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Bagus Hermansyah


Scorpion are nocturnal and feed on
insects and other arthropods
Attack man accidentally
There are two general types of venoms:
(1) produces a local reaction with only
mild or with no systemic effect, (2)
neurotoxin and its effect can be lethal

Scorpion venoms contain in differing

amount depending on the species;
neurotoxins, hemolysins, hemorrhagins,
leukolysins, agglutinins, coagulants,
enzymes, lecithin, cholesterin, a cardiac
toxin, and a vascular toxin
Mortality 25% in children, 0,25-1,8% in

The body of a scorpion is divided into two
parts: the cephalothorax (prosoma) and
the abdomen (opisthosoma). The
abdomen consists of the mesosoma and
the metasoma.

The cephalothorax, also called the
prosoma, is the scorpion's head,
comprising the carapace, eyes,
chelicerae (mouth parts), pedipalps (
claws) and four pairs of walking legs

The metasoma, the scorpion's tail,
comprises six segments (the first tail
segment looks like a last mesosoman
segment), the last containing the
scorpion's anus and bearing the telson
(the sting). The telson, in turn, consists of
the vesicle, which holds a pair of venom
glands, and the hypodermic aculeus, the
venom-injecting barb.

Symptoms of scorpions
Sharp pain, numbness, throbbing,
drowsiness and an itching sensation in
the mouth, nose & throat
Initially there is a hypersalivasi together
with a sensation of a ball of hair in the
The tongue is sluggish & the muscles of
the jaw are contracted

Disorder of movement in the arms and

Lately, rapid rise in temperature,
reduction of salivary secretion
Toxic effect on the myocardium

One pointed penetration
Ascending motor paralysis
Local pain xylocain
Ligature - cryotheraphy


Spider anatomy:
(1) four pairs of legs
(2) cephalothorax
(3) opisthosoma
Prosoma is joined to
the opisthoma by a
narrow pedicel
Chelicerae have
hook-like movable
digit which carry the
ducts of poison gland

Nervous system blue

Digestive & excretory system green
Circulatory system red
Respiratory system pink
Reproductive system yellow
1 Fang (chelicera)
2 Venom gland
3 Brain
4 Pumping stomach
5 Forward aorta branch
6 Digestive cecum
7 Heart
8 Midgut
9 Malphigian tubules
10 Cloacal chamber
11 Rear aorta
12 Spinneret
13 Silk gland
14 Trachea
15 Ovary (female)
16 Book lung
17 Nerve cord
18 Legs
19 Pedipalp

The vast majority of spiders are
completely harmless
Arachnidisme is a condition caused by a
bite of spiders belonging to the genus
Lactrodectus mactans (black widow
spider) is the most toxic spesies
Lactrodectus venom is neurotoin ( 15x

Local symptom
A slight local swelling around two tiny red
Gangren (by Loxosceles), in children can
evoke severe systemic reaction like
haemolytic anemia and

The pain from Lactrodectus may be
relieved by relaxing the muscle spasm
with iv injections of calcium salts or
magnesium sulphate
Lactrodectus antivenin
Ligature cryotheraphy
For necrotic arachnidism : antihistamin
i.m or i.c, ACTH and corticosteroid
Spesific antivenin


Centipedes (from Latin prefix centi-,
"hundred", and Latin pes,pedis, "foot")
They are elongated metameric animals
with one pair of legs per body segment.
A key trait uniting this group is a pair of
venom claws or forcipules formed from a
modified first appendage

Some species of centipedes can be

hazardous to humans because of their
bite. Although a bite to an adult human
may only be painful, those with allergies
that are similar to that of bee stings and
small children are at greater risk. Smaller
centipedes usually do not puncture
human skin, while larger centipedes may
cause anaphylactic shocks.

Scolopendra gigantea


Millipedes (Class Diplopoda, previously
also known as Chilognatha) are
arthropods that have two pairs of legs
per segment (except for the first segment
behind the head which does not have
any appendages at all, and the next few
which only have one pair of legs).
Each segment that has two pairs of legs
is a result of two single segments fused
together as one.

Most millipedes have very elongated

cylindrical bodies, although some are
flattened dorso-ventrally, while
pill millipedes are shorter and can roll
into a ball, like a pillbug.
Millipedes are detritivores and slow
Most millipedes eat decaying leaves and
other dead plant matter, moisturising the
food with secretions and then scraping it
in with the jaws.



