Chapter 20 - Emergency Med Flashcards
1
Q
What is the most common cause of cardiac arrest in a child?
A
a lack of oxygen supply to the heart secondary to a pulmonary problem, respiratory arrest, or shock
2
Q
What is the most common cause of airway obstruction and what are two methods for opening an airway?
A
- the victim’s tongue
- head-tilt method or jaw-thrust method
3
Q
What is shock?
A
a clinical state characterized by inadequate delivery of oxygen and metabolic substrates, which may be present with normal or decreased blood pressure
4
Q
What are the three degrees of shock?
A
- compensated: blood pressure and cardiac output are adequate but there is maldistribution of blood flow to essential organs
- decompensated: hypotension and inadequate tissue perfusion
- irreversible: that characterized by cell death which is refractory to medical treatment
5
Q
What is the most common cause of shock in pediatrics?
A
hypovolemic, secondary to hemorrhage or dehydration
6
Q
What volume loss is required for decompensated shock?
A
20-25%
7
Q
What are the two subtypes of distributive shock?
A
anaphylactic and neurogenic
8
Q
What is neurogenic shock?
A
a subtype of distributive shock in which there is a loss of distal sympathetic cardiovascular tone with resulting hypotension
9
Q
What physical exam findings are consistent with shock?
A
- tachycardia typically occurs before hypotension
- tachypnea occurs to compensate for severe metabolic acidosis
- mental status change
- prolonged capillary refill with cool with mottled extremities
10
Q
What labs are indicated in someone who is in shock?
A
- CBC to assess for blood loss and infection
- electrolytes to assess for abnormalities including acidosis
- BUN and creatinine to evaluate renal function and perfusion
- calcium and glucose
- coagulation factors to evaluate for DIC
- toxicology screens
11
Q
How should shock be managed?
A
- supplemental oxygen and early endotracheal intubation
- obtaining vascular access and first providing a 20 mL/kg bolus of normal saline
- restore intravascular volume before use of inotropic or vasopressor agents
- inotropic and vasopressor medications
- treatment of metabolic derangements
- antibiotics if infection is present, blood products for hemorrhage, and fresh-frozen plasma for those in DIC
12
Q
Shock
A
- defined as inadequate delivery of oxygen and metabolic substrates with or without hypotension
- goes through compensated, decompensated, and irreversible stages
- may be hypovolemic, distributive, or cardiogenic
- often presents with tachycardia, tachypnea, mental status change, and prolonged capillary refill
- evaluate patient with a CBC, electrolyte panel, BUN and creatinine, calcium and glucose, coagulation factor assessment, and toxicology screen
- treat with supplemental oxygen and ET intubation, fluid resuscitation including an initial 20mL/kg bolus, inotropic and vasopressor medications, and correction of metabolic derangements
- may also require antibiotics, blood products for hemorrhage, or fresh-frozen plasma for DIC
13
Q
What is the leading cause of death in children less than 1 and older than 1?
A
- less than 1 yo is SIDS
- more than 1 yo is trauma with MVA’s being the leading cause of trauma-related deaths
14
Q
Why are children affected by trauma differently than adults?
A
- children have a shorter neck supporting a relatively greater weight
- children have a more pliable rib cage meaning more energy is transmitted to internal organs
- children have growth plates that leave weak epiphyseal-metaphyseal junctions, weaker than ligaments
- children have underdeveloped abdominal musculature and thus less protection from abdominal trauma
15
Q
What are the ABCDEs of emergency med?
A
- airway
- breathing
- circulation
- disability (glasgow coma score)
- exposure/environmental (undress to facilitate examination and then warm to prevent hypothermia)
16
Q
What three things could pulseless electrical activity on an ECG indicate?
A
- cardiac tamponade
- tension pneumothorax
- profound hypovolemia
17
Q
What are the most common complications of pediatric head trauma?
