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Senoir 21-2 > Stings And Bites > Flashcards

Stings And Bites Flashcards

1
Q

What is the venoms of bees and wasps

A

Hymenoptera

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2
Q

What is Hymenoptera from and what is it made from

A

Bees and wasps

Made of histamine
Melittin: degranualtes basophils and mast cells
Phospholipase and hyaluronidase

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3
Q

What is the most common response to Hymenoptera

A

The most common response to a Hymenoptera sting is a transient local reaction.
—Localized itching, pain, erythema, and swelling are common.

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4
Q

Getting stung in the eye by a bee or wasp can lead to what complications

A

Eye lid swelling

Anterior capsule cataract

Atrophy of the iris

Lens abcess

Globe perforation

Glaucoma

Refractive changes

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5
Q

If a pt presents with involuntary muscle spasm and edema without urticaria

Think what?

A

Bee or wasp sting - Hymenoptera

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6
Q

What is the typical onset of fatality iwth a wasp or bee sting

A

Within the 1st hour

In general, the shorter the interval between the sting and the onset of symptoms, the more severe is the reaction!!

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7
Q

What is the general non anaphylactic treatment for Hymenoptera
(wasp/bee stings)

A

removal of the stinger by any means

Wash the site

Cold compress may help

Oral analgesics, nsaids, and antihistamines

Elevate the limb as necessary to reduce edema

Corticosteroids are controversial but are still used

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8
Q

What is the treatment for Hymenoptera (bee stings) anaphylaxis

A

ABCs 1st

Im Epi 0.3-0.5 1:1000

Aggressive fluids with crystaloids

Anithistamines 1 and 2

+/- steroids

D/c with steroids, antihistamines, and epi pens

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9
Q

Describe a brown recluse

A

A pigmented, violin-shaped pattern on the cephalothorax

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10
Q

What is the venom from a brown recluse

A

The venom of the brown recluse contains multiple enzymes, including hyaluronidase and sphingomyelinase D, which is the major enzyme responsible for necrosis!!

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11
Q

Are brown recluse bites painful?

A

No

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12
Q

What is the red white and blue sign of a brown recluse bite

A

By day 3 or 4, the hemorrhagic area may become ecchymotic, which leads to the “red, white, and blue” sign
(erythema, blanching, and ecchymosis)
»The ecchymosis becomes necrotic, with eschar formation»Significant cosmetic defect requiring skin grafting.

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13
Q

What is the treatment for a brown recluse bite

A

Supportive

ABX if signs of infection

+/- dapsone and surgical incision

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14
Q

What si the f/u for a brown recluse bite

A

Surgical debridement should be delayed until clear margins are established, often 2 to 3 weeks after the bite. (Not in ED!)

Patients with systemic symptoms following a bite warrant hospitalization.
(hypotension, hypertension, sepsis)

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15
Q

What is the scientific name for a brown recluse

A

Loxosceles reclusa

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16
Q

Describe a Black widows spider

A

Black with a orange red hourglass

17
Q

What is the scientifc name for a black widow

A

latrodectus

18
Q

What is the most active component of the black widow venom

A

highly potent venom with the most active component of the venom is
α-latrotoxin

19
Q

What is the effect of alpha latrotoxin

A

Acts through both calcium-dependent and calcium-independent pathways leading to receptor stimulation, pore formation, and ultimately massive release of neurotransmitters (predominantly acetylcholine and norepinephrine)

Acetylcholine release accounts for neuromuscular manifestations, and norepinephrine release accounts for the cardiovascular manifestations.

20
Q

A black widow bites painful ?

A

Yes

21
Q

A pt presents with a painful spider bite after cleaning out his wood shed

He know has severe abdominal pain and cramping with HTN and TachyHR
HA, N/V, diaphorsis and photophobia

Think

A

Latrodectus - black widow

22
Q

What is the tx appraoch to latrodectus -black widow bites

A

Supportive measures
+/- IV calcium

Opiods for pain
Benzos for spans

Anti venom

23
Q

What is the pathophys of a scorpion sting

A

Most stings cause localized pain at the bite site and can open neuronal sodium channels that cause prolonged and excessive depolarization.

