This document discusses various environmental emergencies, beginning with snake envenomations. It provides statistics on snake bites in the US and describes the clinical effects of different snake species. It discusses the signs and symptoms of envenomation as well as the treatment, including antivenin administration. It also covers spider bites from black widows and brown recluses. For marine envenomations, it describes jellyfish and echinoderm stings and their treatments. It concludes with sections on drowning, discussing the pathophysiology and emphasizing the importance of immediate resuscitation.
This document provides an overview of environmental emergencies, including thermal injuries, burns, electrical injuries, hypothermia, frostbite, and heat-related illness. It discusses the epidemiology, presentation, assessment, treatment, and management of these conditions. Key points include that burns can be classified based on depth and size, inhalation injury increases mortality, and fluid resuscitation follows the Parkland formula. Hypothermia ranges from mild to severe based on core temperature, with cardiovascular and neurological impacts. Rewarming techniques include passive external rewarming and active external or internal rewarming depending on severity.
Submersion injuries can cause drowning, near-drowning, or secondary drowning. Drowning is a leading cause of accidental death, especially in children under 5. Near-drowning can cause hypoxic injury, fluid overload, pulmonary injury, and hypothermia. Treatment involves airway management, oxygenation, ventilation, warming, and monitoring for secondary complications. Prognosis depends on factors like submersion time, response to resuscitation, and neurological status. Prevention focuses on education, supervision, and safety measures.
The document provides information on submersion injury or near-drowning, including definitions, epidemiology, pathophysiology, clinical manifestations, investigations, treatment procedures, prognosis, prevention measures, and a painting illustrating how quietly drowning victims are often discovered. It notes that drowning is a leading cause of injury death among children globally and in the Philippines specifically. The pathophysiology involves hypoxia from fluid aspiration into the lungs from submersion. Treatment involves aggressive warming, ventilation, and monitoring for complications like respiratory failure or multiple organ dysfunction. Prognosis depends on factors like response to resuscitation and neurological status upon arrival to emergency care.
drowning and near drowning are the common type of accident in children. this PPT will aquaint you with the definitions, types and indetail pathophysiology and its management.
This document summarizes current concepts regarding drowning. It defines drowning as a process causing respiratory impairment from liquid submersion or immersion. Risk factors include male sex, young age, alcohol use, low income, lack of supervision, and aquatic exposure. Pathophysiology involves pulmonary injury from liquid inhalation and central nervous injury from hypoxia. Treatment involves pre-hospital CPR, maintaining airway and oxygenation in the emergency department, and monitoring for complications like sepsis or renal failure in the ICU. Prevention strategies are also discussed.
Drowning is a major public health issue worldwide, accounting for over 500,000 deaths per year. It is a leading cause of accidental death for those under age 45. The pathophysiology of drowning involves hypoxemia from aspiration of water into the lungs, which affects multiple organ systems. Management involves early rescue and CPR, with a focus on ventilation. In the hospital, patients may develop pulmonary edema, neurological impairment, or other end-organ effects and require monitoring and support. Standardizing definitions and reporting of drowning incidents can help improve outcomes.
Oxygen therapy involves administering oxygen at concentrations greater than room air to treat hypoxemia. The purpose is to increase oxygen saturation in tissues where it is too low due to illness or injury. Oxygen can be delivered via various low or high flow devices like nasal cannulas, masks, tents or venturi masks to maintain adequate oxygen saturation. Close monitoring of oxygen saturation levels via pulse oximetry or arterial blood gases is needed to properly titrate oxygen therapy.
This document provides an overview of environmental emergencies, including thermal injuries, burns, electrical injuries, hypothermia, frostbite, and heat-related illness. It discusses the epidemiology, presentation, assessment, treatment, and management of these conditions. Key points include that burns can be classified based on depth and size, inhalation injury increases mortality, and fluid resuscitation follows the Parkland formula. Hypothermia ranges from mild to severe based on core temperature, with cardiovascular and neurological impacts. Rewarming techniques include passive external rewarming and active external or internal rewarming depending on severity.
Submersion injuries can cause drowning, near-drowning, or secondary drowning. Drowning is a leading cause of accidental death, especially in children under 5. Near-drowning can cause hypoxic injury, fluid overload, pulmonary injury, and hypothermia. Treatment involves airway management, oxygenation, ventilation, warming, and monitoring for secondary complications. Prognosis depends on factors like submersion time, response to resuscitation, and neurological status. Prevention focuses on education, supervision, and safety measures.
The document provides information on submersion injury or near-drowning, including definitions, epidemiology, pathophysiology, clinical manifestations, investigations, treatment procedures, prognosis, prevention measures, and a painting illustrating how quietly drowning victims are often discovered. It notes that drowning is a leading cause of injury death among children globally and in the Philippines specifically. The pathophysiology involves hypoxia from fluid aspiration into the lungs from submersion. Treatment involves aggressive warming, ventilation, and monitoring for complications like respiratory failure or multiple organ dysfunction. Prognosis depends on factors like response to resuscitation and neurological status upon arrival to emergency care.
drowning and near drowning are the common type of accident in children. this PPT will aquaint you with the definitions, types and indetail pathophysiology and its management.
This document summarizes current concepts regarding drowning. It defines drowning as a process causing respiratory impairment from liquid submersion or immersion. Risk factors include male sex, young age, alcohol use, low income, lack of supervision, and aquatic exposure. Pathophysiology involves pulmonary injury from liquid inhalation and central nervous injury from hypoxia. Treatment involves pre-hospital CPR, maintaining airway and oxygenation in the emergency department, and monitoring for complications like sepsis or renal failure in the ICU. Prevention strategies are also discussed.
Drowning is a major public health issue worldwide, accounting for over 500,000 deaths per year. It is a leading cause of accidental death for those under age 45. The pathophysiology of drowning involves hypoxemia from aspiration of water into the lungs, which affects multiple organ systems. Management involves early rescue and CPR, with a focus on ventilation. In the hospital, patients may develop pulmonary edema, neurological impairment, or other end-organ effects and require monitoring and support. Standardizing definitions and reporting of drowning incidents can help improve outcomes.
Oxygen therapy involves administering oxygen at concentrations greater than room air to treat hypoxemia. The purpose is to increase oxygen saturation in tissues where it is too low due to illness or injury. Oxygen can be delivered via various low or high flow devices like nasal cannulas, masks, tents or venturi masks to maintain adequate oxygen saturation. Close monitoring of oxygen saturation levels via pulse oximetry or arterial blood gases is needed to properly titrate oxygen therapy.
1. Drowning is defined as respiratory impairment from submersion in a liquid medium and is a major cause of accidental death, especially in children ages 1-14.
2. Management of drowning victims involves resuscitation, treatment of hypoxic-ischemic encephalopathy, and prevention of complications.
3. Prevention strategies focus on supervision during water activities, swimming lessons, CPR training, and safety measures around pools.
This document provides checklists for responding to common ventilator alarms and troubleshooting a crashing ventilated patient. For high airway pressures, possible causes include a tube in the right main bronchus, bronchospasm, mucous plugs, and pneumothorax. For low minute volumes, possible causes are an endotracheal tube cuff deflation allowing an air leak or chest wounds allowing air to escape. The checklist for a crashing ventilated patient follows the acronym D.O.P.E.S. to identify potential problems, then D.O.T.T.S. to address them, such as checking tube position or ventilator settings.
Oxygen therapy requires understanding oxygen delivery and toxicity risks. The presentation covered:
1. Indications for oxygen therapy include hypoxia, dyspnea, and low blood oxygen levels.
2. Oxygen delivery devices include nasal cannulas, masks, and venti-masks which provide varying levels of oxygen concentration depending on flow rates and patient breathing.
3. High oxygen concentrations over long periods risk toxicity including hypoventilation, absorption atelectasis, and pulmonary damage. Careful monitoring is needed to avoid risks while meeting patient needs.
This document defines and describes the main types of shock: cardiogenic, hypovolemic, anaphylactic, and obstructive shock. Cardiogenic shock occurs when the heart is damaged and cannot pump enough blood to the organs. Hypovolemic shock is caused by severe blood or fluid loss that makes the heart unable to circulate blood properly. Anaphylactic shock is a severe allergic reaction that affects the whole body. Obstructive shock prevents blood and oxygen from reaching the organs due to something blocking blood flow like a blood clot or tumor. The document provides examples of causes and conditions that can lead to each type of shock.
1. Mechanical ventilation troubleshooting involves identifying the cause of a patient's sudden respiratory distress by analyzing monitor alarms, physical signs, and ventilator graphs.
2. Common causes include ventilator issues like leaks, circuit blocks, or setting errors as well as patient issues such as pneumonia or pneumothorax.
3. The document outlines steps for troubleshooting including disconnecting the patient to manually bag and assess response, then treating the most likely problem by procedures like suctioning, adjusting settings, or emergency thoracostomy.
