snakebite guidelines- medicinal terms and meanings

8/11/2019 Snakebite Guidelines- Medicinal Terms and Meanings

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SNAKE BITE GUIDELINES MEDICAL

TERMS AND MEANING;

Executive Summary

Acute- short period

Chronic- long period

Envenom- Poison

Entamoeba histolytica- kind of amoeba causing dysentery

Mortality -Death

Morbidity- Suffering

Acute- Short duration

Chronic- long duration

Antidote Medicine given to neutralise poison

Immunoglobin Antivenom Specific treatment for envenoming by

snake bites

Skin / Conjunctival hypersensitivity testing- Test to know if thepatient is allergic to Antivenom

Epinephrine/ Adrenaline- Drug given to prevent allergic reaction

produced by Antivenom

Respiratory/Bulbar paralysis- Inability to use respiratory muscles

Asphyxiation- difficulty in breathing along with decrease in oxygenin the body


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Fasciotomy- Surgical procedure done to relieve pressure in a

particular area

Hemostatic abnormality- Abnormality on the clotting pathway

resulting in either uncontrollable bleeding or abnormal clotting

Tenderness- Pain on touching the affected area

Intracompartmental syndrome- No sufficient blood supply to

muscles and nerves due to increase in the pressure in the leg or arm

Inflammation- Pain, warmth, Redness and Swelling

Snake venoms

Hydrolases, hyaluronidase, kininogenase, amino-acid oxidase,

phosphomono- and diesterases, 5-nucleotidase,

DNAase, NAD-nucleosidase, phospholipase A2 and peptidases- these

are enzymes that act against proteins present in our body.

Vascular endothelium- cells lining the blood vessels.

Serine protease-this enzyme act against protein in body

Procoagulant enzymes (factor V, X,IX, XIII, prothrombin) - these

helps in clotting of blood

Fibrin- substance needed for clotting

Incoagulable- inability to clot

Plasmin fibrinolytic system- breaks the formed clot

Consumption coagulopathy clotting factors present in the body gets

depleted leading to abnormal bleeding.

Anti-haemostatic factors factors that prevent clotting of blood


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Haemorrhage- Bleeding

Mitochondria- part of the cell

Presynaptic neurotoxic activity- Venom destroys the nerve endings

Opiate (opium)-Drug causing sedation

Histamine- Enzyme released from immune cell to neutralise toxic or

in response to allergen

Anti-coagulation- Inability of blood to clot

Neuro transmitter - Enzyme that helps to carry impulse from one

nerve to the other.

Acetylcholinesterase- Enzyme that destroy the neuro transmitter

(acetylcholine)

Proteolytic enzymes- These destroy proteins

Vascular permeability- leak from the blood vessels

Oedema- Swelling

Blister- Visible pus collection

Bruising- Bleeding from deep structures (inner muscles)

Necrosis- Death of tissue

Symptoms and signs of snake bite

6.1; when venom has not been injected

Tetany Muscle is in state of involuntary contraction (ie)muscle

spasm


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Vasovagal shock fainting following bite

Collapse loss of consciousness and low blood pressure

Congestion redness or accumulation of blood in an area

Conjunctivitis inflammation of eye

Aspiration pneumonia inflammation of lung due to inhalation of

material like saliva or foreign body (ie) choking

Bronchospasm narrowing of smaller airway

Pneumothorax air in space around lung

6.2; when venom has been injected

Lymph nodes- organ of immune system located all over the body

Axilla- armpit

Groin- inner part of each thigh at the junction of thigh with body

Local symptoms and signs in bitten part

Blister- Visible pus collection

Bruising- Bleeding from deep structures (inner muscles)

Abscess collection of pus in a cavity

Necrosis death of tissue

Generalised symptoms and signs

general

Prostration- abrupt failure of functions

cardiovascular

Hypotension- fall in blood pressure


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Cardiac arrhythmias abnormality in rhythm of heart beat

