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
Rhabdomyolysis- Breakdown of muscle protein
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
Ptosis- Drooping of eyelids
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
Necrosis- Death tissue
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
Ptosis- Drooping of eyelids
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)
Ptosis- Drooping of eyelids
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
Rhabdomyolysis- Breakdown of muscle protein
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
Necrosis- Death tissue
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
Rhabdomyolysis- Breakdown of muscle protein
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:
Neuro transmitter - Enzyme that helps to carry impulse from one
nerve to the other.
Acetylcholinesterase- Enzyme that destroy the neuro transmitter
(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:
Necrosis- Death tissue
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
Rhabdomyolysis- Breakdown of muscle protein
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
Neuro transmitter - Enzyme that helps to carry impulse from one
nerve to the other.
Acetylcholinesterase- Enzyme that destroy the neuro transmitter
(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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