The document discusses several orders of venomous arthropods including insects and arachnids. It describes the clinical effects of bites and stings from Hymenoptera insects like bees, wasps, and fire ants. Their venom contains biogenic amines, enzymes, and peptides that can cause local reactions or potentially fatal allergic reactions. It also discusses venomous spiders like the brown recluse and black widow. The brown recluse's venom can cause dermonecrosis while the black widow's neurotoxic venom acts on motor endplates and causes muscular pain, sweating, and other systemic effects. Treatment involves wound care, analgesics, antivenom, and managing allergic or toxic reactions.
Clinical features & Management of ARTHROPODS STING AND BITES.pptxvuyyuribhaargavi
Envenomation is the process by which venom is injected by the bite or sting of a venomous animal such as a snake, scorpion, spider, or insect. Arthropods can infest human skin ex: head lice.
Arthropods can inflict bites and stings. They can carry diseases such as malaria, yellow fever and filariasis. Order of insects belongs to stings are:
a) Hymenoptera - bees, wasps, hornets, fire ants.
b)Scorpionida- scorpions.
Hymenoptera venom contains
Biogenic amines (histamine, 5-HT and acetylcholine),
enzymes (phospholipase A and hyaluronidase)
toxic peptides (kinins in wasps, mast cell degranulating peptides in bees).
Clinical features & Treatment
1) Local reaction:
Clinical features
Local pain
Edema
Airway obstruction
By wasps - severe cutaneous infection & cellulitis (serious bacterial infection, skin is swollen and inflamed)
Treatment:
Remove stings
Local application – 20% Aluminium sulfate
Antihistamines – Diphenhydramine (500mg), Chlorpheniramine (4mg)
2) Allergic reaction – Tingling sensation, flushing, vomiting, Urticarial skin rash, pedal edema. Sometimes fever, malaise, renal failure.
Treatment: 0.1% adrenaline
Antihistamins, Corticosteroids
Cardiac monitoring, Analgesics, Haemodialysis- for renal failure.
Toxic reaction: Multiple stings
vasodilation, Hypotension, Fatigue, Diarrhoea, Headache
seizures, Delayed toxic reaction:
Renal failure, coagulopathy.
Treatment : Parenteral antihistamins.
Large dose corticosteroids.
Bronchodilators
Haemo dialysis.
Vit k for coagulopathy
SCORPION:
Scorpions differ in colour from straw yellow or light brown, to black.
Tail of the scorpion terminates into Bulbous enlargement called telson, which contains the stinger and venom apparatus.
venom
The main toxins include phospholipase, acetylcholinesterase, hyaluronidase, serotonin, and neurotoxins.
The venom of Buthus species of India contains phospholipase A, which causes gastrointestinal and pulmonary haemorrhages, and disseminated intravascular coagulation ( presence of severe abnormal blood clots in blood vessel)
Mode of Action
Affects Na+ channels with prolongation of Action Potentials.
Depolarisation of Nerves of both Adenergic & PSNS
Clinical features:
Local: Rapidly developing local pain, swelling, edema, lymadenopathy.
Systemic: Autonomic stimulation, Mydriasis, Profuse sweating, Excessive salivation
Urticaria, Hypertension, Convulsions, Priapism, nausea, Pulmonary oedema may develop within 2 to 3 hours leading to death, Intracerebral haemorrhage,
TREATMENT:
1) During transport to hospital:
Immobilize the affected extremity. Do NOT apply tourniquet.
Local application of ice is beneficial in relieving pain. Prolonged cryotherapy is however contraindicated.
A negative-pressure suction device may be used, if available
2)On Arrival at Hospital:
Rep. failure- Mechanical Ventilation, administer oxygen.
Pain- PCM/Morphine tabs.
Allergy- Antihistamines.
Nifidepine 10 to 20 mg (adults)
prazocin HCL, Dopamine, Diazepam, Metoclopramide, Antivenom therapy
Clinical features & Management of ARTHROPODS STING AND BITES.pptxvuyyuribhaargavi
Envenomation is the process by which venom is injected by the bite or sting of a venomous animal such as a snake, scorpion, spider, or insect. Arthropods can infest human skin ex: head lice.