This document summarizes a presentation on basic and advanced cardiac life support. It discusses key concepts in BLS including recognition of cardiac arrest, activating emergency services, performing chest compressions, minimizing interruptions, monitoring compression quality, ventilation, and use of an automated external defibrillator. It then covers ACLS, including treatment algorithms, airway management, defibrillation procedures, medications used during CPR, monitoring techniques, and management of specific arrhythmias like ventricular fibrillation, asystole, and pulseless electrical activity. The goal of BLS and ACLS is to provide immediate life-saving interventions for cardiac arrest patients until the underlying cause can be addressed.
Hypothermia is defined as a core body temperature below 35°C. Mechanisms of heat loss include radiation, evaporation, convection, and conduction. As temperature decreases, physiological responses include vasoconstriction, shivering and changes in basal metabolic rate. Clinical features range from vague symptoms in mild hypothermia to loss of consciousness and absent reflexes in severe cases. Management focuses on passive or active rewarming depending on severity. Outcomes are worse with prehospital cardiac arrest, hemodynamic instability, and lab abnormalities indicating organ damage.
EMS and TBI: Immediate Field Care for High Impact InjuriesRommie Duckworth
Traumatic Brain Injuries (TBI’s) account for approximately 2.5 million annual ED visits. Of these, many patients leave with lifelong disabilities and more than 50,000 don’t leave at all (one third of ALL injury related deaths). In those first moments following impact, the EMS care that you provide is a major factor in your patient's outcome. Hyperventilate? Intubate? Permissive hypotension? Do you know what to do? Using case-studies, evidence based guidelines and a common-sense approach, this program gives you strategies for the prehospital management of traumatic brain injuries in a way that real-world medics and EMTs can use them in real world trauma settings.
For More Information See:
www.RomDuck.com
www.RescueDigest.com
Learning Objectives: Students will learn:
- How to recognize traumatic brain injuries of all levels as they present in the field.
- How to perform field and clinical differentiation between concussion, mild TBI, moderate TBI and severe TBI.
- How to prioritize field assessment and treatment of TBI patients according to cur-rent clinical guidelines for immediate prehospital care.
- How to best coordinate with hospital trauma teams for improved outcomes for TBI patients.
- How to implement local TBI prevention strategies.
1) The patient has signs of shock including hypotension, tachycardia, and elevated lactate and base deficit.
2) Fluid resuscitation with 2L LR improved hemodynamics but lactate and base deficit remain elevated, indicating ongoing shock.
3) Aggressive resuscitation with blood products following a 1:1:1 ratio of PRBCs, FFP, and platelets is indicated to replace blood loss and prevent coagulopathy, given the suspicion for hemorrhage.
1) The document defines sepsis, severe sepsis, and septic shock and provides diagnostic criteria. It discusses initial resuscitation goals for the first 6 hours including fluid administration, vasopressors, and ScvO2/lactate monitoring.
2) Management recommendations are provided for antimicrobial therapy, source control, fluid therapy, vasopressors, blood products, glucose control, and other areas. Bundle elements are outlined to be completed within 3 and 6 hours of diagnosis.
3) Guidelines include level of evidence ratings and discuss evidence from studies on topics like fluid resuscitation, vasopressor use, and ventilator management for patients with severe sepsis or septic shock.
This document discusses drowning, providing definitions and discussing epidemiology, pathophysiology, management, and related topics. It notes that drowning is the process of experiencing respiratory impairment from submersion or immersion in liquid. The highest drowning death rates are seen in children aged 1-4 and 15-19, with common locations being bathtubs, pools, and natural water reservoirs. Progressive hypoxia and hypothermia can occur, affecting multiple organ systems. Management focuses on rapid oxygenation, ventilation, and circulation in the pre-hospital setting, followed by careful monitoring of cardiopulmonary and neurological status in the hospital.
Ventilator Management In Different Disease EntitiesDang Thanh Tuan
The document discusses ventilator management in different disease entities. It covers indications for mechanical ventilation in conditions like respiratory failure, ARDS, COPD, chest trauma, and head injury. For ARDS specifically, it summarizes the key findings of the NIH ARDS Network trial which demonstrated that a lower tidal volume strategy of 6 ml/kg predicted body weight reduced mortality compared to the traditional higher tidal volume approach.
This document provides information on mechanical ventilation including basics, meaning, indications, clinical conditions requiring ventilation, terminology used, types of ventilation (invasive and non-invasive), initial ventilator settings, assessing equipment, complications, management, and weaning. It discusses how mechanical ventilators can maintain oxygen delivery and ventilation over a prolonged period. The various modes of ventilation, parameters, and criteria for initiating and weaning a patient from ventilation are described. References are provided for additional information.
This document defines near drowning and summarizes its symptoms, treatment, and prevention. Near drowning occurs when someone submerges in water and may or may not breathe in water, resulting in confusion, lack of breathing or heartbeat, and pale skin. Proper treatment includes CPR and encouraging swimming safety. With early rescue and medical care, full recovery is possible, but complications like infection or brain damage can occur without treatment.
This document summarizes new developments in pediatric acute respiratory distress syndrome (ARDS). It discusses the definition and pathophysiology of ARDS, as well as associated clinical disorders and outcomes. Therapies covered include mechanical ventilation strategies like low tidal volumes, permissive hypercapnia, high frequency oscillation, and prone positioning. Pharmacological approaches discussed are surfactant, steroids, inhaled nitric oxide, and partial liquid ventilation. The use of extracorporeal membrane oxygenation for severe respiratory failure is also mentioned.
1) ECMO and ECCO2R are being re-examined as alternatives to invasive mechanical ventilation for critically ill patients, as the technologies have improved.
2) Specifically, ECMO is being used instead of mechanical ventilation for some patients awaiting lung transplantation, with promising results.
3) While ECMO and ECCO2R may help reduce ventilator-induced lung injury and duration of mechanical ventilation, more research is still needed to determine if they can fully replace invasive mechanical ventilation.
This document discusses various animal bites and stings. It covers bites from dogs, snakes including pit vipers and coral snakes, other reptiles like lizards, and marine animals. It also discusses stings from insects like bees, wasps and fire ants, spiders including black widows, scorpions, and jellyfish. For each type of bite or sting, it describes symptoms and what first aid steps to take, such as calling 911, applying a pressure bandage, giving pain medication, and keeping the affected area immobilized.
This document provides information on snake bites, including epidemiology, causes, pathophysiology, signs and symptoms, management, and prevention. It notes that snake bites affect millions globally each year, causing tens of thousands of deaths annually in India alone. The document discusses the venom and toxins of snakes, as well as the local and systemic effects of envenomation. It provides guidance on first aid, clinical assessment, investigations, antivenom treatment, and supportive care for snake bite victims.
This document provides an overview of environmental emergencies, including snake envenomations, spider bites, marine envenomations, drowning, dysbarism, dive medicine, and high altitude illness. For snake envenomations, it discusses common venomous snakes, signs and symptoms, grading of envenomation severity, antivenin treatment, and complications. For spider bites, it focuses on black widow and brown recluse spiders. For marine envenomations, it reviews jellyfish stings, symptoms, and treatment involving vinegar or alcohol to inactivate nematocysts.
Three main classes of marine creatures can harm humans through venom delivery: nematocysts, bites, and stings. Nematocysts from jellyfish, fire corals, and other invertebrates can cause symptoms ranging from stinging to cardiovascular failure. Sharks, octopi, and other biting creatures may cause bleeding, injury, or paralysis. Sea urchins, cone shells, stingrays, and other stingers can induce pain, swelling, nausea, paralysis, and potentially respiratory arrest. Proper first aid and medical treatment depends on the type of envenomation but may include pressure immobilization, antivenom, CPR, and life support.
1. Drowning is defined as respiratory impairment from submersion in a liquid medium and is a major cause of accidental death, especially in children ages 1-14.
2. Management of drowning victims involves resuscitation, treatment of hypoxic-ischemic encephalopathy, and prevention of complications.
3. Prevention strategies focus on supervision during water activities, swimming lessons, CPR training, and safety measures around pools.
This document provides checklists for responding to common ventilator alarms and troubleshooting a crashing ventilated patient. For high airway pressures, possible causes include a tube in the right main bronchus, bronchospasm, mucous plugs, and pneumothorax. For low minute volumes, possible causes are an endotracheal tube cuff deflation allowing an air leak or chest wounds allowing air to escape. The checklist for a crashing ventilated patient follows the acronym D.O.P.E.S. to identify potential problems, then D.O.T.T.S. to address them, such as checking tube position or ventilator settings.
Oxygen therapy requires understanding oxygen delivery and toxicity risks. The presentation covered:
1. Indications for oxygen therapy include hypoxia, dyspnea, and low blood oxygen levels.
2. Oxygen delivery devices include nasal cannulas, masks, and venti-masks which provide varying levels of oxygen concentration depending on flow rates and patient breathing.
3. High oxygen concentrations over long periods risk toxicity including hypoventilation, absorption atelectasis, and pulmonary damage. Careful monitoring is needed to avoid risks while meeting patient needs.