Pulmonary oedema swollen lung

Conjunctival oedema- swelling of eyes

BLEEDING ANG CLOTTING DISORDER

Epistaxis- bleeding from nose

Meningism- inflammation of coverings of brain

Lateralizing signs- these are signs indicating pathology in particular

part of brain

Hemoptysis coughing of blood

Maelena- black stools or feaces due to bleeding in stomach

Haematuria- bloody urine

Antepartum hemorrhage- bleeding in pregnant women

Petechiae,Purpura,Ecchymosis- bleeding under skin visible as redness

of variable size

Subconjucntival hemorrhage- redness in the eyes

Cerebral artery thrombosis- clot in artery supplying brain

Thrombosis- clot

Neurological

Paresthesia- abnormal sensation lice pins and needles

Ptosis- drooping of eyelids

External ophthalmoplegia- drooping of eyelids along with limitation

of movements of eye ball


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Aphonia- complete loss of voice

Flaccid paralysis- weakness of muscle(here muscles are flabby-not

stiff)

Skeletal muscle breakdown

Trismus- lock jaw

Myoglobinuria- excretion of muscle protein in urine

Hyperkalemia- excess of potassium in blood

Cardiac arrest- Failure of heart to pump blood

Acute renal failure- Failure of kidney in a short duration after the

bite

Renal

Haematuria- Bloody urine

Haemogloubinuria- Excretion of blood in the urine

Myoglobinuria- excretion of muscle protein in urine

Oliguria- Decrease in urine output

Anuria- Absence of urine output

Uraemia- Accumulation of toxic nitrogen products in blood due to

decreaseing in kidney function

Nausea- Tendency to vomit

Acidotic breathing- Rapid and deep breathing


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Pleuritic chest pain- Chest pain due to inflammation of coverings of

lung

EndocrinePituitary- Gland located in brain

Adrenal- Gland located in upper pole of kidney which produces

hormone-adrenalin which is needed during situations like fright, fear

and fight

Adrenal insufficiency- decrease in the secretion of adrenalin

Infarction of the anterior pituitary- Lack of blood supply to

pituitary gland.

Hypoglycaemia- Decrease in blood sugar

Loss of Libido- Decreased sexual activity in males

Amenorrhoea- Lack of menstruation in females

Testis- Male Reproductive gland

Testicular atrophy- Decrease in the size of the testis

Hypothyroidism- Decrease in level of thyroid hormone in blood

Haemorrhagic infarction- Lack of blood supply to pituitary gland

due to massive haemorrhage (bleeding) in brainPanhypopituitarism- decrease in level of all the hormones produced

by pituitary gland

Autopsy- post-mortem

Capillary permeability- leak from minute blood vessels resulting in

bleeding


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Rhabdomyolysis- Breakdown of muscle protein

Conjunctival oedema- Swelling of eyes

Ptosis- Drooping of eyelids

External ophthalmoplegia- Ptosis with limitation of movements of

eyeball

Facial paralysis- Weakness of facial muscles

Long term complications of snake bite

Sloughing or surgical debridement- Surgical removal

Necrotic areas- Death tissue

Amputation- Severing/taking away the bitten part

Osteomyelitis- infection of underlying bone

Contractures- contraction of the muscle resulting in the limitation

of movements

Arthrodesis- Stiffness of the joints (lost movement in the joints)

Arthritis- Inflammation of the joint

Malignant transformation- Tendency of the wound to turn into

cancer

Necrotic-death tissue

Deformity- Abnormal shape of the part leading to loss of function

Squamous cell carcinoma- Tendency of the wound to turn into

cancer

Osteomyelitis- infection of underlying bone

Cortical necrosis- Death of tissues in the kidney


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Panhypopituitarism- decrease in level of all the hormones produced

by pituitary gland

Diabetes insipidus- Excess of urination due to lack of ADH (hormone

secreted by pituitary gland)

