This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Pediatric Resuscitation: A Practical Overview- for ResidentsOpen.Michigan
This is a lecture by Andrew Hashikawa from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Pediatric Coma
Introduction
Disorders of Consciousness
Coma Mimics
Etiologies
Evaluation
Brainstem Reflexes
Pediatric Glasgow Coma Scale
Management
Coma Sequelae
This is a lecture from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC - Insect Stings and Spider Bites- Resident TrainingOpen.Michigan
This is a lecture by Dr. C. James Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC - Parasitic Infections - for NursesOpen.Michigan
This is a lecture by Katherine A Perry from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Pediatric Resuscitation: A Practical Overview- for ResidentsOpen.Michigan
This is a lecture by Andrew Hashikawa from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Pediatric Coma
Introduction
Disorders of Consciousness
Coma Mimics
Etiologies
Evaluation
Brainstem Reflexes
Pediatric Glasgow Coma Scale
Management
Coma Sequelae
This is a lecture from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC - Insect Stings and Spider Bites- Resident TrainingOpen.Michigan
This is a lecture by Dr. C. James Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC - Parasitic Infections - for NursesOpen.Michigan
This is a lecture by Katherine A Perry from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Case Study 11.1 Why the Circus No Longer Comes to TownFor 146 y.docxjasoninnes20
Case Study 11.1: Why the Circus No Longer Comes to Town
For 146 years, the Ringling Brothers and Barnum & Bailey Circus traveled the United States by train, putting on shows featuring acrobats, trapeze artists, clowns, and exotic animals. In 2017, the circus held its last performances after a significant decline in attendance and revenue due to changing public tastes. Shorter attention spans also contributed to its demise. The final blow to the circus came from its decision to eliminate elephant acts. According to a press release from Feld Entertainment, the company that owned the circus, this move led to a “greater than could have been anticipated” decline in ticket sales.1
For decades the American Humane Society, PETA (People for the Ethical Treatment of Animals), and other animal rights groups tried to ban elephant acts in Ringling Brothers performances. Protesters regularly picketed the circus, and for 14 years animal rights groups fought Ringling Brothers in court. Activists claimed that elephant acts were cruel and pointed out that these highly intelligent animals were chained up much of their lives. In 2011, Feld Entertainment was fined $270,000 for violations of the Animal Welfare Act. However, Feld Entertainment successfully fended off the lawsuits, winning a $24 million judgment against the animal rights groups in 2014. Nonetheless, Ringling Brothers agreed to retire all traveling elephants to its Center for Elephant Conservation in Florida that same year. (During this same period, Los Angeles, Oakland, and Asheville, North Carolina, restricted animal acts.)
Animal rights groups cheered the closing of the circus. According to PETA’s president, “PETA heralds the end of what has been the saddest show on earth for wild animals, and asks all other animal circuses to follow suit, as this is a sign of changing times.”2 The CEO of the United States Humane Society said, “I applaud their decision to move away from an institution grounded on inherently inhumane wild animal acts.”3 CEO Kenneth Feld acknowledged that the negative publicity generated by the lawsuits took its toll: “We prevailed in court 100% [but] obviously, in the court of public opinion we didn’t win.”4
Ringling Brothers/Feld Entertainment isn’t the only company that has had to deal with changing societal attitudes toward animals. For decades killer whales were the major attraction at SeaWorld parks in San Diego, Orlando, and San Antonio. However, the death of trainer Dawn Brancheau, who was dragged into the water and drowned by Sea World’s largest breeding male, Tilikum (“Tilly”), galvanized opposition to captive orca programs. The film Blackfish documented the death of Brancheau and whale mistreatment. Matt Damon, Harry Styles, Willie Nelson, and other celebrities joined the protest. Animal activists noted that orcas (which are really large dolphins) never kill humans in the wild. In captivity, young killer whales are separated from their families and are forced to live thei ...
This is the Immune System Lesson PowerPoint which is one small part of my Human Body Systems Unit from www.sciencepowerpoint.com . This portion of the unit also includes parasites, HIV, AIDS, and STD's. These are posted on slideshare. Please visit the Human Body Systems Unit to learn more.
