What is the management approach for spider bites?

Management of Spider Bites

First aid for spider bites should include cleaning the wound, applying ice for pain relief, and using over-the-counter pain medications, with emergency services called immediately if systemic symptoms develop. 1

Initial Assessment and Triage

When to Seek Emergency Care

• Call emergency services immediately if the person develops:

  • Difficulty breathing
  • Muscle rigidity
  • Dizziness
  • Confusion
  • Any systemic symptoms 1, 2

• Seek medical care if:

  • Pain extends beyond the bite site
  • Pain becomes severe and uncontrolled by OTC medications
  • An open wound develops
  • Systemic symptoms appear 1

First Aid Management

Immediate Care

1. Clean the wound with soap and water 2
2. Apply ice to the bite site for local pain relief 1, 2
3. Administer over-the-counter pain medications:
   • Acetaminophen
   • NSAIDs (ibuprofen, naproxen) 1
4. If skin is intact, topical 5% lidocaine can be applied for pain relief 1

Species-Specific Management

Black Widow Spider Bites

• Characterized by severe crampy pain, muscle rigidity, diaphoresis, and hypertension 2
• Minimal local tissue damage but significant neuromuscular symptoms 3
• Treatment options:
  • Pain control with acetaminophen/NSAIDs for mild cases
  • For moderate to severe cases: antivenom is most effective 2
  • Alternative treatments include IV opioids with benzodiazepines for muscle relaxation 2, 3

Brown Recluse Spider Bites

• Can cause dermonecrosis within 72-96 hours 3
• First aid approach:
  • Rest and ice compresses
  • Antibiotics to prevent infection
  • Consider dapsone (prescription medication) 3, 4
• Surgical intervention:
  • Generally delayed for several weeks after bite 3
  • May be considered for refractory cases with significant tissue necrosis 5, 6

Common Pitfalls and Caveats

• Misidentification: Most spider bites are misdiagnosed; the offending spider is rarely seen or recovered 7
• Overtreatment: Most spider bites cause only minor local reactions and heal without specific intervention
• Delayed care: Failure to recognize systemic symptoms requiring emergency care can lead to serious complications 1, 2
• Premature surgery: Early surgical intervention for necrotic bites may worsen outcomes; delay surgery when possible 3

Monitoring and Follow-up

• Monitor for development of systemic symptoms
• Ensure tetanus prophylaxis is current 2
• For necrotic wounds, regular wound care and follow-up are essential
• Facial bites should be evaluated by specialists due to cosmetic concerns 2

Remember that while many spiders can bite humans, only a few species in North America (primarily black widow and brown recluse) cause medically significant envenomation 3, 7.