Most important venomous
insect known to humans
More fatalities result from
stings by these insects.

Three major subgroups:

Apidae includes honeybee
and bumblebee
Vespidae includes yellow
jackets, hornets and wasps
Formicidae ants
Most of all allergic reaction
reported yearly occur from
vespid stings.

Apids are usually docile, stinging

only when provoked.
Female bee is capable of stinging
only once. (Male bees have no
Vespid have ability to perform
multiple stings.

Africanized honeybees

Known as killer bees

Now found in Texas, Arizona, California, and
most of the temperate southeastern and
southwestern states.
Attack from these bees massive stinging
resulting in multisystem damage and death
from severe venom toxicity.

Hymenoptera Venom
Contain several components.
Histamine is only a minor component within
the venom.
50% of the venom consist of Melittin.
Melittin is a known membrane-active
polpeptide that can cause degranulation of
basophils and mast cells.
Yellow jackets venom is perhaps the most
potent sensitizer.

Hymenoptera Venom:
Local Reaction
Toxic Reaction
Urticarial lesion contiguous
with the sting site.

Multiple stings (Africanized bees)

can lead to systemic toxic

Severe local reaction may

involve one or more
neighboring joints.

Symptoms may resemble

anaphylaxis, but these pts can
also develop N/V/D.

If the sting involve the mouth

or throat, it can produce
airway obstruction.

They may also have HA, fever,

drowsiness, involuntary muscle
spasms, edema without urticaria,
and convulsions.
Complication Renal / Hepatic
failure, DIC, and Death

Hymenoptera Venom: Anaphylactic


Can occur from a single sting or multiple

May range from mild to fatal and death within
There is no correlation between the systemic
reaction and the number of stings.

Hymenoptera Venom: Delayed


Delayed reaction appearing 5 14 days after

the sting consists of serum sickness-like
signs and symptoms.
Pts can develop fever, malaise, HA, urticaria,
lymphadenopathy, and polyarthritis.

This reaction is believed to be immune


Hymenoptera Venom:

Immediate removal of the

Oral antihistamines and
bee stinger from the wound,
analgesic may limit discomfort,
is the important principle
pruritis, and decrease local
rather than the method of

If pts develop symptoms of

Wash the sting site with soap
anaphylaxis then most
and water to decrease risk of
important agent to give is
Intermittently apply ice to the
site to limit local reaction and
delay absorption of venom.

Epinepherine 0.3 to 0.5mg (0.3

to 0.5 mL of 1:1000 conc.) in
adults and 0.01 mg/kg in children
(never more than 0.3 mg) given

Hymenoptera Venom: Treatment

Other treatment should include:
Diphenhydramine 25 to 50 mg IV, IM or PO
H2-receptor antagonists (ranitidine 50 mg IV)
Methylprednisolone 125 mg
Use Beta agonist nebulization if pt has evidence of
IVF, oxygen, cardiac monitor, pulse ox.
Persistent hypotension after multiple IVF bolus may require
Dopamine or Epinepherine drip

Hymenoptera Venom: Disposition

Pts who develop severe systemic reactions

should be admitted monitored for potential
cardiac, bleeding, renal or neurologic
Skin tests and RASTs (radioallergosorbent
test) are not reliable in determining which
patients are at risk in developing future
systemic reactions.

Hymenoptera Venom: Disposition

Every patient who has had a systemic

reaction should be provided with an
insect sting kit containing premeasured
epinepherine and be carefully instructed
in its use. The physician should stress
that the patient must inject the
epinepherine at the first sign of a
systemic reaction.

Ants (Formicidae)
5 known species of fire ants
(S. aurea, S. geminata, S. xyloni,
S. invicta, and S. richteri)
Fire ants swarm when provoked
and they may attack in numbers.
Fire ants sting simultaneously in
response to an alarm pheromone
A Solenopsis xyloni major
worker surrounded by minor

Ants (Formicidae)
Fire ants sting result in a
papule that becomes a sterile
pustule in 6 to 24 hrs.
Pustule can lead to localized
necrosis scarring
secondary infection.
Systemic reaction (urticaria /
angioedema) can also occur.

Treatment includes:
local wound care.
Usual treatment for
anaphylaxis should be initiated
if there is evidence of systemic

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