See also

Spider bite - redback spider

Poisoning – Acute guidelines for initial management
Resuscitation

Key points

1.  Big black spiders include the Sydney Funnel Web, which can cause lethal envenoming, however there have not been any cases of severe envenoming in Victoria, despite some Victorian spiders having similar toxicity
2. Apart from Red back spiders, other Victorian spiders do not require medical intervention or observation unless infection develops

Background

• The Victorian Funnel Web spider, found in the Dandenong Ranges area, is not significantly venomous and causes minor symptoms such as bite-site pain, headache and nausea
• Whilst Sydney Funnel Webs should not be found in Victoria, beware of collectors 
• Other funnel web spiders and mouse spiders have a distribution extending into Eastern Victoria and may cause systemic symptoms
• Museum Victoria has a picture gallery of common Victorian spiders

Patients requiring assessment

• Any patient in whom a Sydney Funnel Web spider bite is possible
• Any symptomatic patient

Risk Assessment

History and Examination

• Bitten by a big black spider, with sudden pain 
• Bite marks are usually seen
• Only a small number of bites develop systemic envenomation
• If systemic symptoms develop, they do so over 10 min - 4 hours
• Perioral tingling
• Headache, nausea, vomiting, abdominal pain
• Salivation, piloerection, sweating and lacrimation, due to autonomic hyperactivity
• Hypertension and tachycardia - may progress to bradycardia and hypotension
• Pulmonary oedema, cyanosis, respiratory failure

Always check for Medicalert bracelet in any unconscious patient, or any other signs of underlying medical condition (fingerprick marks etc)

Investigations:

• Nil initially required

Acute Management

• First Aid
• Apply a pressure immobilisation bandage
• If history or examination findings suggest envenomation, leave bandage in place and discuss with the Poisons Information Centre (13 11 26). 

• Resuscitation
• Standard procedures and supportive care. See resuscitation

• In the absence of antivenom, management may require
• Pulmonary oedema - intubation, IPPV/ PEEP,
• Hypertension and tachycardia- sympathetic blockade (alpha)
• Hypotension - fluids, ionotropes, atropine

• Antivenom
• Contact Poisons Information Centre (13 11 26) in Victoria as no hospitals stock Sydney Funnel Web antivenom
• If Sydney Funnel Web is possible, or if symptomatic, obtain 4 ampoules of CSL funnel web spider antivenom before removing bandage

Consider consultation with local paediatric team when 

Consult Contact Victorian Poisons Information Centre 13 11 26 for advice

Consider transfer to a tertiary centre when

Patients requiring care outside the comfort level of the local hospital. 
For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.  

Consider Discharge when

If Sydney funnel Web is possible, or if was symptomatic: discharge if asymptomatic at 4 hours post bite, at least 2 hours after removal of first aid. 

Last Updated August, 2018