Case Study 11.1 Why the Circus No Longer Comes to TownFor 146 y.docxdewhirstichabod
Case Study 11.1: Why the Circus No Longer Comes to Town
For 146 years, the Ringling Brothers and Barnum & Bailey Circus traveled the United States by train, putting on shows featuring acrobats, trapeze artists, clowns, and exotic animals. In 2017, the circus held its last performances after a significant decline in attendance and revenue due to changing public tastes. Shorter attention spans also contributed to its demise. The final blow to the circus came from its decision to eliminate elephant acts. According to a press release from Feld Entertainment, the company that owned the circus, this move led to a “greater than could have been anticipated” decline in ticket sales.1
For decades the American Humane Society, PETA (People for the Ethical Treatment of Animals), and other animal rights groups tried to ban elephant acts in Ringling Brothers performances. Protesters regularly picketed the circus, and for 14 years animal rights groups fought Ringling Brothers in court. Activists claimed that elephant acts were cruel and pointed out that these highly intelligent animals were chained up much of their lives. In 2011, Feld Entertainment was fined $270,000 for violations of the Animal Welfare Act. However, Feld Entertainment successfully fended off the lawsuits, winning a $24 million judgment against the animal rights groups in 2014. Nonetheless, Ringling Brothers agreed to retire all traveling elephants to its Center for Elephant Conservation in Florida that same year. (During this same period, Los Angeles, Oakland, and Asheville, North Carolina, restricted animal acts.)
Animal rights groups cheered the closing of the circus. According to PETA’s president, “PETA heralds the end of what has been the saddest show on earth for wild animals, and asks all other animal circuses to follow suit, as this is a sign of changing times.”2 The CEO of the United States Humane Society said, “I applaud their decision to move away from an institution grounded on inherently inhumane wild animal acts.”3 CEO Kenneth Feld acknowledged that the negative publicity generated by the lawsuits took its toll: “We prevailed in court 100% [but] obviously, in the court of public opinion we didn’t win.”4
Ringling Brothers/Feld Entertainment isn’t the only company that has had to deal with changing societal attitudes toward animals. For decades killer whales were the major attraction at SeaWorld parks in San Diego, Orlando, and San Antonio. However, the death of trainer Dawn Brancheau, who was dragged into the water and drowned by Sea World’s largest breeding male, Tilikum (“Tilly”), galvanized opposition to captive orca programs. The film Blackfish documented the death of Brancheau and whale mistreatment. Matt Damon, Harry Styles, Willie Nelson, and other celebrities joined the protest. Animal activists noted that orcas (which are really large dolphins) never kill humans in the wild. In captivity, young killer whales are separated from their families and are forced to live thei.
GEMC- Ghana Grab Bag Pediatric Quiz- Resident TrainingOpen.Michigan
This is a lecture by Hannah Smith, MD and Ruth S. Hwu, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Save the planet.
Let us all protect our mother nature.
Let us raise our voice and claim her rights.
-Animals have soul too.They need protection from us.So let us make a choice.
We can't live without animals.They can live without us.
Integrating Native Pollinators into Wildlife Conservation Practices slide notesNancy Adamson
These slide notes accompany a slideshow of the same name prepared by Nancy Lee Adamson (Xerces Society), many other Xerces Society staff, & Carol Heiser (VA Department of Game & Inland Fisheries), for Virginia Master Naturalists promoting meadow establishment for pollinator & upland game conservation, with input & support from Virginia Department of Game & Inland Fisheries biologists & the USDA-NRCS East National Technology Support Center.
Many invasive species hitch-hiked in cargo ships. Others were brought over deliberately because they are beautiful The big, bad surprise was that when a species has no natural predators, it can crowd out the species that belong in an area.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Jim Holliman, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Case Study 11.1 Why the Circus No Longer Comes to TownFor 146 y.docxjasoninnes20
Case Study 11.1: Why the Circus No Longer Comes to Town
For 146 years, the Ringling Brothers and Barnum & Bailey Circus traveled the United States by train, putting on shows featuring acrobats, trapeze artists, clowns, and exotic animals. In 2017, the circus held its last performances after a significant decline in attendance and revenue due to changing public tastes. Shorter attention spans also contributed to its demise. The final blow to the circus came from its decision to eliminate elephant acts. According to a press release from Feld Entertainment, the company that owned the circus, this move led to a “greater than could have been anticipated” decline in ticket sales.1
For decades the American Humane Society, PETA (People for the Ethical Treatment of Animals), and other animal rights groups tried to ban elephant acts in Ringling Brothers performances. Protesters regularly picketed the circus, and for 14 years animal rights groups fought Ringling Brothers in court. Activists claimed that elephant acts were cruel and pointed out that these highly intelligent animals were chained up much of their lives. In 2011, Feld Entertainment was fined $270,000 for violations of the Animal Welfare Act. However, Feld Entertainment successfully fended off the lawsuits, winning a $24 million judgment against the animal rights groups in 2014. Nonetheless, Ringling Brothers agreed to retire all traveling elephants to its Center for Elephant Conservation in Florida that same year. (During this same period, Los Angeles, Oakland, and Asheville, North Carolina, restricted animal acts.)
