Environmental Injuries And Anaphylaxis Flashcards
Electrical injuries can cause what things?
Electrical flash and arc burns cause sudden vaporization of metal and deposition of what on the skin?
Electrical arcs also produce what?
In contact burns,tissue damage is more extensive than in which burns or is it tissues manage is more extensive idk check
Can cause cardiac and respiratory arrest
•Muscle spasms can cause dislocations or fractures
•Electrical flash and arc burns
•Cause sudden vaporisation of metal and deposition of a thin layer of hot metal on the skin
•May look dramatic because of discolouration of the skin
•Often superficial and heal uneventful
•Electrical arcs produces high temperatures, may cause deep dermal or full-thickness burns
•Contact burns
•Tissue damage more extensive is than visible burns
•Muscle damage may cause myoglobinuria and renal failure
What are the effects of electrical injuries on these conditions :neurological,ophthalmic ,electrocution in pregnancy
Neurological :
Coma •Fits •Headaches •Transient paralysis •Peripheral neuropathy •Mood disturbances
Ophthalmic : Burns
•Cataracts
•glaucoma
Electrocution in pregnancy:
Major risk for the foetus
•Spontaneous abortion
Lightening burns are superficial often with what characteristic appearance?
Why are the limbs mottled and cold?
What will cause coma in lightening burns?
Lightening burns are superficial
•Often with characteristic feathered or fern-like appearance
•Limbs are mottled and cold due to arterial spasm
•Deep muscle damage and myoglobinuria are rare
•Coma
•Result from direct brain injury
•Head injury due to a fall
•Cardiac arrest
•Survivors
•Confused and amnesic for several days
What’s the management of electrical burns and lightening burns
Make sure current is turned off before anyone approaches or touches the casualty
•High voltage electricity can arc through the air or pass through the ground
•ABC
•Electrical burns of the mouth and throat may cause oedema and airway obstruction
•Perform CPR if necessary
•Minimise spine movement
•Examine for:
•head, chest, abdominal and skeletal injuries
•Entry/exit burns
•Pulses, sensation
Admit
•Check ECG
•Arrhythmias, conduction defects, ST-elevation, T-wave changes
•Full blood count, Urea and electrolytes and creatine kinase, urine for blood
•Treat for Myoglobinuria to prevent renal failure
•Seek specialist care
•IV Fluids
Most snake bites are non-poisonous
•Commonest cause of poisonous snake bite in tropical Africa: Vipers
•All cases should be observed for at least 6 hours
True or false
How are snakes classified with regards to their fangs
Which people usually get bitten
Drunk young men •Children in endemic areas •Hobbyists with pet snakes •Adventure travellers •Field workers: missionary, military, biologists •Rural farm workers
Viperidae : mobile front •Crotalidae (pit viper): mobile front •Elapidae: : fixed front •Hydrophiidae: fixed front •Colubridae : fixed back •Atractaspididae: sideways
What signs will you see in a patient bitten with veperidae or crotalidae
And signs in elapidae
What are the initial generalized symptoms of snake bite, the local symptoms of snake bite
V and C:
Fangs are fixed at the mobile front
Symptoms are hemorrhagic ,necrosis and cardiotoxic
Elapidae:
Fangs fixed at the front
Symptoms are neurotoxic (also sea snake),necrosis
Initial generalised symptoms ➢Fear ➢Dizziness (hyperventilation +++) ➢Nausea and vomiting ➢Malaise ➢Weakness ➢Pain at the bite site
Local symptoms: Local symptoms ➢Wounds by fangs, teeth and misapplied “first aid” ➢Local pain ➢Local ecchymosis & bleeding ➢Local infection & inflammation ➢Local vesicles & necrosis ➢Local lymphangitis ➢Lymphadenopathy
What neurological symptoms and endocrine complications are seen in snake bites
Neurological •paresthesias •ptosis •mydriasis •diplopia and blurred vision •metallic taste •Fasciculations •dysphagia •slurred speech and •aphony
Endocrine complications
•Addison (weakness)
•SIADH
What DIC symptoms and renal toxicity symptoms are seen in snake bites
Disseminated Intravascular Coagulation •Bleeding fang marks and venapuncture sites •Bleeding gums, nose, vagina •Petechiae •Retroperitoneal bleeding •Hematemesis •Hypophysis •Adrenals
Renal Toxicity •Pigment nephropathy (myoglobin, haemoglobin) •Immune complex nephritis - antivenin •Acute tubular necrosis •Cortical necrosis •Hyperkalaemia •Shock
What Eye lesion symptoms and muscle toxicity symptoms are seen in snake bites
Muscle toxicity •Especially sea snakes and tiger snakes •Stiff painful muscles •Rhabdomyolysis (myotoxins) •Myoglobinuria •Hyperkalaemia
Eye lesions
•Spitting cobras: Chemical keratitis with pain and blepharospasms
•Russell’s adder: Chemosis
What treatment should be done in snake bites before going to the hospital
Treatment: before hospital •Diminish fear •Immobilize limb with a splint •Compressive elastic bandage (block lymphatic drainage) •Rinse eyes if relevant
•Transport to the hospital !!
