Wahts your Poison?

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assignment

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  • Watch out Joe!!
  • Joe has been bitten!! What should I do?
  • Apply a pressure bandage that immobilises the limb and transfer Joe to a facility that has antivenom, and if possible try to identify the snake.
  • We need the snake venom detection kit! And we need to check his coags and electrolytes!
  • Joe may be showing signs of neurological damage, with visual disturbances and limb and respiratory muscle weakness
  • I'm confused!
  • double vision
  • Venom induced consumption coagulopathy (VICC) Acitvates the clotting pathway by prothrombin activator toxins and consumption of clotting factors. International normalised ratio (INR) is elevated and activated partial thromboplastin time ( APTT) may be prolonged Fibrinogen is low or undetectable and D-dimer level is very high. Elevated creatine kinase indicates myotoxicity.
  • fibrinogen
  • Administer antivenom and observe for signs of anaphylaxis Release the PBI
  • SUMMARY * Ascertain snake bite and identify * Immobilise the limb with a pressure bandage *Transport to appropriate facility *Resuscitate and give antivenom * Observe for anaphylaxis *Repeat bloods at 6,12 & 24 hours to check for coagulation correction * Continues observation in a critical care area for signs of neurotoxicity, myotoxicity and thrombotic microangiopathy
  • References: Journal article reviewed: Ibister, G, Brown, S, Page, C, McGroubrie, D, Greene, S & Buckley, N, 'Snakebite in Australia: A pratical approach to diagnoses and treatment', Medical Journal of Aurtralia, vol. 199, no. 11, pp. 763 - 768.
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