A
- self-limited post-traumatic seizures
- infants are at risk for subgaleal and epidural bleeds
- risk epidural or subdural hematoma
- intracerebral hematoma, usually affecting the frontal or temporal lobe as a contrecoup injury
18
Q
Epidural Hematoma
A
- a collection of blood between the dura and the skull
- classically caused by a fracture of the temporal bone, which ruptures the middle meningeal artery
- must be an artery because a vein doesn’t have enough pressure to open a space between the dura and temporal bone
- often presents with a lucid interval before the onset of neurologic signs and progression indicates an abrupt expansion
- expansion may cause transtentorial herniation with CN III palsy
- seen as a “lens-shaped” lesion on CT which doesn’t cross suture lines
- herniation is the feared, lethal complication which is why epidural hematomas require immediate surgical drainage
19
Q
Subdural Hematoma
A
- a collection of blood beneath the dura
- due to tearing of the bridging veins that lie between the dura and arachnoid, typically with trauma
- presents with the immediate onset of progressive neurologic signs
- crescent-shaped lesion on CT that crosses suture lines and which is hyperdense if acute and hypodense if chronic
- transtentorial herniation is the feared, lethal complication, but drainage is not as emergent as for an epidural hematoma
20
Q
How does an epidural hematoma differ from a subdural hematoma?
A
- subdural are more common in pediatric patients
- epidural appears lens-shaped on CT while subdural appears crescent-shaped
- epidural is associated with trauma and fracture of the temporal bone, which injures the middle meningeal artery while subdural is associated with age-related cerebral atrophy and rupture of veins
- epidural hematomas often have a lucid period after the injury followed by the onset of neurologic symptoms while subdurals have no associated lucid period
- epidurals require immediate drainage whereas subdural are not as emergent
21
Q
Describe the first and other signs and symptoms of ICP, the complications of rising ICP, and the management.
A
- headache is usually the first symptom while pupillary changes and altered mental status are the first signs
- other symptoms include vomiting, stiff neck, double vision, transient vision loss, gait disturbance, dulled intellect, and irritability
- other signs include papilledema, cranial nerve palsies, stiff neck, head tilt, retinal hemorrhage, obtundation, hyper resonance of the skull to percussion, unconsciousness, and progressive hemiparesis
- can be complicated by transtenorial or uncalled herniation, producing bradycardia, fixed and dilated ipsalteral pupil which is later bilateral, contralateral hemiparesis, and Cushing’s triad
- should be managed with mild hyperventilation, elevation of the head to encourage venous drainage, and diuretics like mannitol
22
Q
What is Cushing’s triad?
A
- a triad of hypertension, bradycardia, and respiratory depression following a rise in intracranial pressure
- increased intracranial pressure constricts arterioles and contributes to cerebral ischemia
- pCO2 rises and pH drops, triggering the central chemoreceptor to initiate reflex sympathetic activity
- this increases perfusion pressure (hypertension), which stretches the carotid wall and activates the carotid baroreceptor
- the effect is bradycardia
23
Q
What is SCIWORA?
A
spinal cord injury without radiographic abnormality, which is more common in children than adults
24
Q
Tonsillar Herniation
A
- displacement of the cerebellar tonsils into the foramen magnum
- results in compression of the brainstem and cardiopulmonary arrest
- the most common form of brain herniation
25
Uncal Herniation
- displacement of the temporal lobe uncus under the tentorium cerebelli
- compresses CN III, leading to a "down and out" positioning of the eye with dilated pupil
- also compresses the PCA, leading to infarction of the occipital lobe with contralateral homonymous hemianopsia with macular sparing
- Kernohan notch (indentation of the contralateral cerebral peduncle) results in a "false localization" sign with paralysis on the side ipsilateral the primary lesion/herniation
26
Transtentorial Herniation
- herniation caused by a supratentorial mass
- results in caudal displacement of the brain stem
- potential for rupture of the paramedian artery leading to a brainstem hemorrhage (aka Duret hemorrhage)
- usually fatal
27
Tension Pneumothorax
- due to a penetrating chest wall injury
- air enters but cannot exit the pleural space, pushing the trachea to the side opposite the injury
- presents with distended neck veins, diminished breath sounds, unilateral chest expansion, pulseless electrical activity, and hyper-resonance to percussion
28
Duodenal Hematoma
- most commonly due to injury of the right upper quadrant, classically from a bicycle handle bar
- presents with abdominal pain and vomiting
- bowel obstruction is found on abdominal x-ray
29
What are the most common injuries induced by a lap belt?
- chance fracture (flexion disruption of the lumbar spine)
- liver and spleen laceration
- bowel perforation
30
What defines a first-degree, superficial second-degree, deep second-degree, and third-degree burn?