This document defines and describes the main types of shock: cardiogenic, hypovolemic, anaphylactic, and obstructive shock. Cardiogenic shock occurs when the heart is damaged and cannot pump enough blood to the organs. Hypovolemic shock is caused by severe blood or fluid loss that makes the heart unable to circulate blood properly. Anaphylactic shock is a severe allergic reaction that affects the whole body. Obstructive shock prevents blood and oxygen from reaching the organs due to something blocking blood flow like a blood clot or tumor. The document provides examples of causes and conditions that can lead to each type of shock.
1. Mechanical ventilation troubleshooting involves identifying the cause of a patient's sudden respiratory distress by analyzing monitor alarms, physical signs, and ventilator graphs.
2. Common causes include ventilator issues like leaks, circuit blocks, or setting errors as well as patient issues such as pneumonia or pneumothorax.
3. The document outlines steps for troubleshooting including disconnecting the patient to manually bag and assess response, then treating the most likely problem by procedures like suctioning, adjusting settings, or emergency thoracostomy.
This document summarizes a presentation on basic and advanced cardiac life support. It discusses key concepts in BLS including recognition of cardiac arrest, activating emergency services, performing chest compressions, minimizing interruptions, monitoring compression quality, ventilation, and use of an automated external defibrillator. It then covers ACLS, including treatment algorithms, airway management, defibrillation procedures, medications used during CPR, monitoring techniques, and management of specific arrhythmias like ventricular fibrillation, asystole, and pulseless electrical activity. The goal of BLS and ACLS is to provide immediate life-saving interventions for cardiac arrest patients until the underlying cause can be addressed.
Hypothermia is defined as a core body temperature below 35°C. Mechanisms of heat loss include radiation, evaporation, convection, and conduction. As temperature decreases, physiological responses include vasoconstriction, shivering and changes in basal metabolic rate. Clinical features range from vague symptoms in mild hypothermia to loss of consciousness and absent reflexes in severe cases. Management focuses on passive or active rewarming depending on severity. Outcomes are worse with prehospital cardiac arrest, hemodynamic instability, and lab abnormalities indicating organ damage.
EMS and TBI: Immediate Field Care for High Impact InjuriesRommie Duckworth
Traumatic Brain Injuries (TBI’s) account for approximately 2.5 million annual ED visits. Of these, many patients leave with lifelong disabilities and more than 50,000 don’t leave at all (one third of ALL injury related deaths). In those first moments following impact, the EMS care that you provide is a major factor in your patient's outcome. Hyperventilate? Intubate? Permissive hypotension? Do you know what to do? Using case-studies, evidence based guidelines and a common-sense approach, this program gives you strategies for the prehospital management of traumatic brain injuries in a way that real-world medics and EMTs can use them in real world trauma settings.
For More Information See:
www.RomDuck.com
www.RescueDigest.com
Learning Objectives: Students will learn:
- How to recognize traumatic brain injuries of all levels as they present in the field.
- How to perform field and clinical differentiation between concussion, mild TBI, moderate TBI and severe TBI.
- How to prioritize field assessment and treatment of TBI patients according to cur-rent clinical guidelines for immediate prehospital care.
- How to best coordinate with hospital trauma teams for improved outcomes for TBI patients.
- How to implement local TBI prevention strategies.
1) The patient has signs of shock including hypotension, tachycardia, and elevated lactate and base deficit.
2) Fluid resuscitation with 2L LR improved hemodynamics but lactate and base deficit remain elevated, indicating ongoing shock.
3) Aggressive resuscitation with blood products following a 1:1:1 ratio of PRBCs, FFP, and platelets is indicated to replace blood loss and prevent coagulopathy, given the suspicion for hemorrhage.
1) The document defines sepsis, severe sepsis, and septic shock and provides diagnostic criteria. It discusses initial resuscitation goals for the first 6 hours including fluid administration, vasopressors, and ScvO2/lactate monitoring.
2) Management recommendations are provided for antimicrobial therapy, source control, fluid therapy, vasopressors, blood products, glucose control, and other areas. Bundle elements are outlined to be completed within 3 and 6 hours of diagnosis.
3) Guidelines include level of evidence ratings and discuss evidence from studies on topics like fluid resuscitation, vasopressor use, and ventilator management for patients with severe sepsis or septic shock.
This document discusses drowning, providing definitions and discussing epidemiology, pathophysiology, management, and related topics. It notes that drowning is the process of experiencing respiratory impairment from submersion or immersion in liquid. The highest drowning death rates are seen in children aged 1-4 and 15-19, with common locations being bathtubs, pools, and natural water reservoirs. Progressive hypoxia and hypothermia can occur, affecting multiple organ systems. Management focuses on rapid oxygenation, ventilation, and circulation in the pre-hospital setting, followed by careful monitoring of cardiopulmonary and neurological status in the hospital.
Ventilator Management In Different Disease EntitiesDang Thanh Tuan
The document discusses ventilator management in different disease entities. It covers indications for mechanical ventilation in conditions like respiratory failure, ARDS, COPD, chest trauma, and head injury. For ARDS specifically, it summarizes the key findings of the NIH ARDS Network trial which demonstrated that a lower tidal volume strategy of 6 ml/kg predicted body weight reduced mortality compared to the traditional higher tidal volume approach.
This document provides information on mechanical ventilation including basics, meaning, indications, clinical conditions requiring ventilation, terminology used, types of ventilation (invasive and non-invasive), initial ventilator settings, assessing equipment, complications, management, and weaning. It discusses how mechanical ventilators can maintain oxygen delivery and ventilation over a prolonged period. The various modes of ventilation, parameters, and criteria for initiating and weaning a patient from ventilation are described. References are provided for additional information.
This document defines near drowning and summarizes its symptoms, treatment, and prevention. Near drowning occurs when someone submerges in water and may or may not breathe in water, resulting in confusion, lack of breathing or heartbeat, and pale skin. Proper treatment includes CPR and encouraging swimming safety. With early rescue and medical care, full recovery is possible, but complications like infection or brain damage can occur without treatment.
This document summarizes new developments in pediatric acute respiratory distress syndrome (ARDS). It discusses the definition and pathophysiology of ARDS, as well as associated clinical disorders and outcomes. Therapies covered include mechanical ventilation strategies like low tidal volumes, permissive hypercapnia, high frequency oscillation, and prone positioning. Pharmacological approaches discussed are surfactant, steroids, inhaled nitric oxide, and partial liquid ventilation. The use of extracorporeal membrane oxygenation for severe respiratory failure is also mentioned.
1) ECMO and ECCO2R are being re-examined as alternatives to invasive mechanical ventilation for critically ill patients, as the technologies have improved.
2) Specifically, ECMO is being used instead of mechanical ventilation for some patients awaiting lung transplantation, with promising results.
3) While ECMO and ECCO2R may help reduce ventilator-induced lung injury and duration of mechanical ventilation, more research is still needed to determine if they can fully replace invasive mechanical ventilation.
This document discusses various animal bites and stings. It covers bites from dogs, snakes including pit vipers and coral snakes, other reptiles like lizards, and marine animals. It also discusses stings from insects like bees, wasps and fire ants, spiders including black widows, scorpions, and jellyfish. For each type of bite or sting, it describes symptoms and what first aid steps to take, such as calling 911, applying a pressure bandage, giving pain medication, and keeping the affected area immobilized.
This document provides information on snake bites, including epidemiology, causes, pathophysiology, signs and symptoms, management, and prevention. It notes that snake bites affect millions globally each year, causing tens of thousands of deaths annually in India alone. The document discusses the venom and toxins of snakes, as well as the local and systemic effects of envenomation. It provides guidance on first aid, clinical assessment, investigations, antivenom treatment, and supportive care for snake bite victims.
This document provides an overview of environmental emergencies, including snake envenomations, spider bites, marine envenomations, drowning, dysbarism, dive medicine, and high altitude illness. For snake envenomations, it discusses common venomous snakes, signs and symptoms, grading of envenomation severity, antivenin treatment, and complications. For spider bites, it focuses on black widow and brown recluse spiders. For marine envenomations, it reviews jellyfish stings, symptoms, and treatment involving vinegar or alcohol to inactivate nematocysts.
Three main classes of marine creatures can harm humans through venom delivery: nematocysts, bites, and stings. Nematocysts from jellyfish, fire corals, and other invertebrates can cause symptoms ranging from stinging to cardiovascular failure. Sharks, octopi, and other biting creatures may cause bleeding, injury, or paralysis. Sea urchins, cone shells, stingrays, and other stingers can induce pain, swelling, nausea, paralysis, and potentially respiratory arrest. Proper first aid and medical treatment depends on the type of envenomation but may include pressure immobilization, antivenom, CPR, and life support.
This pptx is on recognition of different snakes, snake bite management particularly in children. At the end of the slide show you will definitely able to recognize and manage snake bites.
Snake Bite and Scorpion Stings,(Kurdistan)Znar Mzuri
This document provides information about snake bites and scorpion stings. It discusses the epidemiology, common types of snakes and scorpions, clinical effects of envenomation, signs and symptoms, grades of severity, appropriate investigations, first aid treatments, and initial hospital management. Snake bite is a medical emergency that can cause localized and systemic effects from neurotoxins, cardiotoxins, and other venom components. Scorpion stings also present varying degrees of severity and symptoms involving pain, swelling, seizures, and potentially life-threatening effects on the heart, lungs and brain. Appropriate first aid includes calling for emergency help, immobilizing the affected area, and bringing the victim promptly to the hospital for further treatment
1. The document discusses snake classification, types of venomous snakes in India, signs and symptoms of snake bites, and management of snake bites.