Animal rights groups cheered the closing of the circus. According to PETA’s president, “PETA heralds the end of what has been the saddest show on earth for wild animals, and asks all other animal circuses to follow suit, as this is a sign of changing times.”2 The CEO of the United States Humane Society said, “I applaud their decision to move away from an institution grounded on inherently inhumane wild animal acts.”3 CEO Kenneth Feld acknowledged that the negative publicity generated by the lawsuits took its toll: “We prevailed in court 100% [but] obviously, in the court of public opinion we didn’t win.”4
Ringling Brothers/Feld Entertainment isn’t the only company that has had to deal with changing societal attitudes toward animals. For decades killer whales were the major attraction at SeaWorld parks in San Diego, Orlando, and San Antonio. However, the death of trainer Dawn Brancheau, who was dragged into the water and drowned by Sea World’s largest breeding male, Tilikum (“Tilly”), galvanized opposition to captive orca programs. The film Blackfish documented the death of Brancheau and whale mistreatment. Matt Damon, Harry Styles, Willie Nelson, and other celebrities joined the protest. Animal activists noted that orcas (which are really large dolphins) never kill humans in the wild. In captivity, young killer whales are separated from their families and are forced to live thei ...
This is the Immune System Lesson PowerPoint which is one small part of my Human Body Systems Unit from www.sciencepowerpoint.com . This portion of the unit also includes parasites, HIV, AIDS, and STD's. These are posted on slideshare. Please visit the Human Body Systems Unit to learn more.
Case Study 11.1 Why the Circus No Longer Comes to TownFor 146 y.docxdewhirstichabod
Case Study 11.1: Why the Circus No Longer Comes to Town
For 146 years, the Ringling Brothers and Barnum & Bailey Circus traveled the United States by train, putting on shows featuring acrobats, trapeze artists, clowns, and exotic animals. In 2017, the circus held its last performances after a significant decline in attendance and revenue due to changing public tastes. Shorter attention spans also contributed to its demise. The final blow to the circus came from its decision to eliminate elephant acts. According to a press release from Feld Entertainment, the company that owned the circus, this move led to a “greater than could have been anticipated” decline in ticket sales.1
For decades the American Humane Society, PETA (People for the Ethical Treatment of Animals), and other animal rights groups tried to ban elephant acts in Ringling Brothers performances. Protesters regularly picketed the circus, and for 14 years animal rights groups fought Ringling Brothers in court. Activists claimed that elephant acts were cruel and pointed out that these highly intelligent animals were chained up much of their lives. In 2011, Feld Entertainment was fined $270,000 for violations of the Animal Welfare Act. However, Feld Entertainment successfully fended off the lawsuits, winning a $24 million judgment against the animal rights groups in 2014. Nonetheless, Ringling Brothers agreed to retire all traveling elephants to its Center for Elephant Conservation in Florida that same year. (During this same period, Los Angeles, Oakland, and Asheville, North Carolina, restricted animal acts.)
Animal rights groups cheered the closing of the circus. According to PETA’s president, “PETA heralds the end of what has been the saddest show on earth for wild animals, and asks all other animal circuses to follow suit, as this is a sign of changing times.”2 The CEO of the United States Humane Society said, “I applaud their decision to move away from an institution grounded on inherently inhumane wild animal acts.”3 CEO Kenneth Feld acknowledged that the negative publicity generated by the lawsuits took its toll: “We prevailed in court 100% [but] obviously, in the court of public opinion we didn’t win.”4
Ringling Brothers/Feld Entertainment isn’t the only company that has had to deal with changing societal attitudes toward animals. For decades killer whales were the major attraction at SeaWorld parks in San Diego, Orlando, and San Antonio. However, the death of trainer Dawn Brancheau, who was dragged into the water and drowned by Sea World’s largest breeding male, Tilikum (“Tilly”), galvanized opposition to captive orca programs. The film Blackfish documented the death of Brancheau and whale mistreatment. Matt Damon, Harry Styles, Willie Nelson, and other celebrities joined the protest. Animal activists noted that orcas (which are really large dolphins) never kill humans in the wild. In captivity, young killer whales are separated from their families and are forced to live thei.
