Snakes and Scorpions

Dr J Rieck

Department of Emergency Medicine

Sheba Medical Centre

General

• 40 species of snake in Israel.

• 9 poisonous.

• Front fang.

• Identification of snake and assessment of bite is unreliable.

Venom

• Components.Variable.

• Enzymes- proteases,hyaluronidase,p-lipase.

• cause soft tissue destruction and DIC.

• Toxins.

• Hemorrhagins.- lung damage.

• Cardiotoxins- depolarising agent.

• Neurotoxins- neuromuscular, non-depol’.

Signs of possible envenomation

• Pain.

• Open/bleeding wound.

• Swelling.

• Dizzy, sweating.

• Raised pulse.

• Nausea or vomiting.

• Loss of co-ordination or fainting.

Prehospital treatment DO’S.

• Irrigate

• Calm patient and restrict movement.

• Find and kill snake. (remember reflex bite)

• Splint.

• Keep affected area below heart level.

• Remove restrictive objects. Eg: rings.

• Place IV line and urgent evac’ to hospital.

Prehospital treatment DONTS’

• Do not

• CUT

• SUCK

• TOURNIQUET

• FREEZE.

Hospital care

• ABC and vital signs. History and examination. (5 grade system)

• Lab-CBC, Clotting, Renal/Hepatic function.

• Cross match + 4 units, consider FFP, etc.

• ECG and chest X ray.

• Specific immunoassays.

Antivenom

• If there are no signs of systemic or progressive local envenomation-monitor.

• If there are signs of envenomation consider anti-venom. Beware allergic reactions.

• Wound care tetanus, antibiotics.

• Refer to national protocol.

• Minimum 24 hr observation.

Complications

• Hypovolemia.

• Hemolysis.

• Coagulopathy.

• ARDS

• Of antivenom - anaphylaxis.

• - serum sickness.

Scorpions

SCORPIONS

• 2 Species in Israel with N-S distribution.

• Black (N)

• Yellow (S) Leiurus quinquestriatus.

Venom

• Species specific and variable.

• Proteins causing hemolysis and tissue destruction.

• Neurotoxins and Cardiotoxins.

• Pincer size related to amount of venom.

Treatment

• Prehospital principles similar to snakebite.

• May apply icepack.

• Hospital- monitor, particularly cardiac.

• - LVF, arrythmiae, HTN

• - parasthesia- local and systemic.

• 6 hours symptom free, can discharge.

CHILDREN

• CHILDREN - up to 30% serious envenomation. ? Anti venom.

• Systemic/ multi organ failure.