Frederick CPR Instruction

Below are a couple of images depicting typical changes seen on an EKG during an acute myocardial event (commonly called a "heart attack" by the lay public).  The changes can give an indication of not only the level of injury, but the location within the heart of the injury.  Note that patients can also have NSTEMI (Non-ST elevation Myocardial Infarction) where there is damage without EKG changes, but the 12 lead EKG is still the fastest down and dirty test available in the setting of acute chest pain!  It is an absolute priority to obtain one in an otherwise stable (I.E. not needing immediate life saving measures) patient complaining of chest pain that could be cardiac in origin. 

Click the images to enlarge them for easier reading.  For another little trick on remembering the location of the heart that corresponds to an EKG, check out the video on Hooper's sign here: https://www.youtube.com/watch?v=NSpAFdoTNts

The brown recluse spider has a violin shaped body.  As the name implies, this spider is a good hider, and can be found in caves, wood piles, and sheds. They range through the south and Midwest, extending to the westward edge of West Virginia.  They are not thought to commonly be in Maryland, although they are predicted to greatly stretch their range over the next several years due to global warming.  In rare instances, they could 'hitch a ride' in a package or freight to Maryland.

The venom of a brown recluse is a hematotoxin.  The toxin causes vasoconstriction of the area around the bite, cutting off blood flow and causing necrosis.  The venom also causes platelet aggregation, which forms clots in the  vessels around the bite, and hemolysis (breaking of red blood cells).   Still, 90% or more of bites heal without a scar.

Bites are graded in a similar way as hematotoxic snake bites.

Grade 1 - no symptoms.

Grade 2-  there is erythema (redness),and edema (swelling)

Grade 3- necrosis (some death of tissue), healing will leave a scar

Grade 4- systemic effects are present, such as fever, chills, nausea/ vomiting, weakness, and rash.  There can even be worse effects, such as generalized hemolysis,  DIC (disseminated intravascular coagulopathy), Rhabdomyolysis (protein in the urine, clogging the kidneys), renal failure, and pulmonary hemorrhage  The bite is potentially fatal to small children.

The initial bite can be painless, but within 2-8 hours a lesion can develop, with induration, and a cyanotic ring around the area, showing lack of blood flow.  This can progress to eschar formation (dark dead tissue) in 4 days or so.

There is no antivenin for a brown recluse bite. The treatment is supportive care for symptoms, and possible hyperbaric oxygen treatment to the wound, to promote blood flow.

'Critter bites' are covered in AHA's First Aid course.