{"id":5426,"date":"2011-07-14T20:26:26","date_gmt":"2011-07-14T20:26:26","guid":{"rendered":"http:\/\/crashtext.org\/misc\/5426.htm\/"},"modified":"2011-10-02T19:31:26","modified_gmt":"2011-10-02T19:31:26","slug":"venomous-animal-injuries","status":"publish","type":"post","link":"https:\/\/crashingpatient.com\/toxicology\/venomous-animal-injuries.htm\/","title":{"rendered":"Venomous Animal Injuries"},"content":{"rendered":"

 <\/p>\n

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<\/span>Snakes<\/span><\/h2>\n

Five Types of Snakes throughout the World<\/strong><\/p>\n

1.\u00a0\u00a0\u00a0\u00a0\u00a0 Colubridae Rear Fixed fangs African boomslang is the only truly dangerous one<\/p>\n

2.\u00a0\u00a0\u00a0\u00a0 Elapidae front fixed fangs the poisonous family<\/p>\n

3.\u00a0\u00a0\u00a0\u00a0 Hydrophidae Sea Snakes front, fixed fangs Paralysis and myonecrosis<\/p>\n

4.\u00a0\u00a0\u00a0\u00a0 Atractaspididae front, mobile fangs<\/p>\n

5.\u00a0\u00a0\u00a0\u00a0 Viperidae front, mobile fangs Pit Vipers and True Vipers<\/p>\n

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CBC, PT\/PTT, Fibrin Splits, Fibrinogen, T+C 4 units<\/p>\n

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Copperhead-often do not need to be treated<\/p>\n

Timber Rattlesnake-rocky bluffs or ridges, Cause PLT destruction<\/p>\n

Eastern Diamondback-most dangerous in US, don\u0092t retreat from humans<\/p>\n

Western Diamondback-also will attack humans<\/p>\n

Cottonmouth-swims and crawls<\/p>\n

Eastern Coral-red on yellow kills a fellow, neurotoxic.\u00a0 Has to chew instead of inject venom<\/p>\n

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4 Rows of scratches=non-venomous snake<\/p>\n

Pseudosnake bite-self-inflicted puncture wounds to get pain meds<\/p>\n

Typical snake bite victim:\u00a0 99% men, 99% white, 40% with tattoo on L forearm<\/p>\n

Venom injected SC not IM<\/p>\n

snake bite extractors do not work (Annals EM February 2004 \u0095 Volume 43 \u0095 Number 2)<\/strong><\/p>\n

<\/span>Pit Vipers<\/span><\/h3>\n

Crotalinae of viperidae family:\u00a0 Rattlesnakes, sidewinders, diamondbacks<\/p>\n

Agkistrodon:\u00a0 copperheads and cottonmouths<\/p>\n

Pit between eye and nostril<\/p>\n

Bite is immediately painful<\/p>\n

Toxin disrupts coagulation path leading to DIC, shock, and NCPE<\/p>\n

Paresthesias, muscle fasiculations, weakness, paralysis, respiratory failure, renal failure<\/p>\n

Antivenin for patients with moderate or severe envenomation<\/p>\n

CroFab<\/h4>\n

best if administered within 6 hrs of bite.<\/p>\n

6 vials to start, if initial control, give 2 vials at 6, 12, and 18 hours<\/p>\n

If no control (systemic effects, Lab abnormalities, Spread of Local Swelling), give additional 6 vials and repeat until control.\u00a0 Starts to work in 1-2 hours, no pretreatment needed.\u00a0 Antibiotics only if signs of infection.\u00a0 Same crofag dose in peds.<\/p>\n

Contraindicated if allergic to papayas.<\/p>\n

$800 per vial<\/p>\n

timber rattler not included in the antivenin, ? of cross reactivity<\/p>\n

test dose has 10% rate of false positive and false negative.\u00a0 Can cause anaphylaxis, most will get serum sickness.<\/p>\n

