Emergency Nursing For Bites, Stings, And Lightening

Front 1

Bites

How many poisonous snakes are in N. America?

What are the names of these poisonous snakes?

Back 1

1) Two
2) Crotalidae and Elapidae

Front 2

Snakes

What do Crotalidae (pit viper) snakes look like?

Back 2

--Depression between each eye and nostril that serves as a heat sensitive organ for locating warm-blooded prey --North pit-vipers- triangle shaped head, 2 retractable curved fangs

Front 3

Snakes

What are some common traits of Elapidae snakes?

Back 3

* All are venomous, some highly venomous
* Have hollow, fixed fangs used to inject venom
* Most have long, slender bodies with smooth scales
* Most Elapidae are oviparous, meaning they lay eggs
* Most are active hunters (as opposed to ambush predators)

Front 4

Snake Bites

Examples of Elapidae snakes?
Examples of Crotalidae snakes?

Back 4

1) Coral, Sea Snakes
2) Rattlesnakes, copperheads, and water moccasins.

Front 5

Snake Bites

Describe coral snakes?
Describe north pit vipers?

Back 5

1) non-aggressive with neurotoxic venom, short fixed fangs.

2) triangle shaped head, 2 retractable curved fangs

Front 6

Snake Bites

Describe the pathophysiology of a snake bite?
What do venomous bites cause?
What does these lead to?

Back 6

1) The primary function of venous if to immobilize, kill, aid in digestion of prey.
2) Causes local and systemic toxic effects because the enzymes breakdown human tissue protein.
3) -- Alters the membrane integrity -- Impairs blood clotting
-- Tissue necrosis
-- Massive tissue swelling
-- Intravascular fluid shifts
-- Hypovolemic shock
-- Pulmonary edema
-- Renal failure

Front 7

Snake bites

Local S/S
Systemic S/S

Back 7

1) Puncture wounds, severe pain, swelling, redness, ecchymosis
2) Minty, rubbery metallic taste in mouth, tingling and paresthesis of the scalp, face and lips, muscle fasciculation (muscle twitching), weakness, nausea, vomiting, hypotension, seizures, coagulopathy or DIC

Front 8

Snake bites

What are the manifestations based on?

Back 8

Type and amount of venom injected.
The bite location, age, size and health status of the victim.

Front 9

Snake Bites

What are NON-MEDICAL interventions for snake bites?
What are MEDICAL interventions for snake bites?

Back 9

1) -- Move person away from snake.
-- Rest to decrease circulation of the venom.
-- Keep extremity below level of the heart.
-- No alcohol or stimulants.
-- Apply bandage proximal to the site- if treatment is delayed.
2) -- Supplemental O2.
-- 2 large bore IV’s, NSS or LR.
-- Cardiac monitoring
-- Tetanus
-- Antibiotics
-- Antivenom [norm. effective within 4 hours (CroFab)]
-- Serum sickness can occur from antivenom- comes from horse serum

Front 10

Snake Bites

What lab studies would be done?

Back 10

Coagulation, CBC, creatinine, kinases, type and cross, UA and EKG

Front 11

Snake Bites

Coral Snakes:
Found where?
Fangs are?
Venom?
What does the snake look like?

Back 11

1) S.E. USA (TX and AZ)
2) Small and fixed
3) Post synatapic neurotoxin and myotoxin
4) Bands of black, red, and yellow that completely encircles the body.

Front 12

Snake Bites

Coral Snakes
Describe the path. of their venom?
When does this happen?
Early s/s?

Back 12

1) Venom blocks the binding of acetylcholine at the postsynaptic junction
2) 12-13 hours post-bite
3) n/v, headache, pallor and abdominal pain
4) paresthesias, numbness, mental status changes, cranial nerve and peripheral nerve deficits

Front 13

Snake bites

How should a coral snakebite be medically managed?

Back 13

-- Compression dressing that doesn't restrict blood flow.
-- Continuous cardiac monitoring
-- Vital signs
-- Antivenom
-- Any past reaction to venom?

Front 14

Brown Recluse Spider

What are their bites famous for?
Why are they brown?

Back 14

1) Causing ulcerative lesions
2) Hide on dark, secluded boxes, closets, basements, sheds, garages, luggage, shoes, clothing and sheets.

Front 15

Brown Recluse Spider

What type of effects does it have on the tissue?
What would the site look like at 1st?
Days 1-3?

Back 15

1) Cytotoxic effects= painless or sharp pain
2) bleb or vesicle surrounded by edema and erythemia
3) Toxins spread to become a necrotic, eschar.

Front 16

Brown Recluse Spider

Medical interventions?
S/S?
Could lead to?

