Snakebite is a medical emergency in rural India caused mainly by four venomous snake species. Poisonous snakes can be identified by small head scales, large belly scales, a compressed tail, and two fangs. The most common types are cobras, kraits, Russell's vipers, and saw-scaled vipers. Snake venom causes neurotoxicity or vasculotoxicity depending on the species. First aid involves reassuring the patient, immobilizing the bite area, seeking immediate medical help, and avoiding tourniquets. At the hospital, antivenom is administered along with treatment of symptoms like local swelling, neurotoxicity, and anticoagulant effects. Complications can include paralysis, bleeding disorders,
- The document provides guidance on treating snake and scorpion bites in children in India. It discusses:
- Four important poisonous snakes in India and first aid steps of "Do it R.I.G.H.T." which includes reassuring the patient and getting to the hospital immediately.
- Diagnosis, investigations, administration of anti-snake venom including dosage and handling adverse reactions. Repeat doses are given every 6 hours until coagulation is restored.
- Scorpion sting pathophysiology involves an autonomic storm and effects on multiple organs. Prazosin is the primary treatment and should be given within 4 hours of the sting.
This document summarizes guidelines for treating snake bites with anti-snake venom (ASV) from various species of snakes found in India. It describes: the types of snakes that cause bites; symptoms of envenomation; criteria for ASV administration; dosing protocols for different types of envenomation; monitoring patients and treating reactions; and considerations for special groups like children and pregnant women. The guidelines provide evidence-based recommendations on optimizing ASV therapy to treat snake bites while minimizing risks.
Snake bite ppt by
Dr Sujith Chadala,
Consultant Physician Diabetologist
Ankura Hospitals, Banjara hills, Nanakaramguda,Hyderabad,
Yello Clinics Diagnostics, Kokapet, Hyderabad.
MD,IDCCM,PGPC, CCEBDM,FIDM.Snake envenimation,AntiSnake Venom,Fistaid to Snakebite,Management of Snake bite,Complications of Snakebite,Cobra bite,Viper bite,Krait bite, Complications of Snakebite, ASV indications,20min Whole blood clotting time,Antibiotic in snake bite,average yield per venom, Hemotoxicity of snake bite,Neurotoxicity of snake bite,ASV test dose,ASV administration,ASV reactions,ASv route,ASV in children and pregnant, Hemodialysis in Snakebite,compartment syndrome in Snakebite,local bite management,maximum ASV vials,blood transfusions in snake bite,early and late ASV reactions,discharge criteria in snake bite,Snake bite local tissue care,Snakebite Management,fluids in snakebite,ASV reactions management,Neostigmine test,Intubation in snake bite,ABC management in snakebite,timing of ASV,saw scaled viper bite,ASV forms,fluid resuscitation,vasopressors,torniquet,ICU, Russell's viper,sea snakes,snakebite mortality,pit viper,Kingcobra,Neurotoxins,snake venom composition,hemotological complications of snake bite,neurological complications of Snakebite,local complications of snakebite,generalised complications of snakebite ,Snakebite guidelines,WHO snakebite guidelines, cardiovascular complications of snake bite,renal complications of snakebite,electrotherapy,pressure immobilisation
The document outlines guidelines for the treatment of snake bites, including rapidly assessing the airway, breathing, and circulation of the patient; administering tetanus toxoid, antibiotics, and anti-venom as needed based on symptoms; and closely monitoring vital signs and administering supportive care for any complications like respiratory failure, hypotension, or renal failure. Laboratory tests are also recommended to identify coagulopathies or tissue damage from the venom.
Management of snake bite at rural hospital in indiaAbhay Mange
This document provides information on managing poisonous snake bites in India. It discusses the "Big Four" snakes that cause most bites (cobra, krait, Russell's viper, saw-scaled viper) and their clinical features. It outlines testing and treatment protocols, including administering antivenom (ASV) for signs of envenomation and monitoring for complications. ASV should be given in repeated doses every 6 hours until coagulation is restored for hemorrhagic bites or until neurological symptoms resolve for neurotoxic bites. Patients showing signs of worsening symptoms need referral to a facility with ventilator support.
Snake bite management discusses snake bites, their epidemiology, clinical effects, diagnosis, and treatment. Some key points:
- Snake bites can be life-threatening due to toxins and cause 600,000 envenomings and 81,000-138,000 deaths annually worldwide. In Nepal, 20,000 people are bitten yearly resulting in over 1,000 deaths.
- Clinical effects depend on snake species but include local swelling, bleeding, necrosis, and systemic effects like nausea, vomiting, paralysis. Diagnosis considers symptoms, signs of coagulopathy on tests like 20WBCT, and syndrome based on features.
