1 / 64

Snake Bite ,Bee sting and Scorpian Bite

Snake Bite ,Bee sting and Scorpian Bite. Dr Pavan .M MD(A &EM), VMKVMC. Epidemiology. 3 million bites and 1,50,000 deaths/year from venomous snake worldwide. Bites highest in temperate and tropical regions. 3000 species of snakes, out of them only 10-15% of snakes are venomous

remedy
Download Presentation

Snake Bite ,Bee sting and Scorpian Bite

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Snake Bite ,Bee sting and Scorpian Bite Dr Pavan .M MD(A &EM), VMKVMC

  2. Epidemiology • 3 million bites and 1,50,000 deaths/year from venomous snake worldwide. • Bites highest in temperate and tropical regions. • 3000 species of snakes, out of them only 10-15% of snakes are venomous • 97% of all snake bites are on the extremities

  3. Common Snakes - INDIA • Cobras(nagraj) –Naja naja,N.oxiana, N.kabuthia • Neurotoxicity usually predominates.

  4. Common krait(karayat)-Bungarus caeruleus

  5. Russell’s viper(kander)-Daboia russelii • Heat-sensing facial pits (hence the name "pit vipers").

  6. Echis.carinatus(afai)-Saw scaled viper

  7. Features of poisonous & non-poisonous snakes Approximately 2500 different species of snakes are known. Approximately Non Poisonous Snakes Head - RoundedFangs - Not presentPupils - RoundedAnal Plate - Double row Bite Mark - Row of small teeth. Poisonous Snakes Head – Triangle Fangs – Present Pupils - Elliptical pupil Anal Plate - Single row Bite Mark - Fang Mark

  8. Snake Venom • Snake venom is highly modified saliva

  9. Mechanism of toxicity • Cytotoxic effects on tissues • Hemotoxic • Neurotoxic • Systemic effects. • Toxic dose. The potency of the venom and the amount of venom injected vary considerably. • 20% of all strikes are "dry" in which no venom is injected.

  10. Snake Venom, Necrosis • Proteolytic enzymes have a trypsin-like activity. • Hyaluronidase splits acidic mucopolysaccharides and promotes the distribution of venom in the extracellular matrix of connective tissue. • Phospholipases A2- break down membrane phospholipids -causes cellular membrane damage

  11. Contd.. • all these enzymes cause oedema, blister formation and local tissue necrosis

  12. Snake Venom ,Paralysis • block the stimulus transmission from nerve cell to muscle and cause paralysis • does not penetrate the blood-brain barrier

  13. Contd.. • postsynaptic effects are reversible with antivenom and neostigmine. • presynaptic nerve terminal, e.g. beta-bungarotoxin and here neostigmine will not be effective.

  14. Snake venom, Hemorrhages • activate prothrombin (e.g. ecarin from Echis carinatus) • Effect on fibrinogen and convert it into fibrin -thrombin-like activity, such as crotalase (rattlesnake venom) • Activate factor 5, factor 10 , Protein C • Activate or inhibit platelet aggregation • Haemmorhagins- cause endothelial damage

  15. Clinical syndromic approachSyndrome 1 • Local envenoming (swelling etc) with bleeding/clotting disturbances VIPERIDAE

  16. Syndrome 2 Ptosis, external opthalmoplegia, facial paralysis etc and dark brown urine=Russell's viper, Sri Lanka and South India

  17. Syndrome 3 Local envenoming (swelling etc) with paralysis=Cobra or king cobra

  18. Syndrome 4 • Paralysis with minimal or no local envenoming Krait, Sea snake

  19. Syndrome 5 • Paralysis with dark brown urine and renal failure: Russle viper

  20. Grade 0 • No evidence of envenomation • Suspected snake bite • Fang mark may be present • Pain and 1 inch edema & erythema • No systemic signs- first 12 hours • No lab changes

  21. Grade 1 • Minimal envenomation • Snake bite suspected • Fang wound & moderate pain present • 1-5 inches of edema or erythema • No systemic involvement in present after 12 hours • No lab changes

  22. Grade 3 • Severe envenomation • Within 12 hours edema spreads to the extremities and part of trunk. • Petechiae and ecchymosis may be generalized • Tachycardia • Hypotension • Subnormal temperature

  23. Grade 4 • Envenomation very severe • Sudden pain rapidly • Progressive swelling which leads to ecchymosis all over trunk • Bleb formation and necrosis

  24. Grade 4 contd… • Systemic manifestations within 15 min after the bite. • Nausea,vomitings,vertigo, • Numbness,tingling lips and face, muscle fasciculations,urinary incontinence, • Weak pulse • Convulsions, coma

  25. What investigation to do? • CBC • RFT • Coagulation studies • Blood grouping & cross matching • Sr.electrolytes • Urinalysis

  26. 20 min whole blood clotting time • A few milliliters of fresh blood are placed in a new, plain glass receptacle (e.g., test tube) and left undisturbed for 20 min.