Chronic neurological defecit problems due to nerve damage lasts

for longer duration


Trismus- lock jaw

Facial paralysis- Weakness of facial muscles

Ptosis- drooping of eyelids

Myoglobin- Muscle protein

Myoglbinuria- excretion of muscle proteins in urine

Myoglobinemia- release of muscle protein into blood

Hyperkalemia- excess of potassium in blood

Myalgia- muscle pain

Congested conjunctiva- redness of eyes

Spasm- contration of eye muscles

Photophobia- irritation of eyes on seeing the bright light

Corneal ulcer-damage in the membrane covering black of the eye

Endophthalmitis- infection of the eye

Bilateral conjunctivitis- inflammation of both eyes

Corneal scarring- Scar in the eye


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Clouding of vision- Blurring of vision

Management;

Lymphatics-organ of immune system located all over the body

Ischemia - Lack of blood supply

7.4

Cardiopulmonary resuscitation- pressing the heart against anahatha(sternum) to make the heart pump along with mouth to mouth

breathing

Airway- air passage from nose to lungs

Circulation- it is a function of heart to supply blood to whole body

Airway patency- keeping the air passage clear of secrtions

Profound hypotension- unrecordable blood pressure (very low

pressure)

Hypovolemia- low blood volume

Inflammatory vasoactive mediators- chemical substance released

during inflammation.

Haemorrhagic shock- Loss of consciousness due to blood loss

Primary anaphylaxsis- Allergic reaction

Hyper kalemia- Increase in level of potassium in blood

Septicemia- Generalised infection.

Necrosis- Death tissue


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Defibrinogenated- Lack of fibrinogen (Fibrinogen-Substance needed

for clotting)

Thrombocytopenia- Decrease in level of thrombocytes(

Thrombocyte- type of cell needed for clotting)

Trismus- Lock jaw


Ophthalmoplegia- Ptosis + Limited movements of eye balls

Palpation- Examining the affected part by touchEcchymoses- Bleeding from deep structures like muscles

Lymphangitic- Redline tracking from the bitten part

Oedematous- Swollen limb

Intravascular thrombosis- Formation of clot inside the blood vessel

Compartmental syndrome- Lack of blood supply to a particular part

due to increase of pressure in that area

Patency of artery and veins- Free flow of blood


Demarcated darkening- A black line separating living tissue from

dead tissue

Smell of putrefaction- Rotten smell produced from decaying tissue

General examination

Hypovolemia- Loss of blood volume


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Petechia, Purpura, Discoid Haemorrhage, Echymosis- Bleeding under

the skin visible as redness

Haemorrhage- Bleeding

Chemosis- Swelling of eyes

Gigival sulci- Inner space between cheek and lower jaw

Epistaxis- Bleeding from nose

Renal ischemia- Lack of blood supply to kidney

Intracranial haemorrhage- Bleeding inside the brain

Lateralizing neurological signs- Signs indicating pathology in

particular part of brain

Convulsion- Fits

Neurotoxic envenoming

Ophthalmoplegia- Drooping of eyelids + Limited movements of eye

balls

Trismus Lock jaw

Pterygoid muscle- Muscle used for chewing


Innervated Supplied

Broken neck sign- Neck falls back due to paralysis of front muscles

of neck

Pharynx- Airway

Bulbar paralysis- Paralysis of respiratory muscles


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Leucocytosis- Increase in number of WBC

Neutrophil- Type of WBC

Schistocytes- Abnormality in RBC

Microangiopathic haemolysis- Death of RBC in minute vessels

Myoglobinemia- Release of muscle protein in blood

Aminotransferase- Enzyme used to assist liver function

Bilirubin- Substance released due to splitting of haemoglobin

Hepatic dysfunction- Abnormal liver function

Extravasation- Leak

Hyperkalemia- Increase in level of potassium

Rabdomyolysis- Breakdown of muscle protein

Metabolic acidosis- Increase in level of acid in blood causing rapidand deep breathing