- Treatment involves first aid, resuscitation, antivenom, and
1) The patient presented with abdominal pain, cough with expectoration, decreased appetite and history of low grade fever. Diagnostic tests showed chronic pancreatitis with possible extra pulmonary tuberculosis.
2) Treatment included antibiotics, pain medications, antacids and antitussives. Advice was given to avoid alcohol, smoking and fatty foods.
3) For the tuberculosis, the patient was counselled on taking medications on time, avoiding double doses, smoking cessation and maintaining hygiene.
Snakes and scorpions can inject venom through bites or stings that is dangerous and sometimes fatal. There are over 50,000 deaths from snake bites worldwide each year. Venoms vary and can be neurotoxic, vasculotoxic, or myotoxic. Immediate medical help is needed for bites. Scorpion venom can also be neurotoxic or haemolytic, causing local or systemic effects like paralysis, cardiac issues, or death in severe cases. Treatment involves immobilization, antivenom, supportive care, and monitoring for complications.
- The document provides guidance on treating snake and scorpion bites in children in India. It discusses:
- Four important poisonous snakes in India and first aid steps of "Do it R.I.G.H.T." which includes reassuring the patient and getting to the hospital immediately.
- Diagnosis, investigations, administration of anti-snake venom including dosage and handling adverse reactions. Repeat doses are given every 6 hours until coagulation is restored.
- Scorpion sting pathophysiology involves an autonomic storm and effects on multiple organs. Prazosin is the primary treatment and should be given within 4 hours of the sting.
This document summarizes guidelines for treating snake bites with anti-snake venom (ASV) from various species of snakes found in India. It describes: the types of snakes that cause bites; symptoms of envenomation; criteria for ASV administration; dosing protocols for different types of envenomation; monitoring patients and treating reactions; and considerations for special groups like children and pregnant women. The guidelines provide evidence-based recommendations on optimizing ASV therapy to treat snake bites while minimizing risks.
Snake bite ppt by
Dr Sujith Chadala,
Consultant Physician Diabetologist
Ankura Hospitals, Banjara hills, Nanakaramguda,Hyderabad,
Yello Clinics Diagnostics, Kokapet, Hyderabad.
MD,IDCCM,PGPC, CCEBDM,FIDM.Snake envenimation,AntiSnake Venom,Fistaid to Snakebite,Management of Snake bite,Complications of Snakebite,Cobra bite,Viper bite,Krait bite, Complications of Snakebite, ASV indications,20min Whole blood clotting time,Antibiotic in snake bite,average yield per venom, Hemotoxicity of snake bite,Neurotoxicity of snake bite,ASV test dose,ASV administration,ASV reactions,ASv route,ASV in children and pregnant, Hemodialysis in Snakebite,compartment syndrome in Snakebite,local bite management,maximum ASV vials,blood transfusions in snake bite,early and late ASV reactions,discharge criteria in snake bite,Snake bite local tissue care,Snakebite Management,fluids in snakebite,ASV reactions management,Neostigmine test,Intubation in snake bite,ABC management in snakebite,timing of ASV,saw scaled viper bite,ASV forms,fluid resuscitation,vasopressors,torniquet,ICU, Russell's viper,sea snakes,snakebite mortality,pit viper,Kingcobra,Neurotoxins,snake venom composition,hemotological complications of snake bite,neurological complications of Snakebite,local complications of snakebite,generalised complications of snakebite ,Snakebite guidelines,WHO snakebite guidelines, cardiovascular complications of snake bite,renal complications of snakebite,electrotherapy,pressure immobilisation
The document outlines guidelines for the treatment of snake bites, including rapidly assessing the airway, breathing, and circulation of the patient; administering tetanus toxoid, antibiotics, and anti-venom as needed based on symptoms; and closely monitoring vital signs and administering supportive care for any complications like respiratory failure, hypotension, or renal failure. Laboratory tests are also recommended to identify coagulopathies or tissue damage from the venom.
Management of snake bite at rural hospital in indiaAbhay Mange
This document provides information on managing poisonous snake bites in India. It discusses the "Big Four" snakes that cause most bites (cobra, krait, Russell's viper, saw-scaled viper) and their clinical features. It outlines testing and treatment protocols, including administering antivenom (ASV) for signs of envenomation and monitoring for complications. ASV should be given in repeated doses every 6 hours until coagulation is restored for hemorrhagic bites or until neurological symptoms resolve for neurotoxic bites. Patients showing signs of worsening symptoms need referral to a facility with ventilator support.