2. Poisonous snakes are classified based on the type of venom secreted into three families - Elapidae which secretes neurotoxic venom, Viperidae which secretes haemotoxic venom, and Hydrophidae which secretes myotoxic venom.
3. Common poisonous snakes in India include cobras, kraits, Russell's vipers, and sea snakes. Bites from kraits and Russell's vipers are more toxic than cobra bites.
4. Management of snake bites involves local treatment, administration of antivenom, and supportive care depending
This document provides information on snake bites and snake venom in South-East Asia. It details the clinical presentation of different types of snake bites, including local and systemic symptoms. It discusses important snake families in the region, differences between cobra and viper bites, and recommended first aid and management approaches. Laboratory tests that can help assess severity are also outlined.
The document discusses envenomations from animal bites and stings. It covers the types of venomous animals found around the world, the effects of their venoms, symptoms of envenomation, and treatment methods including antivenins. Key points include that most bites cause local effects but some venoms are neurotoxic or cause tissue damage and systemic symptoms. Antivenins derived from animals carry risks of allergic reactions but can prevent death from severe envenomation if given promptly.
The document discusses poisonous insects including bees, wasps, hornets, ants, and toads. It describes their venom components and mechanisms of action, as well as clinical signs and treatment approaches. The key points are that these insects and toads release irritating or toxic venoms through stinging or gland secretions that can cause local or systemic effects depending on dosage. Symptoms range from mild pain and swelling to anaphylactic shock. Treatment focuses on removing stingers, flushing areas, and controlling symptoms.
The document summarizes information about common venomous snakes in Saudi Arabia and the clinical presentation and management of snake envenomation. It describes 5 common venomous snake species in the region, noting characteristics like size, venom type, and behavior. For clinical presentation, it distinguishes between viper and cobra envenomation, covering local and systemic effects. Management involves first aid, transport, assessment, antivenom administration, monitoring response, wound care, and rehabilitation. Key steps of first aid and indications for antivenom are outlined, along with types of antivenom reactions and administration methods.
This document provides guidance on snake bites in India. It discusses that snake bites are a major public health issue, killing over 11,000 people annually. The most common venomous snakes in India are Russell's viper, hump-nosed viper, cobra, and krait. It outlines the clinical presentation of envenomings from different snakes, including neuroparalytic effects from cobras and kraits, bleeding disorders from vipers, and muscle damage from sea snakes. The document emphasizes rapid assessment, resuscitation, detailed examination to identify the snake species, laboratory tests, and antivenom treatment for snake bites in India.
This document summarizes information about snake and scorpion envenomations. It describes the components of snake and scorpion venom, their toxic effects, severity factors for snake bites, diagnosis, and management approaches. For snake bites, recommended first aid includes immobilization, reassurance, and not applying tight bands or making incisions. Antivenom is the primary treatment. For scorpion stings, symptoms include neurotoxic effects and potential cardiotoxicity. Recommended treatment includes immobilization, antivenin therapy, and supportive measures like controlling convulsions and injecting calcium gluconate.
This document discusses several venomous marine creatures found in Australian waters that can cause envenomation in humans, including jellyfish, sea snakes, blue-ringed octopuses, stonefish, and box jellyfish. It provides details on the clinical presentations and recommended emergency management for stings and bites from each creature. Key points covered include that jellyfish stings are the most common marine medical emergency, causing pain and swelling; sea snake and blue-ringed octopus bites can cause paralysis; box jellyfish stings can potentially cause cardiac arrest; and stonefish have venomous spines that commonly cause severe pain. The document emphasizes the importance of supportive care, application of hot water or vinegar to affected areas, monitoring
Snake bite and its management by first aid and antivenomShwetaKhadka
about snake bite ,venom,types of venom,first aid,antivenom,and management ,epidemiology ,dosage and route of antivenom administration , anaphylactic reaction due to antivenom , general symptoms of snake bite,immobilization process , formation of antivenom
Snake bite and its management- Mayank Kumar Dubey (Forensic/DNA Expert & Asst...Mayank Kumar Dubey
Snake bite and its management presentation is useful for Medical and Forensic students, It will give an idea about the different snakes,their venom composition,sign/symptoms and treatment.
Presentation prepared by-
Mayank Kumar Dubey
Senior Forensic/DNA Expert
Ex- General Manager,Assistant Director and Scientific Officer
(Forensic Laboratory and CID Police FSL)
Ex-Assistant Professor-Forensic Science/Forensic Medicine and Toxicology.
UGC-NET Qualified (2006 and 2007)
This document provides information on snake bites, including epidemiology, causes, pathophysiology, signs and symptoms, management, and prevention. It notes that snake bites affect millions globally each year, causing tens of thousands of deaths annually in India alone. The document discusses the venom and toxins of snakes, as well as the local and systemic effects of envenomation. It provides guidance on first aid, clinical assessment, investigations, antivenom treatment, and supportive care for snake bite victims.
Tetanus Presentation for medical doctorsGloria682723
Tetanus is caused by Clostridium tetani toxin called tetanospasmin. It is characterized by muscle spasms and rigidity due to blockade of inhibitory neurotransmitter release in the central nervous system. Tetanospasmin is retrogradely transported from the peripheral motor nerve terminals to the spinal cord where it inhibits GABA and glycine release. This results in uncontrolled muscle spasms. Generalized tetanus affects muscles throughout the body while localized tetanus is restricted to the area near the infection site. Prognosis depends on severity which is graded based on symptoms. Treatment involves wound care, antitoxin administration and supportive care.
This document discusses animal poisons and venoms, focusing on scorpions and snakes found in Libya. It defines the differences between venomous and poisonous animals. It then describes the 9 main species of scorpions found in Libya, noting their geographic distributions and relative toxicity levels. The document outlines the pathophysiology of scorpion envenomation, describing the composition and effects of scorpion venom on the body. It also discusses the clinical manifestations and treatment approaches for scorpion stings of varying severity grades. For snakes, it briefly notes that only about 15% of snake species worldwide are dangerous to humans, and describes the composition and effects of snake venoms.
"Venomous Encounters: Understanding the Physiology, Treatment, and Prevention...krjx9cpvdg
Snake bites epitomize a multifaceted intersection between humans and reptiles, often culminating in dire consequences. The intricate dynamics of venom delivery mechanisms and their intricate interplay with the human physiology underscore the urgency of comprehensively understanding and addressing this complex issue.
Venomous snakes, equipped with specialized fangs honed by evolution, wield venom as a potent weapon. This venom, a sophisticated blend of toxins, serves diverse purposes, including immobilizing prey, aiding in digestion, and self-defense. The composition of snake venom varies markedly across species, each venom boasting a unique concoction of enzymes, peptides, and proteins meticulously tailored to disrupt physiological functions in their unsuspecting victims.
The ramifications of a snake bite can be profound and diverse, spanning from localized tissue damage and systemic toxicity to potentially life-threatening complications. The severity of envenomation hinges on myriad factors, including the potency of the venom, the volume injected, the site of the bite, and the health status of the victim. Neurotoxic venoms, for instance, can precipitate paralysis and respiratory failure, while hemotoxic venoms may induce extensive tissue necrosis and coagulopathies, underscoring the pernicious diversity of snakebite outcomes.
Timely recognition and appropriate management are pivotal in mitigating the impact of snake bites. Immediate implementation of first aid measures, such as immobilizing the affected limb, maintaining the victim's composure, and promptly seeking medical assistance, can substantially ameliorate outcomes. In regions where venomous snakes hold sway, access to antivenom and proficient healthcare professionals assumes paramount importance for efficacious treatment.
Nonetheless, the challenges posed by snake bites transcend the confines of mere medical intervention. Socioeconomic determinants, encompassing factors like limited healthcare accessibility, inadequate infrastructure, and geographical remoteness, can markedly exacerbate the burden of snakebite-related morbidity and mortality, particularly among marginalized populations.
Preventive strategies wield considerable influence in curtailing the incidence of snake bites and attenuating their repercussions. Educational initiatives geared toward disseminating knowledge about snake behavior, imparting proficiency in first aid techniques, and advocating preventive measures like donning protective attire and circumventing high-risk locales constitute indispensable pillars of snakebite prevention.
Furthermore, endeavors aimed at conserving snake habitats and fostering cohabitation between humans and serpents are pivotal for long-term snakebite mitigation. By fostering an understanding of the ecological roles of snakes and championing their conservation, societies can engender an environment conducive to harmonious coexistence between humans and reptiles.
