Toxinology pdf
- 1. VIEWER DISCRETION ADVISED IF YOU HAVE A GENUINE PHOBIA OF SNAKES RATHER LEAVE NOW!!
- 2. TOXINOLOGY
- 3. if YOU bite IT and you die, it’s POISONOUS if IT bites YOU and you die, it’s VENOMOUS
- 4. SNAKE BITES
- 5. THERE ARE 3 BROAD CLASSES HAEMOTOXIC CYTOTOXIC NEUROTOXIC
- 6. AND 5 FIVE CLINICAL SYNDROMES
- 7. SYNDROME PAIN SWELLING CYTO TOXIC NEURO TOXIC COAGULOP ATHY 1 2 3 4 5 + + + + ++ + + + - - - - - - --+ + + + - - - -
- 8. OUR MOST COMMON SNAKES IN KZN
- 14. NATAL BLACK SNAKE SWELLING PAIN MINIMAL SYSTEMIC EFFECTS
- 17. EARLY SWELLING WITH SEVERE PAIN EXTENSIVE SWELLING CAN OCCUR MULTIPLE BLISTERS AND BULLAE SKIP LESIONS
- 19. HYPOVOLAEMIA DUE TO EXTRAVASATION OF FLUID, ESP. IN CHILDREN COMPARTMENT SYNDROME THROMBOCYTOPAENIA IS A COMMON FINDING, BUT IT IS UNLIKELY TO LEAD TO LIFE THREATENING BLEEDS
- 20. CREATININE KINASE LEVELS RISE RHABDOMYOLYSIS IS SIGNIFICANT EVENTUAL RENAL DYSFUNCTION
- 21. MAMBAS THE AGITATED, NERVOUS, POOR BREATHER
- 22. PROGRESSIVE DESCENDING FLACCID PARALYSIS STARTS AS PARAESTHESIA OF TONGUE AND LIPS BLURRED VISION, PTOSIS, DILATED PUPILS DYSARTHRIA, DYSPHONIA, DYSPHAGIA EVENTUAL RESPIRATORY FAILURE
- 23. WHAT WE SEE TREMBLING MUSCLE FASCICULATIONS VOMITTING CHEST AND LIMB PAIN HYPERSALIVATION ARRYTHMIAS SIMILAR TO SCORPION STINGS AND SPIDER BITES
- 25. BERG ADDER THE AGITATED, NERVOUS, SWOLLEN, POOR BREATHER
- 26. SAME SYMPTOMS AS THE MAMBA BITE BUTALSO LOTS OF SWELLING MARKED HYPONATRAEMIA MAY LEAD TO CONVULSIONS SWELLING WITH BULLAE AND NECROSIS BUT NOTAS EXTENSIVE AS THE RHINKALS THERE IS NO TREATMENT!!!
- 29. EARLY NAUSEAAND VOMITING HEADACHES AND DIZZINESS PERSISTENT OOZING FROM WOUND GINGIVAL BLEEDING
- 30. FULL ON HAEMOTOXIC SYMPTOMS MAY OCCUR UP TO 24 HRS LATER MAY DEVELOP EPISTAXIS, PURPURAAND GIT BLEEDS WILL THEN GET SUBARACHNOID AND INTRACRANIAL BLEEDS EVENTUAL MULTI-ORGAN FAILURE
- 32. PT-INRS WILL BE DERANGED YOU CAN DO BEDSIDE WHOLE BLOOD CLOTTING TEST 3-4ML BLOOD IN AYELLOWTUBE, LEFT UNDISTURBED AT ROOM TEMP FOR 20 MINUTES TILTTHE BOTTLE, SHOULD HAVE CLOTTED WITH ONLY A BIT OF PLASMA MOVING AROUND
- 34. NATAL BLACK SNAKE THE WORRIED, SWOLLEN BUTWELL PATIENT
- 35. PAIN FEVER REGIONAL LYMPHADENOPATHY BLISTERING AND NECROSIS AT BITE SITE
- 37. MANAGEMENT
