1. Animal Poisoning (Envenomations) بسم الله الرحمن الرحيم Animal Poisoning (Envenomations) د / عبد المنعم جودة مدبولى دكتوراة الطب الشرعى و السموم الأكلينيكية, مدرس الطب الشرعى و السموم الأكلينيكية, استشاري علاج التسمم بمستشفى بنها الجامعى

2. Objectives (ILOs) Objectives (ILOs): Types & Incidence. Study of some types: Snake & Scorpion (Snake & Scorpion) 1. 1. Animal ch.ch.. 2. 2. Mechanism of action 3. 3. Clinical presentation 4. 4. Diagnosis & DD. 5. 5. Treatment & prevention.

3. Types & incidence Types & incidence: 50% …………. Insect sting. 30% ………… Snake bite. 14% ………… Spider bite. 6% other ………………. الأحصاءات هنا فى مصر؟؟؟؟؟؟؟؟؟؟؟

4. Snake bite

5. Poisonous & Non-poisonous snakes: Non Poisonous Snakes: Head – ---------- Rounded Fangs - --------- Not present Pupils –--------- Rounded Anal Plate ----- Double row of plates Bite Mark ------ Row of small teeth. Poisonous Snakes: Head -------- Triangle - except Cobra Fangs –--------- Present Pupils ----------- Elliptical pupil Anal Plate ------ Single row of plates Bite Mark ------ Fang Mark

6. Mechanism of toxicity Localdamage(cytotoxic) Proteolytic enz. Hyalourinidaze enz. Phospholipase enz. Systemiceffects Hemotoxic (hemorrhage): 1- + prothrobin, factors V,X, Ptn. C 2- fibrinogen ---- fibrin 3- -- Platelet aggreg. Neurotoxic (paralysis): 1- NM- blocking. 2- not penetrate BBB

7. C/P of Snake bite: عاما “ Local symptoms: Fang marks, Pain, Inflammation, swelling Systemic effects: - Paralytic …… - Vasclutoxic …. - Myotoxic …….. + (CNS, GIT, Autonomic,.)

8. I- Elapidae (Cobra or Krait): Mild Local symptoms: Mild Local symptoms: 1- No swelling 1- No swelling 2- painful + necrosis 2- painful + necrosis Marked Neurotoxic effects: Marked Neurotoxic effects: 1. 1. Earliest symptom – Vomiting, Shock and Muscle weakness. 2. 2. Early paralysis: Ptosis- inability to keep Eyes open. 3. 3. Spreading Paralysis -causing difficulty in speaking and breathing, Salivation,. Frothing around mouth.

9. II- Viperidae : Local symptoms : 1- Severe swelling (massive) 2- Pain + Necrosis Vomiting, shock (early e’in 30 mints). Vasculotoxic Marked Vasculotoxic effects. Bleeding from mucous membrane of the Mouth, Nose and hemorrhages under the skin.

10. III- Hydrophidae ( Sea Snakes): No Local symptoms. Severe Pain while (myalgia). Severe Pain while moving Neck, Trunk and Limbs. A few hours later (myalgia). Acute renal failure Myoglobin Acute renal failure = Urine turns Brown to Black due to the presence of muscle protein Myoglobin.

11. Management: I- Basic first-aid techniques (Pre-hospital): calm Remain calm. Immobilize with a splint Immobilize with a splint the bitten area and keep it at body level. Allow wound to free bleed <30 sec Wash with soap & water Allow wound to free bleed <30 sec, Wash with soap & water. medical help Get medical help. +/_ a bandage +/_ If a victim is unable to reach medical care within 30 minutes, a bandage, wrapped two to four inches above the bite, may help slow venom.

12. A suction device (Extractor) A suction device (Extractor) may be placed over the bite to help draw venom out of the wound without making cuts. Suction instruments often are included in commercial snakebite kits.

13. Allay anxiety and fright: Deathsshock due to fright Deaths have been reported from shock due to fright even when the bites were by non- poisonous snakes. 1. Not all snakes are poisonous. 2. Not all poisonous snakes are fully charged with venom. 3. Even those that are fully charged do not always inject a lethal dose. Keep bitten extremity at body level Keep bitten extremity at body level, when the person is lying. Raising it can cause venom to travel into the body. Holding it down, can increase swelling.