Snake bite management discusses snake bites, their epidemiology, clinical effects, diagnosis, and treatment. Some key points:
- Snake bites can be life-threatening due to toxins and cause 600,000 envenomings and 81,000-138,000 deaths annually worldwide. In Nepal, 20,000 people are bitten yearly resulting in over 1,000 deaths.
- Clinical effects depend on snake species but include local swelling, bleeding, necrosis, and systemic effects like nausea, vomiting, paralysis. Diagnosis considers symptoms, signs of coagulopathy on tests like 20WBCT, and syndrome based on features.
- Treatment involves first aid, resuscitation, antivenom, and
1) The patient presented with abdominal pain, cough with expectoration, decreased appetite and history of low grade fever. Diagnostic tests showed chronic pancreatitis with possible extra pulmonary tuberculosis.
2) Treatment included antibiotics, pain medications, antacids and antitussives. Advice was given to avoid alcohol, smoking and fatty foods.
3) For the tuberculosis, the patient was counselled on taking medications on time, avoiding double doses, smoking cessation and maintaining hygiene.
Snakes and scorpions can inject venom through bites or stings that is dangerous and sometimes fatal. There are over 50,000 deaths from snake bites worldwide each year. Venoms vary and can be neurotoxic, vasculotoxic, or myotoxic. Immediate medical help is needed for bites. Scorpion venom can also be neurotoxic or haemolytic, causing local or systemic effects like paralysis, cardiac issues, or death in severe cases. Treatment involves immobilization, antivenom, supportive care, and monitoring for complications.
1. A seizure is caused by abnormal electrical activity in the brain, and epilepsy is recurrent seizures. Common triggers include sleep deprivation, alcohol withdrawal, infections, and flashing lights.
2. Emergency management of seizures focuses on stabilizing the airway and maintaining breathing and circulation. The patient should be placed in the lateral decubitus position with oxygen to prevent hypoxia.
3. For status epilepticus, which is prolonged or repeated seizures, intravenous benzodiazepines like diazepam or lorazepam are given followed by phenytoin, fosphenytoin, or phenobarbital if seizures continue. Intubation and ventilation may be needed along with general anesthesia if seizures
This document defines epilepsy and seizures, describes different types of seizures and epilepsy, and outlines treatment approaches. Epilepsy is defined as recurrent unprovoked seizures, while seizures are excessive electrical discharges in the brain causing uncontrolled muscle spasms or altered consciousness. Seizures can be focal or generalized onset. Treatment involves anti-epileptic drugs, with choices based on seizure type. Status epilepticus is a medical emergency requiring benzodiazepines or other drugs to stop prolonged seizures.
1) Snake bites are a major public health issue in India, with an estimated 200,000 bites and 15,000-20,000 deaths annually. The "Big Four" venomous snakes that cause the majority of bites are the saw-scaled viper, Russell's viper, common krait, and Indian cobra.
2) Symptoms of snake envenomation depend on the species, with cobras and kraits causing neurotoxicity and vipers causing hemotoxicity. Examination focuses on neurological status, local wound, bleeding, and kidney function.
3) Treatment involves snake antivenom (ASV), supportive care, and management of specific toxicities. ASV is administered
This document provides an overview of different types of anaesthesia including general anaesthesia and conductional anaesthesia. It describes general anaesthesia protocols and drugs used. It discusses spinal anaesthesia in detail including the procedure, drugs, complications and advantages over epidural anaesthesia. Epidural anaesthesia and caudal anaesthesia are also summarized. Regional anaesthesia and local anaesthesia techniques are briefly mentioned.
Anaphylaxis is a serious allergic reaction that is rapid in onset and can cause death. It involves multiple organ systems and its symptoms can include skin issues, respiratory distress, gastrointestinal symptoms and low blood pressure. It is most often triggered by foods, medications or insect stings. Diagnosis is clinical based on symptoms appearing shortly after exposure to a potential trigger. Treatment involves epinephrine, oxygen, fluids and monitoring vital signs. Patients are observed for potential biphasic reactions after initial treatment and provided anaphylaxis action plans and epinephrine autoinjectors upon discharge.
Snakebite is a medical emergency that requires prompt treatment. The document discusses the management of snakebite victims. It describes assessing for neurotoxicity or hematotoxicity. For neurotoxic bites, neostigmine may be given to reverse paralysis along with antivenom. Antivenom should be administered promptly according to protocols, with monitoring for adverse reactions. Supportive care including monitoring for complications is also important in managing snakebite victims.
The correct answer is e. Hemodialysis is not associated with high-flow priapism. The other answer choices are all known causes or associations of high-flow priapism.