This document provides information on snake envenomation and its management in India. It discusses that India has the highest snakebite mortality in the world, with an estimated 83,000 bites and 11,000 deaths annually. The four main venomous snakes in India are cobras, kraits, Russell's vipers, and saw-scaled vipers. Symptoms of envenomation depend on the snake species but can include local tissue damage, neurotoxicity, coagulopathy, renal toxicity, and myotoxicity. First aid involves reassuring the patient, immobilizing the bite area, and rapidly transporting to a hospital. At the hospital, investigations are carried out and antivenom is administered via intravenous route in
Most of the world's snakes are what are referred to as clinically non-venomous. This means they do not produce a toxin that is clinically significant to people.
Similar to Environmental emergencies ii kman 8 15 final (20)
This document summarizes Dr. Nicholas Kman's use of social media, particularly Facebook Live, for his "First Aid Friday" sessions to educate the public on various medical topics. It provides best practices for using Facebook Live that Dr. Kman has learned, such as testing the video quality first, engaging with viewers' comments, and analyzing metrics like viewership and audience retention to improve future broadcasts. The document also shares statistics on Dr. Kman's First Aid Friday videos so far, which have reached thousands of people and addressed various medical emergencies.
AAMC Table 92 Residency Readiness in the 4th Year of Medical School: Using ACGME Milestones to Assess & Prepare Medical Students for Residency
In many cases, the fourth year of medical school continues to be a lost opportunity for learning. The popularity of boot camps with an emphasis on the student’s specialty of choice continues to grow. At several institutions, the fourth year is designed to use specialty-specific milestones to improve the transition to residency. The senior year should be more robust with consideration for student assessment for selected ACGME milestones expected of an incoming resident in their designated specialty.
This lecture intended for Medical Students bound for Emergency Medicine will:
Map out 4th year for EM Applicants citing important dates and deadlines.
Discuss AAMC Standardized Video Interview and important dates associated with it’s completion.
The document describes a curriculum at The Ohio State University College of Medicine called the Lead Serve Inspire Curriculum (LSI) which aims to develop competency in healthcare quality improvement and patient safety. It consists of three parts, with Part 1 focusing on clinical foundations, Part 2 on clinical applications, and Part 3 containing the Health Systems, Informatics, and Quality (HSIQ) project. The HSIQ project is a longitudinal experience where students work in groups on value-creation projects around cost-conscious care, patient experience, and identifying systems failures. They apply a process improvement methodology to propose, implement, and measure interventions. The document discusses lessons learned and challenges in engaging students and assessing competency in quality improvement and patient
Social Networking 201:Engaging Learners and Professional Networking with Tw...Nicholas Kman, MD, FACEP
Presentation from the Generalists in Medial Education with Larry Hurtubise (@hur2buzy) Kristina Dzara (@KristinaDzara)
Elissa Hall (@erhall1) Nicholas Kman (@DrNickKman) and Justin Kreuter (@kreutermd)
Discuss, Develop and Demonstrate strategies for leveraging social media networking sites (twitter) for dissemination of scholarly work and medical education
Compare and contrast the features and benefits of social media networking sites for development of a national reputation.
Use basic feature of Twitter like #, and @, as well as deleting tweets to best harness the potential reach of your profile, expand your social network, and develop a national reputation
1. Review background literature on:
Undergraduate Medical Education (UME) to Graduate Medical Education (GME) continuum
Competency based medical education
Current state of the 4th year of medical school
2. Describe how a clinical track based on ACGME competencies could bridge the chasm between UME and GME.
3. Identify strategies for creating specialty specific milestones reports at your institutions.
4. Identify barriers and derive solutions to these “feedforward” concepts.
Objectives
Describe how a clinical track based on ACGME competencies could bridge the chasm between UGME and GME.
Demonstrate how Clinical Tracks are improving the 4th year at our institution.
The document discusses challenges with the fourth year of medical school and proposes improvements. It describes common criticisms of the fourth year as lacking educational purpose and structure. There are also concerns about student preparation for residency. The discussion proposes using competencies and EPAs to guide curriculum development and ensure students are adequately prepared to enter residency programs. Specialty-specific objectives and tracks could help address gaps and weaknesses in training.
This document provides an overview of emergency response to natural disasters since 9/11. It discusses key aspects of the disaster management cycle including preparation, mitigation, response, recovery and prevention. Specific natural disasters like floods, winds and earthquakes are examined. Injury patterns from collapsed buildings, winds and flooding are defined. The importance of preparation, having an incident command system and surge capacity plan are emphasized.
After watching this lecture, learners will be able to:
Describe the various etiologies of non-traumatic paralysis
Illustrate the neuro exam for the paralyzed patient
Recognize the signs and symptoms of acute peripheral neuropathies
Explain the treatment of acute peripheral neuropathies
Explain importance of early, consistent EM education for all medical students.
Discuss opportunities to engage & have impact throughout the 4 year curriculum.
Highlight learning communities, the “How to be a doctor course”, and EMIG.
Evaluate factors that influence a student’s choice of specialty as related to above.
Curricular Innovations: An Expert Educator Shift for Assessing MilestonesNicholas Kman, MD, FACEP
This document describes a study that used expert educator shifts to assess medical students on emergency medicine milestones. During the shifts, students were directly observed by attending physicians as they cared for patients, and were assessed on 10 milestones. Results showed that students who participated rated direct observation, feedback, and the educational experience more highly compared to previous students. The study concluded that expert educator shifts can effectively assess competency-based milestones and help prepare students for residency. Future directions involve developing an advanced clinical track to teach residency-level milestones prior to graduation.
Observation without Active Participation is an Effective Method of LearningNicholas Kman, MD, FACEP
Participants in team-based simulation are often assigned or self-selected to play active or passive roles
Limited data on impact of learner roles on the efficacy of simulation-based training
A few studies have suggested that observation alone may be as effective for learning as active participation in simulation
CDEM has grown significantly since its founding in 2007. It now represents over half of US medical schools' EM clerkships and provides various educational resources for members. Challenges include establishing CDEM's role within SAEM and addressing tensions between the organizations. The future includes further developing the curriculum, collaborating with other groups like CORD and EMRA, and establishing CDEM as the leader in undergraduate EM education.
This is my Grand Rounds for Nationwide Children's Hospital on 9/11/14 at 8am. This talk gives the background of National and Regional Preparedness in Columbus, OH post 9/11.
This document provides an overview of environmental emergencies related to thermal injuries, including burns, electrical injuries, lightning injuries, hypothermia, and frostbite. It discusses the pathophysiology, clinical presentation, treatment priorities, and management strategies for each type of injury. For burns, it covers burn depth, size assessment, fluid resuscitation formulas, wound care, and referral criteria. For hypothermia, it describes the stages based on core temperature, associated signs and symptoms, diagnostic testing, and active external and internal rewarming techniques. Throughout, it emphasizes the importance of preventing further heat loss, anticipating cardiac issues, and treating hypothermia before addressing other injuries.
This document describes different approaches to mentorship programs in emergency medicine. It discusses a near-peer mentorship program that pairs fourth-year medical students with emergency medicine residents to provide guidance on residency. It also describes a tiered mentorship model at Ohio State University involving faculty, residents, and students of various levels. This model forms small mixed-gender groups with one faculty mentor and one resident mentor. An evaluation found that students were not influenced by the gender makeup of their group and preferred identifying with faculty mentors regardless of gender. The document introduces challenges with assigning mentors and managing group sizes and dynamics.
This document discusses the structure and purpose of the fourth year of medical school and opportunities for advanced training in emergency medicine. It reviews the literature on the lack of standardization of the fourth year and recommendations to improve preparation for residency. Examples are provided of innovative EM electives at different institutions, including advanced topics in EM, ultrasound training, and critical care rotations. The future of competency-based education and advanced competencies is discussed. Overall, the document argues that the fourth year should provide advanced clinical training opportunities to prepare students for intern level responsibilities in their chosen specialties.
Healthy Eating Habits:
Understanding Nutrition Labels: Teaches how to read and interpret food labels, focusing on serving sizes, calorie intake, and nutrients to limit or include.
Tips for Healthy Eating: Offers practical advice such as incorporating a variety of foods, practicing moderation, staying hydrated, and eating mindfully.
Benefits of Regular Exercise:
Physical Benefits: Discusses how exercise aids in weight management, muscle and bone health, cardiovascular health, and flexibility.
Mental Benefits: Explains the psychological advantages, including stress reduction, improved mood, and better sleep.
Tips for Staying Active:
Encourages consistency, variety in exercises, setting realistic goals, and finding enjoyable activities to maintain motivation.
Maintaining a Balanced Lifestyle:
Integrating Nutrition and Exercise: Suggests meal planning and incorporating physical activity into daily routines.
Monitoring Progress: Recommends tracking food intake and exercise, regular health check-ups, and provides tips for achieving balance, such as getting sufficient sleep, managing stress, and staying socially active.
Michigan HealthTech Market Map 2024. Includes 7 categories: Policy Makers, Academic Innovation Centers, Digital Health Providers, Healthcare Providers, Payers / Insurance, Device Companies, Life Science Companies, Innovation Accelerators. Developed by the Michigan-Israel Business Accelerator
R3 Stem Cell Therapy: A New Hope for Women with Ovarian FailureR3 Stem Cell
Discover the groundbreaking advancements in stem cell therapy by R3 Stem Cell, offering new hope for women with ovarian failure. This innovative treatment aims to restore ovarian function, improve fertility, and enhance overall well-being, revolutionizing reproductive health for women worldwide.