Back 16

1) Surgerical interventions
2) n/v, fever, chills, malaise, joint pain, and petechiae.
3) Hemolytic reactions, renal failure and death.

Front 17

Brown Recluse Spider

Interventions for these bites?
What should be done during 1st 4 days?
Why?
What should you never do?

Back 17

1) Cold compresses, rest and elevation, sterile dressing, antibiotics, debridement and skin grafting.
2) Apply cold compress
3) Assist in decreasing the enzymatic activity of the venom and may limit tissue necrosis.
4) NEVER apply heat to the site

Front 18

Black Widow Spider

Where do they live?
Preference?
Type of venom?
Usual prey?

Back 18

1) Every state except Alaska
2) Cool damp environment
Outdoor log piles
Vegetation and under rocks
Inhabit barns, sheds, and garages
3) Neurotoxic venom
4) Small lizards and snakes.

Front 19

Black Widow Spider

What does a bite look like?
Clinical s/s?
s/s?

Back 19

1) Tiny papule or small red puncture site. Intense pain at the site. Usually only experience a local reaction.
2) Latrodectism: the venom causes neurotransmitter release from nerve terminals.
3) severe abdominal pain, muscle rigidity, spasm, hypertension, n/v, facial swelling, ptosis, diaphoresis, weakness, increased salivation, priapism, increased respiratory secretions.

Front 20

Black Widow Spider

NON-MEDICAL interventions for a bite?
MEDICAL interventions for a bite?
Is Antivenom used?

Back 20

1) Apply ice to site, inhibits the action of the neurotoxins
2) Vital signs
Supportive therapy
Pain medications
Valium
Tetanus
Antihypertensive agent
3) Antivenom- not used often

Front 21

Tarantulas

Where can they be found?
What does their venom do?
Describe another defense mechanism of theirs?
Why?

Back 21

1) Found on tropical and subtropical areas of the U.S.
2) Paralyzes prey and causes muscle necrosis and local effects

Front 22

Tarantulas

Describe another defense mechanism of theirs?
What does it cause?

Back 22

1) Launching the urticarting hairs in their dorsal abd. area towards victims.
2) Hair penetrates the skin, eyes and causes severe inflammatory response

Front 23

Tarantulas

S/S of bite?
Interventions?
Tidbit?

Back 23

1) Pain, Swelling, Redness, Numbness, Lymphangitis, Intense itching that can last up to several weeks
2) Supportive, Analgesics,
3) Use sticky tape to remove the hairs. Then, irrigate the skin.

Front 24

Scorpions

Where are they found?
How do they sting you?

Back 24

1) Anywhere if they are a pet, in luggage or packages. Bark scorpions can be found in trees, wood piles and debris
2) Device in tail injects venom.

Front 25

Scorpions

S/S of a sting?
S/S of a bark scorpions?
Could L/T?
Duration?

Back 25

1) Local pain, Inflammation and mild systemic reactions.
2) Neurotoxic= cranial nerve and musculoskeletal system
3) respiratory failure, pancreatitis
4) Max intensity in 5 hours

Front 26

Scorpions

Interventions?

Back 26

1) Vital signs
Assessment and continuous monitoring.
Apply ice to site for pain control
Tetanus prophylaxis and basic wound care
Analgesic and sedatives for pain control

Front 27

Bee and Wasps

Pathophysiology of a sting?
S/S?

Back 27

1) Discomfort to the severe pain and life threatening anaphylaxis.
Stings can be done repeatedly.
2) Immediate pain, wheel and flare reaction, generalized edema, n/v/d

Front 28

Bee and Wasps

Sting intervention?
What do you do if allergic to sting?

Back 28

1) Remove the stinger, apply ice to site, avoid pinching the stinger,
brush off or gently scrap.
2) Administer Epi Pen, Benadryl, Steroids, and beta 2 antagonist ( Pepcid)

Front 29

Lightening

Who's at risk?
How many volts in high voltage electricity?
Lightening strike?

Back 29

1) Anyone without adequate shelter is at risk
2) > 1000 Volts
3) > 1 million volts

Front 30

Lightening

Risks (why?)

Back 30

-- Cardiopulmonary and central nervous system are affected
-- A massive current can cause either asystole or ventricular fibrillation
-- Prolonged arrest can cause hypoxia
-- Myocardial injury can occur
-- Temporary paralysis
-- Loss of consciousness
-- Amnesia
-- Confusion and disorientation

Front 31

Lightening

Interventions for it?
Tidbit?
Medical Interventions?

Back 31

1) Monitoring for injuries
Spinal immobilization
ABC’s
3) There is no danger for rescuer of being electrocuted
3) Vital signs
Cardiac monitoring
EKG
Labs (Ck, CKMB, BUN, Creatine)
Tetanus prophylaxis