- 38. MYTHS SUCKING OUT VENOM HELPS INCISING THE WOUNDS HELPS AMPUTATING DIGITS PREVENTS SPREAD APPLICATION OF PETROL, ICEPACKS, POTASSIUM PERMANGANATE, SNAKE STONES AND ELECTRIC SHOCKS TOURNIQUETS ARE ONLY USED FOR BLACK MAMBA BITES, AND NOT SO AS TO CUT OFF ARTERIAL FLOW
- 39. IN THE FIELD REMOVE CONSTRICTING CLOTHING REASSURE THE VICTIM ARRANGE URGENT TRANSPORT IMMOBILISE THE PATIENT TAKE DEAD SNAKE ALONG
- 40. ED MANAGEMENT C-A-B’S KEEP YOUR PT ALIVE ANALGESIA PARACETAMOL, PARACETAMOL/CODEINE AVOID ASPRIN AND NSAIDS AVOID OPIATES IF THERE IS RESP. DEPRESSION HYPONATRAEMIA AND HYPOVOLAEMIA FLUIDS
- 42. POLYVALENT USED IN ALL ENVENOMATIONS (NOT BITES) EXCEPT BOOMSLANG, BERG ADDER AND VINE-SNAKE OR ALL EXCEPT ‘NATURE’ BERG, BOOM AND VINE
- 43. BOOMSLANG OR MONOVALENT ANTI-VENOM ONLY FOR BOOMSLANG SO IF YOU GET BITTEN BY AVINE-SNAKE OR BERG ADDER, GOODBYE!
- 44. ANTIVENOM NEUTRALIZES A FIXED AMOUNT OF VENOM THE SAME AMOUNT OF VENOM IS INJECTED INTO ADULTS AND CHILDREN SO THE DOSAGE OF ANTI-VENOM IS THE SAME
- 45. ANTI-VENOM IS NOT NEEDED FORALL BITES!! 10-50% OF BITES FROM VENOMOUS SNAKES ARE ‘DRY’, I.E , DOES NOT CAUSE ENVENOMATION
- 46. INDICATIONS OBVIOUS NEUROTOXICITY SIGNS OF COAGULOPATHY RAPID AND EXTENSIVE CYTOTOXICITY AT LEAST HALF THE LIMB CVS MANIFESTATIONS ARRYTHMIAS, SHOCK/HYPOTENSION
- 47. ‘ THE CURE CAN BE AS DEADLY AS THE DISEASE!!’ DO NOTADMINISTER UNLESS DIRECT SUPERVISION BYA SPECIALIST PHYSICIAN, SURGEON, EM PHYSICIAN, OR TELEPHONIC GUIDANCE FROM POISON CONTROL REQUIRES PROPHYLACTIC ADRENALIN AND CONTINUOUS MONITORING IT IS NEVER TOO LATE TO GIVE ANTI-VENOM, BUTTHE EARLIER THE BETTER
- 48. IT IS ADMINISTERED INTRAVENOUSLY DILUTE 5-10AMPOULES (50-100ML) IN 200ML N SALINE AND INFUSE OVER 30-60MINUTES BLACK MAMBA BITES MAY REQUIRE AS MUCH AS 20 AMPOULES BOOMSLANG ANTI-VENOM IS A STANDARD 20ML DOSAGE FOLLOW-UP DOSES MAY BE REQUIRED
- 49. AND AFTER YOU GIVE IT YOUR PT WONT GET BETTER!! ESPECIALLYTHE NEUROTOXIC ENVENOMATIONS PTS WILL STILL NEED ICU FOR VENTILATORY SUPPORT BUTTHE COAGULOPATHY FROM BOOMSLANG BITES REVERSES RAPIDLY
- 50. PTS MAY DEVELOP ANTI-VENOM REACTIONS ESSENTIALLYAN ACUTE SEVERE ANAPHYLACTOID REACTION IT IS MANAGED AS ALL OTHER MAJOR ANAPHYLAXIS IM ADRENALIN IV ANTI-HISTAMINES AND STEROIDS
- 51. SNAKE VENOM OPTHALMIA WHEN VENOM IS SPAT INTO THE EYE IRRIGATE WITH LARGE AMOUNTS OF FLUID TOPICAL ANAESTHETICS ALLOW OPENING OF THE EYE DO NOT GIVE ANTI-VENOM REQUIRES REVIEW BY OPHTHALMOLOGIST