Page 327 - Learnwell EVS
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omous bites and stings
Clinical signs and treatment
Time Clinical manifestations Possible Treatment
since bite aggressor
Bite
0 F ang m ark s ? S trict rest, im m o bilisatio n o f the lim b
P ain at the site o f bite with a sp lint to slo w the d iffusio n o f
veno m2 .
W o und cleansing.
T etanus p ro p hy laxis, p age 1 7 0 .
O bserve fo r m anifestatio ns o f
enveno m atio n.
A the d isp ensary level, p rep are
p atient evacuatio n to a referral
centre.
Envenomation
1 0 -3 0 m inutes H y p o tensio n, m y o sis, E lap id s Insert a p erip heral IV line.
excessive salivatio n and IV antiveno m serum as so o n as
sweating, dy sp hagia, dy sp noea p o ssible.
L o cal p araesthesia, p aresis
Inflam m ato ry sy nd ro m e: Vip erid s Insert a p erip heral I V line.
intense p ain, extensive C ro talid s IV antiveno m serum as so o n as
regio nal o ed em a p o ssible.
A nalgesic3s .
IV o r P O3 anti-inflam m ato ries.
3 0 m inutes- C o bra sy nd ro m e: bilateral E lap id s Intubatio n and assisted ventilatio n.
5 ho urs ey elid d ro o p ing, trism us,
resp irato ry m uscle p araly sis
S ho ck S ee Shock, p age 1 7 .
3 0 m inutes- H aem o rrhagic sy nd o m e: V ip erid s M o nito r co agulatio n (blo o d clo tting
4 8 ho urs ep istaxis, p urp ura, haem o ly sis C ro talid s test in a d ry tube).
o r d issem inated intra- T ransfusio n o f fresh blo o d in the
vascular co agulatio n event o f severe anaem ia.
S ho ck S ee Shock, p age 1 7 .
6 ho urs N o signs o r changes in ? Reassure the p atient.
o r m o re co agulatio n (no n-veno m o us S end him ho m e after 1 2 ho urs.
snak es o r snak e bite witho ut
enveno m atio n)
T issue necro sis Rem o ve blisters, clean; d aily (no n
o cclusive) d ressings.
S urgical interventio n fo r necro sis,
d ep end ing o n the extent, after the
lesio ns stabilise (m inim um 1 5 d ay s).
– I n case o f clinical evid ence o f infectio n o nly : d rainag e o f any ab scess;
am o xicillin/ clavulanic acid (co -am o xiclav) fo r 7 to 1 0 d ay s in case o f cellulitis.
I nfectio ns are relatively rare, and m o st o ften asso ciated with trad itio nal treatm ent o r
with no so co m ial transm issio n after unnecessary o r p rem ature surgery .
2 Tourniquets, incision-suction and cauterisation are ineffective and may be dangerous.
3 Do not use acetylsalicylic acid (aspirin).
284
Clinical signs and treatment
Time Clinical manifestations Possible Treatment
since bite aggressor
Bite
0 F ang m ark s ? S trict rest, im m o bilisatio n o f the lim b
P ain at the site o f bite with a sp lint to slo w the d iffusio n o f
veno m2 .
W o und cleansing.
T etanus p ro p hy laxis, p age 1 7 0 .
O bserve fo r m anifestatio ns o f
enveno m atio n.
A the d isp ensary level, p rep are
p atient evacuatio n to a referral
centre.
Envenomation
1 0 -3 0 m inutes H y p o tensio n, m y o sis, E lap id s Insert a p erip heral IV line.
excessive salivatio n and IV antiveno m serum as so o n as
sweating, dy sp hagia, dy sp noea p o ssible.
L o cal p araesthesia, p aresis
Inflam m ato ry sy nd ro m e: Vip erid s Insert a p erip heral I V line.
intense p ain, extensive C ro talid s IV antiveno m serum as so o n as
regio nal o ed em a p o ssible.
A nalgesic3s .
IV o r P O3 anti-inflam m ato ries.
3 0 m inutes- C o bra sy nd ro m e: bilateral E lap id s Intubatio n and assisted ventilatio n.
5 ho urs ey elid d ro o p ing, trism us,
resp irato ry m uscle p araly sis
S ho ck S ee Shock, p age 1 7 .
3 0 m inutes- H aem o rrhagic sy nd o m e: V ip erid s M o nito r co agulatio n (blo o d clo tting
4 8 ho urs ep istaxis, p urp ura, haem o ly sis C ro talid s test in a d ry tube).
o r d issem inated intra- T ransfusio n o f fresh blo o d in the
vascular co agulatio n event o f severe anaem ia.
S ho ck S ee Shock, p age 1 7 .
6 ho urs N o signs o r changes in ? Reassure the p atient.
o r m o re co agulatio n (no n-veno m o us S end him ho m e after 1 2 ho urs.
snak es o r snak e bite witho ut
enveno m atio n)
T issue necro sis Rem o ve blisters, clean; d aily (no n
o cclusive) d ressings.
S urgical interventio n fo r necro sis,
d ep end ing o n the extent, after the
lesio ns stabilise (m inim um 1 5 d ay s).
– I n case o f clinical evid ence o f infectio n o nly : d rainag e o f any ab scess;
am o xicillin/ clavulanic acid (co -am o xiclav) fo r 7 to 1 0 d ay s in case o f cellulitis.
I nfectio ns are relatively rare, and m o st o ften asso ciated with trad itio nal treatm ent o r
with no so co m ial transm issio n after unnecessary o r p rem ature surgery .
2 Tourniquets, incision-suction and cauterisation are ineffective and may be dangerous.
3 Do not use acetylsalicylic acid (aspirin).
284