This document discusses snakebite management in pediatrics. It outlines that only 200 of over 3,000 known snake species are poisonous to humans, with the majority belonging to 3 families. Symptoms and progression of envenomation depend on the snake type. Treatment involves immobilization, testing for coagulopathy, monitoring symptoms, and administering antivenom if indicated based on severity. Adverse reactions to antivenom can be managed with adrenaline, steroids, and antihistamines. Repeat antivenom doses are based on symptom progression and test results over subsequent hours. Prognosis is good with early antivenom use.
This document provides an overview of snake bite management. It discusses the epidemiology, types of venomous snakes and their venom mechanisms. It outlines the signs and symptoms of snake bites, as well as first aid measures and laboratory tests. The main treatment involves administration of antivenom. Supportive treatments are also described, such as managing hypotension, acute kidney injury, haemostatic disturbances and ophthalmia. Recent research advancements involving herbal antidotes and potential medicinal uses of snake venom are also mentioned.
This document presents a case study of a 7-year-old boy who was bitten by a snake on his left foot. He experienced swelling and pain that progressed up his left leg. He was initially treated with IV fluids, analgesics, and antivenom at a local hospital before being referred for possible antivenom allergy.
On examination, he had swelling up to his knee with tenderness and blebs. Investigations showed elevated white blood cell count. He developed worsening swelling and pus, and was diagnosed with necrotizing fasciitis. He underwent wound debridement and antibiotics were changed. Cultures grew Klebsiella pneumoniae. He was treated surgically and with antibiotics.
The document summarizes safety aspects of contrast media used in medical imaging. It discusses ideal properties of contrast media including iodine being well-suited due to its atomic number and excretion through kidneys. It also covers physiology of administration and excretion, potential toxicities including reactions to hyperosmolality, chemicals and immunologically. Treatment approaches for different types and severities of reactions like hives, bronchospasm and hypotension are provided.
Sepsis and septic shock result from a dysregulated host response to infection that leads to organ dysfunction. Management involves immediate resuscitation within 1 hour with IV fluids, antibiotics, and vasopressors if needed. Ongoing care includes source control, frequent reassessment of volume status, and supportive care such as mechanical ventilation and nutrition. The goals are to treat the underlying infection while supporting failing organs until the host response normalizes. Sepsis affects millions worldwide and requires swift treatment to prevent progression to septic shock and death.
1. Priapism is classified as ischemic or non-ischemic based on blood flow and oxygen levels in the corpora cavernosa. Ischemic priapism requires emergency treatment due to hypoxic conditions while non-ischemic can often be managed conservatively.
2. Treatment for ischemic priapism involves aspiration of blood from the corpora cavernosa followed by injection of vasoconstrictors if needed. If unsuccessful, surgical shunting procedures are used to drain blood and reestablish outflow.
3. Non-ischemic priapism does not require emergency intervention as it is caused by arterial inflow without venous leakage. Conservative management is attempted initially using ice or observation
1. Priapism is classified as ischemic or non-ischemic based on blood flow and oxygenation levels. Ischemic priapism requires emergency treatment while non-ischemic can be managed conservatively.
2. Treatment of ischemic priapism involves aspiration of blood from the corpora cavernosa followed by injection of vasoconstrictors if detumescence is not achieved. Surgical shunting may be needed if conservative measures fail.
3. Non-ischemic priapism has intact venous drainage and does not require emergent intervention. It is often associated with trauma and can sometimes resolve spontaneously or with ice application.
INTRAOCULAR PROCEDURES AND IT’S ANAESTHETIC IMPLICATIONS.pptxSaikumar Patil
1) Intraocular procedures require careful anaesthetic management to control intraocular pressure, prevent oculocardiac reflex, and minimize risks of bleeding and vomiting.
2) Regional techniques like retrobulbar blocks or general anaesthesia can both be used, with general anaesthesia allowing better airway control but higher risk of nausea.
3) Procedures like strabismus surgery carry risk of oculocardiac reflex while retinal detachment surgery requires avoiding nitrous oxide if intraocular gases are used.
4) Ophthalmic drugs can cause systemic side effects like hypertension, bradycardia, or bronchospasm that anaesthetists must manage. Emergencies require prompt intervention to prevent vision loss
The document defines syncope as a transient loss of consciousness due to decreased blood flow to the brain. It classifies syncope into cardiac, reflex/neurocardiogenic, and orthostatic hypotension categories based on etiology. Cardiac syncope can be due to arrhythmias like bradycardia or structural issues like aortic stenosis. Reflex syncope includes vasovagal which can be triggered by emotions or orthostatic stress, and carotid sinus syncope caused by pressure on the carotid sinus. Orthostatic hypotension syncope results from autonomic dysfunction or drugs/illnesses that cause volume depletion.
