ACEP Frontline - Emergency Medicine Pedsapalooza from PEM Assembly at Accelerate26
Mar 17, 2026
Richie, a pediatric toxicology and envenomation educator, presents clinical cases and practical tox Q&A. He covers backyard envenomations, antivenom basics, and first aid myths. Short case rundowns include salicylate overdose, hypoglycemia pitfalls, calcium‑channel blocker ingestion, and methemoglobinemia. Practical poison control and triage advice ties the topics together.
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Elapid Versus Pit Viper Dictates Presentation And Antivenom Need
- Recognize two snake classes because clinical effects differ: elapids (coral) cause neurotoxic descending paralysis while pit vipers (rattlesnake, copperhead) cause coagulopathy and local tissue necrosis.
- Treatment thresholds differ: neurotoxicity, hypotension, bleeding, hemolysis, severe local swelling, or involvement of digits prompt antivenom.
Treat Stings Locally And Remove Stinger Fast
- For hymenoptera stings treat locally with ice and antihistamines and reserve steroids only for anaphylaxis.
- Remove honeybee stinger quickly (forceps are fine) because speed matters more than technique to limit venom delivery.
Small Scorpions And Spiders Cause Different Toxic Syndromes
- Not all scary‑looking creatures are clinically dangerous; small scorpions in Arizona have potent ion channel toxins causing cholinergic symptoms and may need antivenom.
- Black widows cause muscle rigidity and abdominal pain; brown recluse causes local necrosis, so analgesia and targeted care are mainstays.