What is usually the first step in the treatment of a severe spider bite?

In cases of severe spider bites, the first step in treatment typically involves the application of ice to the area of the bite. This helps to reduce swelling and pain and can slow the spread of venom through vasoconstriction. Cooling the affected area limits edema and may provide symptomatic relief.

While other treatments like antibiotic therapy may be utilized if there is a secondary infection or if the bite causes an ulcerative lesion, these interventions are not the initial priority in managing the bite itself. Surgical excision is usually reserved for cases where there's significant necrosis or an infection that warrants more invasive intervention and is not usually part of the first response. Intravenous fluid administration can be important in cases of systemic involvement and severe reactions but is also not the immediate action taken right after a spider bite. Thus, the application of ice serves as an effective initial treatment strategy for limiting complications from the venom while assessing the patient's condition further.