Snakes and Scorpions Dr J Rieck Department of Emergency Medicine Sheba Medical Centre.

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Presentation transcript:

Snakes and Scorpions Dr J Rieck Department of Emergency Medicine Sheba Medical Centre

General 40 species of snake in Israel. 9 poisonous. Front fang. Identification of snake and assessment of bite is unreliable.

Venom Components.Variable. Enzymes- proteases,hyaluronidase,p-lipase. cause soft tissue destruction and DIC. Toxins. Hemorrhagins.- lung damage. Cardiotoxins- depolarising agent. Neurotoxins- neuromuscular, non-depol’.

Signs of possible envenomation Pain. Open/bleeding wound. Swelling. Dizzy, sweating. Raised pulse. Nausea or vomiting. Loss of co-ordination or fainting.

Prehospital treatment DO’S. Irrigate Calm patient and restrict movement. Find and kill snake. (remember reflex bite) Splint. Keep affected area below heart level. Remove restrictive objects. Eg: rings. Place IV line and urgent evac’ to hospital.

Prehospital treatment DONTS’ Do not CUT SUCK TOURNIQUET FREEZE.

Hospital care ABC and vital signs. History and examination. (5 grade system) Lab-CBC, Clotting, Renal/Hepatic function. Cross match + 4 units, consider FFP, etc. ECG and chest X ray. Specific immunoassays.

Antivenom If there are no signs of systemic or progressive local envenomation-monitor. If there are signs of envenomation consider anti-venom. Beware allergic reactions. Wound care tetanus, antibiotics. Refer to national protocol. Minimum 24 hr observation.

Complications Hypovolemia. Hemolysis. Coagulopathy. ARDS Of antivenom - anaphylaxis. - serum sickness.

Scorpions

SCORPIONS 2 Species in Israel with N-S distribution. Black (N) Yellow (S) Leiurus quinquestriatus.

Venom Species specific and variable. Proteins causing hemolysis and tissue destruction. Neurotoxins and Cardiotoxins. Pincer size related to amount of venom.

Treatment Prehospital principles similar to snakebite. May apply icepack. Hospital- monitor, particularly cardiac. - LVF, arrythmiae, HTN - parasthesia- local and systemic. 6 hours symptom free, can discharge.

CHILDREN CHILDREN - up to 30% serious envenomation. ? Anti venom. Systemic/ multi organ failure.