This document discusses arthropod bites and stings from venomous insects and arachnids. It describes three orders of toxicological importance in class insecta: Hymenoptera, Lepidoptera, and Coleoptera. It focuses on Hymenoptera, which includes bees, wasps, yellow jackets, and hornets. Their venom is a mixture of biogenic amines, enzymes, and toxic peptides. Stings can cause local reactions or systemic allergic reactions. Two important orders of venomous arachnids discussed are Scorpionida and Aranea (spiders), including descriptions of brown recluse spiders, black widows, wolf spiders, and tarantulas. Scorpion st
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.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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
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
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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
CLINICALFEATURES:
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