1 / 26

Get hurt while hiking

HKCEM College Tutorial. Get hurt while hiking. Author Dr. Tommy Lam Shing Kit Nov., 2013. Triage (Category II). Female 40 year old Hiking with friends weekend Get hurt over left ankle in grass ? Bitten BP 158/94 Pulse 100/min Temp 37.2 °C. Assessment.

eyal
Download Presentation

Get hurt while hiking

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. HKCEM College Tutorial Get hurt while hiking Author Dr. Tommy Lam Shing Kit Nov., 2013

  2. Triage (Category II) • Female 40 year old • Hiking with friends weekend • Get hurt over left ankle in grass • ? Bitten • BP 158/94 • Pulse 100/min • Temp 37.2 °C

  3. Assessment • Assess and stabilize ABC if necessary

  4. Physical Exam • Is it a snake bite ? • Is it a dry bite/ non venomous snake bite ? • Is there envenomation ? • Local sign and symptom? • Systemic sign and symptom ?

  5. Left ankle

  6. Physical Exam • Fang mark , Number of fang mark ? • Swelling ? Longitudinal and involved joint • Progression ? Mark by “marker” at different time or taking photo • Clinical compartment syndrome? • Ecchymosis ? • Blisters? • Necrosis?

  7. 4 hours later

  8. Snake identification • History taking • Any snake specimen available ? • What we can do if in doubt on the snake specimen ? • Consult snake identification from KadoorieFarm & Botanic Garden (KFBG)

  9. Poisonous snake in HK • Viperidae • Colubridae • Elapidae • Hydrophidae

  10. Local features • Pain • Bruising • Blister • Necrosis

  11. Systemic features • Bleeding tendency • Oozing from the wound

  12. Neuromuscular • Breathing difficulty • Paresthesia • Ptosis, diplopia • Dysphagia • Muscle weakness

  13. Clinical Feature

  14. Investigation • Complete blood picture (especially Platelet count) • Renal and liver function test • Clotting profile • Fibrinogen • ECG • Urine for RBC  Need serial blood tests if present too early

  15. Treatment • Remove constricting object from injured part or limbs (e.g. remove ring if bitten finger) • Dressing • ATT • Analgesic • Antibiotic for infected wound or significant local reaction • Antivenom

  16. Some Poisonous Snake in HK • Green Pit Viper/ Bamboo Snake/Cryptelytropsalbolabris/青竹蛇

  17. Some Poisonous Snake in HK • Chinese Cobra/Najaatra/眼鏡蛇/飯鏟頭

  18. Some Poisonous Snake in HK • King Cobra/Ophiophagushannah/眼鏡王蛇, 過山烏

  19. Some Poisonous Snake in HK • Many-banded Krait/Bungarusmulticinctus/銀腳帶

  20. Some Poisonous Snake in HK • Banded Krait/Bungarusfasciatus/金腳帶

  21. Some Poisonous Snake in HK • Red-necked Keelback/ Rhabdophissubminiatus/紅脖游蛇

  22. Common envenomation syndrome

  23. Antivenom for common snake bite in HK

  24. Pretreatment • Antihistamine -- Piriton (Chlorpheniramine) • Hydrocortisone • Watch out for anaphylaxis or anaphylactoid reaction

  25. Our patient • Present with mild wound pain and snake specimen confirmed Green Pit Viper • Observation after 24 hours • Pain controlled by analgesics • Serial blood tests revealed no systemic involvement • Discharge uneventfully

  26. Thank you

More Related