snake bite
Introduction
Introduction to snake bites The cause of the disease after the snake bite is due to the snake venom secreted in the venom gland, mainly composed of protein, polypeptide and various enzymes. Snake venom can be divided into neurotoxin and blood toxin. The former has damage to the central, peripheral nerve and neuromuscular conduction functions, which can cause convulsions, paralysis and respiratory paralysis; the latter causes damage to the cardiovascular and blood system, causing arrhythmia. Circulatory failure, hemolysis, and hemorrhage. Mainly found in rural areas in southern China, mountainous areas, more incidence in summer and autumn. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious Complications: shock, coma
Cause
Cause of snake bite
Cause (80%):
Bitten by a poisonous snake.
Classification of venomous snakes: 1. Venomous snakes with neurotoxicity: there are golden snakes, silver snakes and sea snakes. The venom mainly acts on the nervous system, causing muscle paralysis and respiratory paralysis. 2, blood poisonous snakes: bamboo leaves green, python and turtle shell snake, venom mainly affects the blood and circulatory system, causing hemolysis, bleeding, blood clotting and heart failure. 3. Venomous snakes with both neurotoxicity and blood toxicity: there are pythons, large cobras and cobras, and their venoms have two characteristics of neurotoxicity and blood toxicity.
Active ingredients of snake venom : 1. Neurotoxicity: mainly acts on the nervous system. 2, heart poison: mainly affects the heart caused by heart failure. 3, cytotoxicity: blood cells can be destroyed, vascular endothelial cells are necrotic. 4, prothrombin: can cause thrombosis. 5, a variety of enzymes: can cause hemolysis and tissue destruction.
Toxicity of snake venom : The toxicity intensity of various venom venoms is different. Some venomous snakes have high mortality after injury, and some only cause symptoms.
Pathogenesis
Snake venom can be divided into neurotoxin and blood toxin. The former has damage to the central, peripheral nerve, neuromuscular conduction function, etc., which can cause convulsions, paralysis and respiratory paralysis; the latter causes damage to the cardiovascular and blood system, causing arrhythmia, Circulatory failure, hemolysis and hemorrhage, due to phospholipase A in snake venom and histamine released by polar body, serotonin, bradykinin, etc. cause increased permeability of local blood vessel wall, extravasation of plasma, and obvious edema.
Prevention
Snake bite prevention
Snake bites seriously threaten the health of the majority of workers. Active prevention measures should be taken in areas with the greatest harm to minimize the incidence of snake bites and reduce mortality. First, we must establish a comprehensive snake injury prevention network. It will be implemented from the organization and manpower, so that the task is clear, the person is responsible, and secondly, the masses should be mobilized to do a good job of environmental sanitation around the house, completely eliminate the weeds, clean up the rocks, block the caves, eliminate the hidden places of the snakes, and often carry out Kill snakes and catch snakes, and at the same time do a good job in preventing basic snakes. Persons engaged in labor production in the wild should drive the snakes with sticks before entering the grass. When working and standing on the mountain jungle, they should always pay attention to the surrounding situation and eliminate hidden dangers in time. They should wear long-sleeved tops, trousers and shoes. Socks, wear a straw hat if necessary, do not panic when encountering a poisonous snake, should use the left and right turn to avoid the chasing snake, or stand in the same place, facing the viper, pay attention to the situation to avoid, look for opportunities to pick up the branches Self-defense, rubbing anti-snake liquid and mouth-snake wound detoxification tablets can all play a role in preventing snake wounds.
Complication
Viper bite complications Complications, shock, coma
Severe paralysis, shock, coma, convulsions, respiratory paralysis and heart failure.
Symptom
Symptoms of snake bites Common symptoms Capillary leak syndrome, fatigue, nausea, abdominal bleeding, diplopia, diarrhea, nasal discharge
After being bitten by a poisonous snake, the speed and severity of the symptoms of the patient are significantly related to the type of snake and the dose and nature of the snake venom. Of course, the location of the bite, the depth of the wound and the patient's resistance also have a certain impact. When the snake poisons people in a state of hunger, the amount of detoxification is large and the consequences are serious.
(1) The manifestation of nerve poisoning: numbness in the wound, loss of consciousness, or only slight itching, redness and swelling of the wound are not obvious, bleeding is not much, about half an hour after the injury, feeling dizzy, lethargy, nausea, Vomiting and fatigue, severe dysphagia, hoarseness, aphasia, drooping eyelids and diplopia, and finally dyspnea, blood pressure drop and shock, resulting in hypoxia, cyanosis, body sputum, if the rescue is not timely, the last breath And circulatory failure, the patient can die quickly, the nerve toxic absorption is fast, the risk is high, and the local symptoms are light, often overlooked, the first 1-2 days of the injury is a dangerous period, once through this period, the symptoms can be It will soon improve, and there will be no sequelae after the cure.
(2) The performance of blood poisoning: The local part of the bite is swollen rapidly, and it develops continuously to the near side. The wound is severely painful and bleeding. The skin around the wound is often accompanied by blisters or blood bubbles, subcutaneous ecchymosis and tissue necrosis. In severe cases, extensive systemic hemorrhage, such as subconjunctival hemorrhage, nasal discharge, hematemesis, hemoptysis and hematuria, etc., individual patients may also have chest, abdominal hemorrhage and intracranial hemorrhage, and finally lead to hemorrhagic shock, patients with head and tail, nausea , vomiting and diarrhea, joint pain and high fever, because the symptoms appear earlier, the general treatment is more timely, so the mortality rate can be lower than the patients with neurotoxicity, but because of the acute disease, the disease course is longer, so the dangerous period is longer. The treatment is too late and the consequences are serious. After the cure, there are often sequelae of local and internal organs.