Arthropods can inflict bites and stings. They can carry diseases such as malaria, yellow fever and filariasis. Order of insects belongs to stings are:
a) Hymenoptera - bees, wasps, hornets, fire ants.
b)Scorpionida- scorpions.
Hymenoptera venom contains
Biogenic amines (histamine, 5-HT and acetylcholine),
enzymes (phospholipase A and hyaluronidase)
toxic peptides (kinins in wasps, mast cell degranulating peptides in bees).
Clinical features & Treatment
1) Local reaction:
Clinical features
Local pain
Edema
Airway obstruction
By wasps - severe cutaneous infection & cellulitis (serious bacterial infection, skin is swollen and inflamed)
Treatment:
Remove stings
Local application – 20% Aluminium sulfate
Antihistamines – Diphenhydramine (500mg), Chlorpheniramine (4mg)
2) Allergic reaction – Tingling sensation, flushing, vomiting, Urticarial skin rash, pedal edema. Sometimes fever, malaise, renal failure.
Treatment: 0.1% adrenaline
Antihistamins, Corticosteroids
Cardiac monitoring, Analgesics, Haemodialysis- for renal failure.
Toxic reaction: Multiple stings
vasodilation, Hypotension, Fatigue, Diarrhoea, Headache
seizures, Delayed toxic reaction:
Renal failure, coagulopathy.
Treatment : Parenteral antihistamins.
Large dose corticosteroids.
Bronchodilators
Haemo dialysis.
Vit k for coagulopathy
SCORPION:
Scorpions differ in colour from straw yellow or light brown, to black.
Tail of the scorpion terminates into Bulbous enlargement called telson, which contains the stinger and venom apparatus.
venom
The main toxins include phospholipase, acetylcholinesterase, hyaluronidase, serotonin, and neurotoxins.
The venom of Buthus species of India contains phospholipase A, which causes gastrointestinal and pulmonary haemorrhages, and disseminated intravascular coagulation ( presence of severe abnormal blood clots in blood vessel)
Mode of Action
Affects Na+ channels with prolongation of Action Potentials.
Depolarisation of Nerves of both Adenergic & PSNS
Clinical features:
Local: Rapidly developing local pain, swelling, edema, lymadenopathy.
Systemic: Autonomic stimulation, Mydriasis, Profuse sweating, Excessive salivation
Urticaria, Hypertension, Convulsions, Priapism, nausea, Pulmonary oedema may develop within 2 to 3 hours leading to death, Intracerebral haemorrhage,
TREATMENT:
1) During transport to hospital:
Immobilize the affected extremity. Do NOT apply tourniquet.
Local application of ice is beneficial in relieving pain. Prolonged cryotherapy is however contraindicated.
A negative-pressure suction device may be used, if available
2)On Arrival at Hospital:
Rep. failure- Mechanical Ventilation, administer oxygen.
Pain- PCM/Morphine tabs.
Allergy- Antihistamines.
Nifidepine 10 to 20 mg (adults)
prazocin HCL, Dopamine, Diazepam, Metoclopramide, Antivenom therapy
you will get information about the layers of sclera and its diseases such as episcleritis and scleritis.
types of scleritis and episcleritis are also eplained in these slides. such as diffuse and nodular types of episclera, necrotizing and non-necrotizing types of anterior scleritis, posterior sleritis.
there etiologies. complications, investigations and treatment are also explained in detail.
Allergic conjunctivitis is inflammation of the conjunctiva (the membrane covering the white part of the eye) due to allergy.Although allergens differ among patients, the most common cause is hay fever. Symptoms consist of redness (mainly due to vasodilation of the peripheral small blood vessels), edema (swelling) of the conjunctiva, itching, and increased lacrimation (production of tears). If this is combined with rhinitis, the condition is termed allergic rhinoconjunctivitis.
The symptoms are due to release of histamine and other active substances by mast cells, which stimulate dilation of blood vessels, irritate nerve endings, and increase secretion of tears.
