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Flashcards in Venomous Animal Injuries Deck (10):

How can you differentiate an American coral snake from a king snake, and which one is deadly?

Coral snake: Red next to yellow kills a fellow
King snake: Red next to black, venom lacked
Coral snakes are deadly


How do you differentiate a venomous from non-venomous snake

Venomous: triangular head with pointed nose, fangs, pits between eyes and nose
elliptical pupils
caudal plates arranged in a single row

Non venomousL round head, no fangs, no pits, round pupil and double row of caudal plates


Outline your first-aid and ED management of a snake envenomation.

- Remove any constricting jewelry or clothes
- Minimize spread of venom: calm the patient, immobilize the bitten area
- Compression: constricting band proximal to bite (collapse lymphatics and superficial veins) NOT a tourniquet
- Identify snake
- Cardiac monitoring, IV access, fluids
- DON’T: tourniquet, suction, incise, ice submerge wound

ED mgmt
- Supportive care
- Basline coag panel
- Anticipate complications: compartment syndrome, DIC à frequent pulse checks, tcross match blood products
- Wound care
- Antivenom


How is severity of pit viper envenomation graded?

Grade 0 (minimal): No evidence of envenomation, snakebite suspected
- LT 1 inch edema, minimal pain, no systemic effects
Grade 1 (minimal): Mild envenomation
- LT 5 inches of edema and erythema, throbbing pain at site, no systemic effects
Grade II (moderate): Edema, pain spreading to trunk, petichiae limited to area of edema
- Nausea, vomiting, mild fever
Grade III (severe): Generalized petichiae, edema involving trunk
- Tachycardia, hypotension
- Evidence of coagulation cascade activation
- Evidence of end organ dysfucntion
Grade IV (very severe): Most often after bite of large rattlesnake
- Local bleb, necrosis, rapidly spreading edema
- Weakness, fasciculations, cramps, seizures


Who requires antivenin for a snake bite?

Rattlesnake: Moderate (4-6 vials) to severe reaction (8+ vials)

Coral snake: all
3-5 vials


Name 3 adverse effect from anti-venin treatment

1. Anaphylaxis
2. Recurrence of coagulopathy if not re-dosed soon enough
3. Serum sickness:
a. At 1 week: all who receive horse antivenin, 15% who receive FabAV
b. Managed with cemitidine, Benadryl, +/- steroids if severe


Describe the clinical features of the black widow spider:

Describe the management of a black widow bite.

- Local:
o Pain and minimal swelling
o 2 small fang marks at bite site
- Systemic:
o Dull crampy ache
o Rigid abdomen although minimally tender
o Preterm labour, precipitous delivery
o Bulbar Sx, nausea / vomiting, H/A, facial swelling, weakness
o ECG: May look like Dig
- Resolution:
o Pain and cramping for several hours, with resolution over several days
o Children may have severe reaction, may not survive

- Local:
o Ice pack to bite site
o Cleaned with soap and water
- Muscle cramps / spasms:
o Analgesics
- Antivenin (horse serum):
o Indications:
§ Pregnant, pediatric, elderly
§ Severe envenomation: Sz, respiratory compromise, uncontrolled HTN
o Dose of IM epi before administration


What type of toxicity does the brown recluse spider venom result in?

- Hemolytic enzymes and vasoconstrictive substance
- Results in severe tissue destruction


What is the management of the Brown recluse envenomation?

- Little able to treat the wound locally
- Dapsone 50-200mg/day can prevent local effects of venom, especially if used in first 48hrs
- Analgesics
- Supportive care
- Antivenon only available in Mexico and Brazil


How can jellyfish and marine bites be treated by first aid?

- Immersion in hot water (100F) for 30-90min
- Application of vinegar
Antivenin: stonefish, box jellyfish