GEMC- Ghana Grab Bag Pediatric Quiz- Resident TrainingOpen.Michigan
This is a lecture by Hannah Smith, MD and Ruth S. Hwu, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Save the planet.
Let us all protect our mother nature.
Let us raise our voice and claim her rights.
-Animals have soul too.They need protection from us.So let us make a choice.
We can't live without animals.They can live without us.
Integrating Native Pollinators into Wildlife Conservation Practices slide notesNancy Adamson
These slide notes accompany a slideshow of the same name prepared by Nancy Lee Adamson (Xerces Society), many other Xerces Society staff, & Carol Heiser (VA Department of Game & Inland Fisheries), for Virginia Master Naturalists promoting meadow establishment for pollinator & upland game conservation, with input & support from Virginia Department of Game & Inland Fisheries biologists & the USDA-NRCS East National Technology Support Center.
Many invasive species hitch-hiked in cargo ships. Others were brought over deliberately because they are beautiful The big, bad surprise was that when a species has no natural predators, it can crowd out the species that belong in an area.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Jim Holliman, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Alterations in Body Temperature: The Adult Patient with a Fever- Reside...Open.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Rapid Sequence Intubation & Emergency Airway Support in the Pediatric E...Open.Michigan
This is a lecture by Michele Nypaver, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Disorders of the Pleura, Mediastinum, and Chest Wall- Resident TrainingOpen.Michigan
This is a lecture by Andrew Barnosky, DO from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Dental Emergencies and Common Dental Blocks- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Arthritis and Arthrocentesis- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Bursitis, Tendonitis, Fibromyalgia, and RSD- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Right Upper Quadrant Ultrasound- Resident TrainingOpen.Michigan
This is a lecture by Jeff Holmes from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: Nursing Process and Linkage between Theory and PracticeOpen.Michigan
This is a lecture by Jeremy Lapham from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
2014 gemc-nursing-lapham-general survey and patient care managementOpen.Michigan
This is a lecture by Dr. Jeremy Lapham from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Jessica Holly from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: The Role of Radiography in the Initial Evaluation of C-Spine TraumaOpen.Michigan
This is a lecture by Dr. Stephen Hartsell from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Sickle Cell Disease: Special Considerations in Pediatrics- Resident Tra...Open.Michigan
This is a lecture by Hannah Smith, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
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1. Project: Ghana Emergency Medicine Collaborative
Document Title: Snakebites
Author(s): Jim Holliman, M.D., F.A.E.C.P., Uniformed Services University
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3. Snakebites
Jim Holliman, M.D., F.A.C.E.P.
Program Manager, Afghanistan Health Care Sector
Reconstruction Project
Center for Disaster and Humanitarian Assistance Medicine
Professor of Military and Emergency Medicine
Uniformed Services University
Bethesda, Maryland, U.S.A.
3
Jim Holliman, Uniformed Services
University
4. Snakebites
Epidemiology
ƒ About 3000 species of snakes
worldwide
ƒ 375 medically important venomous
snakes worldwide
ƒ Snakes belong to Class Reptilia, Order
Squamata, Suborder Serpientes
– Comprised of 11 families
– Venomous snakes are in 5 families
4
6. General Anatomic Comparisons
of Venomous Snakes
ƒ Colubridae : rear - fanged
ƒ Elapids : front fangs, fixed maxilla
ƒ Vipers : (both true & pit vipers) front fanged, mobile maxilla
6
7. Snakebite Epidemiology
ƒ No required reporting of cases, so
quoted incidence numbers may be
inaccurate
ƒ Worldwide annually:
– Possibly one milllion venomous bites
– Possibly 30,000 to 60,000 deaths
ƒ In U.S.A. annually :
– 45,000 snakebites
– 8000 venomous snakebites
– 1 to 10 deaths
7
8. Snakebite Epidemiology (cont.)
ƒ 1951 worldwide mortality survey : numbers of
deaths :
– Asia : 35,000
– South America : 4000
– Africa : 1000
– North America : 300 to 500
– Europe : 50
– Oceana : 10
ƒ However a 1980 estimate of deaths from spitting
cobra and carpet viper was 23,000 in West Africa
alone
8
9. Snakebites
Envenomation Risk
ƒ Factors determining relative risks of human
envenomation by different snakes :
– Venom toxicity / potency
– In some species : size of the snake
– "Effectiveness" of the bite (at injecting venom)
– Innate aggressiveness of the snake
– Likelihood of human contact
9
10. Risk of Snakebite in
Field Situations
ƒ Southern Arizona Rescue Association :
115,000 man hours in "snake country" with
no bites
ƒ LeSelva Biological Station in Costa Rica
1968 to 1987 : 350,000 man hours without
incident
ƒ Organization for Tropical Studies in Costa
Rica : one Fer-de-lance bite in 660,000 man
hours
10
11. Risk of Snakebite
in the U.S.A.