Treatment of allergic conjunctivitis is by avoiding the allergen (e.g., avoiding grass in bloom during "hay fever season") and treatment with antihistamines, either topical (in the form of eye drops), or systemic (in the form of tablets). Antihistamines, medications that stabilize mast cells, and nonsteroidal anti-inflammatory drugs (NSAIDs) are generally safe and usually effective.
you will get information about the layers of sclera and its diseases such as episcleritis and scleritis.
types of scleritis and episcleritis are also eplained in these slides. such as diffuse and nodular types of episclera, necrotizing and non-necrotizing types of anterior scleritis, posterior sleritis.
there etiologies. complications, investigations and treatment are also explained in detail.
Allergic conjunctivitis is inflammation of the conjunctiva (the membrane covering the white part of the eye) due to allergy.Although allergens differ among patients, the most common cause is hay fever. Symptoms consist of redness (mainly due to vasodilation of the peripheral small blood vessels), edema (swelling) of the conjunctiva, itching, and increased lacrimation (production of tears). If this is combined with rhinitis, the condition is termed allergic rhinoconjunctivitis.
The symptoms are due to release of histamine and other active substances by mast cells, which stimulate dilation of blood vessels, irritate nerve endings, and increase secretion of tears.
Treatment of allergic conjunctivitis is by avoiding the allergen (e.g., avoiding grass in bloom during "hay fever season") and treatment with antihistamines, either topical (in the form of eye drops), or systemic (in the form of tablets). Antihistamines, medications that stabilize mast cells, and nonsteroidal anti-inflammatory drugs (NSAIDs) are generally safe and usually effective.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. VENOMOUSINSECTS
There are 3 orders of toxicological importance in class insecta:
• Hymenoptera,
• Lepidoptera and
• Coleoptera.
Hymenoptera
• Two-winged flies and ants
• Bees,wasps,yellow jackets,hornets,and fire ants.
Hymenoptera stings are invariably caused by the
• Honeybee* (Apis mellifera),
• Paper wasp (Polistes annularis;Ropalidia gregaria)
• European wasp (V
espula germanica),
• Hornets (V
espa & Dolichovespula species)
• Yellow jackets (Vespula pensylvanica) (Fig 12.36).
• Afew incidents result from stings of fire ants (Solenopsis invicta) and rarely,
jumper ants (Myrmecia pilosula).
3.
4. V
ENOM
• Venomis usually injected through a sting which may be barbed (e.g. bee), or
smooth (e.g.wasp).
• Bees inject approximately 50 mcg of venom which is the total capacity of the
venom sac,and leave behind the stings embedded in the skin.
• W
asps and hornets are capable of repeated stings.
• Ants generally bite firmly with their jaws and then sting or spray locally irritating
venom.
• Fire ants have well developed abdominal stingers and inflict multiple stings.
Hymenoptera venom is a mixture of
Biogenic amines (histamine,5-hydroxytryptamine and acetylcholine),
Enzymes (phospholipaseAand hyaluronidase),and
Toxic peptides (kinins in wasps; apamin, melittin, and mast cell degranulating
peptides in bees).
6. MOA
Local Reaction
• Pathology is similar to other immunoglobulin E(IgE)–mediated allergic reactions.
• Anaphylaxis may occur and is typically a result of sudden systemic release
of mast cells and basophil mediators.
Clinical features:
Local Reaction
• Vasoactive amines and peptides-local pain, redness, irritation, itching, and
swelling,which resolve in a few hours.
• If the site of the sting is in a vital location, e.g. mouth or tongue (oedema leading to
airway obstruction),or near the eye (cataract formation,glaucoma,etc.).
• External eye stings can cause pain, swelling, acrimation, hyperaemia, and
conjunctiv
• Corneal stings can cause corneal oedema, ulceration, hyperaemia, pain, scarring,
and linear keratitis.
• Severe cutaneous infection and cellulitis have occurred after stings from
yellow jackets and wasps, which may pick up virulent bacteria while
foraging on decaying animal and vegetable matter.
7. CLINICAL F
EATURES
Allergic Reactions
• About 4% of the human population is hypersensitive to hymenoptera venom.
• Anaphylaxis is IgE-mediated
• IgE antibodies attach to tissue mast cells and basophils in a previously sensitised
individual.
• These cells are then activated, resulting in the progression of the cascade reaction
of increased vasoactive substances such as leukotrienes, eosinophil chemotactic
factor-A(ECF-A),and histamine.