Hyponatremia- Decrease in level of Sodium in blood

Haemostatic abnormality- Abnormality in clotting of blood causing

either massive bleeding or abnormal clotting

Arterial oxygen saturation- Amount of oxygen present in blood

Finger oxymetry- Instrument used to measure oxygen in blood

Myoglobin- Muscle protein

Immunoassay- Study used to distinguish myoglobin from haemoglobin

Erythrocytes- RBC


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Glomerular bleeding- Bleeding from kidney

Proteinuria- Excretion of protein in urine

Capillary permeability- Leakage from the minute blood vessel

Antivenom treatment

Antidote- Substance used to neutralize toxin

Coagulopathy- Clotting

Immunoglobin- Protein

Thrombocytopenia- Decrease in thrombocytes( thrombocyte- cell

needed for clotting)


Ophthalmoplegia- Ptosis+ Limited movements of eye balls

Hypotension- Decrease in blood pressure

Cardiac arrhythmias- Abnormality in rhythm of heart beat

Oliguria- Decrease in urine output

Anuria- Absence of urine output

Creatinine, urea- Substance used to assist kidney function

Intravascular haemolysis- Death of RBC in blood vessel


Hyperkalemia- Increase in blood potassium

Torniquet- Cloth tied to the limb to prevent spreading of venom via

blood


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Haemostatic abnormality- Abnormality in clotting of blood causing

either massive bleeding or abnormal clotting


Coagulopathy- Clotting

Antivenom Reaction

Sensitization- Prior exposure to allergen

IgE mediated Type I Hypersensitivity- A type of allergic reaction

Anaphylactic reaction- Allergic reaction

Urticaria- Red patches on the skin

Nausea- Tendency to vomit

Abdominal colic- Abdominal pain

Tachycardia- Increase in heart rate

Hypotension- Decrease in Blood Pressure

Bronchospasm- Narrowing of smaller airways

Angioedema- Swelling of eyes and lips due to allergic reaction

Radioallergosorbent test- Test to know whether patient is allergicto Antivenom

IgE, IgG- Proteins forming a part of immune system

Fc fragment- A part of Ig

Mast cells, Basophils- Cells of immune system

Pruritis- Itching


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Vasodilatation- Broadening of blood vessels

Febrile convulsions- Fits occurring due to increased body

temperature

Pyrogen contamination- Infected Antivenom

Serum sickness- Mild sickness due to Antivenom

Arthralgia- Joint pain

Myalgia- Muscle pain

Lymphadenopathy- Enlarged lymph nodes (Organs forming a part ofimmune system)

Mononeuritis- Inflammation of nerve

Proteinuria- Excretion of protein in urine

Periarticular swelling- Swelling of joints

Immune complex nephritis- Inflammation of kidney produced due to

deposition of antigen, antibody complex( Antigen- foreign substance

inside the body, Antibody- Substance produced in body to fight

against the antigen)

Encephalopathy- Inflammation of brain due toxins crossing blood

brain barrier.

Antihistamines, corticosteroids- Drugs preventing allergic reaction

Skin and conjunctivital hypersensitivity test- Allergic reaction

IgE mediated Type I hypersentivity- Allergic reaction

Anaphylactic- Allergic

Serum sickness- Sickness produced by Antivenom


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Complement- factor needed for immune reaction

Contraindication of Antivenom

Contraindication- Conditions where anti venom should not be given

Prophylaxis- Prevention

Atopic disease- Allergy

Empirically- experimental

Epinephrine/Adrenaline- Drug to prevent allergic reaction

Antihistamines, Steroids- Drug to prevent allergy

Adrenergic Beta2 Agonist(Salbutamol)- Drug to treat Wheezing

Bronchospasm- Narrowing of smaller airways

Prevention of anti venom reactions:

