Snake bites and insect stings Snake bites and insect stings.

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Case Report Case Report u 15 y male u Barefoot u Sudden onset of pain in Lt foot u Snake seen and killed

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Snake bites and insect stings

Outline

Case presentationClinical manifestations of snake bitesTreatment

Case Report

15 y maleBarefoot Sudden onset of pain in Lt footSnake seen and killed

Alert, in painSwollen legBP 140/85 P 110

Epidemiology

There are approximately 300,000 poisonous snakebites in the world each year. Approximately 10% of these bites results in death; most of these due to cobra bites in southeast Asia.

Poisonous Snakes in Israel

" (Vipera palaestina) (Vipera bornmuelleri) (Cerastes vipera) (Cerastes gasperetti) (Cerastes cerastes) (Pseudocerastes fieldi) - (Atractaspis engaddensis) (Waltrinnesia aegyptia) (Echis coloratus)

"

In Israel most cases are due to Vipera palaestina

(Vipera bornmuelleri)

(Echis coloratus)

(Cerastes cerastes)

(Pseudocerastes fieldi)

Clinical Manifestations

Bites usually occur on the extremities, causing burning pain and swelling at the site within minutes. As the venom spreads to the body through the lymphatics, there is advancing edema and echymosis with lymphadenopathy.

Clinical Manifestations - Systemic Symptoms

Nausea and vomiting, diaphoresis, numbness or tingling around the mouth, scalp and digits and muscle fasciculations.Generalized edema, shock, cardiac arrhythmias and death. Clotting abnormalities are common in viper envenomations.

Treatment

The patient should be placed at rest with local pressure and immobilization of the involved extremity. A tourniquet should be placed proximal to the site of envenomation ???.

Treatment

suction may remove some venom, in practice the procedure may aggravate bleeding, introduce infection and delay recovery. Isotonic solutions are needed.

Treatment

Fresh frozen plasma, cryoprecipitate, platelet infusions - if necessary.Tetanus prophylaxis.A broad-spectrum antibiotic.Antivenin - depends on the severity or rapid progression of symptoms. Antivenin is most effective within 4 hrs from the bite; questionable value if delayed more than 12 hr.

Antivenins

Antivenins are animal-derived Immunoglobulins Work by direct binding and neutralization of the antigens contained in the venom

Antivenins

Concentrates of animal serum.Immediate and delayed hypersensitivity reactions are common and may themselves be life threatening.

System for Grading Envenomation

EnvenomationReactionDosage

NoneNo local or systemic reactionsNo antivenin

MinimalLocal swelling but no systemic reactions 5 vials

ModerateSwelling that progresses beyond the site

of the bite together with a systemic reaction,

laboratory changes, or both 10 vials

SevereMarked local reaction, severe symptoms,

and laboratory abnormalities10-15 vials

Serum Sickness

Results from the deposition of antibody-antigen complexes on endothelial surfacesSymptoms occur 7-21 days after administration of the antivenin and may last days or weeks

Serum Sickness Symptoms

Fever, malaise, lymphadenopathy, rash, arthralgia. Arthritis, nephritis, vasculitis and neuropathy. Treatment - Antihistamines and corticosteroids.

1 ' - 100 " .

- 500 " .

Summary

Always start with ABCFor snake bite treatment with antivenin is indicated in case of systemic toxicity or rapid progression of local signs

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