DECODING THE RISKS - ALCOHOL, TOBACCO & DRUGS.pdfDr Rachana Gujar
Introduction: Substance use education is crucial due to its prevalence and societal impact.
Alcohol Use: Immediate and long-term risks include impaired judgment, health issues, and social consequences.
Tobacco Use: Immediate effects include increased heart rate, while long-term risks encompass cancer and heart disease.
Drug Use: Risks vary depending on the drug type, including health and psychological implications.
Prevention Strategies: Education, healthy coping mechanisms, community support, and policies are vital in preventing substance use.
Harm Reduction Strategies: Safe use practices, medication-assisted treatment, and naloxone availability aim to reduce harm.
Seeking Help for Addiction: Recognizing signs, available treatments, support systems, and resources are essential for recovery.
Personal Stories: Real stories of recovery emphasize hope and resilience.
Interactive Q&A: Engage the audience and encourage discussion.
Conclusion: Recap key points and emphasize the importance of awareness, prevention, and seeking help.
Resources: Provide contact information and links for further support.
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
At Apollo Hospital, Lucknow, U.P., we provide specialized care for children experiencing dehydration and other symptoms. We also offer NICU & PICU Ambulance Facility Services. Consult our expert today for the best pediatric emergency care.
For More Details:
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Name: Apollo Hospital
Address: Singar Nagar, LDA Colony, Lucknow, Uttar Pradesh 226012
Phone: 08429021957
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Get Covid Testing at Fit to Fly PCR TestNX Healthcare
A Fit-to-Fly PCR Test is a crucial service for travelers needing to meet the entry requirements of various countries or airlines. This test involves a polymerase chain reaction (PCR) test for COVID-19, which is considered the gold standard for detecting active infections. At our travel clinic in Leeds, we offer fast and reliable Fit to Fly PCR testing, providing you with an official certificate verifying your negative COVID-19 status. Our process is designed for convenience and accuracy, with quick turnaround times to ensure you receive your results and certificate in time for your departure. Trust our professional and experienced medical team to help you travel safely and compliantly, giving you peace of mind for your journey.
Gemma Wean- Nutritional solution for Artemiasmuskaan0008
GEMMA Wean is a high end larval co-feeding and weaning diet aimed at Artemia optimisation and is fortified with a high level of proteins and phospholipids. GEMMA Wean provides the early weaned juveniles with dedicated fish nutrition and is an ideal follow on from GEMMA Micro or Artemia.
GEMMA Wean has an optimised nutritional balance and physical quality so that it flows more freely and spreads readily on the water surface. The balance of phospholipid classes to- gether with the production technology based on a low temperature extrusion process improve the physical aspect of the pellets while still retaining the high phospholipid content.
GEMMA Wean is available in 0.1mm, 0.2mm and 0.3mm. There is also a 0.5mm micro-pellet, GEMMA Wean Diamond, which covers the early nursery stage from post-weaning to pre-growing.
Hypertension and it's role of physiotherapy in it.Vishal kr Thakur
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
COPD Treatment in Ghatkopar,Mumbai. Dr Kumar DoshiDr Kumar Doshi
Are you or a loved one affected by Chronic Obstructive Pulmonary Disease (COPD)? Discover comprehensive and advanced treatment options with Dr. Kumar Doshi, a preeminent COPD specialist based in Ghatkopar, Mumbai.
Dr. Kumar Doshi is dedicated to delivering the highest standard of care for COPD patients. Whether you are seeking a diagnosis, a second opinion, or exploring new treatment avenues, this presentation will guide you through the exceptional services available at his practice in Ghatkopar, Mumbai.
As Mumbai's premier kidney transplant and donation center, L H Hiranandani Hospital Powai is not just a medical facility; it's a beacon of hope where cutting-edge science meets compassionate care, transforming lives and redefining the standards of kidney health in India.
6. Snake Bites
9,000 snakebites annually in U.S. with 2,000
treated as envenomations
Est. 2.5 million venomous snakebites occur
internationally, with 125,000 deaths annually.
About 12 deaths/year in U.S.
60% rattlesnakes
Important to know distribution of venomous
snakes in your area
Lavonas et al. BMC Emergency Medicine 2011, 11:2
8. Snake Bites
Species of Snakes
Viperidae - rattlesnakes, cottonmouth,
copperhead (pit-vipers)
Elapidae - coral snake only member in
U.S.; others include cobra and sea
snakes
Rattlesnakes CopperheadCottonmouth
9. Coral Snake (Elapidae)
Only 1/100 bites in U.S. annually
Distinct red band bordered by yellow
stripes
Neurotoxic component to their potent
venom
Short fixed fangs making it difficult to
envenomate humans
File:Coral snake close-up.jpg - Wikimedia Commons
10.
11. Coral Snake (Elapidae)
Effects may be delayed up to 12 hrs
Mild envenomation:
localized swelling only
Severe envenomation:
Any systemic symptoms
Nausea, vomiting, headache, mental
status, neurologic
Respiratory distress
12. Coral Snake (Elapidae)
Initial appearance may be innocuous
Early evacuation to prepare for antivenom
administration
Evacuate ALL patients with elapidae bites,
regardless of symptoms
14. Signs and Symptoms
Check for signs of envenomation:
1 or more fang marks, pain, edema,
erythema, or ecchymosis. Bullae may
appear.
Systemic effects: AMS, tachycardia,
tachypnea, resp distress, hypotension,
coagulopathy, renal failure, hemolysis.
15. Snake Bites
Grades of Envenomation
Grade 0
Fang marks
No envenomation
Grade I
"Mild" envenomation
Fang marks
Pain and edema at site
Local ecchymosis
Blistering
Necrosis
Minimal to no spread of edema proximal to site
Torpy, Janet M (04/18/2012). "Snakebite". JAMA : the journal of the American Medical Association (0098-
7484), 307 (15), p. 1657.
16. Moderate
56% of bites
Severe pain
Spreading edema beyond
site of bite
Systemic signs – nausea,
vomiting, paresthesias,
muscle fasciculations, mild
hypotension
Photo by N. Kman
17. Severe
• Marked swelling of extremity that
occurs rapidly
• Subcutaneous ecchymosis
• Systemic symptoms – coagulopathy,
hypotension, altered mental status
20. SNAKE BITES
Immediate First Aid
Get away from the snake
Stay calm
Immobilize the bitten extremity at a position
of heart
Apply a constricting band or wrap (Coral
Snake)
TRANSPORT TO MEDICAL FACILITY
http://www.howitworksdaily.com/environment/how-to-survive-a-snakebite/
21. Snake Bites: Treatments to Avoid
Tx to Avoid in (Pit Viper) Snakebite
Cutting and/or suctioning of wound
Ice
NSAIDs
Prophylactic antibiotics or fasciotomy
Routine use of blood products
Shock therapy (electricity)
Steroids (except for allergic phenomena)
Tourniquets
Lavonas et al. BMC Emergency Medicine 2011, 11:2
22. Snake Bite ED Management
Notify Regional Poison Center
ABC’s
At least 1 IV line, draw labs while starting
If no signs of envenomation, observe 8 hours
for further progression
Measure circumference of limb, mark leading
edge every 15-30 minutes
If signs of envenomation, antivenin admin.
23. SNAKE BITES
Ovine (Sheep Derived) Fab Antivenin (CroFab)
Mix 4-6 vials in 250ml of NS
Additional 4-6 vials until control achieved
Scheduled 2-vial doses at 6, 12, and 18 hr
Initial dose given slowly for first 10 min
Rest of dose over 1 hr
24. Snake Bite General Wound Care
Cleanse wound thoroughly
Tetanus prophylaxis
General supportive care
Opioid Analgesics
25. Snake Bite Complications
Compartment syndrome – surgery is rarely indicated; if
worried, do pressure monitoring
Serum sickness (type III hypersensitivity) – up to 3
weeks after antivenin; fever, chills, arthralgias, diffuse
rash
Rx-steroids and antihistamines
26. Quiz
A 23 year old male was playing with a copperhead
when he was surprisingly bit. He had premedicated
with about “eleventeen” beers. He is complaining of
severe pain, spreading edema, and has mild
hypotension. What is the best treatment?
A. Lecture on the dangers of mixing snakes and
alcohol
B. 4 Vials of CroFab Antivenin
C. 2 Vials of Horse Serum Derived Antivenin
D. Applying oral suction to the bite site
27. Quiz
A 23 year old male was playing with a copperhead
when he was surprisingly bit. He had premedicated
with about “eleventeen” beers. He is complaining of
severe pain, spreading edema, and has mild
hypotension. What is the best treatment?
A. Lecture on the dangers of mixing snakes and
alcohol
B. 4 Vials of CroFab Antivenin
C. 2 Vials of Horse Serum Derived Antivenin
D. Applying oral suction to the bite site
31. Ohio’s Biting Spiders
2 main groups of spiders; the recluse
spiders and the widow spiders.