- Avoid electroshock
- Avoid arterial tourniquet
What treatment should be done in snake bites in the hospital
Evaluate symptoms : dry bite or not? •Vitals : airway, respiration, BP, pulse, gross bleeding •Skin swab for venom detection •IV line •Intubation set ready •Wound care •Limb elevation (swelling) •Measure limb circumference (repeat) •BP-monitoring : crystalloids, vasopressors
Investigations
•FBC, Coagulation parameters (INR, APTT, Fibrinogen)
•Dry tube
•Renal function and ionogram
•Glocose, CK, myoglobin
•Urine: blood, myoglobin, pigmented granular casts
•Stools: occult blood
•Plasma-expander: albumin
•Neostigmine 1 mg: blocks acetylcholinesterase
•Atropine 0,6 mg : inhibition muscarine receptors
•Antibiotics
•Tetanus vaccination
•Oxygen
•Crossmatch blood
•Treat myoglobinuria : HCO 3 –, IV mannitol (1 2 g/kg) & loop diuretics
•Treat hyperkalemia (adult)
When will you treat with antivenom What will you use to premeditate? What types of antivenom are there? How do you give the antivenom? How do you repeat the antivenom? When do you repeat the antivenom?
Only if venom was injected evidenced by symptoms
•Premedicate with epinephrine and steroids
•Polyvalent or monovalent antivenom
•Dilute, give slow IV over one hour
•Repeat antivenom: 2 vials, diluted after 6, 12 and 18 hours
•Repeat antivenom if
•New bleeding
•Reverting clotting time
•Worsening neurotoxic or cardiovascular effects after 1-2 hours
What are the complications of snake bites
What are the common mistakes done in treating snake bites
Abruptio placenta •Compartment syndrome •Wound infections •Volkmann ischemic contracture •Algoneurodystrophy •Renal failure •Endocrine longterm complications
Common mistakes
•Arterial tourniquet
•Cryotherapy, incision of wound
•Incomplete immobilization during transport
•Not thinking of the possibility of snake bite
•Not considering possible worsening of symptoms over time
•Forgetting to control hemostasis repeatedly
•Giving only vasopressors, without IV fluid
•Thinking it is too late to give antivenin
•Too low dosage antivenin, undiluted
•No epinephrine stand by
May carry the rabies virus •Rabies is a viral infection •Carried by other animals such as cats, foxes, bats •Present in the animal’s saliva True or false After dog bites what should be done?
Immediate •Wash site with soap and water •Irrigation with copious amounts of saline with cetrimide plus and chlorhexidine solution •Pharmacological treatment •Flucloxacillin •Amoxicillin •Antitetanus prophylaxis •Rabies immunisation and Rabies vaccine
What is the indication for the use of rabies immunoglobulin and rabies vaccine (condition of the animal stating what happens after observing the animal for ten days and the treatment you’ll give)
At time of attack
Dogs condition was Normal
During observation there was No change after
10 days
Vaccination procedure :Do not vaccinate
Immunoglobulin administration :Give first dose
Condition of dog was Normal
During observation Confirmed signs of
rabies after 10 days
Vaccination procedure:Initiate vaccination in patient upon first sign of rabies in animal
Immunoglobulin administration:Give according to
guidelines below(on the next slide)
a.Dog had Strong suspicion of rabies During observation :Unconfirmed sign in animal Vaccination procedure:Initiate vaccination. Stop if animal is normal on day 5 Immunoglobulin administration:Give according to guidelines.
b.When Rabies is confirmed in the dog with strong suspicion for rabies,
Continue vaccination
regime
Immunoglobulin administration:Give according to
guidelines
Dog has Rabies: Immediate vaccination Give according to guidelines
What is the vaccination schedule for rabies with Patients vaccinated within last three years and Patients with no vaccinaton or more than 3 years since vaccination
Rabies immunization post exposure (Patients vaccinated within last three years)
Day 0:
Infiltrate wound and around wound with rabies immunoglobulin (10 IU/kg body weight); and
Rabies Immunoglobulin (10 IU/kg body weight) by IM injection;
1 ml Rabies vaccine by IM injection
Day 3 (or any day up to day 7): 1 ml Rabies vaccine by IM injection
Patients with no vaccinaton or more than 3 years since vaccination
Day 0:
Infiltrate wound and around wound with rabies immunoglobulin (10IU/kg body weight); and
Rabies Immunoglobulin (10 IU/kg body weight) by IM injection;
1 ml Rabies vaccine by IM injection
Days 3, 7, 14, 30
1 ml Rabies vaccine by IM injection*