The document provides information about different types of seizures:
1. Status epilepticus is a condition where seizures continue for more than 30 minutes or seizures occur without recovery in between.
2. Several types of seizures are defined, including absence seizures (petit mal), atonic seizures (drop attacks), clonic seizures, myoclonic seizures, tonic seizures, and tonic-clonic seizures (grand mal).
3. Simple partial seizures can affect motor function, senses, autonomic functions, or thinking/emotions, while the person remains conscious. Complex partial seizures involve impaired consciousness in addition to symptoms.
1. A seizure is caused by abnormal electrical activity in the brain, and epilepsy is recurrent seizures. Common triggers include sleep deprivation, alcohol withdrawal, infections, and flashing lights.
2. Emergency management of seizures focuses on stabilizing the airway and maintaining breathing and circulation. The patient should be placed in the lateral decubitus position with oxygen to prevent hypoxia.
3. For status epilepticus, which is prolonged or repeated seizures, intravenous benzodiazepines like diazepam or lorazepam are given followed by phenytoin, fosphenytoin, or phenobarbital if seizures continue. Intubation and ventilation may be needed along with general anesthesia if seizures
This document defines epilepsy and seizures, describes different types of seizures and epilepsy, and outlines treatment approaches. Epilepsy is defined as recurrent unprovoked seizures, while seizures are excessive electrical discharges in the brain causing uncontrolled muscle spasms or altered consciousness. Seizures can be focal or generalized onset. Treatment involves anti-epileptic drugs, with choices based on seizure type. Status epilepticus is a medical emergency requiring benzodiazepines or other drugs to stop prolonged seizures.
1) Snake bites are a major public health issue in India, with an estimated 200,000 bites and 15,000-20,000 deaths annually. The "Big Four" venomous snakes that cause the majority of bites are the saw-scaled viper, Russell's viper, common krait, and Indian cobra.
2) Symptoms of snake envenomation depend on the species, with cobras and kraits causing neurotoxicity and vipers causing hemotoxicity. Examination focuses on neurological status, local wound, bleeding, and kidney function.
3) Treatment involves snake antivenom (ASV), supportive care, and management of specific toxicities. ASV is administered
This document provides an overview of different types of anaesthesia including general anaesthesia and conductional anaesthesia. It describes general anaesthesia protocols and drugs used. It discusses spinal anaesthesia in detail including the procedure, drugs, complications and advantages over epidural anaesthesia. Epidural anaesthesia and caudal anaesthesia are also summarized. Regional anaesthesia and local anaesthesia techniques are briefly mentioned.
Anaphylaxis is a serious allergic reaction that is rapid in onset and can cause death. It involves multiple organ systems and its symptoms can include skin issues, respiratory distress, gastrointestinal symptoms and low blood pressure. It is most often triggered by foods, medications or insect stings. Diagnosis is clinical based on symptoms appearing shortly after exposure to a potential trigger. Treatment involves epinephrine, oxygen, fluids and monitoring vital signs. Patients are observed for potential biphasic reactions after initial treatment and provided anaphylaxis action plans and epinephrine autoinjectors upon discharge.
Snakebite is a medical emergency that requires prompt treatment. The document discusses the management of snakebite victims. It describes assessing for neurotoxicity or hematotoxicity. For neurotoxic bites, neostigmine may be given to reverse paralysis along with antivenom. Antivenom should be administered promptly according to protocols, with monitoring for adverse reactions. Supportive care including monitoring for complications is also important in managing snakebite victims.
The correct answer is e. Hemodialysis is not associated with high-flow priapism. The other answer choices are all known causes or associations of high-flow priapism.
This document discusses snakebite management in pediatrics. It outlines that only 200 of over 3,000 known snake species are poisonous to humans, with the majority belonging to 3 families. Symptoms and progression of envenomation depend on the snake type. Treatment involves immobilization, testing for coagulopathy, monitoring symptoms, and administering antivenom if indicated based on severity. Adverse reactions to antivenom can be managed with adrenaline, steroids, and antihistamines. Repeat antivenom doses are based on symptom progression and test results over subsequent hours. Prognosis is good with early antivenom use.
This document provides an overview of snake bite management. It discusses the epidemiology, types of venomous snakes and their venom mechanisms. It outlines the signs and symptoms of snake bites, as well as first aid measures and laboratory tests. The main treatment involves administration of antivenom. Supportive treatments are also described, such as managing hypotension, acute kidney injury, haemostatic disturbances and ophthalmia. Recent research advancements involving herbal antidotes and potential medicinal uses of snake venom are also mentioned.