The black widow, Latrodectus mactans,
and the northern widow, Latrodectus
variolus.
33. Black Widow
• Initial bite may be no more than a prick
• Within 30 min – systemic symptoms
• Muscle cramping – local to large groups such as
abdomen, back, chest, thighs
• Nausea, vomiting
34. Black Widow
May mimic an acute abdomen
Hypertension, tachycardia
Latrodectus facies – spasm of
facial muscles, edematous eyelids
Priapism, weakness, diaphoresis,
fasciculations may all occur in
severe envenomation
35. Treatment
Ice to bite site
Pain medication
Benzodiazepines for muscle spasm
Calcium gluconate no longer recommended
Tetanus prophylaxis
Antivenin – for severe symptoms not relieved by
above measures, esp. hypertension; pregnancy
36. Brown Recluse
• Loxosceles reclusa
• Coast to coast
• Attics, closets, woodpiles, storage sheds
• Violin-shaped marking
• Cytotoxic
• Necrotic arachnidism
• Local and systemic effects
https://en.wikipedia.org/wiki/Sicariidae#/medi
a/File:Brown_recluse_spider,_Loxosceles_reclus
a.jpg
37. Cutaneous Loxoscelism
Initially a sharp stinging sensation, some
report no awareness of being bitten
Over 2-8 hrs aching and itching develop
Bulls-eye lesion: erythema surrounds
vesicle circumscribed by a ring or halo of
pallor
Necrosis may develop within 3-4 days,
becoming ulcerated
38. Brown Recluse Venom
Cytotoxic enyzmes cause destruction of
local cell membranes:
Alkaline phosphatase
5-ribonucleotide phosphohydrolase
Esterase
Hyaluronidase
SPHINGOMYELINASE D
41. Systemic Loxoscelism
Rarely correlates with the severity of the skin
lesion
Children most at risk
Fever, chills, myalgias, arthralgias, morbilliform
rash
DIC, seizures, renal failure, hemolysis
Steroids may decrease amount of hemolysis
Alkalinize urine
42. Quiz
A 19 year old male is reaching into a tackle
box when he feels a prick. He thought he
poked himself with a fishing lure, but
becomes nauseated and presents
complaining of severe abdominal pain. On
exam, his abdomen is rigid and tender.
What is the next best treatment?
A. Exploratory Laporatomy
B. Calcium Gluconate
C. Dapsone
D. Analgesics and Benzos for muscle
spasm and pain
43. Quiz
A 19 year old male is reaching into a tackle
box when he feels a prick. He thought he
poked himself with a fishing lure, but
becomes nauseated and presents
complaining of severe abdominal pain. On
exam, his abdomen is rigid and tender.
What is the next best treatment?
A. Exploratory Laporatomy
B. Calcium Gluconate
C. Dapsone
D. Analgesics and Benzos for muscle
spasm and pain
47. Jellyfish
Coelenterates (Portuguese man-of-war, true jellyfish,
hydroid corals, sea anemones, corals)
Coastal areas of U.S.
About 10,000 envenomations each summer off the east
coast of Australia
Nematocysts are stinging cells on outer tentacle
Box jellyfish causes most fatal envenomations
48. Jellyfish
Toxin contains complex mixture of proteins and
polypeptides
Most common presentation is painful papular-
urticarial eruption
Lesions can last for minutes to hours, and rash
may progress to urticaria, hemorrhage, ulceration
51. Jellyfish
Systemic reactions can develop – weakness,
headache, vomiting, muscle spasm, fever, pallor,
respiratory distress, paresthesias
Seabather’s eruption – intensely pruritic
maculopapular eruption on skin that has been
covered by swimwear – larvae of thimble jellyfish;
develops within 24 hrs of exposure and lasts 3-5
days
53. Jellyfish Treatment
Rinse with saltwater
Remove tentacles with protected hand
Pour acetic acid (vinegar) on it to inactivate
the nematocysts
Until pain ceases
Use isopropyl alcohol if vinegar not available
Scrape off nematocysts
May then use ice to decrease pain
Evacuate patients with continued symptoms
or suspected box jellyfish envenomation
54. Removal
Wear gloves for protection
Apply shaving cream, baking soda paste
Shave with razor or other sharp edge
Tetanus prophylaxis
Antihistamines
Watch for infection
http://www.prweb.com/releases/2011/10/prweb8913589.htm
55. Echinoderms
• Sea urchins, starfish, sea cucumbers
• Venoms usually contained in spines
• Local effects most common
• Systemic effects do occur
• Deaths are extremely rare
56. Echinoderms
Remove visible spines
Immersion in hot water for 30-90 minutes
Local or regional anesthesia if hot water
alone is not adequate
X-ray or ultrasound to look for retained
fragments – surgery may be needed
Tetanus prophylaxis
Watch for infection
57. Quiz
A patient presents to your emergency department after being
stung by a jellyfish. At the scene life guard treated with
wound with urine, shaving cream, vinegar, sea water, and
taco sauce. What is the next best treatment?
A. Local wound care and tetanus prophylaxis
B. More urine
C. Vinegar mixed with shaving cream
D. Cold Tap Water
58. Quiz
A patient presents to your emergency department after being
stung by a jellyfish. At the scene life guard treated with
wound with urine, shaving cream, vinegar, sea water, and
taco sauce. What is the next best treatment?
A. Local wound care and tetanus prophylaxis
B. More urine
C. Vinegar mixed with shaving cream
D. Cold Tap Water
60. LLSA: Szpilman D, Bierens J, Handley A, Orlowski J. Drowning. N Engl J Med.
2012;366(22):2102-10.
61. Terminology
Drowning: Process resulting in respiratory impairment
from submersion / immersion in liquid medium. Victim
may live or die during or after process. The outcomes
are classified as death, morbidity, and no morbidity.
The Drowning Process: A continuum that begins when
the victim’s airway lies below the surface of liquid,
usually water, preventing the victim from breathing air.
Drowned: refers to a person who dies from drowning
62. Drowning
Second only to MVA as most common
cause of accidental death in US
Risk factors:
male sex
age <14 years
alcohol use/risky behavior
Low income/Poor education
rural residency
aquatic exposure
lack of supervision.
63. Drowning Pathophysiology
Most important abnormality of drowning is a
profound HYPOXEMIA resulting from
asphyxia.
Sequence of cardiac rhythm deterioration is
usually tachycardia followed by bradycardia,
pulseless electrical activity, then asystole.
64. Drowning Treatment
Immediate and adequate resuscitation is most important
factor influencing survival.
For unconscious: in-water resuscitation may increase
favorable outcome by 3 times.
Drowning persons with only respiratory arrest usually
respond after rescue breaths. If no response, assume
cardiac arrest & start CPR.
Full neurologic recovery is not predicted if victim has
been submerged >60 min in icy water or >20 min in cool
water.
65. Predictors of Outcome
Early BLS and ACLS improve outcomes (ABC’s)
Duration of submersion and risk of death/severe
neurologic impairment after hospital discharge
0–5 min — 10%
6–10 min — 56%
11–25 min — 88%
>25 min — nearly 100%
Wikipedia
67. Dysbarism
All the pathologic changes caused by
altered environmental pressure
Altitude-related event
Underwater diving accident
Blast injury that produces an overpressure
effect
68. Types
Barotrauma – dysbarism from trapped gases
Decompression sickness – dysbarism from
evolved gases
Nitrogen narcosis – dysbarism from abnormal
gas concentration (“Rapture of the Deep”)
69. Pressure is doubled, volume is halved.
PV = K Every 33 ft of descent increases the pressure by 1 atm.
70. Boyle’s Bubbles
Boyle’s law states: pressure of gas
is inversely related to volume.
As pressure increases with descent,
volume of gas bubble decreases, as
pressure decreases with ascent, the
volume of gas bubble increases.
Air-containing spaces act according
to Boyle’s law.
Lungs, middle ear, sinuses and
gastrointestinal tract.
71. Middle Ear Squeeze
Barotitis media-Most common
diving-related barotrauma
Equalization of pressure via
eustachian tube is unsuccessful
Too rapid descent or
infection/inflammation
TM is pulled inward & can
rupture
Fullness in ears, severe pain,
tinnitus
72. Middle Ear Squeeze
PE – erythema or retraction of TM, blood behind
TM or rupture, bloody nasal discharge
Reverse ear squeeze occurs on ascent
Treatment – prevention: clear ears during dive
If TM not ruptured – pseudoephedrine and
oxymetazoline nasal spray
If TM ruptured – antibiotic for 7-10 days
Suspend diving activities
74. Pulmonary Over-Pressurization
A too-rapid ascent
Lung emptying is incomplete
Lung volume expands rapidly
Pneumothorax, pneumomediastinum, SQ
emphysema, rupture into pulmonary vein
causing air embolism
Simple pneumothorax may progress to
tension on further ascent
75. Arterial Gas Embolism (AGE)
Results from air bubbles entering pulmonary
venous circulation from ruptured alveoli
Usually develops right after diver surfaces
Sudden LOC on surfacing should be
considered an air embolus until proven
otherwise
Cardiac – ischemia, dysrhythmias, cardiac
arrest
Neurologic – LOC, confusion, stroke-like sx
76. AGE
Vann, RD.; Butler, FK.; Mitchell, SJ.; Moon, RE.