ƒ Most (60 to 80 %) of reported bites in
the U.S. are "illegitimate" (defined as
bites occurring when the person by
their own decision chose to handle a
snake or expose themself to risk)
ƒ Most "legitimate" (i.e., accidental or
unintentional) bites are on the lower
extremity
11
12. Typical Profile of the U.S.
Venomous Snakebite Victim
ƒ Male
ƒ Age 16 to 40 years
ƒ Intoxicated
ƒ Tatooed
ƒ "Illegitimate" cause of the bite
ƒ Usually bitten on upper extremity
ƒ Most "legitimate" bites (2/3) are from
April thru July
12
13. "Exotic" Snakebites in the U.S.A.
ƒ Estimated 1 million snakes imported into the
U.S. per year
ƒ Largest import firm is in Florida
ƒ Is legal in most states to import venomous
snakes as pets
ƒ Can see cobra bites & other "exotic" nonnative snakebites anywhere in U.S.
ƒ Zoos usually stock exotic snake antivenin for
the species they have
13
14. Risk of Snakebite
in Great Britain
ƒ Vipera berus (European adder) is only
poisonous snake in Britain
ƒ Only 14 fatalities reported from 1876
to 1976
ƒ 50 % of cases have significant local or
systemic toxicity
ƒ Possibly several hundred bites per
year total
14
15. Basic Purposes of Snake Venom
ƒ Immobilize prey
ƒ Assist in or start the digestive process
ƒ Deter other predators
15
16. Functional Classification of
Composition of Snake Venoms
ƒ Neurotoxins
– Mainly paralytic agents
– These are main toxins from cobras, sea snakes
ƒ Myotoxins
– Cause tissue necrosis
ƒ Hemotoxins
– Cause coagulopathies
– These are main toxins from pit vipers
ƒ Locally active toxins
– Cause tissue necrosis, blistering
16
17. Components of Snake Venom
ƒ Almost all are complex, multi-component mixtures :
– Proteolytic enzymes
– Collagenases
– Hyaluronidase
– Phospholipase
– Lactate dehydrogenase
– Acetylcholinesterase
– Nucleotidases
– Steroids
– Inorganic elements : zinc, magnesium
– Histamine, bradykinins, serotonin
– Aminopolysaccharides
17
18. Venomous U.S. Snakes
ƒ Crotalidae (pit vipers) : 95 % of bites :
– Rattlesnakes : about 20 species in 47 states
ƒ Mojave rattlesnake : only one with mainly
neurotoxins ; only in Arizona
– Cottonmouth (Water Moccasin) : Midwest and
South states
– Copperhead : in about 40 states ; least toxic
(almost never requires use of antivenin)
18
22. Ryan E. Poplin, Wikimedia Commons
Diamondback rattlesnake
22
23. Venomous U.S. Snakes (cont.)
ƒ Elapidae : 3 to 5 % of bites
– Eastern coral snake : Southeastern U.S.
– Western Coral Snake : Arizona, New Mexico
– Both these species are unaggressive
– Yellow-bellied sea snake : off California in
Pacific Ocean
ƒ Gila Monster : world's only poisonous
lizard : in New Mexico, Arizona
ƒ Exotic pet snakes or zoo snakes
23
24. Most Dangerous U.S.
Venomous Snakes
ƒ Eastern Diamondback Rattlesnake*
– Largest U.S. native snake
ƒ Western Diamondback Ratllesnake*
ƒ Mojave Rattlesnake
ƒ Least toxic type is Copperhead
* Account for 95 % of deaths
but only 10 % of total bites
24
25. Identification Characteristics
of U.S. Venomous Snakes
ƒ Pit Vipers
– Indentation or "pit" between eye and nostril
– Flat triangular-shaped head
– Vertical pupils
– Curved fangs (usually 2 ; sometimes 1 to 4)
– Rattlesnakes have "rattle" at end of tail
ƒ Coral Snakes
– Rounded head, black snout
– Red & black bands separated by yellow or white rings
– "Red on black: venom lack ; red on yellow: kill a fellow"
is how to tell apart from banded King and corn snakes
25
28. Identification Characteristics of
U.S. Non-venomous Snakes
ƒ rounded head
ƒ round pupil
ƒ 2 rows of small teeth
ƒ double row of subcaudal plates (less
reliable)
Note: many non-North
American venomous snakes
have above characteristics
28
29. Characteristics of U.S. Pit Vipers
ƒ Deaf, poor vision, color blind
ƒ Excellent sense of smell and vibration
ƒ Feed at night ; less active during day
ƒ Are venomous from birth
ƒ Are strict carnivores
ƒ Top speed only 3 m.p.h.
ƒ Can strike at > 8 feet/second speed
ƒ Strike up to half body length
ƒ Live up to 30 years
29
30. Venom Apparatus of U.S. Pit Vipers
ƒ Venom gland is modified salivary gland
ƒ Venom duct runs into groove in fangs
ƒ Fangs retract or fold down when snake closes mouth
ƒ Anywhere from 20 % to 75 % of venom in gland can be
discharged at one strike
ƒ Snake has some control over amount of venom injected :
tends to inject larger amounts if suspected larger prey
ƒ Small snakes have lesser amounts of venom than larger
snakes
ƒ If fang breaks, it can be replaced by a new one growing in
from behind
30
31. Major Actions of Pit Viper Venom
ƒ Local tissue damage / necrosis
ƒ Coagulopathy
– Thrombocytopenia
– Fibrinolysis
ƒ Hemolysis
ƒ Vascular wall / capillary damage
ƒ Neurotoxins : from Mojave rattlesnake
cause respiratory paralysis
31
32. Complications of Pit Viper
Envenomation
ƒ Hypotension : can progress to frank shock
ƒ Pulmonary edema or respiratory distress syndrome
ƒ Disseminated intravascular coagulation / fibrinolysis
– Bleeding from bite site, mucus membranes, other sites
– Thrombosis of smaller vessels
ƒ Rhabdomyolysis*
ƒ Fasciculations*
ƒ Hemolytic anemia*
*these can cause acute renal failure
32
33. Manifestations of Coagulopathy
in the Envenomated Patient
ƒ Bleeding from bite site
ƒ Hematuria
ƒ Epistaxis
ƒ Melena
ƒ Petechiae / Purpura
33
34. Sequence of Local and Regional Signs and
Symptoms from Pit Viper Envenomation
(in rough order of occurence)
ƒ Pain
ƒ Swelling / edema
ƒ Ecchymosis
ƒ Fasciculations
ƒ Vesiculation
ƒ Tissue necrosis
34
35. Systemic Envenomation Symptoms
from Pit Viper Bites
ƒ Perioral tingling or numbness
ƒ Numbness of extremities or scalp
ƒ Metallic taste in mouth
ƒ Nausea and vomiting
ƒ Weakness
ƒ Diaphoresis
ƒ Faintness / Chills
ƒ Coagulapathy
ƒ Neurologic (rare) : paralysis, seizures
35
36. Symptoms & Signs of
Envenomation by Copperheads
ƒ Pain disproportionate to appearance
ƒ Proximal pain
ƒ Extremity paresthesias
ƒ Bitter or altered taste
ƒ Nausea
ƒ Lightheadedness
ƒ Edema & ecchymosis at site with proximal progression
ƒ Normal platelets, protime
ƒ Mild rhabdomyolysis
36
37. Symptoms & Signs of
Envenomation by Rattlesnakes
ƒ Similar to copperhead, except :
– Vomiting & other systemic sx & signs
– Rapid onset severe thrombocytopenia
– Site bleeding
– Delayed hemorrhagic bullae
– Generalized fatigue
– Tissue necrosis
– Metallic taste
– D.I.C.
– Severe rhabdomyolysis
37
39. Source Undetermined
Arm swelling in the patient envenomated by the preserved
snakehead (skin puncture site was on the index finger)
39
40. Systemic Envenomation Symptoms
from Elapidae (Coral Snake) Bites
ƒ Mild pain +/- paresthesias at bite site
ƒ Peripheral nerve block (numbness +/- motor
weakness)
ƒ Ptosis / blurred vision
ƒ Muscle weakness
ƒ Hypersalivation / nausea / dyspnea
ƒ May progress to diaphragm paralysis & respiratory
failure
ƒ Cobras cause above effects & also cardiotoxic
effects
40
41. Diagnostic Confirmation of
Venomous Snakebite
ƒ History of confirmed strike : if only suspected,
could be just injury from thorns or branch, etc.