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Necrosis, hemolysis, PLT destruction, edema, dry gangrene, early Hypotension (bradykinin), shock, and bleeding diatheses<\/p>\n

<\/span>Coral Snakes<\/span><\/h3>\n

Eastern and Sonoran coral snakes<\/p>\n

Red next to yellow kills a fellow, Red next to black, venom lack. (Only here does the rhyme apply, not Africa)<\/p>\n

Block neuromuscular transmission. Ptosis, diplopia, dysphagia, paresthesias and paralysis.<\/p>\n

Antivenin for eastern coral, recommended to give before symptoms, as symptoms can be delayed and severe<\/p>\n

Never discharge secondary to late morbidity<\/p>\n

Neurotoxin, can cause paralysis<\/p>\n

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If bitten on finger, swelling to the midpalm is minor, the wrist moderate, above is severe<\/p>\n

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Acute compartment syndrome-muscle injuries not necessarily associated with compartment pressures, so do not perform empirically<\/p>\n

 <\/p>\n

Finger dermotomy is recommended.\u00a0 Call hand surgeon.<\/p>\n

<\/span>Lizards<\/span><\/h2>\n

Gila monster and Mexican beaded lizard<\/p>\n

<\/span>Hymenoptera<\/span><\/h2>\n

Bees, wasps, hornets-remove stinger c back of scalpel blade<\/p>\n

Remove bee stings as rapidly<\/a> as possible regardless of method, no increase in venom in blood by method, definitely increases with time to removal (JB 23, Also Lancet Article)<\/p>\n

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Fire ants-hemolysis and complement activation<\/p>\n

Refer severe sting allergies to allergist for desensitization<\/p>\n

<\/span>Spiders (Arthropods)<\/span><\/h2>\n

<\/span>Black Widow<\/span><\/h3>\n

Shiny black with red or yellow hourglass on rounded abdomen<\/p>\n

Only the female has long enough fangs to bite humans<\/p>\n

Neurotoxic venom<\/p>\n

Initially only small sting.\u00a0 15-30 minutes after the bite, dull crampy pain spreading outwards<\/p>\n

Abd and chest get rigid<\/p>\n

CNS abnormalities and autonomic dystability<\/p>\n

Give tetanus toxoid<\/p>\n

Monitor 4 hours<\/p>\n

One amp CaGluc Q2-4 hrs<\/p>\n

Consider valium or dantrolene<\/p>\n

<16 or >65 get antivenin, or life threatening complications<\/p>\n

<\/span>Brown Recluse or Fiddleback<\/span><\/h3>\n

Little brown spider with violin marking on back<\/p>\n

Prefer dark, dry places:\u00a0 basements, woodpiles, barns<\/p>\n

Venom is tissue destructive.\u00a0 Bite is initially painless.\u00a0 2-6 hours later, get itching, mild tenderness, and erythema<\/p>\n

1-7 days erythematous area is now large necrotic lesion<\/p>\n

Systemic effects can occur 24 hours after bite and include:\u00a0 n\/v, malaise, hemolysis, DIC, ATN<\/p>\n

Vasoconstrictive area around bite then necrosis spreads outwards.<\/p>\n

Systemic effects, can get DIC<\/p>\n

Local wound care, dT,<\/p>\n

Give dapsone 25 to 100 mg PO BID for 2 weeks, make sure not G6PD<\/p>\n

<\/span>Tarantulas<\/span><\/h3>\n

Not venomous, but their abdomens are covered with urticating hairs, will cause inflammatory response if they flick them at you.\u00a0 Explorers club ate them and got pharyngeal tingling.<\/p>\n

<\/span>Scorpions<\/span><\/h2>\n

Worst sequelae is respiratory failure.\u00a0 Venom causes prolonged and excessive firing of nerves.<\/p>\n

Antivenin available, but usually supportive care, benzos, and intubation if needed are sufficient<\/p>\n