- first involves only the epidermis; presents with red, blanching, painful skin; and heals without a scar
- superficial second involves the entire dermis and the outer portion of the dermis; presents with moist, painful, red skin which blisters but doesn't scar
- deep second involves the entire epidermis and lower dermis; presents with pale white skin which blisters and scars
- third involve the epidermis, dermis, and subcutaneous tissue; presents with dry, white, and leathery skin that isn't painful due to destruction of nerve endings
31
What are two methods for calculating the body surface area of a burn? Which is preferred for pediatrics?
- the rule of 9s: each arm is 9%, each leg is 18%, the anterior trunk is 18%, the posterior trunk is 18%, and the head/neck is 9%
- the rule of 9s overestimates burns in children because children have relatively larger heads and smaller legs
- instead, we say that the palm is approximately equivalent to 1% body surface area
32
How should burns be managed?
- endotracheal intubation for anyone who has inhaled hot gases
- assessment of oxygenation by pulse ox
- establishment of IV access with initial fluid resuscitation
- skin care depending on the degree of burn: first requires moisturizers and analgesics; second require analgesics, debridement, and removal of ruptured bullae; third require grafting, hydrotherapy, and possibly escharotomy
- second and third degree require antibiotics, typically 1% silver sulfadiazine
- hospitalization for anyone who has a second-degree burn covering more than 10% of body surface area, third-degree covering more than 2% of surface area, suspected inhalation injury, or suspected non-accidental trauma
33
Why should anyone who has inhaled hot gases be intubated?
because a burn to the upper airway results in progressive edema and airway obstruction
34
What are the indications for hospitalization in burn patients?
- second-degree covering more than 10% of surface area
- third-degree covering more than 2% of surface area
- suspected inhalation injury
- suspected non-accidental trauma
35
What is the primary antibiotic used in burn patients?
1% silver sulfadiazine
36
How does skin care differ for the different degrees of burns?
- first: moisturizers and analgesics
- second: analgesics, debridement, and removal of only ruptured bullae since intact bullae protect against infection
- third: grafting, hydrotherapy, and possibly escharotomy
- second and third degree require antibiotics, typically 1% silver sulfadiazine
37
What is an escharotomy?
surgical removal of a constricting scar which may be needed if the burn restricts blood flow or chest expansion
38
What is the difference between a wet drowning and a dry drowning?
- wet involves asphyxia from aspirating liquid
| - dry is asphyxia resulting from laryngospasm
39
In what ways does water damage the lungs and contribute to respiratory failure?
exposure to fresh or salt what causes diminished pulmonary compliance, increased airway resistance, increased pulmonary artery pressures, and impaired gas exchange through three mechanisms
- causes desaturating of surfactant
- triggers alveolar instability and collapse
- leads to pulmonary edema
40
Near Drowning
- may be a wet drowning in which asphyxia results from aspiration of water or a dry drowning in which asphyxia results from laryngospasm
- wet drowning is complicated by surfactant denaturation, alveolar instability and collapse, and pulmonary edema due to exposure to the lungs to water
- presents with absent or irregular respirations and cough productive of pink frothy material; you may also see neurologic insult, cardiovascular abnormalities, or renal failure as a result of hypoxia
- over the next 24 hours, there may be a slow deterioration of pulmonary function with hypoxemia and hypercarbia or development of pneumonia from aspiration of fluid containing oral flora
- treat with initial ABCs, cervical spine immobilization, removal of wet clothes, PEEP, and rewarming with warm saline gastric lavage
- children have a better prognosis than adults because their primitive dive reflex shunts blood to vital organs
- however, children younger than 3, those submerged more than 5 minutes, those who experienced a more than 10 minute delay in resuscitation, those who required cardiopulmonary resuscitation, those with abnormal neurologic findings/seizures, and those with pH<7 all have a poor prognosis
41
What factors suggest a poor prognosis in pediatric patients who suffer a near drowning?
- younger than 3
- submerged more than 5 minutes
- had a more than 10 minute delay in resuscitation
- required cardiopulmonary resuscitation
- have abnormal neurologic findings/seizures
- have a pH<7
42
What are the risk factors for being a victim of child abuse?
- younger than 4 years old
- mental retardation or challenging temperament
- history of premature birth, low birth weight, neonatal separation from parents, or multiple births
- chronic illness
43
What are the risk factors for being an abusive caregiver?
- low self-esteem, social isolation, depression, or history of substance abuse
- history of child abuse
- history of mental illness
- history of violent temperament
- family dynamics including single parenthood, unemployment, poverty, martial conflicts, and domestic violence
44
What sorts of bruises are consistent with inflicted injury?
