Exam 3 Flashcards
Tetanus prophylaxis vaccines
- Tdap or Td
- Give if it ws given >5 yrs ago
4 Don’ts in general bite management
- Suck the venom out
- Apply a tourniquet or pressure bandages
- Drain the bite site
- Capture the snake & bring it to the ED
Pit Vipers head, fangs
- Triangle shaped, vertically elliptical pupils, heat-sensing pit behind nostrils
- Front, mobile fangs, small row of teeth, persistent reflexes
PV Venom effects 3
- Local tissue damage
- Coagulopathies
- Neurotoxic
PV diagnosis
- Quantify swelling: distance from bite, circumference
- Lab monitor: CBC, platelets, PT/INR, aPTT, fibrinogen…
PV management
- ABCs
- Maintain limb at heart level
- Pain: IV opioids, avoid NSAIDs, icepacks
- Life-threatening bleeding: blood products + antivenom
PV antivenom indication
- Progression of local tissue damage
- Coagulopathy: PT >15 s, fibrinogen <150, platelets <150K
- Systemic signs: HoTN, anaphylaxis, neurotoxicity
PV FabAV (CroFab): allergy, initial dose, maintenance dose
- Latex, papaya, pineapple, papain, bromelain, sheep
- 4-6 vials
- 2 vials Q6H x3
PV F(ab’)2 (Anavip): allergy, initial dose, maintenance dose
- Papain, cresol, horses
- 10 vials
- 4 vials PRN
PV antivenoms counseling points 4
- Repeat labs in 3-5 days
- Hypersensitivity rxns possible w/ future antivenom
- Avoid activities with bleeding risks for 14 days
- Monitor serum sickness
Coral snakes body, fangs
- Red on yellow, kill a fellow vs Red on black venom lack
- Much smaller fangs, hang onto victim and chew
CS clinical manifestations
- Minimal/No local tissue injury
- Speech: slurred, dysphagia
- Ocular: diplopia, ptosis (drooping)
- Neuromuscular: paresthesias/weakness/fasciculations (minor), paralysis (life-threatening)
- Pulmonary: stridor, resp paralysis
CS management supportive care when?
Intubate at earliest signs of bulbar paralysis
CS antivenom Antivenin
- Requires skin testing prior to administration
- 3-5 vials in 250-500 mL NS
- Initial rate: 25-50 mL/hr for the first 10 mins
CS Antivenin counseling point
Serum sickness
Alkalis: dissociated ___ –> ___ necrosis
hydroxide ions (OH) –> liquefactive
Acids: dissociated ___ –> ___ necrosis
hydrogen (H) –> coagulative
Household chemicals imaging should be done when?
within 12 hrs of ingestion (no later than 24 hrs)
HC management: decontamination for oral & dermal exposure
- Remove clothing, jewelry, irrigation with water
- Blisters should be popped
- No role for gastric decontamination
- Dilutional therapy avoid unless asymptomatic + w/i first few mins of ingestion
HC management: symptomatic & supportive care
- Airway inspection, intubation
- Airway inflammation: dexamethasone
- HoTN: IV fluid repletion
- Surgical intervention as necessary
- No role for empiric antibiotics
HC ocular exposures tx
- Remove contact lenses, false eye lashes etc
- Immediate + copious irrigation: hold eyes open for at least 15 mins, use room temp (tepid) water or 0.9% NaCl
HC ocular exposures when to refer
Strong or concentrated caustic/pain, swelling, lacrimation or photophobia despite irrigation
Hydrofluoric acid: cause of toxicity, binds to ___, result in ___
- Liberation of F- ions, not H+
- Extra/Intracellular Mg, Ca
- Hypomagnesemia, hypocalcemia –> ventricular arrhythmia
Hydrofluoric acid toxicity local tissue injury, absorption, systemic effects
- Minimal visible damage
- Deep penetration
- Life threatening cardiac effects: hypocalcemia, hypomagnesemia, hyperkalemia
Hydrofluoric acid toxicity management
- Decontamination: water, saline
- Airway management: avoid succinylcholine due to hyperkalemia
- Pain control: topical calcium gluconate gels, avoid sedating analgesics, nebulized calcium for pulmonary exposures
- Electrolyte repletion calcium + Mg
Hypochlorite examples & management
- Household bleach: dilute with water
- Industrial strength cleaners/swimming pool disinfectants: symptomatic, supportive care
Hypochlorite combination: chlorine vs chloramine
- Chlorine (hypochlorite + acid) dissolution –> hypochloric acid + hypochlorous acid
- Chloramine (hypochlorite + ammonia) dissolution –> hypochlorous acid + ammonia + oxygen radicals
Single-use detergent sacs toxicity clinical manifesfations
- GI, pulmonary, ocular, metabolic
- CNS seizures
Single-use detergent sacs toxicity diagnosis
- Changes in mental status or resp difficulty, persistent ocular symptoms
Single-use detergent sacs toxicity management
- Decontamination w water
- Resp difficulty w/ hypoxemia: oxygen, bronchodilators, intubate if necessary
- Prolonged V/D: IV fluid
- Seizures: BZD
Hydrogen peroxide mechanism of toxicity
- Local tissue injury: [low] = irritant, [high] = corrosive
- Gas formation: H2O2 interacts w/ tissue catalase –> O2, H2O liberation
H2O2 clinical manifestations [High]
Gas embolization
- Gastric/Intestinal perforation
- Rapid deterioration in mental status, HoTN, cardiac ischemia, coma, intestinal gangrene