Venomous snake bites are medical emergencies.

SNAKE BITES

Children between 1-9 years old are the most common victims. Greatest number of bites occurs during the daylight hours and early evenings of summer. Most common site: upper extremity Pit vipers-most frequent poisonous snake biters.

Clinical Manifestations
Edema Ecchymosis Hemorrhagic bullae Symptoms: lymph node tenderness, nausea & vomiting, numbness, metallic taste in the mouth

Management
Initial first aid: -have the person lie down. -remove constrictive items -provide warmth -cleanse and cover the wound with light dressing -immobilize the injured part below the level of the heart -check ABC. -DO NOT apply ice or tourniquet to the injured site.

There is no specific protocol for the treatment of snake bites. Parenteral fluids are used to treat hypotension. The patient is observed closely for 6 hours.

Administration of Antivenin
An antitoxin used to treat snake bites. Should be administered within 4 hours after the snake bite. 2 kinds: A. Antivenin Polyvalent (ACP) B. Crotalidae Polyvalent Immune Fab Antivenin (FabAV) Perform skin or eye test to detect hypersensitivity to antivenin. Before administering antivenin and every 15 mins, the circumference of the affected part is measured. Premeds (dipenhydramine or cimetidine) are indicated to decrease allergic response. Administered through IV infusion.

Initial Evaluation in the ED

If the snake is venomous or nonvenomous Where and when the bite occurred and its circumstances. Sequence of events and S/S Severity of poisonous effects VS Circumference of the injured site Lab. Data ( CBC, urinalysis and coagulation studies)

Insect Stings

an extreme sensitivity to the venoms of insects (order Hymenopter )

bees hornets yellow jackets fire ants Wasps

Venom allergy IgE-mediated reaction and it constitutes an acute emergency can trigger anaphylaxis stings of the head and neck or multiple stings are serious

Clinical manifestations
generalized urticaria itching malaise anxiety due to laryngeal edema to severe bronchospasm shock death Generally, the shorter the time between the sting and the onset of severe symptoms, the worse the prognosis

Management

stinger removal .The stinger is removed with one quick scrape of a fingernail over the site. Wound care with soap and water is sufficient for stings.

**Scratching is avoided because it results in a histamine response. Ice application reduces swelling and also decreases venom absorption.

An oral antihistamine and analgesic will decrease the itching and pain Desensitization therapy should be given to people who have had systemic or significant local reactions.

Patient and family education is an important measure in preventing exposure to stinging insects