• Clinical features develop within a few minutes of the sting, comprising
tingling sensation of scalp, flushing, dizziness, visual disturbances, syncope,
abdominal cramps, vomiting, diarrhoea, dry cough, wheezing, and
tachycardia.
• In severe cases, the patient develops urticaria, angioedema, glottic oedema,
profound hypotension, and coma
• Hypertension has occurred in children with multiple bee stings, and in adults
with multiple wasp stings.
• Apnoea, respiratory insufficiency and/or cardiopulmonary arrest have been
reported in patients who became comatose after receiving multiple stings
8. CLINICAL F
EATURES
AllergicReactions
• Death may occur within minutes.
• Delayed Reaction: Afew patients develop urticaria, skin rash, pedal oedema, and
arthritis between 1 to 5 days after the sting.
• Sometimes, a serum sickness–like syndrome occurs a week or more after the sting.
This is characterised by malaise, fever, headache, urticaria, lymphadenopathy, and
polyarthritis.
• Renal failure may occur rarely.
Toxic reactions:
• Multiple stings-Vasodilation,hypotension,oedema,fatigue, vomiting,diarrhoea,
headache,seizures,and coma. There have been reports of acute renal failure.
• Delayed toxic reactions-Haemolysis, coagulopathy, thrombocytopenia,
rhabdomyolysis,liver dysfunction,and disseminated intravascular coagulation.
• Fire ants can cause severe local reaction and even fatal allergic reaction (especially
in young children).
9. LABORATORY DIAGNOSIS
Intradermal skin tests(to assess sting allergy):
venoms are diluted to concentrations in the range of 0.001 mcg to 1 mcg/ml.
• Apositive test is manifested by a specific wheal and flare reaction.
The radioallergoabsorbent test (RAST) :
“in vitro” method that measures the quantity of venom-specific antibodies in the
patient’s serum
10. TREATMENT
LOCALREACTION:
Local cold compresses:
• Application of ice pack at the sting site for 15 minutes every 30 minutes
• Scraping away of retained stinger with scalpel blade.( in bee sting)
• Antihistamines: diphenhydramine ( 50 mg Q 6H)Or chlorpheniramine ( 4 mg Q
6 H)
• Local infiltration with adrenaline 1:1000 (0.1–0.3 ml) near the sting site may
help impede systemic absorption of venom.
ALLERGIC REACTIONS
• 0.1%adrenaline 0.5 to 1 ml S.C/ I.M
• Antihistamine injection (diphenhydramine 50 mg parenterally, then 25 to 50 mg
orally every 4 to 6 hours for 24 to 72 hours)
• Oxygen—5 to 10 L/ min via high flow mask
• Bronchodilators such as salbutamol to relieve dyspnoea and wheezing.
• Corticosteroids:– Methylprednisolone—1 to 2 mg/kg IV every 6 to 8 hours
11. TREATMENT
T
oxicReactions
• Parenteral antihistamines
• Large doses of corticosteroids
• Bronchodilators
• Haemodialysis for renal failure
V
ENOMOUSARACHNIDS
• Arachnids differ from insects mainly in the number of legs they possess: eight
instead of six.
There are two important orders from the toxicological point of view:
Scorpionida
Aranea(spiders)
13. The common Indian spider species that cause serious envenomation include
Brown Recluse
BlackWidow
Wolf Spider
Tarantula.
14. • Species:Loxosceles reclusa
V
enom
• Consists of several toxic components including hyaluronidase, ribonuclease,
deoxyribonuclease,alkaline phosphatase,lipase,and sphingomyelinase D.
• Sphingomyelinase D reacts with sphingomyelin in the RBCmembrane causing
the release of choline and N-acylsphingosine phosphate.
• This causes severe intravascular occlusion of micro-circulation leading to necrosis.
• Act as proteases upon molecular constituents of plasma extracellular matrix
(fi bronectin and fi brinogen),and basement membrane constituents (entactin
and heparin sulfate proteoglycan)
• By disrupting the subendothelial basement membrane, blood vessel wall
instability and increased permeability can occur
BROWN RECLUSE(VIOLIN,BROWN SPIDER,
FIDDLEBACK)
15. LOCAL
• Bite is usually painless,begins to bleed and ulcerate in 2 to 8 hours.