This document presents a case study of a 7-year-old boy who was bitten by a snake on his left foot. He experienced swelling and pain that progressed up his left leg. He was initially treated with IV fluids, analgesics, and antivenom at a local hospital before being referred for possible antivenom allergy.
On examination, he had swelling up to his knee with tenderness and blebs. Investigations showed elevated white blood cell count. He developed worsening swelling and pus, and was diagnosed with necrotizing fasciitis. He underwent wound debridement and antibiotics were changed. Cultures grew Klebsiella pneumoniae. He was treated surgically and with antibiotics.
The document summarizes safety aspects of contrast media used in medical imaging. It discusses ideal properties of contrast media including iodine being well-suited due to its atomic number and excretion through kidneys. It also covers physiology of administration and excretion, potential toxicities including reactions to hyperosmolality, chemicals and immunologically. Treatment approaches for different types and severities of reactions like hives, bronchospasm and hypotension are provided.
Sepsis and septic shock result from a dysregulated host response to infection that leads to organ dysfunction. Management involves immediate resuscitation within 1 hour with IV fluids, antibiotics, and vasopressors if needed. Ongoing care includes source control, frequent reassessment of volume status, and supportive care such as mechanical ventilation and nutrition. The goals are to treat the underlying infection while supporting failing organs until the host response normalizes. Sepsis affects millions worldwide and requires swift treatment to prevent progression to septic shock and death.
1. Priapism is classified as ischemic or non-ischemic based on blood flow and oxygen levels in the corpora cavernosa. Ischemic priapism requires emergency treatment due to hypoxic conditions while non-ischemic can often be managed conservatively.
2. Treatment for ischemic priapism involves aspiration of blood from the corpora cavernosa followed by injection of vasoconstrictors if needed. If unsuccessful, surgical shunting procedures are used to drain blood and reestablish outflow.
3. Non-ischemic priapism does not require emergency intervention as it is caused by arterial inflow without venous leakage. Conservative management is attempted initially using ice or observation
1. Priapism is classified as ischemic or non-ischemic based on blood flow and oxygenation levels. Ischemic priapism requires emergency treatment while non-ischemic can be managed conservatively.
2. Treatment of ischemic priapism involves aspiration of blood from the corpora cavernosa followed by injection of vasoconstrictors if detumescence is not achieved. Surgical shunting may be needed if conservative measures fail.
3. Non-ischemic priapism has intact venous drainage and does not require emergent intervention. It is often associated with trauma and can sometimes resolve spontaneously or with ice application.
INTRAOCULAR PROCEDURES AND IT’S ANAESTHETIC IMPLICATIONS.pptxSaikumar Patil
1) Intraocular procedures require careful anaesthetic management to control intraocular pressure, prevent oculocardiac reflex, and minimize risks of bleeding and vomiting.
2) Regional techniques like retrobulbar blocks or general anaesthesia can both be used, with general anaesthesia allowing better airway control but higher risk of nausea.
3) Procedures like strabismus surgery carry risk of oculocardiac reflex while retinal detachment surgery requires avoiding nitrous oxide if intraocular gases are used.
4) Ophthalmic drugs can cause systemic side effects like hypertension, bradycardia, or bronchospasm that anaesthetists must manage. Emergencies require prompt intervention to prevent vision loss
The document defines syncope as a transient loss of consciousness due to decreased blood flow to the brain. It classifies syncope into cardiac, reflex/neurocardiogenic, and orthostatic hypotension categories based on etiology. Cardiac syncope can be due to arrhythmias like bradycardia or structural issues like aortic stenosis. Reflex syncope includes vasovagal which can be triggered by emotions or orthostatic stress, and carotid sinus syncope caused by pressure on the carotid sinus. Orthostatic hypotension syncope results from autonomic dysfunction or drugs/illnesses that cause volume depletion.
The document provides information about different types of seizures:
1. Status epilepticus is a condition where seizures continue for more than 30 minutes or seizures occur without recovery in between.
2. Several types of seizures are defined, including absence seizures (petit mal), atonic seizures (drop attacks), clonic seizures, myoclonic seizures, tonic seizures, and tonic-clonic seizures (grand mal).
3. Simple partial seizures can affect motor function, senses, autonomic functions, or thinking/emotions, while the person remains conscious. Complex partial seizures involve impaired consciousness in addition to symptoms.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
SNAKEBITE.pptx
1. SNAKE BITE & ITS MANAGEMENT
DR. ALLEN DAVID S
MODERATOR: DR. GOPAL
2. INTRODUCTION
• Snakebite is an acute life-threatening time limiting and preventable
medical emergency faced by mainly rural population in India.
