Module21

Poisons,stingsandbites

Poisons,stingsandbites
Poisonisanysubstancethatcanproduceharmfuleffectsonthebodyprocess o Thesesubstancescanalterand/destroybodytissues Canbeingested,injected,inhaledorabsorbedthroughtheskin

DEFINITIONOFAPOISON

1.1

Ingestedpoisons
Poisonthathasbeentakenorally(liquidorsolid) o canrangefromtabletstodetergentstocorrosives o Remaininthestomachforarelativelyshortperiodoftimewithminimalabsorbsion Adultsnormallytakesedativesandhypnotics Childrentakehouseholdproducts,detergents,acidsandalkali's

1.1.1

History
Whatwastaken? When? Howmuch? Patient'sage? Hasthepatientvomitedifsosavevomitus.

1.1.2

Signsandsymptoms
Burnt\stainedmouth Unusualodours Dyspnoea Tachypnea Sweating Dilatedpupils Salivation(lotsofsalivary) Vomiting Abnormaltenderness Diarrhoea

1.1.3

Management
BSI ABC Oxygen o Keepsuctionunitready Donotmakepatientvomit Focussedassessmentwithvitalsigns Takeasampleofthepoisonwith Contactpoisoncontrolifneeded Lateral Backup Transport

1.2

Absorbedpoisons
Whenpoisonsabsorbedthroughtheskinmainlyinfarmingareas o Mostcommontypeistheorganophosphate(pesticides)poison Thispoisoninhibitsthesympatheticnervoussystem Pt.thushasnosympatheticresponse

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Module21 1.2.1
D U M B E L S

Poisons,stingsandbites

SignsandsymptomsOrganophosphatepoisoning
Diaphoresis,diarrhoea Urination Miosis(constrictionofpupils) Bradycardia Emesis(vomiting) Lacrimation(tearingofeyes) Salivationandseizures

1.2.2

Management
Yoursafetyfirst BSI o Protectyourselfwithprotectiveclothingandglovesasthepoisoncanbeabsorbedthroughyourskin Firstprincipleremovethepatienttoasafearea Removeclothing Washpt.downwithwater ABC Maintaintheairway o Haveyoursuctionunitready! o Rememberthereisanexcessofsecretions,thereforesuctioningisvital Oxygen CallforBackup Focussedassessmentandvitalsigns Prompttransportation

1.3

Inhaledpoisons
Breathinginofpoisonousgasses E.g.CarbonMonoxide,ammoniaorglue DrugslikeCocainecanalsobeinhaled(sniffed) Yoursafetyfirst BSI o Protectyourselfsafetyfirstasyoucouldalsobeovercomebythefumes. Thenremovethepatienttoasafearea

1.3.1

SignsandsymptomsCarbonmonoxidepoisoning(Hypercarbia)

FYImostofthesepts.havetriedtocommitteesuicide Dyspnoeaonexertion Throbbingheadache Nauseaandvomiting DecreasedLOC Cherryredcolourisaverylatesign(Hypercarbia)

1.4

Injectedpoisons
Bymeansof o Aneedleandsyringe o Insectbite o Snakebite Poisoniseitherinjectedundertheskin/intoavein Mostcommoninjectedpoisonsarenarcoticssuchascocaineandheroine

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Module21 1.4.1

Poisons,stingsandbites

Signsandsymptoms
Puncturemarks Localisedpain/burning Bruisingaroundthepuncturemark Weaknessanddizziness Headaches Dyspnoea Musclecrampsandpaininjoints Nauseaandvomiting Changeinbehaviour DecreaseinLOC Diaphoresis

1.4.2

Management
ABC Oxygen Positionlateralandassistventilations o Assistwithventilationifpt.breathingis6bpmorbelow Focussedassessment,vitalsigns Treatassociatedinjuries Backupifneeded

Bitesandstings
Includethoseof: o Humans o Canines o Felines o Spiders o Scorpions o Snakes

2.1

Spiderbites
SouthAfricanspidersareclassifiedaccordingtotheactionoftheirvenom o Sowhatthevenomdoestothept. Eventhosespidersconsideredmedicallysignificantdonotposeathreattothehealthyadult Theelderly,children,peoplewithunderlyingmedicalproblemsandpeoplepronetoallergiesarehoweverat increasedriskofdevelopinglifethreateningsymptoms

Spidervenomclassification:
Neurotoxicvenom Cytotoxicvenom

2.1.1

Neurotoxicvenom
Venomaffectsthebrainandcentralnervoussystem o Causingdizziness,difficultybreathing,nausea,blurredvision,musclerigidity,amongotherthings o Thevenommayalsokilltissuesurroundingthebite Blackwidowandbrownwidowspiders(AKAbuttonspiders)fallinthisgroup o Blackwidowsspiderbiteistheonlyspiderbiteconsideredpotentiallylifethreatening

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Module21 2.1.1.1 SignsandSymptoms

Smallredarea Pain,itchingandswelling Mayinterferewithrespiration MostlyNeurotoxic/Cytotoxic Rigidabdomenwithouttenderness DecreasedLOC

