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Envemonations

7/17/2013

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Crotalid Envenomations Dr. Beuhler

  • 2 classes of poisonous snake in NC - pit vipers & coral snakes.  Pit vipers make up the majority of bites we're going to see (Eastern diamondback, Timber rattler, Pygmy rattlesnake, cotton mouth & copperhead)
  • The venom in the pit vipers is made to digest tissues - has proteolytic and hyaluronisdase activity - this leads to localized extremity dysfunction & systemic effects (emesis, tachycardia, hypotension, flushing, mytoxicity, renal toxicity, allergic reactions, angioedema, coagulopathy, and renal dysfunction)
  • Pit viper venom has a degree of neurotoxin activity as well which can lead to weakness, ptosis, and fasiculations as well as localized numbness at bite site

Important steps in management of bite care:

  1. First aid: NO ICE; NO TOURNIQUET; Elevation of affected site - don't bend major joints 90 degrees - need to make sure there is good lymphatic flow 
  2. Grade bite - this will help determine administration of Crofab, length of observation vs admission 
  • Mild - mild swelling, no systemic involvement or lab abnormalities
  • Moderate - <50% limb involvement, minimal systemic involvement
  • Severe - >50% of limb involvement (crosses major joint), lab abnormalities, systemic effects
3. Decision to treat with Crofab is multifactorial - should be used only in high risk populations or those with moderate to severe envenomations. 

Don't just treat lab abnormalities
   

a. Crofab = 10cc/hr; 4 vials & reevaluate after 1-2 hrs. 
Remember crofab interrupts coagulopathy & helps lower compartment pressures & possibly helps with pain - it will NOT stop or reverse local tissue destruction

If you DC home have follow up in < 24 hrs for wound reevaluation  
 
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  • RESIDENCY
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    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
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    • Alumni
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  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
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    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction