Envenomations

Question 1

A 7 year old is bit by this snake and reports dizziness. What is the next step in management?

Answer 1

“Red on yellow, kill a fellow; red on black, venom lack.”

Coral snakes/Elapids are venomous. Look similar to nonvenomous king snakes.

Hind fangs - chew up.

Envenomation is neurotoxic (no heme effects). May have delayed onset - 13 hours out. Consider early intubation bc risk of resp failure.

Antivenom administration should occur immediately after a possible envenomation. Unfortunately, supply is low -manufacture discontinued production.

Question 2

An 8 yo boy is bit by this snake. What is the classic envenomation?

Answer 2

Crotalid envenomation (pit vipers - diamond shaped head, slit pupils and fangs). Primarily hemotoxic, can cause local tissue necrosis. Pts may complain of a metallic taste in their mouth. Occ need surgical involvement. Wait until the development of moderate symptoms to administer antivenom.

Question 3

A patient was bit by this arthrpod. What is the management.

Answer 3

Brown recluse spider (Loxocles). “Violin” Usually sig cutaneous manifestations - tissue necrosis. Supportive care. Transfusion may be required in severe cases (intravasc + extravasc hemolysis - mechanism is attachment of pshingomyelinase D on RBC membrane w/ complement activation). Steroids have not been proven to prevent hemolysis.

Question 4

An 8 year old is bit by this spider. What are the likely symptoms?

Answer 4

Small black spiders (1-2 cm in size) with a red hour glass marking on the abdomen. Can cause systemic reactions (neuro): seizures, spasms, fasiculations, hypertension, cholinergic excess. FIrst line tx benzos and pain control. May need antivenin.

Question 5

A 3 year old is bit by this spider. What is the most likely symptom? How would you manage it?

Answer 5

Tarantula 2.5-10cm in size, covered in hair. Bite marks are frequently visble. Produce a local inflammatory reaction that is pruritic. May need antihistamines and topical corticosteroids.

Question 6

A 9 year old went outdoorsing in Arizona and now has roving eye movements, hyperactivity and difficulty breathing. 10 minutes after being in your emergency room, he has a seizure and his temperature is 40degrees. What is the most likely envenomation?

Answer 6

Scorpion. Need antivenom.

Question 7

Ciguetera Poisoning

Answer 7

Fish Poisoning

From: Reef fish, amber jack, mackeral, barracuda, grouper, moray eee

Question 8

Scromboid

Answer 8

Mechanisms: Not a true allergic reaction, just histamine release
**Fish: Amberjack, achovy, mackeral, tuna, blue fish, herring, merring, mahi mahi, marlins, sardines
Manifestation: Flushed skin, headache, itching, diarrhea**
Treatment: Antihistamins, epinephrine

Question 9

4 Types of Shellfish Poisoning

Answer 9

1. **Amnestic Shellfish Poisoning: **Domoic acid, Permanent short-term memory loss, brain damage, death
2. **Diarrhetic Shellfish Poisoning: **Intensive diarrhea, severe abdominal pain
3. Neurotoxic Shellfish Poisoning: Brevotoxin, Nausea, vomiting, slurred speech
4. Paralytic Shellfish Poisoning: Saxitoxin, Abdominal pain, nausea and
   vomiting, numbness, and tingling of the face
   and extremities, shortness of breath,
   loss of coordination, slurred speech

The treatment for all of the above is supportive care. There is no antidote.