Prophylactic Prevention

Capillary permeability- Leakage from minute blood vessels

Intracranial bleeding- Bleeding from brain

Subcutaneous- Injection of drug under skin

Hypertension- Increase in BP

Arrhythmias- Abnormality in rhythm of heart beat

Hydrocortisone, Chlorphenamine, Promethazine, Diphenhydramine-

Drugs to prevent allergy

Pruritis- Itching


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Facial oedema- Swelling of face

Slow infusion- Drug given by drips

Intravenous push- Drug injected directly into vein

Treatment of Antivenom reactions

Intramuscular- Method of injecting drug into muscle

Lateral- Outer aspect

Urticaria- Red patches over the skin

Tachycardia- Increase in heart rate

Anaphylaxis- Allergic reaction

Pyrogenic reaction- Allergy along with fever

Antipyretic- Drug given to reduce fever

Intravenous fluids- Drug given to treat dehydration

Hypovolemia- Blood loss

Prednisolone- Steroid

Selective storage and shelf life of anti venom:

Lyophilized anti venom- powdered form of anti venom

Monovalent anti venom- Antivenom that acts against particular

species of snakes


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Polyvalent anti venom- Antivenom that acts against more than 1

species of snakes

Administration of Antivenom:

Reconstituted Mixing of anti venom with water just before

injecting

Isotonic fluid- Sodium chloride(Blood ph = Fluid ph, fluid-sodium

chloride)

Bioavailability- Amount of drug that is absorbed into the blood

Intragluteal injection- Injection given in buttock

Haematoma- Blood clot

Observation of the response to anti venom:

Haemolysis- Death of Blood cells


Recurrence of systemic envenoming

Cessation- Stop

Shock- Low blood pressure with Loss of consciousness

Criteria to repeat initial doss of Antivenom

Coagulable clot

Fibrinogen- factor needed for clotting


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Conservative treatment when no Antivenom is available:


nerve to the other.


(acetylcholine)

Haemostatic abnormality- Massive bleeding or abnormal clottingPlatelets-Blood cell needed for clotting

Fresh frozen plasma, cryoprecipitate- To replace depleted clotting

factors

Myocardial damage- Damage to heart muscle

Dopamine, Adrenaline,atropine- Given to increase the heart rate

Hypotension- Low BP

Bradicardia- Decreased heart rate

Myoglobinuria- Excretion of muscle protein in urine

Acidosis- Increased level of acid in blood

Electrolytic imbalance- Imbalance of sodium and potassium in blood

Severe local envenoming:


Intracompartmental syndrome- Loss of blood supply to an area due

to increased pressure


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Consumption coagulopathy- Depletion of clotting factors resulting in

bleeding

Thrombocytopenia- Decrease in level of thrombocytes (blood cell

needed for clotting)

Fibrinolysis- Breakdown of clot

Treatment of neurotoxic envenoming:

Cuffed endotracheal tube, Laryngeal mask- Instrument to giveventilation

Tracheostomy- Opening made in front of the neck to help patients

breathe

Asphyxiation- Difficulty in breathing + Decreased oxygen in blood

Intubation- Insertion of tube into nose or mouth to remove fluids

Automated external defribillator(AED)- Instrument to stimulate

heart beat

Oropharyngeal airway(OPA), nasopharyngeal airway(NPA)- Helps in

ventilation

Trismus- Lock jaw

Hypoxia- Decrease in oxygen

Hypoglycemia- Decrease in blood sugar

Seizure- Fits


Masseter muscles- Muscle of chewing


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Aspiration- Inhalation of material into lungs

Supraglottic device:

Supraglottic device- Helps in ventilation

Gastric tube- Tube inserted into stomach through mouth

Gastro oesophageal reflux- Regurgitation of stomach contents into

food pipe

Infraglottic device:

Infraglottic device, Endotracheal tube- Helps in ventilation

Laryngoscope- Tube inserted into wind pipe to look for any

obstruction and remove secretion.

