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Tropical Medicine > snakebite > Flashcards

snakebite Flashcards

1
Q

Snakebite epidemiology

A

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

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2
Q

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

A

Bungarus bite-SE Asia

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3
Q

What are the two main families of snakes

A

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)

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4
Q

What are the medically important snakes

A

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

Colubridae: Non front fanged snakes

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5
Q

What are the 4e main families of snak venoms

A

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

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6
Q

What are local effects of envenoming?

A

Cytotoxicity: local swelling, bruising, blistering, necrosis

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7
Q

What are systemic effects of envenoming?

A

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

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8
Q

What snakes cause cytotoxicity

A

cobras, vipers, burrowing asps

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9
Q

What snakes cause hemato toxictiy

A

vipers, oceanian elapids, colubrids

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10
Q

what snakes cause neurotox

A

elapids, vipers

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11
Q

what snakes cause hypovolemia/cv shock

A

vipers

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12
Q

what snakes cause increased capillary permeability

A

russelsls vipers, rattlesnakes

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13
Q

what snakes cause myocardial toxicity

A

vipers, burrowing asps

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14
Q

what snakes cause rhabdo

A

seasnakes, elapids, vipers

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15
Q

what snakes cause nephrotoxicity

A

russells vipers, elapids, colubrids

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16
Q

pre-hospital tx of snake bites

A

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

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17
Q

medical treatment of snakebite patients

A

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

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18
Q

Antivenom indications for snake bites

A

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

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19
Q

What snake causes descending flaccid paralysis starting with ptosis

A

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

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20
Q

What causes severe local swelling, brusing, blistering, necrosis

A

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

21
Q

adverse reactions of antivenom

A

early anaphylaxis or pyrogenic reactions; late serum sickness antivenom reactions

22
Q

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

A

failure of restoration of blood coagulability after 6 hours

23
Q

Where are the most deaths from scorpion stings?

A

Brazil , Mexico, Iran

24
Q

most common symptom with scorpion sting

A

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

25
Q

systemic envenoming effects in scorpions

A

Na, K, Ca–>release of autonomic storm and then neurotoxic effects “pseudo convulsions” fasiculations, paralysis

26
Q

How to treat scorpion stings:

A

Local pain: regional block
Systemic: antivenom via slow infusion

27
Q

how do you prevent scorpion stings

A

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

28
Q

Neurotoxic spiders
Necrotic spiders

A

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

29
Q

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

A

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

30
Q

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

A

Wandering spider-neurotoxic spider

31
Q

most deadly spider

A

australian funnel web spiders

32
Q

Envenoming by new world tarantula spider

A

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

33
Q

Fatal anaphylaxis from bees

A

hymenooptera sting fatal anaphylaxis; treat with adrenaline

34
Q

most dangerous caterpillar in the world

A

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

35
Q

fish sting treatmetn

A

hot water

36
Q

jelly fish stings

A

intense pain, wheals, vasospasm

37
Q

how to treat jelly fish stings

A

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

38
Q

timings of seafood poisoning

A

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

39
Q

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

A

Ciguatera fish poisoning

40
Q

which fish should you never eat

A

trigger, parrot, moray eel

41
Q

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

A

ciguatera fish poisoning

42
Q

perioral tingling after eating dark meat of tuna

A

immediate peri-oral tingling

43
Q

what are the toxins in shellfish poisoning?

A

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

44
Q

Treatment of marine poisoning

A

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

45
Q

how do you tell the death cap mushroom

A

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

46
Q

amatoxin mushroom treatment

A

silibinin, N actetyl cysteine, penicillin, hemodialysis, sterodis

47
Q

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

A

atropine poisoning–>after eating night shade

48
Q

how do you treat night shade poisoning

A

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

49
Q

how to get cyanide poisoning in latin america or east africa

A

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

Tropical Medicine (19 decks)

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