• Most deaths due to venomous snakebites in India are caused by four
species
1. Common Cobra
2. Common Krait
3. Russell’s viper
4. Sawscaled viper.
3. CHARACTERISTIC POISONOUS
SNAKE
NON POISONOUS SNAKE
HEAD SCALES SMALL LARGE
BELLY SCALES LARGE SMALL
TAIL COMPRESSED NOT COMPRESSED
TEETH MARK TWO FANG
MARKS
MULTIPLE SMALL MARKS IN
A SEMI CIRCLE
HABIT NOCTURNAL NOT NOCTURNAL
POISONOUS VS NON POISONOUS SNAKE BITE
4. COBRA
KING COBRA COBRA
OPHIOPHAGUS NAJA NAJA
LONGER SHORTER THAN KING COBRA
HOOD SIZE IS SMALL HOOD SIZE IS BIGGER
NO SPECTACLE MARK ON HOOD SPECTACLE MARK ON HOOD PRESENT
6. PATHOGENESIS
• Cobra and common krait are neurotoxic.
• Common krait is more poisonous than cobra – Toxin: Bungarotoxin
• Cobra is more dangerous than krait amount of venom injected in a
bite is more.
• CF: Ptosis, Paralysis - descending paralysis, local symptoms – swelling,
ecchymosis, gangrene
• Cause of death: Respiratory muscle paralysis
7. • Vipers are vasculotoxic – hemolysis, hemorrhage, hematuria
• Can cause DIC – Disseminated Intravascular Coagulation
• Local symptoms are more pronounced
• Sea snakes are
myotoxic
• Can cause muscle
paralysis and renal
failure
VIPER SEA SNAKE
8.
9. FIRST AID PROTOCOL - "Do it R.I.G.H.T."
• R. = Reassure the patient. Seventy per cent of all snakebites are from
non venomous species. Only 50% of bites by venomous species
actually enveno-mate the patient
• I = Immobilise in the same way as a fractured limb.
• G.H. = Get to Hospital immediately.
• T = Tell the doctor of any systemic symptoms such as ptosis that
manifest on the way to hospital.
10. DON’TS
• Don’ts Tie a tight tourniquet—can cause gangrene
• Cut the bite area and suck out blood—harmful
• Use herbs, ice packs, and snake stones—useless and delays ASV
11. PRESSURE IMMOBILIZATION METHOD (PIM)
• Pressure immobilization method involves bandaging the
bitten limb, up to the proximal major joint using a
bandage or pressure pad.
• PIM obstructs lymphatic and venous drainage,
preventing the absorption of large molecule neurotoxins
into the systemic circulation.
• The limb must be splinted as movement will increase
systemic absorption.
12. HANDLING TOURNIQUETS OR PRESSURE
IMMOBILIZATION METHOD
(IF HAD BEEN APPLIED)
• Sudden removal can lead to a massive surge of venom leading to
neurological paralysis, hypotension due to vasodilation, etc.
• Be prepared to handle the complications and to start ASV.
• If the tourniquet has occluded the distal pulse, then a blood pressure
cuff can be applied to reduce the pressure slowly
14. LOCAL SWELLING
• Paracetamol/tramadol for pain. Avoid
nonsteroidal anti-inflammatory drugs (NSAIDs).
• Injection ceftriaxone/amoxicillin/clavulanate +
metronidazole administered for 7 days or more.
• Close monitoring for features of
necrosis/compartment syndrome.
15. NEUROTOXICITY MANAGEMENT
• Snake venoms can cause neurotoxicity by blocking either presynaptic
(kraits) or postsynaptic (cobras) neuromuscular junction (NMJ).
• Those which produce postsynaptic NMJ blockade, experience
improvement with the use of anticholinesterase drugs. Thus all
children with neurotoxic envenomation are given a trial of
anticholinesterase (AN challenge test).
• Injection atropine (0.05 mg/kg, IV), followed by neostigmine (0.04
mg/kg, IV) and dose of 0.01 mg/kg repeated at 30-minute interval for
five doses.
• If child presents with respiratory failure, intubation and ventilation is
the priority followed by ASV infusion.
16. ANTISNAKE VENOM
• Antisnake venom remains the cornerstone in the
management of snakebite envenomation.
• The currently available ASV in India is polyvalent,
containing equine immunoglobulins to the four
common snake venoms
• The immunoglobulins attach to the venom molecule making it unable to bind
to the target tissue.
• Antisnake venom should not be used in asymptomatic bites with normal WBCT
but must wait for signs of envenomation.
17. INDICATIONS FOR ANTISNAKE VENOM
• SYSTEMIC ENVENOMATION:
• Evidence of coagulopathy: Primarily detected by 20-minute WBCT or visible
spontaneous systemic bleeding, gums, etc.
