MEDI7305 Lecture Notes - Lecture 5: Cotton Swab, Diluent, Hemodialysis

30 views10 pages

apricotchimpanzee245

23 Jun 2018

School

Department

Medicine

Course

MEDI7305

Professor

multiple

For unlimited access to Class Notes, a Class+ subscription is required.

M2b - Snakebite and Envenomation in Rural Setting

Snakebite management

Main aims Slow or prevent venom spreading

Immediate hospital transfer

Get appropriate anti-venom early

Monitor & manage complications

Quick summary

table

Pre-hospital

care

Important to remain STILL and CALM to slow/ prevent venom spreading

Venomous Aus snakebites cause shallow envenomation, allowing venom to

enter lymphatics via

o'Milking action' of active skeletal muscles

oPressure changes within thorax during breathing

oValves preventing backflow

oPulsation of neighbouring arteries (arteries, veins and lymphatics

bundled together in connective tissue sheaths) causing 'physical promotion' of lymph

flow

Movement of adjacent tissues is extremely important in propelling lymph

more rapidly through lymphatics (eg physical activity, passive movements)

CALM - maintain low HR and BP

STILL - avoid activity/ movement

PBI - pressure bandage immobilisation of limb always applied to all patients with

suspected snakebite

Life-saving first aid measure

Utilise within first 4hrs of snakebite for effectiveness

Apply bandage over clothing

Method

Lower limb Remove toe rings, anklets, potentially constrictive

items

Broad 15cm bandage (elastic > crepe bandage)

over site bite, then move distally, then move proximally to cover whole

limb; apply same pressure as for sprained ankle

Leave toe tips unbandaged to check circulation

Splint limb, immobilise completely and transfer to

hospital

Hand or

forearm

Remove rings, watch, bracelets, potentially

constrictive items

Broad 15cm bandage over fingers, then upwards as

far as possible; bandage with elbow in bent position; apply same

find more resources at oneclass.com

Unlock document

This preview shows pages 1-3 of the document.
Unlock all 10 pages and 3 million more documents.

Already have an account? Log in

pressure as for sprained ankle

Leave finger tips unbandaged to check circulation

Splint arm and place in sling, immobilise

completely and transfer to hospital

Trunk Apply firm pressure over bitten area without

restricting chest movement

Immobilise completely and transfer to hospital

Head or neck No specific first aid for bitten area

Immobilise completely and transfer to hospital

Maintain bandage and immobilisation until envenomated and anti-venom given or

envenomation safely excluded

Do vs don't

Do Don't

Mark bite site on

bandage with an X

Write down time

of bite

Write down time

of bandage applied

Regularly check

circulation

Wash

venom off skin

Cut the

bitten area

Suck

venom out of wound

Use a

tourniquet

Try to

catch snake

Hospital care Protocol

find more resources at oneclass.com

Unlock document

This preview shows pages 1-3 of the document.
Unlock all 10 pages and 3 million more documents.

Already have an account? Log in

Immediate care

ABCD + resuscitation protocol

Assessment if effective PBI is in place (otherwise, apply PBI if <4hrs since

bite)

IV access - bloods, urine, bite site swab

Cardiac monitoring + ECG

Urine output monitoring via catheter

Phone expert + aeromedical retrieval service (treat until transfer out)

Observations in hospital for at least 12hrs

Formal bloods for laboratory testing via courier or volunteer

Critical questions

Is this patient envenomated? If so, which anti-venom is required?

Will they die waiting for anti-venom if aeromedical transfer is delayed?

Patient is unlikely to be envenomated if they have normal formal lab tests

on admission AND 1-2hrs after PBI removal AND before discharge home

Further history (AMPLE)

Circumstance - Multiple bites? Time of bite(s)? First aid performed? Time of

PBI application?

Any medications affecting blood clotting?

Any allergies?

Tetanus immunisation up to date?

Previous anti-venom?

Current symptoms and signs

Systemic effects of venom H

eadache

N

ausea

A

bdominal pain

C

ollapse

Neurotoxic effects of venom P

tosis

D

iplopia

W

eak cough

find more resources at oneclass.com

Unlock document

This preview shows pages 1-3 of the document.
Unlock all 10 pages and 3 million more documents.

Already have an account? Log in

Document Summary

M2b - snakebite and envenomation in rural setting. Important to remain still and calm to slow/ prevent venom spreading. Venomous aus snakebites cause shallow envenomation, allowing venom to enter lymphatics via o o o o. Pulsation of neighbouring arteries (arteries, veins and lymphatics bundled together in connective tissue sheaths) causing "physical promotion" of lymph flow. Movement of adjacent tissues is extremely important in propelling lymph more rapidly through lymphatics (eg physical activity, passive movements) Pbi - pressure bandage immobilisation of limb always applied to all patients with suspected snakebite. Utilise within first 4hrs of snakebite for effectiveness. Broad 15cm bandage (elastic > crepe bandage) over site bite, then move distally, then move proximally to cover whole limb; apply same pressure as for sprained ankle. Broad 15cm bandage over fingers, then upwards as far as possible; bandage with elbow in bent position; apply same pressure as for sprained ankle. Splint arm and place in sling, immobilise completely and transfer to hospital.

MEDI7305 Lecture Notes - Lecture 5: Cotton Swab, Diluent, Hemodialysis

Document Summary

Get access

Related Documents

BLG 10A/B Chapter Notes -Regulatory T Cell, Splenic Artery, Adenoid