Tracheostomy- Opening made in front of neck to help patient

breathe

Peripheral oxygen saturation- Measurement of oxygen level in blood

Digital oxymeter- Instrument used to measure oxygen in blood

Hypersalivation- Increased secretion of saliva

Cyanosed- Bluish discolouration

Bag valved mask device(BVM)- Helps in ventilation

Carotid pulse- Pulse felt in neck portion

Auscultation- Examining patients using stethoscope


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Tidal volume- Residual air present in lung after expiration

Flaccid paralysis- Paralysis of muscle(muscles are flabby)

Lung collapse- Lung cannot function

Weaning- Withdrawing gradually(ventilation)

Cytotoxicity- Drugs that are toxic to cells

Intravenous catheter- Tube inserted into vein to give drugs

Urinary catheter- Tube inserted into urinary bladder to drain urine

Centralvenous lines- Tube inserted into neck vein to measure

pressure

Intraarterial lines- Tube inserted into artery to give fluids and

drugs


nerve to the other.


(acetylcholine)

Myasthenia Gravis- Disease affecting nerves(Auto immune disease)

Endotracheal tube intubation- Insertion of tube through mouth or

nose to help patient breathe

Glycopyronium, Neostigmine, Prostigmin,Edrophonium- Muscle

relaxant

Capillary permeability- Leakage from minute blood vessel

Vasodilatation- Broadening of blood vessels

Myocardium- Heart muscle


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Arrhythmia- Abnormal heart beat

Plasma expanders Given to replace lost volume

Venous pressure, jugular venous pressure- Pressure measured bypassing a tube into neck vein

Superior vena cava- A vein

Pulmonary oedema- Swelling of lung

Extravasated leak

Pituitary adrenal insufficiency- Decreased in level of harmonessecreted by pituitary and adrenal gland

Septicaemia- Generalized infection

Haemorrhagic infarction- Loss of blood supply due to massive

bleeding

Pericardial friction rub- Abnormal sound heard between heart beat

Flapping tremor- Loss of control over the wrist

Convulsion- Fits

Fetor- Bad breath

Hypotension- Low BP

Auscultation of lung bases for crepitation- Abnormal sound heard in

lung

Oliguric- Decreased urine output

Supine- Lying posture

Postural hypotension- Low BP in changing from one position to

another


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Furosamide- Drug to increase urine output

Antecubital fossa- Junction of arm and forearm

Urethral catheter- Tube inserted to drain urine

Sterile- Aseptic

Insensible loss- Loss of water through sweat

Non nephrotoxic- Not toxic to kidney

Hyperkalaemia- Increased level of potassium in blood

Intravascular haemolysis- Death of blood cells in blood vessel

Calcium gluconate,Dextrose with insulin , Sodium carbonate-Given to

decrease blood potassium

Intravascular infusion- Drug given as drops through vein

Hypotension- Low BP

Acidotic- Increase in level of acid in blood

Kussmal respiration- Rapid and deep breathing

Hypocalcaemia- Decreased level of calcium

Peritonial dialysis- method to purify blood in case of kidney failure

Myoglobinuria- Excretion of muscle protein in urine

Saline dieresis- Giving fluids to increase urine output

Polyuric- Increase in urine output

Hypopituitarism- Decreased level of pituitary hormones

Albuminuria- Excretion of protein in urine

Nocturia- Excessive urination during night


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Mydriatic activity- The enlargement of pupil

Corneal abrasion- Small cut in membrane covering eyeball

Posterior synechia- iris sticks with lens leading to blurred vision

Topical cycloplegic- Eyedrops given to enlarge the pupil

Antihistamines to treat allergy

Keratoconjunctivitis- Inflammation of eyes

Endophthalmitis- Infection of eye

Corneal opacity- Scarring of cornea


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snakebite guidelines- medicinal terms and meanings

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