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87 Cards in this Set
- Front
- Back
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What percentage of snakes are venomous
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10% of the 3000 species
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Howmany snakebite deaths per year?
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50,000-100,000 (unreliable figure)
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How many people handicapped annually by snakebites?
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For each 1 death, 10 handicapped
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What's the 5th most common cause of death in Burma?
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Russel viper bite
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How many families of venomous snakes are there?
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5
Viperidae Elapidae Hydrophilidae Colubidae Atractaspididae |
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What subfamilies of snakes are of the viperidae?
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Crotalinae (rattlesnakes, moccasins, pit vipers)
Viperinae (russel's viper, saw tailed carpet viper) |
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What snakes are in the family elapidae
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cobras
african mambas asian kraits coral snaikes australaisan taipan death adder sea snakes |
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What snakes are of the hydrophiidae
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True sea snakes
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What snakes are of the colubridae family?
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african boomslang, east asian yamagashi
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What snakes are of the atractaspididae family?
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burrowing asp
stiletto snake |
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What snakes are of the boidae family?
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Constrictors
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How many components of snake venom?
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20 or more, mostly proteins/enzymes
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What are some of the actions of snake venoms?
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Digestive enzymes
Hemorrhagins Procoagulant enzymes Neurotoxins Myotoxins Vasoactive peptides Autopharmacological (ace inhibiting..) Complement activating (sepsis like) Nerve growth stimulating |
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Common toxins of crotalids (pit vipers/water mocassins)
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Cytotoxins
(swelling/severe pain in minutes, skin ecchymosis over hours systemic: weaknes, sweating, tongue numbness, thrombocytopenia/hemolytic anemia) |
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Common toxins of viperinae (Russel's viper, saw tailed carpet viper)
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Local cytotoxic, hematologic
(local pain, swelling, bleeding wound/gums, circ collapse Russels: more neurotoxic) |
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Common difference of Russel's viper vs. other viperinae?
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More neurotoxic, and more systemic hemolytic
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Common toxins of Elapid (cobra, mamba, adder, coral snake)
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Neurotoxic
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Cobra bite sx
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Pain within 10 minutes
Slow onset swelling weakness, salivation, facial paralysis, flacid paralysis, ptosis H/A, convulsions Spitting cobras - also cytotoxic |
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Coral snake sx:
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Neurotoxic (delayed)
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Features of Snake Hydropiidae bites
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Neurotoxic
Cytotoxic (mild local pain, skeletal muscle pain, paresthesias of tongue/mouth) Dysphagia Trismus Ptosis, pupillary diltation Rhabdo, myoglobinuria, renal failure |
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Freatrues of snake Colubrid bite
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Hematologic
Cytotoxic Mild local effects Delayed systemic effects N/V, abd pain Bleeding/DIC Death due to renal failure/ATN |
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Features snake bite Attractaspididae
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Cytotoxic
No true neurotoxin Pain swelling, blistering, local necrosis Fever N/V Weakness/shock Myocardial ischemia |
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How to treat a snakebite
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Pressure immobilization bandage constricting lymphatics
Best for neurotoxin, risk with tissue toxins |
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What drugs to avoid with snakebite?
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ASA/NSAID
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Describe antivenins
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Equine or ovine immunoglobulins
Risk serum sickness and allergy some with 80% anaphylaxis |
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When to use antivenin
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All coral snake
Signs envenomation in, crotalid (rattlestnake) and cobra bites Evidence shock, neurotoxicity, necrosis, coagulation disorder, nephrotoxicity |
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What is the bedside coagulation test?
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Blood in tube. If doesn't clot in 20minutes, assume coagulopathy
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Are antivenins specific to each species?
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No.
Heterologous species: give 2-4x as much as homologous |
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Sx of serum sickness?
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rash, fever, arthralgias, adenopathy 3d - 3 weeks later
Glomerulonephritis, neuritis rare Rx: steroids, antihistamines, pain management, supportive care |
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What snakes found in New Orleans area?
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Copperheads
Cottonmouths |
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What are the 4 times of reactions to toxic shellfish poinsoning?
