Adult Envenomation Flashcards
What are our general care priorities for suspected Envenomation
- History alone is enough to suspect
- Manage Airway, ventilation and perfusion
- Pain relief as per PR CPG
- Nausea and vomiting as per NV CPG
- Seizure as per Seizure CPG
Consider ARV and piper for management advice
What are the signs and symptoms of systemic snake envenomation
- Eyelid drooping, diplopia
- Slurred speech
- Muscle weakness
- drooling
- Pain (generalised, lymph nodes, headache, Abdominal)
- N&V
- Respiratory distress
- loss of conciousness/paralysis
- Bleeding from bite site or elsewhere, nose, gums, passing dark or red urine
Treatment of a snake bite
- PBI (pressure bandage with immobilisation)
- PBI should be as tight as that for a sprained limb
- ensure PBI does not cause loss of peripheral pulses.
- use the 15cm elasticated roller bandage.
- Splint
Treatment with all bites
- Do not walk the patient
- immobilise on stretcher
- IV access x2
- Respiratory distress: O2
- Supportive ventilation if required
- CONSULT ARV EARLY if Tx is >30min
Treatment of a red back spider
- NO PBI
- Ice pack
Treatment of a big black spider
- Do not walk the patient
- Bite to limb: PBI
- Immobilise on stretcher
- pulmonary oedema: CPAP
- excessive secretions:
ATROPINE 600mcg (MICA)
Treatment of a tick
- May cause anaphylaxis early (manage as per anaphylaxis CPG)
- May cause slow developing paralysis over days.
Treatment
- Do not attempt to remove tick if encountered (require careful removal so as not to leave the head embedded.
Treatment of non - tropical jellyfish inc blue bottle
- Wash effected area with sea water if possible
- Gently pick of tentacles
- Apply warm or hot water if possible
- consider ice pack if water not available
- DO NOT APPLY Vinegar
Treatment of a barbed fish/ray
- Do not attempt to remove barb
- Manage any hemorrhage
- Immerse in warm/hot water
Treatment of a blue ringed octopus
Consider prolonged respiratory resuscitation. Due to paralysis
When should you expect to see anaphylaxis in the envenomation CPG
- Tick bite
- possible response to antivenom
Which stings/bites/barbs require warm/hot water
- Barbed fish/rays
- Non tropical jelly fish (including bluebottle)
General management of all Envenomation patients
-Contact ARV/PIPER via clinician for management advice
- In the case of a patient who is symptomatic after a suspected or confirmed bite, if Tx time >30 consult early with ARV to facilitate transport of patient to appropriate destination for Anti venom
- caring for patients in the hours following envenomation (inc interhospital tx) will include monitoring for signs of coagulopathy (bleeding from bite site or IV) and renal impairment, inc measuring UO
Paediatric envenomation
-Envenomation should be considered when faced with a paediatric patient with sudden unexplained illness
- Children are at high risk due to venom/body weight ratios