- those on fleshy or protected areas
- those in various stages of healing
- those with distinct patterns consistent with blunt objects
45
Describe the timeline for color change of a bruise.
- 0 to 3 days: red-blue
- 3 to 5 days: blue-purple
- 5 to 8 days: green
- 8 to 14 days: yellow-brown
46
What is a metaphyseal fracture?
one caused by torsional force on a limb or by violent shaking, consistent with inflicted trauma
47
What sorts of fractures are consistent with intentional injury?
- spiral fractures
- metaphyseal fractures
- those on the posterior or first ribs, sternum, scapula, or vertebral spinous process
48
Describe the features of shaken baby syndrome?
- most often occurs in children younger than 2 yo
| - presents with retinal hemorrhages, subdural hematomas, metaphyseal fractures, and significant brain injury
49
Describe the diagnosis and management of sexual abuse.
- obtain a history with open-ended questions; there will often be non-specific abdominal and GU symptoms
- young children may exhibit sexual behavior, which is a red flag
- you may note signs of physical trauma but most physical exams are normal
- should collect forensic evidence (serology for STEDs, pregnancy test, assessment of vaginal fluid for spermatozoa) if abuse occurred within 72 hours
- contact child services, provide high-dose oral contraceptives (morning-after), and antibiotics for the empiric treatment of STDs
50
SIDS
- defined as death of an infant younger than 1 yo, which is unexplained by thorough investigation
- it is the most common cause of death in children younger than 1 with a peak incidence at 2-4 months
- risk factors include prone sleeping position, soft bedding or overbundling, prematurity, twin of SIDS patient, low birth weight, recent illness, lack of breastfeeding, and maternal smoking, drug abuse, or infection
- should always attempt resuscitation
- intrathoracic petechiae are the most common finding on autopsy
51
What screening tests are used in suspected poisoning victims?
- serum glucose
- electrolytes
- serum and urine toxicology
52
Give the toxin associated with these odors:
- bitter almond
- garlic
- acetone
- wintergreen
- moth balls
- bitter almond: cyanide
- garlic: arsenic or organophosphates
- acetone: salicylates or isopropyl alcohol
- wintergreen: methyl salicylate
- moth balls: camphor
53
Give the toxin associated with these skin findings:
- cherry red
- sweaty
- dry skin
- urticaria
- gray cyanosis
- cherry red: CO and cyanide
- sweaty: organophosphates and sympathomimetics
- dry skin: anticholinergics
- urticaria: allergic reaction
- gray cyanosis: methemoglobinemia
54
Give the toxins associated with these eye findings:
- miosis
- mydriasis
- nystagmus
- retinal hemorrhages
- miosis: opiates, phencyclidine, organophosphates, phenothiazines
- mydriasis: amphetamines, cocaine, TCAs, atropine
- nystagmus: dilantin, phencyclidine
- retinal hemorrhages: CO, methanol
55
What is the equation for anion gap?
Na - Cl - HCO3, normal is less than 16
56
What are the causes of anion gap metabolic acidosis?
```
Alcohol
Methanol
Uremia
DKA
Paraldehyde
Iron/Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates
```
57
What toxins are radiopaque?
```
CHIPE
- chloral hydrate and calcium
- heavy metals
- iodine and iron
phenothiazines
- enteric-coated tablets
```
58
What is syrup of ipecac? What are the indications and contraindications?
- it is a direct gastric irritant and CNS chemoreceptor stimulator that rapidly induces emesis
- effective only within the first thirty minutes after ingestion; evidence supporting it's use under any circumstances, however, is limited
- contraindicated in those with decreased consciousness, caustic or hydrocarbon ingestion, and in children less than 6mo
59
What is gastric lavage? What are the indications and contraindications?
- it is a method for evacuating the stomach contents using a large bore tube
- it is indicated for life-threatening ingestions within 1 hour after ingestion or after ingestion of toxins that delay gastric emptying
- contraindicated in ingestions of caustic substances, hydrocarbons, and those with delayed presentation
60
What is activated charcoal? What are the contraindications?
- it is a substance with very large absorptive surface area which binds toxins and minimizes their absorption
- considered in most cases of toxic ingestion apart from those of strong acids, alkalis, or heavy metals (e.g. not for iron, lithium, alcohols, ethylene glycol, iodine, potassium, or arsenic)
- contraindicated in those with caustic ingestion because it interferes with visualization by endoscopy and in those with poor airway protection
61
What is whole bowel irrigation and for which ingestions is it indicated?
