Snake Bite And Scorpion Stings

Prepared by:

Abdulrahman Taha

Znar Abdulwahid Tamar

Mohammad Rashid

Supervised by:

Mr. Salim

Kurdistan Region

University of Duhok

Faculty of Medical ScienceSchool of Nursing

Critical Care Nursing/4th stage

Snake Bite And Scorpion Stings

Contain

Introduction about Snake bite & Scorpions stings

Epidemiology of both

Common Snake & Scorpion

Snake Venom

Clinical effects of venom

Signs & symptoms

Grade of envenomation

What investigation to do ?

First Aid & treatment

Initial Hospital Management

Introduction

A bite from a venomous snake can be deadly, and should always be treated as

a medical emergency. Even a bite from a harmless snake can be serious, leading

to an allergic reaction or an infection. Venomous snake bites can produce an array of symptoms, including localized pain and swelling, convulsions, and

nausea—even paralysis.

Scorpion stings are a major public health problem in many underdeveloped tropical countries . Scorpions vary in size from 1-20 cm in length.

Venom is present in glands in the last tail segment and passes by a duct to a

stinger at the end of the tail.

Continue….

The venom is composed of varying concentrations of neurotoxin, cardiotoxin, nephrotoxin, hemolytic toxin, histamine, serotonin, tryptophan, and cytokine releasers. The most important clinical effects of envenomation are neuromuscular, neuroautonomic, or local tissue effects.

Epidemiology

3 million bites and 1,50,000 deaths/year from venomous snake worldwide.

Bites highest in temperate and tropical regions.

3000 species of snakes, out of them only 10-15% of snakes are venomous

1,500 species of scorpions, out of them 50 are dangerous to human.

World wide :

annual stings > 1.2 million

> 3250 annual death

United states:

In 2008 ,1495 envenomation in children younger than 6 yrs.(NPDS data)

Of these, there was only one death. This is scorpion

Snake Bite

Common Snakes

(Cobras)

Neurotoxicity usually

predominates.

Common Snakes

(Common kraits)

These are very lethal snakes

with a high mortality rate if not

treated with antivenom.

Common Snakes

Russell’s viper

Heat-sensing facial pits

(hence the name "pit vipers").

Common Snakes

Echis-carinatus(Saw scaled viper)

Non Poisonous Snakes:

Head – RoundedFangs - Not presentPupils – RoundedAnal Plate - Double row Bite Mark - Row of small teeth.

Poisonous Snakes

Head – TriangleFangs – PresentPupils - Elliptical pupilAnal Plate - Single rowBite Mark - Fang Mark

Snake Venom

– A combination of proteins and enzymes

– 90% protein by dry weight & most of these are enzymes

– Have 25 different enzymes found in various venoms and

10 of these occur frequently in most venoms

Clinical effects of venom

Neurotoxicity

Systemic toxicity including hypotension and shock

Coagulopathy

Renal failure

Local tissue necrosis

Signs & Symptoms of snake bite

Local pain and swelling

Heavy eyelids

weakness

Difficulty in swallowing and speaking

Bleeding from bite site

Respiratory failure

Internal bleeding

shock

Heavy eyelids

Grades of envenomation

Grade Features

Non-envenomation Presence of fang marks without local/systemic reactions

Mild envenomation Local swelling & pain without systemic reaction

Moderate envenomation Severe pain, Edema spreading towards trunk,

Nausea, vomiting, Mild temperature

Sever envenomation edema spreads to the extremities and part of trunk, Tachycardia, Hypotension, Subnormal temperature.

First Aid for snake bite

Call 122 immediately.

Keep the victim calm and still. Movement can cause the venom to

move more quickly through the body. Consider making a splint to

restrict the movement of the affected area.

Remove constricting clothing or jewelry. The area of the bite will

likely swell, so it is important to remove these items quickly.

Carry or transport the victim by vehicle. This person should not be

allowed to walk.

Do not do any of the following:

Do not use a tourniquet.

Do not cut into the snake bite.

No role of Ice application

Washing the wound

Do not give the victim any medications unless directed by a doctor

Do not raise the area of the bite above the victim’s heart.

Do not attempt to suck the venom out by mouth

Do not use a pump suction device.

Treatments

Local:

ABC’s - oxygen prn

calm patient

immobilize extremity - splint

treat shock prn

draw circle around bite & note time

Transport

Specific: ANTISNAKE VENOM (ASV)

Supportive care for specific syndromes

Initial Hospital Management

Place patient at rest and reassure the patient

Immobilize affected part of body

Clean wound

Give tetanus toxoid

Try to identify type of snake: website, list of snakes, picture

book

Have patient give urine

Scorpion Stings

Common Scorpions

Scorpions come in a variety of colors - from tan to light brown to

black. Each has a long tail segment that contains a stinger.

But two types of the Scorpion more dangerous in the world:

Bark ScorpionFattail Scorpion

Clinical effects of venom

excessive salivation

cardiac arrest

Seizures

Insulin secretion suppression

sting is very painful causing radiating burning sensation

Muscle spasm , convulsions, shock and

respiratory failure death

Locally: tissue inflammation and necrosis.

Signs & Symptoms

Pain, which can be intense

Numbness and tingling in the area around the sting

Slight swelling in the area around the sting

Muscle twitching or thrashing

Unusual head, neck and eye movements

Sweating & vomiting

Hypertension or hypotension

Tachycardia or arrhythmia

Restlessness or inconsolable crying (in children)

Grades of envenomation

Grade Features

Grade I isolated pain.

Grade II Systemic manifestations: fever,

sweating , hypertension.

Grade III life threatening manifestations:

Shock, pulmonary edema, CNS

involvement.

What investigation to do?

CBC

RFT

Coagulation studies

Blood grouping & cross matching

Sr.electrolytes

Urinalysis

Blood sugar test

Treatment

1-Application of tourniquet above the site of bite to

decrease absorption of venom

2-Do not cut into the wound or apply suction.

3-wash with water

4-Ice pack

5-Immobilization of limb

6-Local anesthetics are better than opiates

Treatment

7-Treatment of shock

8-Analgesics

9-Fluid management: esp. for vomiting, sweating

10-Scorpion Venom Antiserum

Reference

Buchanan JA, Varney SM, Mlynarchek SL, et al, “Immediate Adverse Events (AEs) After

Administration of Crotalidae Polyvalent Immune Fab,” Clin Toxicol, 2009, 47(7):703.

Cannon R, Ruha AM, and Kashani J, “Acute Hypersensitivity Reactions Assocoated With

Administration of Crotalidae Polyvalent Immune Fab Antivenom”, Ann Emergency

Medicine, 2008, 51(4):407-11.

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