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Paralytic
Neurotoxic Diarrhetic Amnesic |
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What is the cause of toxic shellfish poisoning?
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Dinoflagellate toxin from algal blooms
Shellfish concentrate toxins |
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Describe paralytic shellfish poisoning
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Saxitoxin
From Gonyaulax sp. Found in clams/mussels Temperate areas, late spring to early fall Onset in 30min, ove 12 hours, last a few days Paresthesias, dysphonia, dysphagia, respiratory paralysis, flushing, nausea Tx: supportive, maybe activated charcoal |
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Describe neurotoxic shellfish poisoning
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Brevotoxins
Similar to ciguatera Respiratory irritation if inhaled Seen with fish/bird dieoffs |
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Describe diarrhetic shellfish poisoning
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Toxin: Okadaic acid
Rapid onset self limited N/V/D |
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Describe amnesic shellfish poisoning
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Toxin: Domoic acid
From Prince Edward Island GI sx to neuro sx to seizures, abnormal motor, hemiparesis, coma, death Persistent memory/cognitive dsfxn |
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Describe ciguatera toxin
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Toxin: Gambeierdiscus
Concentrate from dinoflagellate up food change in predatory reef fish Found in barracuda, jack, snapper, parrot, mackerel, grouper 35 degrees north and s of equator Sx: 1-6 hours: paresthesias, temperature reversal, diarrhea, muscle weakness, paralysis, bradycardia Sick for months Mannitol may prevent neuronal edema, maybe gabapentin for sx |
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What toxin causes temperature reversal?
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Ciguatera toxin
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What toxin causes amnesia?
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Domoic toxin
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What toxin causes zombies?
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Tetrodoxin
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What toxin is found in puffer fish?
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Tetrodotoxin
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What are the sx of tetrodotoxin poisoning?
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Eat a puffer fish (esp internal organs)
Paresthesias, vomiting, numbness, paralysis, cardiac arrhtymias Can be fatal, normally within 6 hours |
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What is scromboid poisoning
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Coliform convert histidine in fish muscle to saurine and histamine
Histamine type poisoning Mackeral/tuna/open ocian fish May have peppery taste Sx: dizziness, headache, burning skin, pruritis, urticaria, N/V/D, bronchospasm |
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What toxin causes a histamine like poisoning?
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Scromboid (from open water fish -- flesh broken down by coliforms)
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If you taste a peppery taste in your tuna, what might the toxin be?
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Scombroid poisoning (saurine and histamine)
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What are the coelenterates?
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Jellyfish, anemones, coral
Nematocyste producers |
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What are the toxins in nematocysts?
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5-hydroxytryptamine
Histamine Prostaglandins Kinins |
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What are the sx of nematatode sting?
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Severe pain, inflammation
Urticaria, Systemic: cough, N/V/D, syncope, sweating |
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What substances stimulate nematocyst firing?
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Fresh water, alcohol
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What substances help prevent nematocyst discharge?
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acetic acid, urine?
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Describe cobumedusae poisoining
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Box jellyfish, sea wasp
Venom affect heart, nervous system, respiratory system, cyanosis, convulsions, sometimes death Supportive care, antivenin Australia, Philippines, Indian Ocean |
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What is Irukankji syndrome?
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From sting of Carukia barnesi mini-box jellyfish (and similar)
NW Austraila Shallow water Sting not painful 30min later, severe back pain, muscle cramps, vomiting, restlessness, anxiety Rarely pulmonary edema, HTN, heart failure Supportive care, maybe Mag Sulfate |
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Sx of Portugueze Man-o-war sting?
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Atlantic, pacific, indian, gulf of mexico
Blue bottles Severe chest/abd pain, wheals, numbness, pain in extremities Sometimes death Rx. Calcium gluconate 10% for cramps |
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Which jellyfish sting may benefit from Mag sulfate?
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Irukandji syndrome mini-box stings (severe back pain)
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Which jellyfish stings occur in as little as 30mm water?
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Irukandji sydrome stings from box and mini-box
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Which jellyfish sting benefits from calcium gluconate for cramps?
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Portugues man-o-war (Physalia)
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What sea life sting with spines?
