity of human habitation where children are frequently playing.
Stingscanbeavoidedbyexercisingcarewhenpickingupstones,logs,orsimilarobjects
underwhichscorpionshideduringtheday.Sincescorpionsarenocturnal,walkingbarefoot
after dark is inadvisable. Shoes and clothing should be shaken vigorously before dressing
in the morning, particularly when camping outdoors. Tents or tarps should be lifted with
caution because scorpions frequently crawl underneath them at night.