- it is a rapid, complete emptying of the intestinal tract with PEG and electrolyte solution
- can be effective for iron, other heavy metals, and sustained-released medications
62
Acetaminophen Toxicity
- causes hepatic damage as it depletes glutathione, which causes more toxic intermediates to be produced by the CYP450 system
- there are several stages of presentation: normal LFTs, n/v, malaise, and diaphoresis in the first 24 hours; hepatotoxicity, elevated AST, and prolonged PT in 24-72 hours; maximal hepatotoxicity after 72-96 hours with jaundice, hypoglycemia, lactic acidosis, coagulopathy, and renal failure
- use the nomogram used on acetaminophen level to determine the need for n-acetyl-cysteine; give activated charcoal; and control n/v
- NAC is given as a 140 mg/kg loading dose followed by 70 mg/kg q4 x 17; it is hepatoprotective if given within 8 hours and still helpful if given within 72 hours
63
Iron Toxicity
- common in children of pregnant women taking pre-natal vitamins
- damage is mediated by free radicals and lipid peroxidation, which impairs various cellular processes
- within hours, patient typically experience abdominal pain, vomiting, diarrhea, Gi bleed, shock, fever, and leukocytosis
- these will resolve before anion gap metabolic acidosis, circulatory collapse, hepatic/renal failure, DIC, and neuro deterioration ensue
- pyloric or intestinal scarring with stenosis are long-term complications
- treat with gastric lavage, IV fluids, IV deferoxamine; activated charcoal will not help
- can also use a deferoxamine challenge; if patient's urine turns red/pink, the challenge is considered positive
64
Salicylate Toxicity
- salicylates causes a respiratory alkalosis early as hyperventilation attempts to overcome the metabolic acidosis it also induces
- in the later stages, metabolic acidosis dominates as oxidative phosphorylation is decoupled and lactic acid accumulates
- presents with tinnitus, dizziness, fever, flushed appearance, coma, convulsions, and respiratory failure
- labs show anion gap metabolic acidosis, hyperglycemia followed later by hypoglycemia, and hypokalemia
- managed with external cooling, mechanical ventilation, IV glucose and electrolytes, sodium bicarb to alkalinize the urine and promote excretion, and activated charcoal
- dialysis may be required in the most severe cases
65
What is the antidote for acetaminophen?
n-acetylcysteine
66
What is the antidote for anticholinergics?
physostigmine
67
What is the antidote for benzodiazepines?
flumazenil
68
What is the antidote for carbon monoxide?
oxygen
69
What is the antidote for cyanide?
amyl nitrite, sodium nitrite, and sodium thiosulfate
70
What is the antidote for digitalis?
digoxin-specific Fab antibodies
71
What is the antidote for heavy metals?
- penicillamine for lead, mercury, arsenic, and copper
- dimercaprol for all heavy metals
- EDTA for lead, nickel, zinc, and manganese
72
What is the antidote for dystonia?
diphenhydramine or benzotropine
73
What is the antidote for methemoglobinemia?
methylene blue
74
What is the antidote for isoniazid?
pyridoxine (vitamin B6)
75
What is the antidote for narcotics?
naloxone
76
What is the antidote for methanol and ethylene glycol?
ethanol or fomepizole
77
What is the antidote for organophosphates?
atropine or pralidoxime
78
What is the antidote for beta-blockers?
