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Emergency Medicine > Snake Bites > Flashcards

Snake Bites Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What are some examples of venomous snakes that can be found in the US? What is their scientific name? What are they also referred to (due to their anatomy)?

A

Rattlesnakes, water moccasins (cottonmouths), and copperheads
Family: Viperidae, subfamily: Crotalinae
AKA “Pit vipers”, from their heat sensing pit located behind the nostrils

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2
Q

Where are rattlesnakes found?

A

Native to and live in all states except for Alaska, Hawaii, and Maine

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3
Q

Where are water moccasins or cottonmouths found?

A

Southeast-South, Virginia-Texas

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4
Q

Where are copperheads found?

A

Eastern continental states, Massachusetts-Texas

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5
Q

A majority of snake bites occur in (children/adults) (males/females)

A

Adult men

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6
Q

~____% of envenomated patients are hospitalized

A

50%

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7
Q

Ecchymosis and progressive swelling are signs of _________

A

Local tissue damage

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8
Q

______ reactions, such as nausea, vomiting, abdominal pain, paresthesias, and dizziness, suggest (less/more) severe envenomation

A

Systemic; more

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9
Q

What are systemic signs from increased vascular permeability following a snake bite?

A

Tachycardia, tachypnea, and hypotension

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10
Q

Oral paresthesia, unusual taste, fasciculations, altered mental status, seizures are all signs of ______

A

Neurotoxicity

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11
Q

_________ is the only type of Crotalid bites that can cause neuromuscular weakness with respiratory failure. This reaction can be delated up to ____ hours post-bite.

A

Mojave rattlesnake; 12

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12
Q

Before the patient arrives at the hospital following a snake bite, the patient should immobilize the injured body part at what level?

A

Heart level

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13
Q

Snake bite patients (should or should not) use pressure immobilization, tourniquets, incision and oral suction, or mechanical suction devices

A

should not

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14
Q

T/F If a snake is dead, it can still bite you

A

True, there may still be an intact bite reflex

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15
Q

T/F Every time a snake bites, there is venom delivered

A

False, dry bites comprise 25% of all Crotalinae snake bites

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16
Q

T/F Hypotension/altered mental status following a snake bite are rare

A

True

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17
Q

Why do we order a serum creatine kinase and UA following a snake bite? What are we looking for?

A

Rhabdomyolysis

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18
Q

T/F You should elevate a snake bite wound

A

False, keep at level of the heart

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19
Q

Matching: Mild, Moderate, Severe envenomation
A. Edema >12 inches around wound, altered lab values
B. Local pain and edema, normal lab values
C. Petechiae, hypoTN, ecchymosis, abnormal lab values

A

A. Edema >12 inches around wound, altered lab values –> Moderate
B. Local pain and edema, normal lab values –> Mild
C. Petechiae, hypoTN, ecchymosis, abnormal lab values –> Severe

20
Q

Is CroFab dosing weight based?

A

No

21
Q

If a pt has certain allergies, they should not receive CroFab. What allergies are we particularly concerned about?

A

Dust mites, papaya, pineapple, and latex

22
Q

CroFab should be administered at a (fast/slow) rate

A

Slow

23
Q

T/F Tetanus prophylaxis is recommended for all snake bite patients

A

True

24
Q

CroFab shows a decreased time for return to full function, but overall no significant difference in outcomes ___ months out from injury.

A

4

25
Q

Can CroFab be administered to individuals with known allergy to it?

A

Yes, in serious envenomation cases

26
Q

T/F CroFab is safe for use in pregnant women and young children

A

False, due to stabilizing preservatives

27
Q

Acute reactions to CroFab are often (immunologic/nonimmunologic) in nature, however allergic reactions can be secondary to _____ _____, particularly in those who have been bitten before or who handle snakes

A

nonimmunologic; venom sensitivity

28
Q

1st line tx for anaphylaxis is _____. 2nd line?

A

1st line: Epinephrine

2nd line: H1 Antihistamine, Beta 2 adrenergic agonists, and glucocorticoids

29
Q

Why is antivenom administration, and not FFP or heparin, the primary tx for Crotalinae-induced coagulopathy?

A

Because transfused platelets and coagulation factors in FFP are inactivated by Crotalinae venom
Heparin is also ineffective as the thrombin-like substances in the venom are not inhibited by antithrombin III

30
Q

Snake venom contains a Protein C activator and thrombin-like glycoproteins which form _____ by working like _____ on the fibrinogen molecules. This results in the development of decreased ______, prolonged _____, and decreased _____

A

fibrin; thrombin; fibrinogen, PT/PTT, platelets

31
Q

What is the triad of rhabdo presentation? hint: think urine content/color/and lab value)

A

pigmented granular casts in the urine,

a red to brown color (“iced tea”) of the urine, and a very high total creatine kinase (CK)

32
Q

What is the initial recommended tx of rhabdo? What electrolyte imbalances should be checked for as well?

A

IV hydration NS

HYPERkalemia, HYPERphosphatemia, HYPOcalcemia

33
Q

What is a potential complication of rhabdo?

A

Acute renal failure

34
Q

_____ syndrome is a rare but serious complication of a snake bite, with paralysis being a (early/late) finding.

A

Compartment syndrome; late

35
Q

What is currently accepted as the best prevention/treatment of compartment syndrome?

A

CroFab

36
Q

T/F Pts with compartment syndrome should be immediately taken in for surgery

A

False, surgical intervention should be avoided if at all possible

37
Q

A fasciotomy should only be considered when the difference between compartment pressure and diastolic blood pressure is less than ____mm Hg or when clinical symptoms are obvious

A

30 mmHg

38
Q

A _____ monitor can be used to evaluate a pt’s compartment pressure, however, if one is not available, what can be used in its place?

A

Stryker; an 18-gauge needle can be attached to an arterial pressure monitor

39
Q

If a pt has received anti-venom tx, do they require admission?

A

Yes

40
Q

If a pt has mild or no toxicity on initial clinical assessment and normal baseline testing, how long should they be observed for following snake bite?

A

8-12 hours

41
Q

If a pt is a child or elderly, has significant comorbidities, or has poor social supports for follow-up, how long should they be observed for following snake bite?

A

up to 24 hours

42
Q

Since neurotoxicity may be delayed in asymptomatic patients with suspected Mojave rattlesnake bites, how long should they be observed for following snake bite?

A

12-24 hours

43
Q

T/F Most victims of venomous North American snakes do not fully recover

A

F, they do; death following Crotalinae snake bites is rare

44
Q

Morbidity/mortality usually associated w/ bites to the ____ or _____

A

face, UEs

45
Q

What is the most common loss following a snake bite, in terms of ability?

A

Loss of ROM

Emergency Medicine (20 decks)

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