• Erythema and pain or pruritus.
• Asmall vesicle may form at the bite area, and the lesion may take on a “bullseye” or
“halo”appearance
• Ulcerated lesions if untreated, usually enlarge until about a week when eschar
formation takes place
CLINICAL FEATURES
16. SYSTEMIC(“loxoscelism”)
• Fever associated with chills and night sweats myalgia, arthralgia,
headache
• Vomiting,haemolysis,DIC,shock,renal failure,jaundice,convulsions and coma.
• Acute tubular necrosis with resulting oliguria or anuria
DIAGNOSIS
Leucocytosis (20,000 to 30,000 per cubic mm).
Prolonged PT and PTT
Coombs positive
Haemolytic anaemia.
Abnormal renal and liver function tests.
17. LOCAL
• Wound cleansing.
• Immobilisation of bitten extremity.
• Tetanus prophylaxis.
• Analgesics
• Application of cold compresses
• Antipruritics:Diphenhydramine 5 mg/kg/day orally,with a maximum dose of 25
to50 mg four times a day.
• Antibiotics,if wound gets infected.
SYSTEMIC
• Admit patient to hospital and monitor for evidence of haemolysis, coagulopathy
and renal failure.
• If haemoglobinuria occurs, renal failure may be prevented by increasing IV
fluids,and alkalinising urine.
• Significant haemolysis should be treated with transfusions
T
REATMENT
18. Latrodectus Species
VENOM
Neurotoxic
Main component: alpha latrotoxin (binds avidly to a specific presynaptic
receptor.)
The venom affects the motor endplates of neuromuscular synaptic
membranes by the binding of gangliosides and glycoproteins at the
synapses.
This causes the channels for sodium influx into neurons to remain open, as a
result of which there is extensive release of acetylcholine and noradrenaline
into the synapses, thereby inhibiting reuptake.
The end result is massive stimulation of motor endplates as the venom
travels through the lymphatic system
BLACKWIDOW (HOURGLASS SPIDER)
19. GRADE1
• Sharp pain at bitesite,which may have one or two small puncture wounds,1 to2
mm apart.
• The immediate area may be warm,mildly indurated,and slightly reddened.
GRADE2
• Muscular pain in bitten extremity extending to the trunk.
• Local diaphoresis of bitten extremity.
• Tender regional lymphadenopathy may be present.
CLINICAL F
EATURES (LATRODECTISM )
20. GRADE3:
Generalised muscle pain and weakness,with difficulty in walking.
Generalised sweating.
T
achycardia and hypertension
ECG changes : QRS with ST and T segments depression,prolonged QT
interval.
Priapism, urinary retention, pyuria, proteinuria,microscopic haematuria, and
testicular pain
Nausea,vomiting,and headache.
Victim often displays a contorted,grimacing, sweating facial appearance,
referred to as“facies latrodectismica”.
Ptosis , salivation, hyperrefl exia, tremor, convulsions, tachypnoea, and
respiratory compromise.
Board-like rigidity of the abdomen,shoulders,and back may develop.
Acute renal failure is uncommon but reported
21. Leucocytosis
Elevated creatine kinase
Albuminuria.
TREATMENT :
• Pain-IV Morphine/pethidine +benzodiazepines
• Application of cold or warm compresses
• Swelling-non-steroidal anti-inflammatory drugs.
• Musclerelaxants suchas diazepam, dantrolene may help relieve muscle spasm.
• Tetanus prophylaxis is essential.
• Milder pain treated with aspirin,paracetamol,and/or codeine.
DIAGNOSIS
22. WOUND CARE:
Cleansing with antiseptics.
Immobilization,elevation,and serial observation.
If infection sets in,antibiotics must be administered.
Surgical intervention (excision) may be necessary if lesion exceeds 4 cmat 12
hours post-envenomation
23. L
YCOSA SPECIES.
Clinical Features
LOCAL:
Generally no serious manifestations
Occasionally it causes moderate pain, erythema, oedema, or pruritis
SYSTEMIC(develops after 1-2 days):fever,chills,myalgia,and arthralgia
TREATMENT
Supportive and symptomaticmeasures.
