1 Snakes and other Pets Frank LoVecchio, DO, MPH, FACEP Co-Medical Director, Banner Good Samaritan Poison Center Maricopa Medical Center, Research Director and Vice-Chairman Department of Emergency Medicine Phoenix, AZ Case: A new antidote for an old problem • A 30 year old man is envenomated by a rattlesnake. • He has no history or asthma and takes no meds • He has no allergies
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Snakes and other Pets - Tucson Osteopathic Medical …€¦ · · 2011-03-29• Antivenom • Antivenom and mannitol Venom ... • Onset of symptoms immediate, ... –Hypersensitivity
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Snakes and other Pets
Frank LoVecchio, DO, MPH, FACEPCo-Medical Director, Banner Good Samaritan Poison Center
Maricopa Medical Center, Research Director and Vice-ChairmanDepartment of Emergency Medicine
Phoenix, AZ
Case: A new antidote for an old problem
• A 30 year old man is envenomated by a rattlesnake.
• He has no history or asthma and takes no meds
• He has no allergies
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Tongue Bites
24 hours
RULE ONE:PLEASE DON’T KISS SNAKES
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Penetrating Ocular Injury Caused by Venomous Snakebite Chien-Chung Chen et alAJOM
RULE TWO:PLEASE DON’T HANDLE DEAD SNAKES
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CroFabTM Dose
NoAdminister Additional 4 - 6 Vials of CroFab (TM)
Initial Control Achieved?
Establish Initial ControlBy Administering 4-6 Vials of CroFab(TM)
Over 1 Hour
Patient with Indication forCroFab(TM) Administration
venom-induced thrombocytopenia and defibrination, with additional findings of:– Hemolysis– Red cell fragmentation– Organ infarction– Diffuse bleeding
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ED Management• IV fluids• Pain control • Measure
circumference• Neurovascular
checks• Elevate extremity
Antivenom?
Indications for Antivenom
• Rapid progression of swelling• Significant coagulopathy or
thrombocytopenia• Neurotoxicity • Shock
The Case of the Concerned Citizen• A guy on I-17
The Alleged Scene
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Venomous Lizards
Heloderma suspectumGila Monster
Heloderma horridumMexican Beaded Lizard
Helodermatidae
H. s. suspectum
H.s. cinctumH. h. horridum
H. h. exasperatum
H. h. alvarezi
Gila Monster bite
Resulting in allergic rxn
...and tabloid story!
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Gila Monster Distribution
Reticulated Gila MonsterH. s. suspectum
Banded Gila MonsterH. s. cinctum
Gila MonsterVenom Delivery
• Venom glands on mandible
• Ducts lead to labial mucosa
• Venom flows through grooved teeth and into wounds
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Removing a Gila Monster• Pry mouth apart with pliers• Jam screwdriver down monster’s throat• Dip monster in gasoline and set on fire• Pour gasoline into mouth and set on fire• Place fire under jaw without gasoline• Strike back of lizard’s head with large
stone
Scorpions• 40 species of scorpions in the US• Only one dangerous, considered to
be potentially fatal– Found in Arizona, some areas of
Texas, New Mexico, California, and Nevada
• >6000 calls/year to Samaritan Regional Poison Control Center
• Most managed at home
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The Bark Scorpion
• Centruroides sculpturatus/exilicauda– Yellow/tan/brown– Up to 5 cm in length– Hard exoskeleton– Segmented tail curves up, ends in a
telson, containing venom glands and stinger
Exoskeleton
Telson
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The Bark Scorpion• Body fluoresces under UV light• Resides in or near trees; wood
–Climbs, but not up glass
Bark Scorpion
Envenomation• Most stings cause only local pain • Onset of symptoms immediate, progress up to 5
hours• Children tend to be most severely affected• No deaths reported in the US since 1968
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Management• Most symptoms improve within 9 to
30 hours without treatment• Pain and paresthesias may last up
to 2 weeks• Options:
–Antivenin (not currently available)–Sedation and pain control
Antivenin
• Recommended for Grade III and IV envenomations
• Results in rapid reversal of neurologic and respiratory toxicity within one hour