Name That Poisonous Beast! (part 2)

It’s part 2 of “Name that Poisonous Beast!”.  Here we go!

Name this poisonous beast!

A)

And his slithery friend…

B)

And what about this guy?

C)

• A) Rattlesnake (pit viper) [Crotalinae]: venom with digestive enzymes and spreading factors
  • In family with Cottonmouths and Copperheads
  • Local effects: pain and edema progress to ecchymosis and bullae (mark borders)
  • Systemic effects:
    • Nausea/vomiting/diarrhea, weakness, lightheadedness, diaphoresis, chills
    • Hypotension, tachycardia, tachypnea
    • Coagulopathy: elevated PT/INR, dec platelets, dec fibrinogen, inc FSP
    • Neurotoxicity: oral paraesthesia (metallic), fasciculations, AMS, seizures
    • Rare complications: compartment syndrome, rhabdomyolysis, shock, direct cardiotoxicity/allergy to venom
  • Treatment:
    • Pre-hospital: supportive care/extremity in functional position at level of heart
      • NOT recommended: tourniquets, incision and oral suction of venom
    • ED: supportive care, wound care/tetanus, antivenom (Crofab) for mod/severe envenomation and/or bite site close to airway; transfusion (pRBC, FFP, platelets) only if sig bleeding s/p antivenom
      • Start with 4-6 vials, then either maintenance therapy (2 vials q6h x3) or continued dosing based on symptom resolution; prep for allergic rxn
• B) Coral Snake (Elapidae) [Micrurus]: neurotoxic venom (competitive inhibition of muscarinic acetylcholine receptors; pre- and/or post-synaptic binding)
  • Local effects: no pain to mild pain/swelling, paraesthesia
  • Systemic effects:
    • Nausea/vomiting, abdominal pain, dizziness
    • Within 12 hours neurotoxicity: bulbar paralysis (ptosis, opthalmoplegia, dysphagia, dysarthria) generalized weakness—>resp depression/failure, rarely seizures
    • Rare: local tissue damage, coagulopathy (with Micrurus lemniscatus halleri)
  • Treatment:
    • Prehospital: supportive care/extremity in functional position below level of heart
      • NOT recommended: tourniquets, incision and oral suction of venom
    •  ED: Wound care/tetanus, respiratory support, antivenom for all envenomations
      • North American snake: 3-5 vials antivenom but up to 10+ vials; prep for allergic rxn
      • If no antivenom available, atropine/glycopyrrolate prior to neostigmine (only works if blockade is post-synaptic)
• C) King Snake: harmless!
  • “Red on yellow, kill a fellow; red on black, venom lack”