• Evidence of neurotoxicity: Ptosis, external ophthalmoplegia, muscle paralysis,
inability to lift the head, etc.
• LOCAL ENVENOMATION: Severe local swelling involving more than
half of the bitten limb (in the absence of a tourniquet). In the case of
severe swelling after bites on the digits (toes and especially fingers).
18. ANTISNAKE VENOM ADMINISTRATION
• Dosage—it is of 10 vials. Each vial is dissolved in 10 mL saline. Total
dose is diluted in 10 mL/kg 0.9% saline or 5% dextrose and given as
an infusion over 1 hour. The patient should be closely monitored.
Keep injection adrenaline 1:1,000; 0.01 mg/kg ready.
19. RESPONSE TO ASV
If an adequate dose of appropriate antivenom has been administered,
the following responses occur:
• Spontaneous systemic bleeding usually stops within 15 minutes.
• Blood coagulability is usually restored in 6 hours.
• Postsynaptic neurotoxic envenoming such as the cobra may begin to
improve as early as 30 minutes, but can take several hours.
Presynaptic neurotoxic envenoming such as the krait usually takes a
considerable time to improve.
20. REPEAT DOSES
ANTIHEMOSTATIC
• After 6 hours, WBCT is repeated
and a further dose 5–10 vials
should be administered over 1
hour, if WBCT abnormal. ; This 6
hourly pattern (time for liver to
replace clotting factors) is repeated
until the coagulation is restored. ;
If 30 vials have been administered
and there is no improvement,
fresh-frozen plasma (FFP) or
factors can be considered. Further
ASV should not be given.
NEUROTOXIC
• If the initial dose has been
unsuccessful in reducing the
symptoms, then a further dose of
10 vials should be administered,
after 1–2 hours. ; Once the patient
is in respiratory failure, has
received 20 vials of ASV, and is
supported on a ventilator, ASV
therapy should be stopped.
21. ANTISNAKE VENOM IN SPECIAL SITUATIONS
NEWBORN AND SMALL INFANTS
• ASV dose is same and
independent of weight. But total
volume is restricted to 5 mL/kg
and given more slowly to
prevent fluid overload.
ANTISNAKE VENOM DOSAGE IN VICTIMS
REQUIRING LIFESAVING SURGERY
• Before surgery, coagulation must
be restored to avoid catastrophic
bleeding with higher initial dose
of ASV of 25 vials.
22. VICTIMS WHO ARRIVE LATE
• If coagulopathy is present, administer ASV.
• In case of neurotoxic envenomation with respiratory failure on
ventilator, administer 8–10 vials of ASV to ensure that no unbound
venom is present.
• No need of ASV for ptosis alone persisting without progression.
23. ADVERSE ANTISNAKE VENOM REACTIONS
• Early anaphylactic reaction
• Pyrogenic reaction
• Late (serum sickness like) reactions
24. EARLY ANAPHYLACTIC REACTION
• Usually occurs 10 minutes to 6 hours post-ASV
• Starts with urticaria, irritability, abdomen pain, and tachycardia
• Often progresses to cause hypotension, angioedema, and shock
• No need of routine prophylactic medication before ASV
25. • At the first sign of a reaction, STOP ASV
• Immediately administer adrenaline 0.01 mg/kg (1 in 1,000 dilutions)
intramuscularly
• Repeat every 5–10 minutes if symptoms persist
• Pheniramine maleate (0.5 mg/kg IV) and hydrocortisone (2–5 mg/kg
IV) can be added
• ASV should be restarted slowly after clinical stabilization and rate
increased to normal
• Persistent shock: Normal saline bolus and adrenaline infusions can be
given
26. PYROGENIC REACTION
• Usually 1–2 hours after ASV
• Includes fever, chills, and rigors
• Caused by pyrogen contamination during ASV manufacturing
• Paracetamol and other cooling procedures (tepid sponging and
fanning)
• No need of stopping ASV
27. LATE SERUM SICKNESS LIKE REACTIONS
• Develops 1–12 days post ASV
• Fever, vomiting, recurring urticaria, arthralgia, myalgia,
lymphadenopathy, and nephritis
• Prednisolone (0.7 mg/kg/day) for 5–7 days, with or without oral
chlorpheniramine maleate (0.25 mg/kg/day)
3000 species of snakes are known, only 200 are poisonous to man. Of the poisonous snakes, 90% are members of elapidae(cobras, kraits), Viperidae (vipers), hydrophidae (poisonous sea snakes)
Those who respond have 50% improvement in ptosis within three doses. The responders are continued on atropine with neostigmine, at 1 hour, 2 hours, 6 hours, 12 hours, and 24 hours.