DR KAPIL RATHOD,MD

CONSULTANT PHYSICIAN
 MEDICAL EMERGENCIES
• REGULAR EMERGENCIES • MLC- EMERGENCIES
1. HEART FAILURE 1. SNAKE BITE
2. MI 2. SCORPION BITE
3. CVA 3. OP POISONING
4. CONVULSIONS 4. ACID INGESTION
5. ASTHMA 5. PHENYL INGESTION
6. COPD 6. METHANOL POISONING
7. DKA 7. ALPHOS POISONING
8. ANAPHYLAXIS
SNAKE BITE
 CLASSIFICATION
• NEUROTOXIC- COBRA, KRAIT

• HEMATOTOXIC- RUSSEL VIPER, SAW SCALED

VIPER

• MYOTOXIC- SEA SNAKE

• 4 IN EVERY 1 LAC DIES IN INDIA
• 30% VENOMOUS BITES
• NON VENOMOUS BITES / DRY BITES
• TIMING OF BITE
• LOCAL SYMPTOMS
• SYSTEMIC SYMPTOMS
• VITALS
• IMPENDING RESPIRATORY FAILURE (SBC>30,BREATH
HOLDING >45 SEC AFTER DEEP INSPIRATION)
• REMOVAL OF TORNIQUET
 INESTIGATIONS
• CBC,RFT,LFT,PT-aPTT-INR,RBS,S.NA,S.K,ABG
• URINE R M
• ECG
• USG ABDO KUB
• 20 MIN WBCT (2ML BLOOD IN GLASS TUBE, SEE
CLOTTING AT 20 MIN, 1 HRLY FOR 3 HRS, 4 HRLY FOR 24 HRS)
 TREATMENT
• ASV- ANTI SNAKE VENOM (COBRA-KRAIT-RUSSEL
VIPER-SAW SCALED VIPER, SAME DOSE FOR ALL AGE
GROUPS,NEUROTOXIC 10+10, HEMATOTOXIC 10+10+10,
ANAPHYLAXIS )

• ATROPIN + NEOSTIGMINE (FIRST 0.6mg F/B 1.5mg,

EVERY 30 MINS FOR 5 DOSES 0.6mg F/B 0.5mg, EVERY 2-3 HRS
FOR 5 DOSES 0.6mg F/B 0.5mg) (KRAIT PRESYNAPTIC BLOCK
SO EXCEPTION)
• IVF

• ANTIBIOTICS

• VENTILATOR

• FFP

• SURGICAL DEBRIDEMENT

• IONOTROPS
 SCORPION STING

LENGTH OF SCORPION MASOBATHUS TAMULUS

DOSEN’T RELATE TO ITS MOST TOXIC
TOXICITY but SIZE DO
 WHAT’S IN SCOPRION POISON?
1. NEUROTOXINS/BETA TOXINS- BLOCKS SODIUM &
POTASSIUM CHANNELS,PERSISTENT DEPOLARIZATION
RELEASES MASSIVE ENDOGENOUS CATECHOLAMINES INTO
CIRCULATION, AUTONOMIC STORM
2. HEMOLYSINS
3. HEMORRHAGINS
4. COAGULINS
5. CARDIOTOXINS
6. NEPHROTOXINS

7. SEROTONIN- LOCAL
 SYMPTOMS
• LOCAL- PAIN,SWELLING,REDNESS,PARESTHESIA
• SYSTEMIC- TRANSIENT CHOLINERGIC & PROLONGED
ADRENERGIC..... PROFUSE
SWEATING,HYPERSALIVATION, THICK MUCUS
SECRETION,LACRIMATION,PINPOINT
PUPIL,DIARRHEA,PRIAPISM,ABDOMINAL
PAIN,BRADYCARDIA,HYPOTENSION FOLLOWED BY
TACHYCARDIA,HYPERTENSION,RESTLESSNESS,MYDR
IASIS,HYPERGLYCEMIA,PULMONARY EDEMA,COLD
EXTRIMITIES
 TREATMENT

• LOCAL BLOCK WITH LIGNOCAINE WITHOUT ADR

• NSAIDS
• IVF AND HYDROCORTISONE FOR SHOCK
• PRAZOSIN FOR STORM (1MG FOR ADULT, 30UG/KG FOR PEDIATRIC,1ST
DOSE HYPOTENSION,REPEAT AFTER 3 HRS AND THEN 6 HRLY,MAX 5MG
PER 24 HR,GIVEN IRRESPECTIVE OF BP IF NO HYPOVOLEMIA
COMPETITIVE ANTAGONIST OF POST SYNAPTIC ALPHA 1 RECEPTOR ,
ALSO INCREASES NITRIC OXIDE)
• IV METOPROLOL
• IV FUROSEMIDE
• IV NTG
• IV DOBUTAMINE IF SHOCK
• ANTI SCORPION VENOM (under RESEARCH)
 METHANOL POISONING
• METHANOL IS NON TOXIC
• METHANOL TO FORMALDEHYDE BY ALCOHOL
DEHYDROGENEASE AND TO FORMIC ACID BY
ALDEHYDE DEHYDROGENASE
• FORMALDEHYDE IS TOO MUCH TOXIC
• FORMIC ACID IS TOXIC
(ACIDOSIS,MITOCHONDRIAL,OCCULAR
TOXICITY)
 SYMPTOMS
• EYES- BLURRING OF VISION,PHOTOBIA,OPTIV
NERVE EDEMA,
• CNS- CONVULSIONS
• CARDIAC- ARRYTHMIA,SHOCK
• RESPIRATORY- TACHYPNEA
• GASTROINTESTINAL- NAUSEA VOMITING
• SIGNS OF METABOLIC ACIDOSIS
• MYDRIASIS
 MANAGEMENT
• BLOOD METHANOL LEVEL (>20MG/DL CONSIDERED TOXIC, OPTIC NERVE DAMAGE
OCCURES AT >30MG/DL)
• ABG
• FUNDOSCOPY
• KEEP PT IN DARK
• LAVAGE WITH CHARCOL
• INJ ETHANOL 10% 10ML/KG IN D5% IV OVER 30 MIN F/B INJ ETHANOL
1.4ML/KG/HR IN D5%
• ORALLY ETHANOL 10% 1ML/KG WITH 200 ML FRUIT JUICE F/B 0.15ML/KG/HR
• TARGET SERUM ETHANOL 100-150MG/DL
• FOMIPIZOLE (BINDS AND INACTIVATE ALCOHOL DEHYDROGENASE) LOADING
15MG/KG OVER 30 MINS F/B 10MG/KG 12 HRLY FOR 4 DOSES F/B 15MG/KG 12
HRLY UNTILL RECOVERY
• CORRECTION OF ACIDOSIS
• SOS HD