(C) the performance of mixed poisoning: both neurotoxic and blood poisoning symptoms, from the local wounds, similar to blood poisoning, such as local redness, ecchymosis, blood sputum, tissue necrosis and lymphadenitis, etc. Look, it is similar to nerve poisoning, the cause of death of such wounds is still mainly neurotoxic.
Examine
Snake bite check
General patients can do routine blood and urine tests, serious patients should also do biochemical and physical auxiliary examinations (such as electrocardiogram, heart enzyme, urea nitrogen, liver function, creatinine, electrolytes, etc.), in order to understand the progress of the disease, to determine the prognosis Master the initiative.
Diagnosis
Diagnosis and identification of snake bites
diagnosis
Consider the following issues when diagnosing snake bites
(1) Whether it is a snake bite: First, it is necessary to clarify the possibility of a snake bite. Other animals can also cause injury, such as an entertaining bite, a wasp chewing, but the latter is not typical. Snakes have dents and have their own characteristics: for example, after the bite, there are two spotted dents arranged in a row, and the wasps or scorpions are partially scattered and scattered. In general, the sputum is injured. After that, the wound was small and there was no obvious systemic symptoms.
(2) Whether it is a snake bite: it is mainly distinguished by special tooth marks, local injuries and systemic manifestations. After the bite of the snake, there are often a pair of or 3 to 4 fangs in the wound, and the surrounding area is obviously swollen and painful. Or numbness, local ecchymosis, blisters or blood bubbles, systemic symptoms are also more obvious, after the non-venomous snake bite injury, local can leave two rows of zigzag tooth marks.
(3) Which kind of venomous snake bite: It is difficult to accurately determine which venomous snake is causing injury. From the characteristics of local wounds, the nerve venomous snake wound and the blood poisonous snake wound can be initially distinguished, and then according to the unique clinical Performance and reference tooth distance and tooth mark morphology can further determine the type of viper. For example, the pupil of a cobra bite often shrinks. Hematuria can occur within half an hour after a bite of a viper, and diplopia can occur after a bite of a viper.
The head of the snake is slightly triangular, with a brightly colored pattern on the body. The upper jaw has pairs of fangs that can be distinguished from non-venomous snakes. The fangs are grooved or tubular and communicate with the venom gland. When the muscles in the gland are contracted, The snake venom is discharged through the catheter into the fangs and injected into the bitten person and animal.
After being bitten by a poisonous snake, the patient's symptoms appear to be fast and slow, and the severity of the snake and the snake species. The dose and nature of the snake venom have a significant relationship. Of course, the location of the bite, the depth of the wound and the patient's resistance also have a certain impact. The snake is in starvation. When actively injuring people, the amount of detoxification is large and the consequences are serious.
Differential diagnosis
A number of fine and shallow scallops can be seen in the wound, arranged in an elliptical zigzag shape, without obvious local swelling and pain and lymphatic system inflammation, and no systemic symptoms, and most of them are non-venomous snakes.
(1) The main difference between poisonous snakes and non-venomous snake bites
Project / Viper / Non-venomous Snake
Tooth marks / 3-4 large tooth marks, deep, purple black (except silver ring snake, sea snake) / tooth marks are small, light, pale, jagged.
Pain/burning, pain, range expansion, (except for the silver ring snake) / pain, no expansion, no significant increase.
Swelling / red, swollen marked, rapid expansion, (except silver ring snake, sea snake) / redness does not significantly expand.
Bleeding/frequent bleeding, surrounding freckles, blisters/less bleeding or no bleeding, no spots, blisters.
Lymph nodes / proximal lymph nodes, tenderness / no swelling, no tenderness.
Systemic symptoms / different types, different symptoms / no.
(2) Identification with bee stings
The main components of bee venom are formic acid, neurotoxin, and histamine. Some bee venom can cause hemolysis and hemorrhage. The main manifestations are local redness, swelling, pain, sometimes fever, headache, etc. There may be systemic urticaria, allergic shock, throat sputum, etc., but no local tooth marks can be seen, combined with the injured environment or medical history can be identified with snake bites.
(3) Identification with bites
The venom contains toxic components like bee venom, such as histamine-like substances, hemolytic proteins, etc. The clinical manifestations include local redness, swelling, pain, or local lymphangitis and tissue necrosis. The whole body may have fever, headache, nausea, vomiting, etc. , or have an allergic shock, etc., no local tooth marks, can be distinguished from snake bites.
(4) Identification with scorpion
The poisonous power of the poisonous cockroach in Northeast China is close to that of cobra venom, which can be fatal. The toxic components are mainly neurotoxins, hemolytic toxins, hemorrhagic toxins, etc., local pain after bruises, no redness and swelling. After being bruised, it is characterized by rapid breathing, runny, sweating, body aches, mouth and tongue muscle rigidity, involving Myocardium has hypotension, pulmonary edema, etc., mainly based on local toothless marks and injured environment, it is not difficult to distinguish with snake bites.