<\/span>Marine<\/span><\/h2>\n

<\/span>Venomous Vertebrates<\/span><\/h3>\n

Stingrays<\/p>\n

Tail barbs can penetrate the hulls of boats<\/p>\n

Has heat labile toxin containing phosphodiesterase and serotonin causing bradycardia, resp depression, and seizures<\/p>\n

Severe pain with a wound that is first dusky then red and hemorrhagic to necrosis<\/p>\n

Muscle cramps, syncope, paralysis, seizures.\u00a0 Severe bacterial infection can also result often with Vibrio vulnificans.<\/p>\n

Give Pain control, immerse limb in warm water to deactivate toxin, treat for any infections<\/p>\n

Marine Snakes<\/p>\n

Myotoxins cause rhabdomyolysis or paralysis<\/p>\n

Supportive care and antitoxin<\/p>\n

Scorpion fish<\/p>\n

Lionfish:\u00a0 <\/strong>complex venom that causes severe pain, swelling, and tissue loss locally<\/p>\n

Stonefish:\u00a0 <\/strong>heat labile toxin.\u00a0 N\/V, hypotension, dysrhythmias, syncope, dyspnea, seizures, coma, paralysis.\u00a0 Soak limb in hot water.\u00a0 Irrigate vigorously.\u00a0 Remove any spines in wound, Tetanus proph,\u00a0 Antivenom available, dose based on number of spines.<\/p>\n

Weeverfish:\u00a0 <\/strong>most venomous fish in the temperate zone.\u00a0 Causes severe local inflammation with tissue loss and possible gangrene<\/p>\n

<\/span>Venomous Invertebrates<\/span><\/h3>\n

Cnidaria (Coelenterates)<\/p>\n

Contain Nematocysts used to immobilize their prey.\u00a0 Even detached tentacles retain toxicity for months.\u00a0 Venom contains bradykinin, hemolysin, serotonin, histamine, etc.<\/p>\n

Localized dermatitis with severe pain and eventual scarring.\u00a0 Systemically, paralysis, CNS changes, seizures, respiratory failure, muscle spasm, coma, and death.<\/p>\n

Rinse with seawater or urine, fresh water will cause further discharge of venom<\/p>\n

Inactivate with vinegar<\/p>\n

Remove tentacles with forceps<\/p>\n

Cover nermatocysts with shaving cream or talcum poweder<\/p>\n

Shave off with razor blade<\/p>\n

are treated by removing the nematocysts without allowing them to discharge. The area should first be washed with sea water; fresh water may cause the nematocysts to discharge. Tentacles should be removed with a gloved hand or forceps. The area should not be rubbed with sand, because this old form of therapy actually makes the condition worse. The remaining nematocysts should be fixed by pouring vinegar over the wound area. Sodium bicarbonate may be used for sea nettle stings. The area should be dusted with talcum powder or covered with shaving cream, and the nematocysts, now adherent to the powder or cream, can be scraped off with a knife. The area should then be washed with sea water, and a steroid cream applied. Most lifeguard stations in areas where coelenterate stings are common have the necessary materials for this regimen. Most EDs have the equipment, but by the time the victim arrives at the hospital the damage may be already done.<\/p>\n

 <\/p>\n

Tetanus<\/p>\n

Antivenin for chironex (most deadly of jellyfish)<\/p>\n

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Irukandji Syndrome<\/strong><\/p>\n

severe local and systemic symptoms after carukia barnes (box jellyfish) sting.<\/p>\n

Nonspecific ekg changes with elevated troponin<\/p>\n

pain, restlessness, diaphoresis, vomiting, coughing<\/p>\n

phentolamine for sympathetic excess<\/p>\n

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|\u00a0\u00a0 \u00a0\u00a0 |\u00a0\u00a0 \u00a0\u00a0 |<\/p>\n","protected":false},"excerpt":{"rendered":"

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