  27. Contd… • The tube is then tipped once to 45° to determine whether a clot has formed. If not, coagulopathy is diagnosed

  28. Hess's test • Blow up a blood pressure cuff to 80 mm Hg and leave it on for 5 minutes. • If a crop of purpuric spots appears below the cuff, the test is positive.

  29. First Aid First Aid

  30. ASV • When to use ASV? • How much to use? • What if a reaction occurs? • When to stop ASV?

  31. When to use ASV • Hemostatic abnormalities(lab and clinical) • progressive local findings • Neurotoxicity • Systemic signs and symptoms • Generalised rhabdomyolysis

  32. Polyvalent antivenin Manufactured by hyper immunizing horses against venoms of four standard snakes • Cobra (naja naja) • Krait (B.caerulus) • Russel’s viper(V.russelli) • Saw scaled viper(Echis carinatus)

  33. Contd.. • Lyophilisedform: stored in a cool dark place & may last for 5 years • Liquid form: has to be stored at 4°c with much shorter life span • Each 1ml of reconstituted serum neutralise0.6 mg of najanaja0.45 mg of Bungaruscaerulus0.6 mg of V.russelli0.45 mg of Echiscarinatus

  34. Guide for initial dose of antivenin

  35. Skin testing- Done if patient is stable and time available • 0.02ml of 1:100 solution of serum is injected sc • A positive reaction occurs within 5 to 30 mins. • Appearance of wheal & surrounding erythema

  36. What to do in case of anaphylactic reaction to ASV • Adrenaline 0.5 to 1ml IM • If hypotension,severe bronchospasm or laryngeal edema give 0.5 ml of adrenaline diluted in 20 ml of isotonic saline over 20 mins iv.

  37. contd.. • A histamine anti H1 blocker-chlorpheniramine maleate-10 mg IV • Pyrogenic reactions-antipyretics • Late reactions-respond to CPM-2 mg, 6 hrly or oral prednisolone-5 mg 6 hrly

  38. What if the patient needs ASV following reaction • dose should be further diluted in isotonic saline and restarted as soon as possible. • concomitant IV infusion of epinephrine may be required to hold allergic sequelae at bay while further antivenom is administered

  39. Serum Sickness • Characterised by fever, chills, urticaria, myalgias, arthralgias, and possibly renal or neurologic dysfunction developing 1–2 weeks after antivenom administration • systemic glucocorticoids (e.g., oral prednisone, 1–2 mg/kg daily) until all findings resolve • dose is tapered over 1–2 weeks. Oral antihistamines (e.g., diphenhydramine in standard doses) provide additional relief of symptoms

  40. When to stop using ASV • Bleeding subsides • Lab values returns to baseline • Signs of neurotoxicity reverses • Local effects halts progression

  41. Supportive treatment • Anticholineesterase have variable but useful role Trial • Atropine sulphate 0.6 mg • Edrophonium chloride 10 mg IV (or) Neostigmine: 1.5–2.0 mg IM (children, 0.025–0.08 mg/kg)

  42. Contd.. If objective improvement is evident at 5 min • continue neostigmine at a dose of 0.5 mg (children, 0.01 mg/kg) every 30 min as needed with • atropine by continuous infusion of 0.6 mg over 8 h -children, 0.02 mg/kg over 8 h

  43. Contd Hypotension • administration of crystalloid (20–40 mL/kg) • a trial of 5% albumin (10– 20mL/kg) • CVP guided fluids • Inotropic support and invasive monitoring

  44. Contd.. • Oliguria & renal failure- fluids,diuretics, dopamine no response-fluid restriction, Dialysis • Local infection- TT,antibiotics • Haemostatic disturbances-FFP,fresh whole blood,cryoprecipitates

  45. Cobra spit opthalmia • topical antimicrobial • 0.1% adrenaline relieves pain • No need for ASV

  46. Compartment syndrome If signs of compartment syndrome are present and compartment pressure > 30 mm Hg: • Elevate limb • Administer Mannitol 1-2 g/kg IV over 30 min • Simultaneously administer additional antivenom, 4-6 vials IV over 60 min If elevated compartment pressure persists another 60 min, consider fasciotomy

  47. Bee Sting Honey bee belong • Family- Hymenoptera • Sub Family-Apidae • only the females have adapted a stinger from the ovipositor on the posterior aspect of the abdomen

  48. Venom • Histamine. • Melittina –membraneactive polypeptide that can cause degranulation of basophils and mast cells, constitutes more than 50 percent of the dry weight of bee venom • Venom commonly causes pain, slight erythema, edema, and pruritus at the sting site

More Related