snakebite

Question 1

Snakebite epidemiology

Answer 1

-rainy season
-heat, rains, flooding
-mating season
high risk:
-farmers, rural communities, ground sleepers, hunter-gatherers

Question 2

Patient with “early morning paralysis” ; usually sleeps ont he ground

Answer 2

Bungarus bite-SE Asia

Question 3

What are the two main families of snakes

Answer 3

Vieridae -vipers, adders, pit-vipers, moccasins, rattlesnakes (short, tick body, short tail, distinctive dorsal pattern, slow moving but strike like lightning)

Elapidae : cobras, kraits, mambas, coral snake, oceanian venmous snakes (they have a long thin body, long tail, uniform color, very fast)

Question 4

What are the medically important snakes

Answer 4

Atractaspididae: live in burrows, nocturnal, reclusive, emerge after heavy rains, bites sleepers

Colubridae: Non front fanged snakes

Question 5

What are the 4e main families of snak venoms

Answer 5

Phospholipases A1, Metalloprotesases, serine proteases, three finger toxins (neuro, cytotoxins)

Question 6

What are local effects of envenoming?

Answer 6

Cytotoxicity: local swelling, bruising, blistering, necrosis

Question 7

What are systemic effects of envenoming?

Answer 7

Hemotoxicity (bleeding, coagulopathy)
Neurotoxicity (descending paralysis)
Cardiovascular toxicity: myocardial damage
Myotoxicity: Generalized rhabdo, hyperK
Nephrotoxicity AKI

Question 8

What snakes cause cytotoxicity

Answer 8

cobras, vipers, burrowing asps

Question 9

What snakes cause hemato toxictiy

Answer 9

vipers, oceanian elapids, colubrids

Question 10

what snakes cause neurotox

Answer 10

elapids, vipers

Question 11

what snakes cause hypovolemia/cv shock

Answer 11

vipers

Question 12

what snakes cause increased capillary permeability

Answer 12

russelsls vipers, rattlesnakes

Question 13

what snakes cause myocardial toxicity

Answer 13

vipers, burrowing asps

Question 14

what snakes cause rhabdo

Answer 14

seasnakes, elapids, vipers

Question 15

what snakes cause nephrotoxicity

Answer 15

russells vipers, elapids, colubrids

Question 16

pre-hospital tx of snake bites

Answer 16

reassure, immobilize the body-bitten limb, remove tight rins/bracelets, apply pressure pad immobilization, transport rapidly, consider anticholinesterase for neurotoxicity

Question 17

medical treatment of snakebite patients

Answer 17

admit x 24 hours, resuscitate, Tdap
Check for envenoming (bed side test for coagulopathy-put the blood in a glass jar)
-If you give antivenom, treat with epinephrine first and then obs x 4 hours

Question 18

Antivenom indications for snake bites

Answer 18

shock, bleeding, incoagulable blood, neurotoxicity, black urine, rapid progressive local swelling

Question 19

What snake causes descending flaccid paralysis starting with ptosis

Answer 19

elapidae (cobras, kraits, mambas, coral snakes, australian snakes, sea snakes)

Question 20

What causes severe local swelling, brusing, blistering, necrosis

Answer 20

viperidae (vipers, adders, pit, rattlesnakes, moccasins)

Question 21

adverse reactions of antivenom

Answer 21

early anaphylaxis or pyrogenic reactions; late serum sickness antivenom reactions

Question 22

after the initial dose of antivenom, what is the indication for repeat dosage

Answer 22

failure of restoration of blood coagulability after 6 hours

Question 23

Where are the most deaths from scorpion stings?

Answer 23

Brazil , Mexico, Iran

Question 24

most common symptom with scorpion sting

Answer 24

immediate agonizing local pain with minimal swelling (exception is the hemiscorpius lepturus-painless)

Question 25

systemic envenoming effects in scorpions

Answer 25

Na, K, Ca-->release of autonomic storm and then neurotoxic effects "pseudo convulsions" fasiculations, paralysis

Question 26

How to treat scorpion stings:

Answer 26

Local pain: regional block Systemic: antivenom via slow infusion

Question 27

how do you prevent scorpion stings

Answer 27

wear gloves, solid boots, long trousers, shake out clothes, UV light

Question 28

Neurotoxic spiders Necrotic spiders

Answer 28

Neurotoxic-black/brown widow, Armed/wandering Necrotic-Brown rcluse, tarantula, funnel web spider

Question 29

What does a brown recluse look like? What does it cause

Answer 29

violin Cutaneous (dermonecrotic) loxoscelism initially painless, then progressive local discomfort Has a red/white/blue sign with serous hemorrhage vesicles/blisters Then systemic symptoms

Question 30

Wide bite marks, at the site of the bite, piloerection, goosebumps, sweating

Answer 30

Wandering spider-neurotoxic spider

Question 31

most deadly spider

Answer 31

australian funnel web spiders

Question 32

Envenoming by new world tarantula spider

Answer 32

physical trauma from fangs, keratitis nodulosa (more local, lesssystemic)

Question 33

Fatal anaphylaxis from bees

Answer 33

hymenooptera sting fatal anaphylaxis; treat with adrenaline

Question 34

most dangerous caterpillar in the world

Answer 34

Lonomia -giant silk worm moth-fatal bleeding, kidney failure

Question 35

fish sting treatmetn

Answer 35

hot water

Question 36

jelly fish stings

Answer 36

intense pain, wheals, vasospasm

Question 37

how to treat jelly fish stings

Answer 37

lignocaine HCL spray -DO NOT use acetic acid as it may stimulate the nematocyst discharge

Question 38

timings of seafood poisoning

Answer 38

scrombroid: 1-120 minutes Puffer fish 10-180 Shellfish: 30-180 Ciguatera 60 mins-24 hours

Question 39

60yoF sailor ate some fish in New Zealand, next morning had abd pain and within 3-4 days, had neuro symptoms, les and back pain, unsteady gait

Answer 39

Ciguatera fish poisoning

Question 40

which fish should you never eat

Answer 40

trigger, parrot, moray eel

Question 41

diarrhea, abdominal colic, vomiting, causes paradoxical dysaesthesia/cold allodynia, pruritis

Answer 41

ciguatera fish poisoning

Question 42

perioral tingling after eating dark meat of tuna

Answer 42

immediate peri-oral tingling

Question 43

what are the toxins in shellfish poisoning?

Answer 43

okadaic acid (acute gastro) Brevetoxins -red tide (parasthesia) tetrahydropurine (descending paralysis domoic acid (amnesia)

Question 44

Treatment of marine poisoning

Answer 44

Ciguatera: mannitol, fluids Scrombroid: antihistamines Paralytics (tetrodotoxin, shellfish): ventilation

Question 45

how do you tell the death cap mushroom

Answer 45

Gills of death cap are WHITE, and they have a sac at the bottom: Basidiomycota, causes amatoxin mushroom poisoning

Question 46

amatoxin mushroom treatment

Answer 46

silibinin, N actetyl cysteine, penicillin, hemodialysis, sterodis

Question 47

red as a beet, dry as a bone, urinary retention-what are you concerned about

Answer 47

atropine poisoning-->after eating night shade

Question 48

how do you treat night shade poisoning

Answer 48

they present as atropine poisoning ; tret with physostigmine (anticholinesterase)

Question 49

how to get cyanide poisoning in latin america or east africa

Answer 49

chronic cassava-neuro ataxic neuropathy (can be confused with tropical spastic)