1 / 58

Snakes, Spiders and Scorpions, Oh My!

Snakes, Spiders and Scorpions, Oh My!. Treatment of Envenomation's from Time Zero to Discharge Susan Smith MSN/Ed RN . Learning Objectives . To identify the patient with an envenomation

ping
Download Presentation

Snakes, Spiders and Scorpions, Oh My!

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Snakes, Spiders and Scorpions, Oh My! Treatment of Envenomation's from Time Zero to Discharge Susan Smith MSN/Ed RN

  2. Learning Objectives • To identify the patient with an envenomation • List the basic signs and symptoms associated with envenomation's and stings and other variances within the different age groups • Identify the correct pre-hospital treatment associated with envenomation and stings. • Identify the correct antivenom, its indications, administration and side effects for each type of envenomation or sting. • Describe situations where consultation with a poison control center or physician expert is recommended. • Describe the essential discharge criteria and follow up of the patient with an evenomation or sting.

  3. Disclosures • Nurse Consultant and Educator for BTG International who manufactures Crofab ®.

  4. Introduction • Time is Tissue • Crucial to recognize and start treatment asap • Prevent life threatening complications • Dynamic subspecialty • Course will cover from time zero, hospital tx, follow up to one month later

  5. North American Snakes Rattlesnake Copperhead Water Moccasin/Cottonmouth Coral Snake

  6. Question? • How many of you have treated rattlesnake victims? • How many of you know which hospital has antivenom?

  7. Pit Viper Characteristics • Triangular –shaped heads • Elliptical pupils • Heat sensing pit between eyes and nose

  8. Epidemiology The real danger of snakebites is a combination of factors: • Rate of dry bites • Size of fangs • Quantity available • Toxicity of venom • Aggressiveness of the snake • Likelihood of encounters of man vs snake

  9. Epidemiology • Most bites on extremities • Children (50%) • Fatalities are rare • Most likely from May to October (Ca from Feb to Nov due to hotter climate)

  10. Pathophysiology • Most complex of all natural poisons • Composed of proteins and enzymes • Cytotoxins • Neurotoxins • Hemotoxins • Cardiotoxins

  11. Symptomatology

  12. Symptoms Neurotoxins Local symptoms Hematological

  13. Signs and Symptoms • Skin puncture marks • Venom alters coagulation factors • Tissue necrosis • Immediate pain and burning • Within minutes redness and swelling

  14. Local Tissue Effects • Occur in almost all patients • Pain, tenderness • Redness • Local tissue necrosis

  15. Neurological Symptoms

  16. Angioedema

  17. Dry Bites • Dry Bite is a bite with no venom • Dry bite rate is variable • Watched for 8 hours • Lab studies

  18. Severity

  19. Question • What current recommendations regarding tourniquets and suction when administering first aid to snake bite victims? • A. Apply a tourniquet, but do not use suction • B. Use suction, but do not apply tourniquet • C. Do not apply tourniquet, do not use suction • D. Apply tourniquet and use suction

  20. EMS

  21. Do and Don’ts of Initial Treatment

  22. Prehospital Treatment • ABC • All monitors • 2 large bore IV • Fluid bolus • Medications • ACLS protocols • Airway equipment ready

  23. Pre hospital • Remove all tight fitting clothing and jewelry • Extremity in neutral position • If tourniquet leave in place do not remove , • Loosen if arterial compromise • Transport to nearest facility with antivenom • Mark swelling and tenderness every 5 minutes on affected extremity with date and time

  24. Pre-hospital NO snakes to the ED, identification is not crucial Take a picture from six feet away if you feel identification is needed A dead snake is a dangerous snake

  25. Prehospital pearls

  26. Emergency Department Geographic variations in treatment Fasciotomy is rare indicated however is 5 x more likely when a surgeon manages patients vs medical toxicologist

  27. Emergency Department Lavonas algorithm for Management Unified approach to treatment Improves outcomes Soon best practices for nurses

  28. Lavonas Algorithm

  29. Emergency Department • Call an in house expert or poison control • Establish 2 large bore IV ( Minimize sticks) • Obtain blood samples • All monitors • Fluid Bolus

  30. Emergency Department • Pain control • No NSAIDS • No anticoagulation therapy • Use algorithm to determine need for antivenom

  31. History • Time of bite • Symptoms • Prior antivenom • Past medical History • Allergies to sheep serum, papaya or latex

  32. Complicated Patients • Pregnancy • Children • Coumadin • Elderly • Co-morbidities • Stressful to a fragile system

  33. Difference between DIC and Snakebite Coagulopathies

  34. Question • Which intervention is indicated in a patient with moderate envenomation with decreased platelets? • A. Administer platelets • B. Administer steroids • C. Administer FFP • D. Administer antivenom

  35. Treatment

  36. Assessment of Swelling

  37. Management of Neurological Symptoms • Medications • Reassurance • Education • Antivenom

  38. Antivenom (Crofab) • First dose is 4-6 vials • Reconstitution is much easier • Be sure to watch video • Only takes 7-10 minutes

  39. Crofab Reconstitution • Each vial is mixed with 18ml of 0.9 % saline from a 250 cc normal saline bag • Slowly inject 18ml of saline into each vial from the saline bag into the vial of Crofab

  40. Crofab AdministrationInitial Dose

  41. Initial control • Reassess • Progression of swelling • Pain control • Coagulation parameters

  42. Maintenance Dosing

  43. Reoccurrence

  44. Discharge Instructions • Labs q 3days (Stat) and prn • No NSAIDS • No surgery or dental work • Return immediately if swelling or bleeding or pain , or weakness • No sports, physical fitness or PE at school

  45. Crofab video http://www.crofab.com/video

  46. Black Widow Bites

  47. Symptoms • Wide range of symptoms • Target bite but not always • Local pain • Muscular pain • Abdominal pain may mimic appy • Chest pain • Diaphoresis and anxiety • Hypertension • Nausea and vomiting

  48. Treatment • Dry bite –observe • IV fluids • Opiates • Benzodiazepines ( Ativan, Valium) • Antivenin( Lactodectus mactans)

  49. Scorpion Stings • Adults no antivenom • Pain medications • Burning sensations • Pain may go on for weeks • Supportive care

  50. Scorpion Stings Children • The sting of the bark scorpion (Centruroides sculpturatus) can cause severe nerve poisoning, especially when the victim is a small child. In the United States, severe cases are very rare, affecting perhaps 250 people per year. But just to the south of Arizona, and extending all the way through the western half of Mexico, an additional quarter of a million people need treatment for scorpion sting annually. Reference: www.viperinstitute/universityofarizona.edu

More Related