Poisons,stingsandbites

2.1.1.2 Management
Thebiteitselfispainless o Andoftengoesunnoticed o Thereforeaccuratehistory+mechanismofinjuryisvitallyimportant Airwayisprimeimportance o Infewfatalitiesrespirationfailurehasbeencauseofdeath Adequateairwayprotectmustbedone o Assistwithventilationifpt.breathingis6bpmorbelow Oxygentobeadministeredathighconcentration Focussedandcompleteassessment Vitals Transporttohospital MONITORvitalsignscontinuously

2.1.2

Cytotoxicvenom
Venomaffectsthetissuearoundthebite Threemainspeciesare: o Violinspider o Sacspider o Sixeyedsandspider Noneareconsideredlethal o Butallhavepainfulbites o Bitesmaycausepermanentdamageneedingamputationifuntreated

2.2

ScorpionStrings
SouthAfricahas175varietiesofscorpions o Allarevenomoustosomedegree TheButhidae o Havethicktailsanddelicatepincers o Considereddangerous TheScorpionidae o Havethintailsandrobustpincers o Consideredlessdangerous Theriskofmortalityforadultsislow AllfatalitiesreportedinSAhavebeenofchildren

2.2.1

SignsandSymptoms
Burningpainatsite Neurotoxicsymptoms Dangerousifthinktailsmallpincers

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Module21 2.2.2

Poisons,stingsandbites

Management/Treatment
Safety ABC Irrigatewound Focussedcompleteassessment Vitals Dresswoundrestrictivebandage Reassurethept. Callforbackupifneeded TransportASAP

2.3

Nonvenomousanimalbites
Biggestdangerfromanimalbitesisinfection o Humanhas47speciesofbacteriainthemouth o Hyenahas16speciesofbacteriainthemouth Aspecificdisease o Occurringfrommammalswhichcanbelethalisrabies

2.3.1

Animalbites
Rabiesisaviraldisease o Itscarriedinthebodyfluidsofinfectedanimals o Itistransmissiblebydirectcontact Incubationperiod: o Infectionisfollowedbyanincubationperiodduringwhichthevirusascendsfromtheinfectionsiteto thebrain o Thepatientmayexhibitrestlessness,confusionandmusclespasms o Thisperiodisvariable,dependingonthedistancebetweentheinfectionsiteandthebrain o Thepatientwillbeasymptomaticduringthisperiod o Orshowflulikesymptoms Furiousperiod: o Unprovoked,irrational,aggressivebehaviour Clinicalperiod: o Signsandsymptomsinclude Hydrophobia Photophobia Hypersalivation Hallucinations Paralysis Convulsions o Deathisinevitablewithin10daysofclinicalsymptomsappearing o Hasamortalityrateof100%oncetheclinicalsymptomshaveappeared o Thereisnocureforrabies,butavaccinationisavailablewhichmustbegivenbeforesymptomsstart toappear o Thereishowever10reportedcasesofpeoplesurvivinglatentclinicalphaseofrabies,ofwhich6are documented Thesewoundsshouldnotbesutured Antibioticcoverandtetanusprophylaxisshouldbeprovided Treatmentofanimalbitesissymptomatic;woundsshouldbeirrigatedandcleaned Arabidanimalshouldnotbeapproached,butreportedtotheauthorities

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Module21 2.4 2.4.1

Poisons,stingsandbites

Snakebites Adders
Hingedfrontfangs Cytotoxicvenom(exceptBergadderneurotoxic) Causesdestructionofbodytissue Slowactingvenom:810hrs

2.4.1.1 Signsandsymptoms
Severepain Grossswellingatsiteofbite Erythema Blistering(severeplasmaleakage) Hypovolaemicshock.

2.4.2

Cobrasandmambas
Fixedfrontfangs Neurotoxicvenom Causesnumbnesstothenerveends Fastactingvenom:46hrs

2.4.2.1 Signsandsymptoms
Pallor(pale,greyskin) Vertigo(anillusionofmovement) Ptosis(droopingeyelids) Dilatationofthepupils Aphasia(speechincoordination) Dysphagia(difficultyinswallowing) Impairedvision Shock Respiratoryfailure DecreaseinLOC Death

2.4.3

Boomslangandvinesnake
Fixedbackfangs Haemotoxicvenom Causesdamagetobloodcells o Noclotting Slowactingvenom:1024hrs

2.4.3.1 Signsandsymptoms
Lethargy Confusion Nauseaandvomiting Bleedingfromallorifices Haemoptysis(coughingupofblood) Haematemesis(vomitingblood) Haematuria(bloodinurine) Melena(bloodinstools)

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Module21 2.4.4

Poisons,stingsandbites

Seasnakes
Fixedfrontfangs Myoneurotoxicvenom Causesdestructionofmuscletissue Andnumbingofthenerveends Fastacting:minutesto6hrs

2.4.4.1 Signsandsymptoms
SameasCobrasandMambas Weaknessinmuscles Severemusclecramps

2.4.4.2 Managementofsnakebites
Safety DetermineLOC Initialassessment Calmandreassure Cleanthewound Applyarestrictingbandagedistaltoproximal Treatanyotherinjuries Trytoidentifythesnake Transport

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