glucagon
79
Iron Toxicity
- common in children of pregnant women taking pre-natal vitamins
- damage is mediated by free radicals and lipid peroxidation, which impairs various cellular processes
- within hours, patient typically experience abdominal pain, vomiting, diarrhea, Gi bleed, shock, fever, and leukocytosis
- these will resolve before anion gap metabolic acidosis, circulatory collapse, hepatic/renal failure, DIC, and neuro deterioration ensue
- pyloric or intestinal scarring with stenosis are long-term complications
- treat with gastric lavage, IV fluids, IV deferoxamine; activated charcoal will not help
- can also use a deferoxamine challenge; if patient's urine turns red/pink, the challenge is considered positive
80
Lead Toxicity
- typically from a chronic ingestion, however, children may also present with acute intoxication
- there may be abdominal complaints as well as CNS complaints
- peripheral blood smear may show microcytic anemia with basophilic stippling and there may be opacities on abdominal radiographs or "lead lines" (dense metaphyseal bands)
- should be managed with dimercaprol or EDTA
81
Ingestion of Caustic Agents
- acids cause coagulation necrosis, producing superficial damage, whereas alkalis cause liquefactive necrosis, producing deep and penetrating damage
- presents with an immediate burning sensation, dysphagia, salivation, retrosternal chest pain, and vomiting
- obstructive airway edema and gastric perforation with peritonitis is likely to follow acid ingestion whereas alkali ingestion is associated with esophageal perforation with mediastinitis
- during treatment, never try to neutralize the agent as this is likely to produce an exothermic reaction and worsen the burn; ipecac, gastric lavage, and charcoal are all contraindicated as well
- perform an endoscopy to assess the degree of damage
82
Carbon Monoxide Poisoning
- CO binds with great affinity for hemoglobin, forming carboxyhemoglobin, which has a low affinity for new oxygen and prevents the release of the remaining oxygen by shifting the dissociation curve to the left
- presents with cherry red skin as venous blood now carries more oxygen than normal, retinal hemorrhages, tachycardia and tachypnea, visual and auditory changes, confusion and syncope
- delayed permanent neuropsychiatric syndrome may occur within 4 weeks of exposure with memory loss, personality changes, deafness, and seizures
- diagnosis is made based on an anion-gap metabolic acidosis, normal PaO2, and diminished oxygen saturation
- treat with hyperbaric 100% FiO2
- hospitalization is indicated for those with more than 25% CO-Hb, more than 10% during pregnancy, neurologic symptoms, metabolic acidosis, or ECG changes
83
What secondary infections are most common following a dog and cat bites?
- dog: S. aureus, Steptococcus, Pasteurella
| - cat: P. multocida and Bartonella henslae
84
How should a dog bite be managed?
- copious wound irrigation
- suture wounds on the face, large wounds, and wounds less than 12 hours old
- treat with antibiotics such as amoxicillin-clavulanic acid
- administer tetanus prophylaxis
85
Why are bites at the metacarpophalangeal joint significant?
because these bites are typical of a fistfight and any infection may penetrate the avascular fascial layers resulting in deep infection and tendonitis
86
Black Widow Spider Bite
- the spider is of the Latrodectus family and characterized by a red or orange hour-glass marking on the ventral surface
- only the female spider is dangerous and bites only if provoked
- bites cause few local symptoms apart from a burning or shape pinprick sensation; but the venom is a potent neurotoxin which causes severe hypertension and muscle cramps
- treat with wound irrigation, tetanus prophylaxis, benzodiazepines or narcotics to relieve cramping, and Latrodectus antivenin
87
Brown Recluse Spider Bite
- the spider is of the Loxosceles species and has a brown, violin-shaped marking on the dorsal surface; these spiders bite only when provoked
- the venom is cytotoxic, containing tissue-destructive enzymes; there is little initial pain, but a painful itchy papule develops that increases in size and discolors, sometimes becoming necrotic and ulcerated
- systemic reactions may occur 1-2 days later with fever, chills, weakness, vomiting, DIC, hemolysis, and renal failure from myoglobinuria
- treat with local wound care and tetanus prophylaxis as there is no antivenin
88
Pit Viper Snake Bite
- rattlesnakes, cottonmouth, and copper head snakes constitute this Crotalidae family and make up 95% of all snake bites
- the bite location and envenomation determine the severity with head and trunk bites being most severe
- there is progressive, severe swelling and ecchymosis at the puncture site; systemic effects include paresthesias, weakness, diaphoresis, a metallic taste in the mouth; coagulopathy, thrombocytopenia, hypotension, and shock may also develop
- should be treated with local wound care, tetanus prophylaxis, immobilization of the extremity, and immediate transport; consider antivenin for all bites and remember that children require more because they receive proportionally more venom
- polyvalent immune Fab are also available and are safer, more potent, and very effective
89
What are the complications of antivenin?
serum sickness and anaphylaxis
90
Coral Snake Bite
- remember for the stripe pattern that "red next to yellow, kill a fellow", red next to black, venom lack"
- the neurotoxic venom causes swelling and tenderness, paresthesia, vomiting, weakness, diplopia, fasciculations, and respiration depression
- treat with antivenin, local wound care, and supportive care
