How to treat scorpion stings and snake bites.
Scorpion stings ( introduction)
the scorpion stings is excruciatingly painful and has mainly local effects such as tissue destruction and hemorrhage.Most complication are due to irritation of peripheral and central nervous systems. Myocarditis and encephalopathy are lethal complications. No specific anti venom is currently available. Early and effective supportive therapy decrease mortality and morbidity.
Scorpion stings ( clinical features )
Local : severe and immediate pain at the sting site, oedema and erythema with numbness and weakness.
Cardiovascular : sinus tachycardia and myocarditis.
Autonomic :nausea, vomiting, excessive salivation, sweating, hypothermia, hypotension.
Central nervous system: anxiety, restlessness, muscle spasms, pseudo seizures, syncope, hemiplegia.
Pediatric: abrupt onset of incessant crying and agitation,profuse sweating, circulatory collapse, bradycardia, tachycardia and convulsions.
Scorpion stings ( management )
First, insert intravenous cannula.
Second, monitor for any evidence of circulatory collapse and cardiac arrythmias.
Third,remove all clothes and foot wears to locate the scorpion stings.
Fourth, apply ice pack to the sites of the stings to reduce the pain ( pain relief )
Fifth, infiltrate the sites with 2% lignocaine 5- 10 ml, every 6 hours repeatedly.
Sixth, oral diazepam, 100mg for restlessness.
Seventh, in patient who manifest pulmonary oedema and tachycardia the drug of choice is tab. Prazosin 1-2 mg in adults and 30micro/kg/dose in children.Repeat the dose after 6 hours if symptoms persists .Alternatively tab. Prazosin 500 microgram can be administrated orally every 3 hours.
Eighth, if hypotension persists due to myocardial failure,injection dopamine may be used.
Finally tetanus immunization and observes for 24 hours.
Snake bites ( introduction )
First aids : Wash well with soap and water.Do not apply a tourniquet. Apply a broad firm bandage around the limb beginning at the distal tip and applying as far proximal as possible. Immobilize limb to reduce venous return.
If the patient is brought in with tourniquet, do not remove it until wide bore IV access is obtained.
Snake bites (management)
First , ensure airway, breathing and circulation is secure.
If no evidence of poison from snake's bites.
Second, establish intravenous access and provide pain relief with injection of morphine 3 mg intravenously in adult patients.
Third, examine the sites with a magnifying glass to confirm the diagnosis, especially when the cause of bite is unknown.
Fourth, look for ptosis, paralysis, hematuria or bleeding gum.
Fifth, laboratory investigations include urea, creatinine, clotting time, and urine microscopy for hematuria.
Sixth, document urine output, monitor vital signs, ptosis, respiratory effort, hematuria, bleeding gum . Observe for ascending cellulitis. Commence antibiotic therapy if spreading infection is noted.
Reassess patients every hours for the first 4-6 hours.
If the patient present with sign of poison by the snake bites then,
Intubate the patient immediately if respiratory paralysis is evident. Correct shock. Then follow the procedures above.
Anti - snake venom therapy.
Administer intravenously injection of hydrocortisone 100 mg and injection of pheniramine malaeate 22.75mg about 20 min prior to anti snake venom therapy infusion.
No test dose is required since there is no alternative if there are signs of hypersensitivity.
All patients who receive anti snake venom therapy should have all facilities for anaphylaxis management available for standby .
The treating physician should be by the bedsides until the first dose is completed.
Dose 1 : 2 vials in 100ml 5% dextrose over 20 min.
Dose 2 : 2 vials in 500ml of 5% dextrose over 1 hour.
Dose 3 : 2 vials in 500ml of 5% dextrose over 4 hours.
There is no established end point for cessation of therapy.
Subsequent doses as required based on symptoms as well as clotting times value.
Avoid local infiltration of anti snake venom at the poisonous site.
Renal failure requires dialysis, local tissue necrosis requires antibiotics and dressings and follow up.
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