WOLF SPIDER
24. Variant of wolf spider
Commonest species involved in bites is Dugesiella hentzi Clinical
features:
Hairs of the tarantula may cause urticaria and conjunctivitis on contact
Bites can be painless,or produce a deep,throbbing pain for an hour
Local swelling may develop.
Treatment :
Application of ice packs
Wound cleansing
Antihistamines
Immobilisation of the affected part,
Elevation,systemic analgesics and supportive care usually suffice.
T
etanus prophylaxis may be required.
TARANTULAS (LYCOSA TARANTULA)
27. The members of this order comprise scorpions
There are at least 650 different types of scorpions divided into 6 families.
Most species are nocturnal,and seek areas that are cool and moist.
The scorpion has a cephalothorax (fused head and chest),an abdomen, and a six
segmented tail which terminates in a bulbous enlargement called telson
The telson contains the stinger and venom apparatus
The commonest Indian species: merobuthus tamulus ( red scorpion )
VENOM
The main toxins include phospholipase, acetylcholinesterase, hyaluronidase,
serotonin,and neurotoxins.
The venom of Buthus species of India contains phospholipase A, which causes
gastrointestinal and pulmonary haemorrhages, and disseminated intravascular
coagulation.
28. • Most scorpion venoms affect sodium channels with prolongation of action
potentials, as well as spontaneous depolarization of nerves of both adrenergic and
parasympathetic nervous systems.Thus, both adrenergic and cholinergic symptoms
occur.
• Hyperkalaemia, hyperglycaemia (with reduction in insulin secretion), and
increased secretion of renin and aldosterone are characteristic of stings by
Mesobuthus tamulus
MODE OF ACTION
LOCAL SYSTEMIC
Excruciating pain,swelling,
redness
Mydriasis,profuse sweating
Urticaria,salivation,priapism,
Hypertension,brady-
/tachyarrhythmiasPulmonary
edema leading to death
Intracerebralhemorrhageresultingin
hemiparesisConvulsions
Hyperglycemia,hypertension
Palamnaeusspeciescauseslocalpain,paraesthesias,mild
autonomicnervoussystemexcitation,pulmonaryinfi
ltration,eosinophilia,salivation,nausea,
sweating,and mild hypotension.
30. During transport to hospital:
• Immobilise the stung limb(do not apply tourniquet)
•Local ice application
On arrival at hospital
• Admit all patients with systemic manifestations (hypertension,hypovolaemia,
pulmonary oedema) to ICU
• Patients with respiratory failure or with CNSdisturbances should be mechanically
ventilated;administer oxygen to all serious cases
• Pain-paracetamol/morphine
• Diazepam for convulsions
• Metoclopramide for vomiting-5-10 mg IV
TREATMENT
31. • Mild to moderate antihistamines, with or without inhaled beta agonists,
corticosteroids,or adrenaline.
• Severe anaphylaxis must include oxygen supplementation, aggressive airway
management,adrenaline,ECGmonitoring,and IV fluids.
• Hypertension(160/110 mmhg)-nifedipine 10-20 mg every 4hrs-6hrs, child dose -
0.3mg/kg
• Hypotension-dopamine infusion:2-5mcg/kg/min
• Furosemide/ prazosin for pulmonary oedema.
• Life-threatening pulmonary oedema may respond to a nitroprusside drip
• Agitation and convulsions can be controlled with IV diazepam (5 to 10 mg,adults;
0.2 to 0.3 mg/kg,children;repeated every 10 minutes as required).
• Alternatively,phenobarbitone can be given,5 to 10 mg/ kg IV
.
• Persistent vomiting usually responds to metoclopramide 5 to 10 mg IV (adults),or
0.5 mg/kg (children).
• Persistent tachyarrhythmias can be reversed with propranolol (1 mg/dose IV
,
administered no faster than 1 mg/min, repeated every 5 minutes until desired
response is seen,or a maximum of 5 mg has been given).
32. Scorpion antivenom effective against Mesobuthus tamulus has recently been
introduced in India.*
The recommended dose is 1 vial (reconstituted in 10 ml of injection water)
initially,followed by further doses if required.
ANTI VENOM THERAPY