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SA DX & TX I > Exam 4 - Envenomation > Flashcards

Exam 4 - Envenomation Flashcards

1
Q

what snakes are included in crotalids (pit vipers) that are venomous in the united states? what about elapidae?

A

crotalids
1. copperheads
2. cottonmouths (water moccasin)
3. rattlesnakes

elapidae
1. coral snakes
2. cobras

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2
Q

what do venomous snakes look like?

A

head is distinctly triangular when viewed from above

elliptical pupils

pits & nostrils are present

undivided scales on the underside of the tail (except for northern copperhead - ends in a rattle)

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3
Q

what 2 pit vipers have this distribution?

A

copperheads & timber rattlesnake

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4
Q

what pit viper has this distribution?

A

western diamondback

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5
Q

what pit viper has this distribution?

A

cottonmouth

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6
Q

what pit viper has this distribution?

A

mojave rattlesnake

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7
Q

what is the largest group of venomous snakes?

A

pit vipers

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8
Q

when do we see the most snake bites from pit vipers?

A

april-october & snakes are most active around dusk

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9
Q

how many pit viper snake bites are seen annually?

A

150,000

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10
Q

what are the primary functions of pit viper venom?

A

immobilize, digest, & kill

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11
Q

from most venomous to least, rank the pit vipers

A

rattlesnake > cottonmouth > copperhead

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12
Q

what are the snake factors of venom?

A

amount injected, multiple bites, agonal bites, & age of snake

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13
Q

what are the patient factors in regards to snake venom?

A

size of the patient, location of the bite, time to presentation, & physical activity

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14
Q

what local effects are seen with snake bites? these signs are most common with what pit vipers?

A

rapid swelling, pain, edema, bruising, & necrosis

copperheads & cottonmouths

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15
Q

what systemic effects are seen with snake bites? these signs are most common with what pit viper?

A

hypotension, coagulopathies, petechiae, weakness, cyanosis, altered mentation, convulsions, lymphadenopathy

rattlesnakes

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16
Q

what are the proteolytic enzymes in venom?

A

hydrolases, hyaluronidase, thrombin-like enzymes, collagenase, phospholipase A2

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17
Q

what neurotoxin is apart of venom?

A

mojave toxin

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18
Q

what renal effects are seen with envenomation?

A

myoglobinuria & hypovolemia

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19
Q

what coagulopathy effects are seen with envenomation?

A

thrombin like enzymes have anticoagulant properties, fibrinolytic products, platelet adhesion & aggregation, & destruction of megakaryocytes

20
Q

what may be seen on a blood smear of a dog bitten by a pit viper?

A

echinocytes

21
Q

what red cell morphology is seen in this smear? what is it supportive of?

A

echinocytes - envenomation

22
Q

what effect does venom have on endothelial cells?

A

polypeptides cause direct damage & inflammation & extravasation

23
Q

what may be seen on a CBC in a patient that was bit by a pit viper?

A

echinocytes, thrombocytopenia, leukocytosis, hypoproteinemia, & increased PCV

24
Q

what is the snake bite minimum database?

A

electrolytes, kidney values, blood smear for RBC morphology & platelet count, PT/PTT

25
Q

what may be seen on urinalysis in a patient that was bit by a pit viper?

A

hemoglobinuria & myoglobinuria

26
Q

what may be seen on a chem panel in a patient that was bit by a pit viper?

A

hypokalemia, increased CK, & azotemia

27
Q

what is the treatment for snake bite envenomation?

A

no prophylactic antibiotics

clip, clean, & dry bite

pain meds - opioids

IVF

28
Q

why are steroids contraindicated for envenomation patients?

A

risks for complications - shock

increase risk of secondary infection

worsen outcomes in human studies

29
Q

why not use frozen plasma or fresh frozen plasma for envenomation patients?

A

the venom inhibits any therapeutic effects to treat the coagulopathy

30
Q

what are some indications for antivenin administration?

A

coagulopathy, shock, neurologic signs, or life threatening swelling

31
Q

how do you administer antivenin?

A

reconstitute & give IV ASAP for best concentration at the site - dilute it in 100-200ml 0.9% saline given over 1-4 hours & monitor like a transfusion

typically 1-2 vials given to effect for reversal of shock, coagulopathy, neuro signs, & swelling

32
Q

T/F: the dose of antivenin is related to the amount of venom, not the size of the patient, so repeat dosing may be needed

A

true

33
Q

what do you do if you have a patient that has an anaphylactic (type I hypersensitivity) reaction to the antivenin?

A

epinephrine & IV fluids - animal may have had previous exposure

34
Q

what clinical signs may be seen if you have a patient that has a serum sickness (type III hypersensitivity) reaction to the antivenin?

A

polyarthritis, myositis, vasculitis, glomerulonephritis, fever - delayed by 2-4 weeks

35
Q

what are some contraindicated first aid treatments commonly used for envenomation?

A

oral suction, incising fang marks, ice or heat, tourniquet, constriction bands, or electrocution

36
Q

what snake has this distribution?

A

coral snakes

37
Q

what does the venom of the coral snake cause?

A

neurotoxin that causes flaccid paralysis - potential for ventilatory failure within 4 hours

38
Q

what is the treatment for envenomation by a coral snake?

A

supportive care, ventilation for respiratory failure, & hospitalize for 24-48 hours for monitoring

39
Q

why hospitalize an asymptomatic patient bitten by a coral snake?

A

clinical signs can be delayed up to 12 hours but will be progressive & there is no antivenin available

40
Q

what kind of snake is this?

A

king snake - red & black bands touch each other

41
Q

what kind of snake is this?

A

coral snake - yellow bands touch the red

42
Q

what evil thing has this distribution?

A

brown recluse

43
Q

what is the major problem in brown recluse venom?

A

sphingomyelinase D

44
Q

what is the treatment for a brown recluse bite?

A

supportive care & wound management - culture the wound

antivenin - not widely available, administer within 1 hour

tetracyclines - apply topically, inhibits MMPs

45
Q

what is the major venom component that black widows have? what does it do?

A

alpha-latrotoxin

stimulates release of neurotransmitters from axon terminals leading to an eventual blockade & clinical signs developing within 8 hours

46
Q

what are the hallmark clinical signs of a black widow bite?

A

abdominal rigidity!!!! muscle spasms & tremors

paralysis in cats

47
Q

what is the treatment used for black widow bites?

A

antivenin, calcium gluconate, muscle relaxants, & opioids

SA DX & TX I (59 decks)

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