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DTM&H > Animal Bites and Stings > Flashcards

Animal Bites and Stings Flashcards

1
Q

What is the global epidemiology of Snake Bites?

A

2.5 million envenomings per year
130 thousand deaths

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2
Q

Snkae bite envenoming is a NTD. What is the NTD goal for reduction of snake bite envenoming deaths and disabilities?

A

50% reduction by 2050

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3
Q

What is the immediate first aid of snake bite?

A
  • DO NO HARM
  • No alcohol
  • No aspirin (> bleeding)
  • Follow normal First Aid protocols
  • Remove constrictive rings, clothing etc
  • Keep victim calm and immobile
  • Immobilise bitten limb with
    pressure immobilisation bandage
    (neurotoxic bites)
  • Take victim rapidly to hospital
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4
Q

What are the limitations to safe and effective antivenoms?

A

Limited species-specificity
* Different products are required to treat bites by different snake species

Poor specificity
* Only 10-20% of antibodies are specific to venom toxins

Poor safety
* Incidence of adverse reactions in up to 55% of cases

Hospital setting
* Intravenous delivery and adverse reactions require hospital setting which delays treatment

Affordability
* The cost of antivenom can be >$1,000 in SSA

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5
Q

What are the main types of envenoming toxicity?

A

Neurotoxic
Haemotoxic
Myotoxic
Cytotoxic

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6
Q

What pattern of envenoming do Vipers produce?

A

Haemotoxic
Cytotoxic

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7
Q

What pattern of envenoming to Elapids (e.g. Cobras) produce?

A

Neurotoxic
Mild cytotoxicity

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8
Q

What pattern of envenoming do sea snakes produce?

A

Myotoxic –> rapid paralysis

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9
Q

What are early symptoms suggestive of envenoming?

A

Enlarged nodes around the site
Nausea, vomitng
Collapse

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10
Q

What is the 20 WBCT?

A

20 min whole blood clotting test - used to assess for haemotoxicity

Simple: take a blood test and see if it has clotted after 20 minutes

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11
Q

How does a neurotoxic snake bite present?

A

Initially Ptosis –> Opthalmoplegia –> Bulbar weakness (POOLING SECRETIONS) –> progressive weakness –> repiratory paralysis

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12
Q

When should you administer antivenom?

A

Signs of neurotoxicity
Extensive cytotoxicity
Shock/ collapse
Renal failure
Bleeding/coagulopathy

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13
Q

How is antivenom produced?

A

Equine Antivenom from Fab/Fab2 antibodies

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14
Q

How do you manage snake bite?

A

Antivenom
Tetanus Toxoid
Abx only if local necrosis

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15
Q

What spider is most likely to cause Fatalities?

A

Funnel Web Spider

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16
Q

How does a person present after being bitten by a funnel web spider?

A

Pain, swelling, hyperaesthesia
Autonomic Dysfxn
Cardiac Failure
Pulmonary Odema
Respiratory Failure

17
Q

How should you manage Scorpion bite sting bradycardias?

A

Atropine

18
Q

What is Rabies?

A

RNA lyssavirus which causes an acute encephalitis and death if untreated

19
Q

How does Rabies Spread

A

BBV/body fluids onto mucosal surfaces

Dogs, bats, wild animal bites

20
Q

How does rabies present?

A

ACUTE: itching, pain, paraestesia at bite site

Fever

FURIOUS RABIES (70%)
Encephalopathy with phases of arousal and lucid intervals

Automonic stimulation
- excess salivation, frothing, temperature dysregulation, priapism

Spasms, Hydrophobia, Aerophobia

Cranial nerve lesions III, VII, VIII

Paralysis

Coma

PARALYTIC RABIES:

  • Ascending paralysis, loss of tendon
    reflexes
  • Fasciculation
  • Sphincter dysfunction
  • Fever, sweating, gooseflesh
  • Bulbar / respiratory paralysis
  • (hydrophobia)
  • Survive < 30 days
21
Q

What is the incubation of Rabies?

A

Generally 1-2 months; can present sooner if the bite is terrible

22
Q

How do you diagnose Rabies?

A

Clinical suspicion +
Viral antigens of brain/tissue/skin OR
CSF antibodies OR
Viral RNA

Saliva, serum and skin biopsies for rabies
–> back of the neck is the best for samples

23
Q

What are the hosts of Rabies virus?

A

dog, fox, raccooon bats

24
Q

What is the epidemiology of Rabies

A

More or less global distribution (athugh in the UK it it European Lyssabat Virus)

In Europe and Canada/USA Dog rabies has been eliminated but bat rabies predominates

59000 deaths per year

25
Q

What kind of virus is the Rapies Virus?

A

RNA Virus

26
Q

How does the rabies virus invade the body?

A

Enters into peripheral nerve cells,

Virus travels centripetally into the central nervous system –> encephalitis

27
Q

What is the differential for Rabies?

A

Hysterical pseudo-hydrophobia
* (Cephalic) tetanus
* Other brain stem encephalitides
– Enterovirus, borrelia, brucella, mycoplasma
* Other causes of muscle spasms
– (eg phenothiazine dystonia, tetany, strychnine
poisoning)
* Delirium tremens
* Cerebrovascular accident, epilepsy
* Porphyria

28
Q

How do you manage fulminant rabies (I.e. beyond the point of PEP)?

A

** Industrial doses of sedatives**

Diazepam
Chlorpromazine
Diamorphine

Barrier nursing
Vaccinaition of staff and intimate contacts
Inform public health

29
Q

What are the two vaccine options?

A
  • Pre-exposure vaccination
    – i.e before get bitten, before travel
    – Simplifies post exposure regimen
    – Active immunization
  • Viral antigen to stimulate immune response
  • Post exposure vaccination
    – Active immunization
    – Passive immunization
  • Antibody (rabies immunoglobulin)
30
Q

What are the WHO Rabies classes?

A

I. Licks on unbroken skin
Touching/petting infected animal

II. Nibbles, cuts, scratches that are oozing

III. Licks on mucous membranes
Bites with breech of skin / bleeding

31
Q

How do you manage Rabies?

A

Management depends on the WHO class

1 –> First aid only
2. –> First Aid + Vax
3. –> First Aid + Vax + Immunoglobulin (NOTE: RIG still needs to be given in immunised people, but the duration is shorter; ie. only required for 24-48h)

32
Q

How effective is the treatment for rabies if given in a timely fashion?

A

PEP + RIG = (nearly) 100% efficacy at stopping rabies if not already disseminated neurologically

33
Q

How should you administer RIG?

A

injected directly into the wound

DTM&H (29 decks)

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