Week 12: Bites and Envenomation Flashcards
Define poison
Is any substance that can cause injury or death if ingested, absorbed or inhaled (toxicology)
define toxin
- Is any poison of plant, animal or microbial origin (toxinology)
define venom
Is any toxin of animal origin
define envenomation
- is the process by which venom is injected into another animal (venom gets in blood stream)
What are the the common effects that a bite from a brown snake have?
Causes mainly bleeding and renal failure
What are the common effects that a snake bite from black snake will cause?
Causes renal failure and rhabdomyolysis (muscle tenderness)
What are the common effects that a bite from a taipan would have?
Causes bleeding and paralysis
What is the acronym used for how snakes basically kill you?
CRAMP
Outline what a snake bite effect has on a human using the acronym CRAMP
- C – Coagulopathy: Anticoagulants which make the animal bleed to death
- Bleeding from bite sight, gums, rectum and cannula sites
- Enlarged tender proximal lymph nodes
- Can cause death from intracerebral bleeds - R – Renal Failure: Nephrotoxins which cause organ failure to kill the animal
- Intrarenal injury from the nephrotoxins (as well as indirectly by myotoxins) - A – Anaphylaxis to anti-venom
- Occurs in 1-4% of patients when given antivenom - M – Muscle breakdown: Myotoxins which tenderises the meat
- Patients will feel muscle tenderness and myalgia
- Urine will be coca-colour coloured from myoglobin (from muscle breakdown) - P – Paralysis: Neurotoxins which stop the animal from running away
- Paralysis will be descending, that is, it will start from the small muscles of the face, and progress down into the respiratory muscles and limb weakness
- Patients will be fully conscious but unable to speak, swallow or move
Outline the investigation you would do determining if envenomation has occured using CRAMP
- Coagulopathy
- Take bloods (at 1, 6 and 12 hours) - Renal Failure
- Test urine and creatinine, if reduced then envenomation - Anaphylaxis to Antivenom
- Is based on clinical diagnosis if antivenom is given - Muscle Breakdown
- Blood tests for CK and Troponin levels, if yes envenomation
- Urine tests for myoglobin (breakdown product of muscles), if yes envenomation - Paralysis
- Peak expiratory flow meter, if reduced after 1 hour suggest envenomation
What is the acronym used for snake bite management?
- F – First Aid
- Pressure immobilisation bandage which stops lymphatic transport
- This buys time until antivenom/hospital
- DO NOTE apply a tourniquet as it with cause limb ischemia, plus do not suck or cut wound - R – Resuscitation
- Follow ABCs and CPR
- Possible intubation and addition of blood products - E – Envenomation?
- Perform a history, exams and the relevant investigations to determine if envenomation has actually occurred - A – Antivenom
- Based on the Snake Venom Detection kit, can be monovalent (2 species) or polyvalent (1 species) - K – Kall for help
- Can call toxicologist as well as possibly haematology and neurosurgery
what is snake antivenom made out of and the clinical significance of this?
animal antibodies - hence can cause anaphylaxis as it is a foreign substance going into your body
Is it a good idea to apply a tonique to a bite? why or why not?
No - as it can cause tissue ischaemia
Differentiate the presentation between a red black spider bite and a funnel web spider bite?
red blacks have no bite marks where as funnel webs leave visible bite marks
What is the common clinical triad that someone who has been bitten by a red black displays?
- Delayed onset of localized pain (longer than 10minutes)
- Piloerection (Goosebumps) from sympathetic stimulation
- Sweating from sympathetic stimulation