“Decompression illness.” The Lancet, v. 377 issue 9760, 2011,
p. 153-64.
77. Arterial Gas Embolism (AGE)
Recompression in hyperbaric chamber
Transport supine, not in Trendelenburg
100% oxygen, intubate if necessary
IVF
Aspirin for antiplatelet activity if not
bleeding
Transport in plane pressurized to sea level
or helicopter no higher than 1000 ft. above
sea level
78. Decompression Sickness (DCS)
Henry’s Law – amount of gas that will dissolve in a liquid
is proportional to partial pressure of gas over the liquid
Nitrogen equilibrates through the alveoli into the blood,
but is 5 times more soluble in fat
The longer and deeper the dive, the more nitrogen gas
will be accumulated in the body
79. Decompression Sickness
During a slow ascent, pressure decreases,
nitrogen in the tissues is released into
blood and alveoli
If ascent is too quick, gas comes out of
solution and forms gas bubbles in the blood
or tissue
Type I – extravascular gas bubbles
Type II – intravascular nitrogen gas emboli
80. Type I DCS
“The Bends” – periarticular joint pain is
most common symptom of DCS
Shoulders and elbows most often affected
Dull, deep ache, mild at first and becomes
more intense
Palpable tenderness
Vague area of numbness around the
affected joint
81. Type I DCS
Cutaneous – pruritus, cutis marmorata,
hyperemia, orange peel
Lymphedema
Fatigue, especially if severe
Vann, RD.; Butler, FK.; Mitchell, SJ.; Moon, RE.
“Decompression illness.” The Lancet, v. 377 issue 9760, 2011, p.
153-64.
82. Type II DCS
Pulmonary system (The Chokes)
Nervous system (The Staggers)
Decompression shock
83. Cerebral AGE vs. DCS II
DCS II
Dive must be long
enough to saturate
tissues
Onset is latent (often
2-6 hrs)
Spinal cord and brain
Cerebral AGE
May occur after any
type of dive
Onset is immediate
(<10-120 min)
Only brain
84. Pulmonary DCS
“The Chokes”
May begin immediately after dive but often
takes up to 12 hours to develop
Triad – shortness of breath, cough, and
substernal chest pain or chest tightness
Cyanosis, tachypnea, and tachycardia
85. Neurologic DCS
Spinal cord is the most common site affected
Lower thoracic and lumbar regions
Low back pain, “heaviness” in legs, paresthesias,
possible bladder or anal sphincter dysfunction
Brain – variety of symptoms and difficult to
distinguish from AGE
Scotomata, headache, confusion, dysphasia
86. Decompression Shock
Vasomotor decompression sickness
Rapid shift of fluid from intravascular to
extravascular spaces (unknown reason)
Rare but often lethal
Weakness, sweating, hypotension,
tachycardia, pallor
Despite fluids, hypotension may not respond
until recompression
87. DCS Diagnostics
History is most important
Lab used to rule out other conditions and/or
obtain baseline measurements
CXR
ECG
CT
MRI
Testing should not delay transfer to HBO
88. DCS Treatment
ABCs
Transport supine, not Trendelenburg
100% oxygen
IVF
Recompression therapy
Divers Alert Network (DAN): 919-684-8111
75-85% have good results when
recognition and treatment are prompt
90. Quiz
You are on a plane from Key West to Cleveland
when the passenger next to you starts to arch his
back and bend his knees. He then starts to rapidly
breath and call for the flight attendant. She asks,
“is there a doctor on the plane?” What do you do?
A. Lecture the passenger on diving too close to a
flight
B. Start high flow O2, keep the patient supine, and
get the patient to a hyperbaric chamber upon
landing
C. Intubate and hyperventilate
91. Quiz
You are on a plane from Key West to Cleveland
when the passenger next to you starts to arch his
back and bend his knees. He then starts to rapidly
breath and call for the flight attendant. She asks,
“is there a doctor on the plane?” What do you do?
A. Lecture the passenger on diving too close to a
flight
B. Start high flow O2, keep the patient supine,
and get the patient to a hyperbaric chamber
upon landing
C. Intubate and hyperventilate
94. High Altitude Illness
Rate of ascent: Graded ascent is safest to
facilitate acclimatization and prevent sickness.
Altitude reached: AMS usually seen at altitudes
in > 2000 meters (6560 ft) and caused by
hypobaric hypoxia.
Sleeping altitude: Increases >600 meters in
sleeping altitude should be avoided.
Individual physiology: Age, gender, and fitness
level do NOT play a role in susceptibility to
altitude illness.
95. Risk Factors
History of high altitude illness
Residence at altitude below 900 m
Exertion
Preexisting cardiopulmonary conditions
Age < 50 years
Physical fitness is not protective
Medications
96. High Altitude Medicine
Acute Mountain Sickness (AMS)
High Altitude Cerebral Edema (HACE)
High Altitude Pulmonary Edema (HAPE)
97. Acute Mountain Sickness
History is key (total elevation gain and rate of
gain)
Starts within hours and can last for days
AMS is present if at altitude and, in addition to
headache, at least one of following is present:
Dizziness or lightheadedness
Fatigue or weakness
Nausea/vomiting/anorexia
Insomnia
99. AMS
Avoid further ascent until symptoms have
resolved
Descend if no improvement in 24 hours or
worsening symptoms
Non-narcotic pain relievers for headache
Supplementary oxygen
Acetazolamide, dexamethasone
Gamow bag
100. Acetazolamide
For both treatment and prevention of AMS
Mechanism of action: increase urinary excretion of
sodium, potassium and bicarbonate resulting in a
hyperchloremic metabolic acidosis, which
stimulates ventilation, improving arterial oxygen
saturation
Decreases periodic breathing and improves
sleeping
102. Dexamethasone
For treatment or prevention of AMS
Does NOT speed up acclimatization
May improve integrity of blood-brain barrier,
thereby reducing edema
4 mg po every 6 hrs for treatment
4 mg po every 12 hrs for prevention
103. Other Treatments
Ginko Biloba (120mg PO BID starting 5 days prior
to ascent)-modest evidence
Prophylaxis against HAPE
Nifedipine 20mg PO q8 for patients with
recurrent HAPE
Salmeterol-effective in reducing risk of HAPE in
those with recurrent episodes
104. Golden Rules of AMS
#0: It’s ok to get AMS. It’s not ok to die of it.
#1: Any illness is AMS, until proven otherwise
#2: Never ascend with AMS symptoms.
#3: If you are getting worse, go down at once.
#4. Never leave someone with AMS alone.
105. High Altitude Cerebral Edema
(HACE)
HACE: progression of AMS to life-
threatening end-organ damage.
Defined as severe AMS symptoms with
additional obvious neurologic dysfunction:
Ataxia
Altered level of consciousness
Severe lassitude
HACE almost never occurs without
antecedent AMS symptoms as a harbinger.
The progression of AMS to coma typically
occurs over 1 – 3 days.
106. HACE
Progression of AMS
Ataxia is the single most useful sign
Diffuse neurologic dysfunction
Altered mental status, nausea, vomiting,
seizures, decreased LOC, coma and finally
death
Once coma present – 60% mortality rate
Cause of death – brain herniation
111. HAPE
Accounts for most deaths from high altitude
illness
Non-cardiogenic pulmonary edema
Commonly strikes the second night at a
new altitude
Rarely occurs after more than four days
112. HAPE
Early diagnosis is crucial to recovery
Decreased exercise performance
Dry cough initially
Tachycardia and tachypnea at rest
Dyspnea at rest
Rales typically originate in right axilla and
become bilateral as illness progresses
Cerebral signs and symptoms are common
114. HAPE
Pulmonary hypertension due to hypoxic
pulmonary vasoconstriction
Elevated capillary pressure
Stress failure of pulmonary capillaries as a result
of high microvascular pressure is the presumed
final process leading to extravasation of plasma
and cells
Impaired clearance of fluid from alveolar space
probably has a role
115. HAPE Treatment
Descent is treatment of choice
Exertion may worsen the illness
Oxygen
Gamow bag if unable to descend
Nifedipine 10 mg po initially, then 20-30 mg
extended release every 12 hrs – decreases
pulmonary artery pressure
Inhaled beta-agonists
117. Quiz
You decide to climb to the top of Mt. Everest. While nearing
the top, your partner begins to have a seizure and becomes
unresponsive. What is the best treatment for him?
A. Prednisone taper
B. Acetazolamide IV
C. High Flow Oxygen
D. Descent
118. Quiz
You decide to climb to the top of Mt. Everest. While nearing
the top, your partner begins to have a seizure and becomes
unresponsive. What is the best treatment for him?
A. Prednisone taper
B. Acetazolamide IV
C. High Flow Oxygen
D. Descent