Snakes: Bites & Stings Flashcards
Useful website for anti venom guide
vapaguide.info
Examples of venomous plants
Which plant/insect can cause contact dermatitis?
What are the snakes that are most commonly venomous?
When are people most at risk to snake bites?
Where are most snakebites happenign?
What can you do to prevent snake bites?
Which coral snakes are venomous?
What are the four different types of reactions that can happen following a snake bite?
How do we treat snake bites?
- First aid
- Wash away venom for 15 minutes
- Remove rings
- Compression bandage towards the heart
- Splint the affected limb
- Snakebite serum
- DO NOT cut/suck/apply ice/tourniquet
Example of venomous spiders
How can you differentiate the brown recluse and black widow and what is the black widow venom?
Normal spiders have 8 eyes in 4 pairs, those have 6 eyes in 3 pairs
- sphingomyelinase toxin D
What are the features of scorpion stings?
General principles of treatment of bee sting
- Pull out sting if still in place
- Avoid colourful clothing
- Antihistamines and hydrocortison
- Adrenaline
What is myiasis?
- Incubates under the skin for 1 -2 weeks (itchy swelling develoing)
What is the global burden of snake bites?
- WHO goal to halve the number of deaths by 2030
When are snakes most active?
- nonpoisonous snakes generally have small teeth
What are the different types of anti-venom available?
- Polyvalent
- can be used for all pit vipers
- Monovalent
- specific
- Children require same dose as they have the same exposure to venom
What are the symptoms of snake bites?
- Generally
- Neurotoxic
- Cannot be treated with anti-venom but compression bandaging will help
- Haemotoxic
- Anti-venom will help
- Neurotoxic
How do we grade severity of a pit viper bite and how does that change management?
How do we care for snake bites pre-hospital?
- Calm and reassure victim -> this will slow spread of venom through lymphatics
- Remove rings and watches
- Don’t try and catch the snake (even if the head is cut off, it maintains a biting reflex)
- Don’t cut fang marks or suck out with mouth
- Compression immobilisation (bandage so hard you should just about be able to slip your finger in)
- Don’t do it too loosely and DO THE WHOLE LIMB
- Tourniquets actually do more harm
- This mostly works only for neurotoxic venom as it allows for the neurotoxin to be broken down hydoxylation in the tissues (so it works in australia but less so in US where there is mostly haematotoxic/cytotoxic)
- Don’t do it too loosely and DO THE WHOLE LIMB
When do you give anti venom?
Are there any other methods to prevent the lymphatic spread of venom?
- Trypsin injections -> proteolytic enzyme that could break down the enzyme. However more studies needed.
- Electric shock therapy doesn’t seem to work
How do you treat snake bite in the ER?
- Clean wound
- Tetanus shot
- IV access
- Take bloods
- Observe patient for at least 12 hours (24 hrs if neurotoxic venom)
- Outline any swelling with a marker pen
- Observe for any coagulopathy
- Keep giving anti-venom over time to prevent coagulopathy
How do you administer anti-venom and what are the indications?
- Systemic
- spontaneous systemic bleeding
- Whole blood clotting time increased
- Thrombocytopenia
- Shock
- Arrhythmia
- Abnormal ECG
- Neuro
- Ptosis and paralysis
- Renal
- AKI
- Rhabdomyolysis
- Hyperkalaemia
- Local sweeling rapidly extending
- Make sure to keep adrenaline close because a lot of patient develop anaphylactic reaction -> some physicians prescribe four weeks of prednisolone 30mg with taperin gdoses to prevent later reactions
- CroFab anti venom can be used which is made from sheep and has less anaphylactic reaction but one vial costs 3500
What are some other measures that can be taken in patients suffering from snake bites?