24
Q

What are the s/s of a scorpion sting

A

restlessness or uncontrollable jerking of the extremities that appears to be seizure-like activity

Tachycardia, HTN , Pulm edema, and cardio shock

AbnNML oculomotor function
Loss of pharyngeal control uncoordinated RR
Tongue fasciulations

Hypersalivation is common and can threaten the airway

25
Q

What cranial nerves are effected by scorpion stings

A

Trigeminal (cranial nerve V)

Facial (cranial nerve VII) Glossopharyngeal (cranial nerve IX)

26
Q

If a scorpion sting presents with Tachycardia, HTN, and mydriasis

What is the tx

A

Antivenmon and prazosin

27
Q

If a scorpion sting presents with pulm edema, what is the tx option

A

Antivenmo
Nitro or prazosin
Dobutamine

28
Q

If a scorpion bite presents with HOTN, bradyHR, salivation, sweating, ab pain, and pancreatitis

What is the tx ?

A

Atropine

29
Q

When should you admit a scorpion sting

A

Patients with mild, local reaction without systemic reactions may be discharged home with pain control, return precautions and close follow up.

Patients with systemic symptoms or cranial nerve impairments may need to be admitted.

30
Q

What is the effect of crotalinae snake venom

A

Complex enzyme mixture that causes local tissue injury, systemic vascular damage, hemolysis, fibrinolysis, and neuromuscular dysfunction, resulting in a mixture of local and systemic effects.

Crotaline venom quickly alters blood vessel permeability; this leads to loss of plasma and blood into the surrounding tissue, which causes hypovolemia.

Crotaline venom activates and consumes fibrinogen and platelets, causing a coagulopathy.

31
Q

How does Crotalinae Snake venom effect cranial nerves

A

In some species, specific venom fractions block neuromuscular transmission, which leads to cranial nerve weakness (e.g., ptosis), respiratory failure, and altered sensorium. (GCS what?!)

32
Q

What are the early S/s or crotalinae snake bites

A

early symptoms and signs are nausea and vomiting, weakness, oral numbness or tingling of the tongue and mouth, dizziness, and muscle fasciculation.

33
Q

What are the systemic effects of crotalinae snake venom

A

Systemic effects include tachypnea, tachycardia, hypotension, and altered level of consciousness.

In general, local swelling at the bite site becomes apparent within 15 to 30 minutes. (Wicked fast!)

34
Q

What are the three possible manifestations of a snake bite

A

Local injury

Hematology abNML

Systemic effects

The absence of any of these manifestations for a period of 8 to 12 hours following the bite indicates a dry bite.

35
Q

What is the Tx appraoch to crotalinae snake bites

A

Antivenom

Crotalidae Polyvalent Immune Fab (Ovine) (FabAV)

Establish initial control with 4-6 vials and repeat if not met goal

If goal of control met
Then induce 2-vials at 6-12-18hrs

Measure for anaphylaxis before, during and after admin of anti venom

Measure limb circumference for compartment syndrome q 30 min

Repeat labs q 4 hours

Pt may need fluids and or blood or blood products

36
Q

What is the F/u for a crotalinae snake bite

A

Observe for 6-8 hours in the ed

Can discharge if dry bite without s.s at 8 hours

Admit if life threatening S/s or receiving anti venom (general ward)

37
Q

Describe Elapid snake bites

A

“Red on yellow, kill a fellow; red on black, venom lack.”

Coral snakes

38
Q

What is the treatment for Elapid Coral Snake bites

A

Coral snake venom is primarily composed of neurotoxic components- no local injury.

Admit potential victims of coral snakebite to the hospital for observation, because venom effects may develop hours after a bite and are not easily reversed.

Administer three to five vials of antivenom, Antivenin® (M. fulvius), IV to patients who have definitely been bitten, because it may not be possible to prevent further effects or reverse effects once they develop.

Additional doses of coral snake antivenom are reserved for cases in which symptoms or signs of coral snake envenomation appear.

Senoir 21-2 (77 decks)

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