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Nagasaki Flashcard Extravaganza > Snakebites and toxicology > Flashcards

Snakebites and toxicology Flashcards

1
Q

What is a cholinergic syndrome in toxicology like?

A

“SLUDGE syndrome” (Salivation, Lacrimation, Urination, Defecation, Gastrointestinal distress and Emesis),

Cholinergics LEAK

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2
Q

What can cause cholinergic toxidrome?

A

Organophosphates
Carbamates
Mushrooms

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3
Q

What are the symptoms of an anti-cholinergic toxidrome?

A

Mad as a hatter, hot as Hell, red as a beet, dry as a bone, and blind as a bat.

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4
Q

What toxins/meds are involved in anti-cholinergic toxidrome?

A

Typical geriatric meds
Antipsychotics, antihistamines
Tropane alkaloids e.g. jimsyn weed

Treat with AchEI e.g. pyridostigmine

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5
Q

What are the symptoms of an opiate toxidrome?

A

Everything is depressed - low BP, low HR, pinpoint pupils, DRY not sweaty

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6
Q

What are the symptoms of a sedative toxidrome?

A

Everything is depressed - low BP, low HR, NORMAL pupils (how to distinguish from opiate), DRY not sweaty

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7
Q

What are the symptoms of a sedative toxidrome?

A

Everything is HIGH - HR, BP, big pupils, sweaty and HOT

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8
Q

What are the general principle of pesticide poisoning management?

A

Decontamination e.g. clothing
Airway support
Sedate for seizures
No specific antidote
Atropine for organophosphates

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9
Q

What causes scromboid?

A

Anaphylaxis type syndrome after eating spoiled fish. Spoiled dark meat of tuna, mackerel, sardines etc. Immediate peri-oral tingling. Releases histadine. Treat like anaphylaxis

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10
Q

What does tetrodotoxin do?

A

10-45 mins after eating scaleless porcupine, sun, puffer, and toad fish, Japanese puffer fish (fugu), neurotoxic symptoms including respiratory paralysis (can be fatal)

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11
Q

What is shellfish poisoning?

A

30 mins after ingestion of bivalve molluscs (mussels, calms, oysters, cockles, and scallops), paralysis, fatal respiratory paralysis (8%)

Prohibit eating shellfish when there has
been a “red tide (toxic plankton bloom)”

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12
Q

What are the symptoms of scorpion sting envenomation?

A

Local effects (pain, paresthesias, and skin changes)

Autonomic storm - parasympathetic and sympthetic effects

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13
Q

How is scorpion sting managed?

A

Supportive
Anti-venom if available

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14
Q

How is a jellyfish sting managed?

A

Analgesia
Soak in hot water or water
Local anaesthetic block
Antivenom in Australia
Tetanus vax
ABx

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15
Q

What is the epidemiology of snakebite envenomation?

A

Local effects (pain, paresthesias, and skin changes)

Hot spots: West Africa, South Asia, New Guinea, and the Amazon region

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16
Q

What are the clinical features of snakebite?

A
  • Cytotoxicity: local pain, swelling, bruising, blistering, tender regional lymph node enlargement, and tissue necrosis
  • Hematotoxicity: incoagulable blood, spontaneous bleeding from gums/nose/etc., persistent bleeding from wounds
  • Cardiotoxicity: shock (hypotension), arrhythmias
    Neurotoxicity: descending paralysis (ptosis, external ophthalmoplegia, bulbar and respiratory muscle paralysis, generalized flaccid paralysis)
  • Myotoxicity: generalized rhabdomyolysis (myalgia, myoglobinuria)
  • Nephrotoxicity: acute kidney injury
17
Q

What is 1st aid for a snakebite?

A

Immobilise
Pressure pad, do not suck out venom
Treat pain
Do not torniquet

Antivenom:
Only a specific antidote is indicated
Indications
* Systemic envenoming
* Local envenoming: rapidly spreading or involves more than half the bitten limb within 24h

Tetanus
ABC if abscess or necrosis
Fasciotomy only if compartment syndrome

18
Q

What are the risks of using antivenom?

A

Anaphylaxis
Serum sickness

19
Q

What are the signs of systematic envenoming?

A

Neurological involvement - paralysis DESCENDING i.e. ptosis
Deranged coagulation - bleeding

20
Q

What are the signs of local envenoming?

A

Necrosis
Rapidly spreading swelling

21
Q

How to manage anaphylaxis during anti-venom treatment?

A

Continue antivenom (or they die) and manage coagulopathy

Nagasaki Flashcard Extravaganza (34 decks)

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