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SA Envenomation

Final

QuestionAnswer
Pit Vipers Water moccasins, rattlesnakes, copperheads and elapids (coral snakes)
Pit Viper anatomy heat sensing pits bt eye and nostril, retractable front fangs, elliptical pupils, triangular heads. Keratin rattles added on every time skin sloughs (does not equal age)
Coral snake anatomy small non-moveable fangs, bright colors w/encircling bands of diff color. Head is black. "Red on yellow dead fellow, red on black friend of jack" . Have to gnaw and hang on to victim for venom to be injected. Shy and must be provoked to bite
CS severity in order Rattle snake (most severe)>water moccasin>copper head (least severe)
Factors influencing severity of bite volume of venom injected, age of snake, aggressiveness of snake, circumstances of bite. Size of victim, site of bite, amt of physical activity after bite, amount of time elapased b4 medical intervention
Signs of snake bite swelling around area of bite, Very painful, hypotension, hypersalivation, mm twitching. Severe bites around neck or muzzle can interfere w/breathing
Main function of venom immobilize the victim and predigest tissues
Ingredients in snake venom Rich in proteolytic enzymes:Phospholipase A, Hyaluronidase (brks down CT), Collagenase (brks down collagen), Thrombin like enzymes
Organ systems affected by venom Respiratory, Coagulation, Renal, Endothelial cells, Cardiac output
Venom effects on Respiratory system direct swelling of upper airways, some have neurotoxin=central resp depression, endothelial dmg=leaky vessels=pulmonary edema.
Venom effects on Coagulation endothelial dmg activates. Thrombin like proteins produced=similar to DIC but No Ddimer produced=diff bt real DIC. Platelets consumed+Fibrinogen ->fibrin=excess clotting then all used up so pt bleeds
What does thrombin do converts Fibrinogen to fibrin
Venom effects on Renal system Myoglobin from mm dmg=renal failure Hypovolemia=acute tubular necrosis
Venom effects on endothelial cells dmg to capillary endothelial cell wall=leaky vessels=loss of protein, rbc,=edema
Venom effects on Cardiac output Vasodilation and loss of volume dt inc vascular permeability=massive decrease in CO
Snake bite DX Immediately get=PCV, TS, azo stick, blood glucose, blood smear (for echinocytes).Stat electrolytes, PTT or ACT and lactate, platelet count
Only antidote to envenomation? Antivenin
Contraindicated TX for envenomation any tx that delays transport. Walking (bc allows venom to circulate), no sucking venom out, no tourniquet, no bite excision. GET TO A HOSPITAL ASAP!!!!
Copperhead bite TX intensive fluid therapy, clip and keep bite wound clean, opiate analgesia, hospitalize 24-36 hours
Cro-Fab newer ovine antivenin-contains fragments of IgG. Small molecular size=renal excretion. less time to reach max blood levels
Antivenin and diphenhydramine Diphenhydramine only used for an allergic reaction to antivenin and has NO effect on the venom itself!!! (some animals have anaphylactoid or anaphylactic rxns to the venin-tx is preceded by Diphen)
Antivenin handling DO NOT SHAKE vial as this can denature proteins. Foaming in vial=proteins denatured
Anaphylactoid vs anaphylactic Anaphylactoid=are concentration, rate and dose dependent on protein in antivenin, tx by stopping infusion+2nd dose diphenhydramine+infuse again at slower rate. Anaphylaxis=type 1 hypersens via IgE dt previous exposure to protein in venin, tx w/IV epi
Abx and snake bites USE them bc snake's mouth is NOT STERILE, also snake bite is classic puncture wound (so give if not vax for tetanus as well)
TX of Crotalidae bites Admin Antivenin, Clean and clip wound, give Abx, Fresh frozen plasma (to supply coag factors), IVF, NO STEROIDS
Elapid venom neurotoxic=induced neuromuscular blockade+not much local rxn at site of bite, delayed onset of action. Resp failure is most common cause of death
Coral snake bite tx vigorous washing of area of bite wound, administer antivenin
Created by: 96402313
 

 



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