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 and if tport time greater then 30min
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 snake 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
Seizure management Adult
- Maintain airway and O2
- Seizure time >5 minutes 10mg of midazolam
-No response after 5 minutes 10mg as a one only repeat
FRAIL - 5 mg repeat once only at 5 min
Consult for further doses monitor ABCs
Seizure management Paediatric
- Airway and oxygen ventilate as required
Midazolam dosing for seizure >5/60 - Newborn (<24 hrs) 0.5 mg IM
- Infant (<12months) 1mg IM
- Small child (1-4y) 2.5 mg
- Medium child (5-11y) 2.5-5 mg
- Large child (12-15y) 5 mg
Repeat original dose at 10min interval once only
CPAP indications and setting
Settings
Commence flow of O2 at 10lt
Fit mask
set pressure to 10cmH2O
increase O2 flow to 12-14 lt/min to achieve 10cmH2O
CPAP contraindications
AIRWAY
- inability to manage own airway (altered conscious state, active vomiting, excessive secretions)
BREATHING
- Hypoventilation (pt must have adequate spontaneous breaths)
- Untreated TNP (TNP must be treated prior to commencing TNP)
CIRCULATION
- Haemodynamic instability (Severe hypotension, ventricular arrythmias etc, should be treated prior to considering CPAP)
OTHER
- Injuries precluding mask application.
Application of a PBI for bites notes and indications
-Indications
** suspected or reported Snake, Big black spider or blue ring octopus bite to limb.
- Contraindications
** none to above indications
Notes
- remove jewelry to effected limb
- Expose limb
- Apply SBB beginning over bite and tension so rectangles turn to squares
- Mark location of bite on bandage
- move distally down limb covering half the bandage width each wrap.
- Ensure end of digits are accessible for vascular obs.
- Move back up the limb using the tension indicators to maintain tension
- Anchor with 5 cm strips of tape and remark bandage at bite site.
- Utilise splinting for limb immobilisation
Differentials for Envenomation
- Dehydration
- Overdose
- Stroke
- Siezure
Focused assessment for envenomation
- AEIOUTIPS
- MASS
- Neurovascular assessment
Envenomation risks of deterioration
- Respiratory distress/arrest
- Multi organ failure
- Coagulopathy
- Tissue failure
- Loss of limb
