Snakes and Scorpions

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Snakes and Scorpions

• Dr J Rieck
• Department of Emergency Medicine
• Sheba Medical Centre

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General

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

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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.

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Signs of possible envenomation

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

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Prehospital treatment DOS.

• 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.

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Prehospital treatment DONTS

• Do not
• CUT
• SUCK
• TOURNIQUET
• FREEZE.

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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.

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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.

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Complications

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

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Scorpions
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SCORPIONS

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

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Venom

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

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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.

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CHILDREN

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