AInimal Poisoning Flashcards
I. Hemorrhagic snake
Heat-sensing facial pitsالطريشة
Clinical picture
Local effects of Hemorrhagic snake
Local effects
- Within minutes of envenomation
- They are so severe and the condition may extend to gangrene
- Fang marks
- Local pain and bleeding from the fang marks
- Edema, which appear within few minutes and may progress to involve the whole limb
- Enlarged tender regional lymph nodes
- Ecchymosis: extravasation from damaged capillaries
- Blistering
- Skin necrosis and gangrene
Clinical picture
Systemic effects of Hemorrhagic snake
1-General manifestations: Anxiety, sweating, nausea,
vomiting, rigors, tachycardia and chest tightness
2-Coagulopathy This leads to bleeding from all body
orifices and presents as:
o Persistent bleeding from the bite site or venipuncture
o Bleeding gums and epistaxis
o Hematemesis and melena
o Hematuria
o DIC
3. Cardiac and circulatory effects: usually secondary to hemorrhagic disturbances leading to the occurrence of hypotension and shock
4. Myotoxicity due to myolysis of skeletal muscles.
II. Paralytic snake (Elapidae) Cobras Clinical picture (Local effects)
Local effects
Fang marks
Minimal local pain and edema around the fang marks
II. Paralytic snake (Elapidae) Cobras Clinical picture (Systemic effects)
Systemic effects
usually occur within a few hours but may rarely be delayed 12 hours or more.
General manifestations:
Anxiety, sweating, nausea, vomiting, rigors, tachycardia
and chest tightness
2. Weakness up to descending paralysis:
This presents as:
- Diplopia, ptosis
- Dysarthria
- Generalized muscle weakness
- Respiratory arrest
3. Consciousness and sensation are spared
Paralytic snake (Elapidae) Cobras Diagnosis
- History of a bite accompanied by seeing or capturing –the snake
- Examination: fang marks and clinical manifestations
- Investigations:
- Viper envenomation, the laboratory findings are
- CBC (Anemia, thrombocytopenia)
- Hypofibrinogenemia
- Increased FDP
- PT and PTT (prolonged)
- Cobra envenomation, ABG is the most important.
Treatment for snake bite
I. First Aid for snake bite (pre-hospital care)
II. Hospital Treatment
I. First Aid for snake bite (pre-hospital care)
1-Rest, reassurance
2-Immobilization of the affected limb
3-Remove any constricting clothing or jewelry.
4-Give analgesic (paracetamol or codeines) avoid aspirin or NSAIDS)
5-Light pressure pad
II. Hospital Treatment for snake bite
Monitor patients closely for at least 6–8 hours after a typical viper bite and for at least 12–24 hours after an elapid bite.
ABC: Mechanical ventilation is the most important line of treatment in case of paralytic snake
B. Antivenom: Do Skin sensitivity test.
It should be given in ICU.
It is indicated in all systemic envenomation.
Dose in children is the same as in adults.
It is given by slow IV injection or IV infusion.
Initial dose is 5 vials to be repeated according to severity and the follow up of the patient.
C. Supportive treatment
Hypotension is treated by IV fluids
Hemostatic abnormalities are treated by fresh whole blood, fresh frozen plasma.
Tetanus prophylaxis is given to non-immune persons.
Treatment of local complication in the form of debridement of necrotic tissue at the bite site and surgical consultation.
Antivenom reaction Caution
Caution: Life-threatening anaphylactic reactions may occur with antivenom administration, even after a negative skin sensitivity test.
Usually within 10-180 minutes of starting antivenom, the patient begins to itch and develops urticaria, dry cough, fever, nausea, vomiting, abdominal colic, diarrhoea and tachycardia.
Antivenom reaction Treatment
Treatment
Epinephrine is given intramuscularly in an initial dose of 0.5 mg
Antihistaminic (Chlorphenamine maleate) 10mg IV
Hydrocortisone 100mg IV
