TABLE 90.18 APPROPRIATE LABORATORY TESTS FOR PATIENTS INVOLVED IN A SIGNIFICANT RADIATION ACCIDENT In the emergency department Complete blood cell count with special attention to the lymphocyte count, repeat every 2–3 hours for the first 8–12 hours following exposure and then every 4–6 hours for the following or days Nasal swabs Collect all excreta Later Cytogenetics Sperm count Eye examination (baseline for cataracts) Human leukocyte antigen typing BITES AND STINGS Goals of Treatment General care should include relief of pain and itching, tetanus prophylaxis, antibiotics if needed, and emotional support Animals must be identified as venomous or not, and appropriate methods to inactivate the venom should be instituted, or if available specific antivenom should be administered Additional clinical observation may be required to determine the extent of injury CLINICAL PEARLS AND PITFALLS Knowledge of common animals in your location of practice is essential in identification and/or treatment of potential victims Shock can occur even with seemingly minor local injury because of the systemic effects of toxins Consider tetanus prophylaxis in all victims of bites or stings Wound closure may be delayed when there is a high risk of infection MARINE INVERTEBRATES