insect sting and snake bites

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    SN KE BITESVenomous snake bites are medical emergencies.

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    Children between 1-9 years old are themost common victims.

    Greatest number of bites occurs duringthe daylight hours and early evenings ofsummer.

    Most common site: upper extremity Pit vipers-most frequent poisonous

    snake biters.

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    Clinical Manifestations

    Edema

    Ecchymosis

    Hemorrhagic bullae

    Symptoms: lymph node tenderness,nausea & vomiting, numbness,metallic taste in the mouth

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    Management Initial first aid:

    -have the person lie down.

    -remove constrictive items

    -provide warmth

    -cleanse and cover thewound with light dressing

    -immobilize the injuredpart below the level of theheart

    -check ABC.-DO NOT apply ice or

    tourniquet to the injuredsite.

    There is no specificprotocol for thetreatment of snake

    bites. Parenteral fluids are

    used to treathypotension.

    The patient isobserved closely for6hours.

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    Administration of Antivenin An antitoxin used to treat snake bites.

    Should be administered within 4 hours after the snakebite.

    2 kinds:

    A. Antivenin Polyvalent (ACP)

    B. Crotalidae Polyvalent Immune Fab Antivenin (FabAV) Perform skin or eye testto detect hypersensitivity to

    antivenin.

    Before administering antivenin and every 15 mins, thecircumference of the affected part is measured.

    Premeds (dipenhydramine or cimetidine) are indicatedto decrease allergic response.

    Administered through IV infusion.

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    Initial Evaluation in the ED

    If the snake is venomous or nonvenomous

    Where and when the bite occurred and itscircumstances.

    Sequence of events and S/S

    Severity of poisonous effects VS

    Circumference of the injured site

    Lab. Data ( CBC, urinalysis and coagulationstudies)

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    Insect Stings

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    an extreme sensitivity to thevenoms of insects (orderHymenopter

    bees hornets yellow jackets fire ants Wasps

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    Venom allergy IgE-mediatedreaction and it constitutes anacute emergency

    can trigger anaphylaxis stings of the head and neck or

    multiple stings are serious

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    Clinical manifestations generalized urticaria itching

    malaise

    anxiety due to laryngeal edema tosevere bronchospasm

    shock

    death

    Generally, the shorter the timebetween the sting and the onset ofsevere symptoms, the worse theprognosis

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    Management

    stinger removal .The stinger isremoved with one quick scrape of afingernail over the site.

    Wound care with soap and water issufficient for stings.

    **Scratching is avoided because itresults in a histamine response.

    Ice application reduces swelling andalso decreases venom absor tion.

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    An oral antihistamine andanalgesic will decrease the itchingand pain

    Desensitization therapy should begiven to people who have hadsystemic or significant localreactions.

    Patient and family education is animportant measure in preventingexposure to stinging insects