Transcript Slide 1
کمک های اولیه در
گزش جانوران
دکتر محمد تراز
گروه داروسازی بالینی دانشگاه علوم پزشکی تهران
فروردین 1394
انواع گزش ها
مار گزیدگی
عقرب گزیدگی
زنبور زدگی
سایر حشرات مثل عنکبوت .....
مار گزیدگی
Snake venom is a complex heterogeneous solution &
suspension of various proteins, peptides, lipids, carbohydrates,
& enzymes, including ribonuclease & deoxyribonuclease,
kinins, leukotrienes, histamine, phospholipase, serotonin,
hyaluronidase, acetylcholinesterase, collagenase,
procoagulants & anticoagulants, cardiotoxins, hemotoxins &
neurotoxins.
Clinical Manifestations
Local tissue damage
Neurotoxicity
Hypotension & shock
Coagulopathy
Rhabdomyolysis
Nephrotoxicity
Non-specific systematic (nausea & vomiting,
dizziness, abdominal pain)
Ascending subcutaneous hemorrhagic ecchymosis
developed within 9 hours after envenomation to the foot.
Envenomation Severity
Grade
Features
Grade 1
Fang marks may be seen, but no local or systemic
symptoms after 8-12 h
Grade 2
Minor local swelling & discomfort only, with no systemic
symptoms or hematologic abnormalities
Grade 3
Grade 4
Progression of swelling beyond area of bite, with local
tissue destruction, hematologic abnormalities, or systemic
symptoms
Marked progressive swelling &pain, with blisters,
bruising, & necrosis; systemic symptoms such as
vomiting, weakness, tachycardia, hypotension, &severe
coagulopathy
The major aspects of snake bite
treatment include:
Field management
Hospital assessment
Hospital management
Field Management
Initial first aid of envenomation is directed at
reducing the spread of venom &
expediting transfer to an appropriate
medical center.
General principles
The patient should be removed from the
snake's territory, kept warm & at rest, & be
reassured.
The injured part of the body should be
immobilized in a functional position below
the level of the heart.
The wound should be cleansed
Attempt to identify the snake, without
endangering the patient or rescuer.
A digital photo taken at a safe distance
may be useful.
Snake parts should not be handled directly.
The bite reflex may remain intact in recently
killed snakes, possibly being able to inflict a
bite.
Transport the patient to the nearest medical
facility as quickly as possible.
Pressure immobilization
Techniques to avoid
Tourniquets
Techniques to avoid
Incision
Techniques to avoid
Oral suction
(can introduce bacteria into the wound)
Techniques to avoid
Cryotherapy
Treatment strategies
Antivenom therapy
Supportive therapy
Antivenom
Antivenin is made by injecting horses with toxins
from venomous snakes & then monitored to make
sure they survive.
Then after the horse builds up an immunity the
blood is extracted & processed into antivenin.
Antivenom Therapy
Antivenoms are generally indicated when:
There is evidence of systemic envenomation
(neurotoxicity, coagulopathy, rhabdomyolysis,
persistent hypotension, and/or renal failure).
There is severe local envenomation, manifested
by local tissue destruction.
میزان تجویز پادزهر:
مسمومیت خفیف 2 :تا 5آمپول
مسمومیت متوسط 5 :تا 10آمپول
مسمومیت شدید 10 :تا 20آمپول
معموال نیمی از این مقدار را در طی نیم تا یک ساعت انفوزیون وریدی
می کنند و بقیه در طی 12تا 48ساعت تزریق می گردد.
Antivenom Dosage in Children
Since snakes inject the same quantity of
venom into children & adults, the dosage
of antivenom for all patients should be the
same, regardless of age or weight.
عقرب گزیدگی
گونه از آنها6 گونه هستند كه23 عقربهاي شناسائي شده در ايران
.خطرناكتر و فراوانتر هستند
Scorpion venoms are complex mixtures containing
mucopolysaccharides, hyaluronidase, phospholipase,
acetylcholinesterase, serotonin, histamine, protease
inhibitors, histamine releasers, and neurotoxins.
Neurotoxins are the most important venom
constituents in human envenomations.
Buthotus saulcyi عقرب دم سياه
Mesobothus eupeus عقرب زرد
Buthotus schach عقرب سياه پرزدار
Hemiscorpios leptorus عقرب گاديم
Androctonus crassicoda عقرب سياه
Odontobothus dorieaعقرب اودونتو
بیش از 70درصد از عقرب گزیدگی ها صرفا دردی شبیه زنبور زدگی
ایجاد می کنند.
عالم موضعی مثل خارش ،قرمزی و التهاب ممکن است در محل نیش
زدگی مشاهده گردد.
عالئم سیستمیک از قبیل تحریک پذیری ،تاکیکاردی ،تنگی نفس ،تهوع
و استفراغ و ...ممکن است مشاهده گردد.
اقدامات اولیه شبیه مارگزیدگی
اقدامات حمایتی
درمان با پادزهر
درمان با پادزهر
تجویز یک یا دو آمپول از راه وریدی یا عضالنی جهت
بهبودی و درمان اغلب بیماران کافی است.
زنبور زدگی
Most people develop only minor local
reactions, but patients with venom allergy
are at risk for systemic allergic reactions
(ie, anaphylaxis), which can be particularly
severe and are a leading cause of
anaphylaxis fatalities.
Venom
Histamine
Melittina –membrane active polypeptide
that can cause degranulation of basophils
and mast cells, constitutes more than 50 %
of the dry weight of bee venom
Stinger Removal
Stingers should be removed as rapidly as
possible after a sting by any means possible,
because venom can continue to be released
for several seconds.
A typical local reaction to a Hymenoptera sting is
redness & an area of painful swelling (1 to 5 cm) at
the site of the sting that develops within minutes &
resolves within a few hours.
Uncomplicated local reactions may be treated with cold
compresses.
Approximately 10 % of individuals
develop exaggerated redness &
swelling at the site of the sting that
gradually enlarges over 1 to 2 days.
This response is called a large local
reaction (LLR).
The area of swelling typically
measures about 10 cm in diameter.
Treatment of LLRs is based upon symptoms.
Cold compresses are soothing acutely
Oral prednisone, 40 to 60 mg given as a single dose or
rapidly tapered over 2 to 5 days, may help reduce
significant swelling.
NSAIDs can reduce pain.
Pruritus can be treated with oral antihistamines
(eg, cetirizine, 10 mg once daily) and high potency topical
corticoid steroids (eg,fluocinonide 0.05% or clobetasol 0.05
% ointment, applied Q4 h) until the itching subsides.
END