ƒ Fang puncture marks
– may be one to four in number per strike (if snake
strikes more than once, can be multiple)
– If skin marks are in multiple rows, this implies nonvenomous snake
ƒ Local +/- systemic envenomation signs
41
42. Sequence of Standard Therapy for
Pit Viper Snakebite
ƒ Oxygen
ƒ Place IV line and draw blood for :
– blood type / crossmatch, CBC, platelet count, protime,
PTT, fibrinogen, electrolytes, BUN, creatinine, glucose,
CPK, liver function tests
– Lymphatic tourniquet / splint
– Urinalysis / EKG
– Tetanus toxoid immunization
– Wound cleansing / irrigation ; consider antibiotics
– Consider compartment pressure monitoring
– Consider use of antivenin ; base use and dose on
classification of degree of envenomation
42
43. Classification of Degree of
Envenomation by Pit Vipers
ƒ None (struck but no venom injected)
– Puncture marks only
ƒ Minimal
– Mild bite site pain & local swelling only
– No progression by 60 minutes
ƒ Moderate
– Swelling progresses beyond the bite site
– Ecchymosis, skin blebs, paresthesias
ƒ Severe
– Swelling or pain involves entire extremity
– Any systemic sign (metallic taste, coagulopathy, etc.)
– Any major lab value changes
43
44. Wyeth Antivenin Dosage for
Pit Viper Bites
Degree of Envenomation
None
Minimal
Dose (Number of vials)
None
Zero to 5
Moderate
6 to 15
Severe
15 to 30
44
45. Antivenin for Pit Viper Bites
ƒ Marketed as Crotalidae Polyvalent Antivenin by Wyeth
ƒ Covers venom from U.S. rattlesnakes, cottonmouth, &
copperhead
ƒ Made from refined horse serum from horses immunized
with venom from Western & Eastern Diamondback
rattlesnakes, South American rattlesnake, & Fer-de-lance
ƒ Separate antivenin required for Mojave Rattlesnake bites
ƒ Separate antivenin also required for coral snake or sea
snake bites
ƒ Polyvalent Crotalidae antivenin also manufactured in Brazil
45
46. New Commercially Available
Type of Antivenin
ƒ Crotalidae polyvalent immune Fab (CroFab,
FabAV) became commercially available in the U.S.
in December 2000
ƒ Derived from sheep hyperimmunized against
Crotalus atrox, C. adamanteus, C. scutulatus, &
Agkistrodon piscivoris
ƒ The sheep antibodies are treated with papain to
cleave off the Fc fragments, leaving the Fab
antibodies
46
47. Initial Clinical Experience with the
New Fab Antivenin FabAV
ƒ More expensive than the Wyeth antivenin
ƒ Lesser incidence & severity of allergic reactions
ƒ Venom induced coagulopathy may be relatively
more resistant to Fab than to Wyeth antivenin
ƒ Recurrence or delayed coagulopathy may occur
ƒ If coagulopathy is only a single factor deficiency
and asymptomatic, then extra Fab doses may not
be needed
47
48. Antivenin for Coral Snake Bites
ƒ Usually need 3 to 5 vials in 300 to 500
cc normal saline
ƒ Should give before development of
symptoms because it may not be
effective once symptoms develop
48
49. Skin Test for Sensitivity to
Antivenin for Snakebites
ƒ Skin test for sensitivity to horse serum
(0.02 ml. of horse serum diluted 1:10)
unnecessary & potentially hazardous
– Not 100 % predictive of anaphylaxis (both
false negative & false positive)
– May sensitize patient to subsequent dose
of antivenin
– Delays administration of antivenin
49
50. Administration of Antivenin for
Snakebites
ƒ Pretreatment
– IV steroids (100 mg hydrocortisone or methylprednisolone)
– IV diphenhydramine 50 mg
– IV fluid loading : at least 300 to 500 cc LR or NS
ƒ Reconstitute each antivenin vial with 10 cc sterile water
ƒ Then dilute each vial dose in 100 to 250 cc D5W or NS
ƒ Give each diluted antivenin vial dose over 1/2 to 2 hours IV ( DO
NOT IV push the vials) ; for first 10 min., give at TKO rate
ƒ Stop or slow infusion (& consider epinephrine 0.1 mg boluses or
drip IV) if patient manifests any signs of anaphylaxis
(hypotension, wheezing, edema, hives)
ƒ Incidence of major allergic reactions low with pretreatment
50
51. Repeat or Additional Doses of
Antivenin