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Stonefish, stingray, scorpionfish, sea urchins, starfish
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What do the echinoderm stings (spiny creatures) feel like?
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Severe local pain
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What is the treatment of echinoderm sting?
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Immersion in hot water (<45C?)
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What type of toxins are carried by spiders?
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Neurotoxins
Tissue toxins |
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What spider causes necrotic skin findings?
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Brown recluse in US (Loxesceles spp)
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How to recognize a brown recluse?
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Brown violin on back of thorax
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What are the toxic effects of a brown recluse bite?
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Tissue necrosis from local vasculitis/destructive enzymes
Hemolysis Platelet aggregation |
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Describe appearance of brown recluse bite
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Starts red/white/blue
Ischemic plaque Necrosises to black eschar Necrossis begins witin 48 hours May continue for weeks Systemic: Fever, adenopathy, DIC, respiratory depression/circ collapse Rhabdo (i small kids) Fatal rarely |
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How to manage brown recluse bite?
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Supportive for systemic
Dapsone may help reduce necrosis by inhibiting PMNs Steroids less evidence NO SURGERY; grafting after finished necrosing Yes antivenin, but disappointing |
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Do big hairy spiders (tarantulas, brazilian wolf spiders) injure?
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Rarely cause a severe bite
Have necrotoxin |
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What are the neurotoxic spiders?
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Black widow (Latrodectus)
Austrailian funnel web spiders S. american banana spider |
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How to recognize black widow (latrodectus)
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Red hourglass on abdomen
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What are sx of black widow bite?
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Neurotoxin
Painlesss bite Systemic includes muscle spasms/especially abdominal |
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Rx of black widow bite?
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Calcium gluconate
Benzos Antivenin |
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Name an aggressive spider
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Austrailian funnel web spider
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Describe austrailian funnel spider bite
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Neurotoxin
Most bites -- no envenomation Local pain, excessive swelling Salivation/Vomiting Rapid rise in BP Coma Resp distress May be fatal |
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What is the treatment of austrailian funnel spider bite?
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Supportive
Pressure immobilization bandage Antivenom if systemic sx |
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Describe the toxins of scorpions
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All scorpions are venomous
Neurotoxins: cholinergic and adrenergic Intense local pain, vomiting, diarrhea, hypersalivation, sweating, hypertension, myocarditis, pulmonary edema, arrhythmia, pancreatitis, respiratory failure |
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What toxic bite can cause pancreatitis?
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Scorpion sting
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Describe the 4 forms of disease caused by scabies
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Papular/papulovesicular
Nodular (can see on penis) Hyperkeratotic (norweigian or crusted) -- maybe due to immunocompromise Zoonotic (transient/atypical lesions) |
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Where is a common place to find nodular scabies?
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Penis
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What kind of scabies might an immunocompromised person get?
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Non-itchy, severely crusted
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Treatment of scabies?
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Permethrin (elemite)
Crotamiton (eurax) Lindane Invermectin 200mcg/kgx1 Sulfur solutions |
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What are the myiaises?
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Tumbu fly
Bot fly Tungiasis |
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Describe tumbu fly infestation
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Africa
Lay clothes on ground to dry Eggs from ground get on clothes Furucles develop IN CLUMPS where flies larvae burrowed Cover with occlusive (vaseline)...when they come out, pull them out Iron clothes |
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What infection might be prevented by ironing your clothes?
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Tumbu fly
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Describe bot fly
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American tropics
Female fly lays eggs on blood sucking arthropod...when these feed, drop eggs larvae hatch, penetrate skin, mature in 6-12 weeks Furucnles (single) Larvae have spines...may require excision Vaseline |
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Describe tungiasis
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Chigger fleas (tunga penetrans)
Flea burrows into feet, forming a yellowish sphere (niguia), eggs are released into ground Found under nails Intense itching and pain Surgical removal of flea |
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If you dont wear shoes, what myiasis might you acquire?
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Tungiasis (chigger flea)
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Are chigger fleas chiggers?
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No
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What infections might you treat with vaseline?
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Bot fly
Tumbu fly |