ƒ Reevaluate extremity circumference,
pain, protime, & platelet count every 2
to 4 hours until stable
ƒ Infuse an additional 1 to 5 vials prn for
any progression of above signs
51
52. Adjunctive Therapy for Snake
Envenomation
ƒ Opiate analgesics
ƒ Constant elevation of limb above heart
once antivenin is started, or for > 4 to 6
hours post-bite (use stockinette or
hanging traction apparatus)
ƒ Splint affected joints
ƒ Hydration to lessen effect of
rhabdomyolysis
ƒ Initiate physical therapy once pain &
edema decrease
52
53. Disposition of Patients with
Snakebites
ƒ Confirmed pit viper bite
– Discharge if no evident envenomation after 4 hours
– Admit to hospital if local signs or antivenin required
ƒ Suspected coral snake, Mojave rattlesnake, or
exotic snakebite :
– All should be admitted (usually to ICU)
– May have delayed symptoms & signs
ƒ Monitor for progression of local or systemic
signs and symtoms
53
54. Serum Sickness After
Antivenin Administration
ƒ 75 % of patients receiving > 5 vials of
antivenin develop serum sickness
ƒ Manifested by fever, malaise, rash,
arthralgias, lymphadenopathy
ƒ Usually symptoms develop at 7 to 21
day delay
ƒ Treat with systemic steroids
(prednisone 1 to 2 mg/kg/day) for 7 to
10 days +/- antihistamines
54
55. Contraindicated Potentially Harmful
Treatments for Snakebites
ƒ Tourniquets beyond only lymphatic compression
– Australians however utilize entire limb compression (via air
splint or elastic wrap) to retard venom absorption
ƒ Cryotherapy (ice packs) : increases tissue damage
ƒ Electric shock
ƒ Excision of the bite site
ƒ Routine fasciotomy
– Only rarely indicated if venom injected below muscle fascia
(most injections are only subcutaneous)
ƒ Incision & suction of bite site
– Only small amount of venom removable
– Increases risk of infection and tendon damage
55
56. Snakebite Infections
ƒ Old references quote high infection rates from
snakebites & recommend routine prophylactic
antibiotics
ƒ Snake venom itself is sterile but snake mouth
& exterior of fangs harbor fecal bacteria from
the snake's prey
ƒ Two recent studies (one for venomous & one
for non-venomous snakes) show low rates of
infection & no need for prophylactic antibiotics
56
57. First Aid and Field Therapy for
Snakebites
ƒ Avoid panic & retreat out of snake's striking range
ƒ Immobilize the affected part & limit activity
ƒ Place lymphatic constriction band
ƒ Don't try to capture & carry the snake
ƒ Rapid transport to medical facility
– Try to make sure the medical facility has sufficient
antivenin (20 to 30 vials may be required)
– Cleanse & irrigate the bite site if this will not delay
transport
57
58. Precautions to Avoid
Snakebite
ƒ Wear knee - high heavy boots & heavy gloves
ƒ Watch where you are walking, sitting, or grasping
ƒ Don't put your hands into ground holes, or under
rocks or bushes
ƒ Don't approach snakes when they are seen
ƒ Wear eye protection if in "spitting cobra country"
ƒ Familiarize yourself with the types of snakes in the
area
ƒ Don't keep pet snakes
58
59. Signs and Symptoms of Envenomation by
the Indian or Common Cobra
ƒ Drowsiness : > 90 %
ƒ Ptosis, respiratory paralysis, dyspnea : 80 %
ƒ Ophthalmoplegia : 40 %
ƒ Palatal or glossopharyngeal paralysis : 40 %
ƒ Limb paralysis : 30 %
ƒ Seizures : 10 to 20 %
ƒ Also can have (at lesser frequency) :
– Nausea, vomiting, hypotension, bite site
pain, abdominal pain, ataxia, headache
59
60. Snakebites
Summary
ƒ Determine the type of snake involved if possible
ƒ Assess for envenomation
ƒ Draw bloodwork early (especially type & crossmatch)
ƒ Monitor for complications
ƒ Decide if antivenin needed
– If used, dilute & administer slowly
– Usually should pretreat to avoid allergic reaction
ƒ If further information needed, call :
– Exotic Snake Antivenin Index (Oklahoma City) :
405-271-5454
– Arizona Poison Center : 602-626-6016
– San Diego Poison Center : 619-543-6000
60