Term
|
Definition
| Also known as hives or wheals, characterized by large, often transient, irregularly shaped, pruitic, erthematous wheals (cause often unknown). Usually is circumscribed, red or white, edematous, blanches on palpation |
|
|
Term
|
Definition
| Painless, deep subcutaneous swelling, often involving periorbital, circumoral, and facial regions |
|
|
Term
| What is critical to proper identification of urticaria? |
|
Definition
| Pruritis (itching) with a central area (wheal) that can be pale in comparison to the erythematous surrounding area (flare) |
|
|
Term
| How does angioedema present itself? |
|
Definition
| Brawny, nonpitting edema, without well defined margins, may or may not have associated itching, often involves lips, tongue, eyelids, genitalia, hands, or feet, is transient |
|
|
Term
| What are the two types of angioedema? |
|
Definition
| Mast cell-mediated (food allergies or allergic stings) begins within minutes of exposure and resolves in 24-48 hrs, bradykinin induced which is not associated with urticaria or other allergic reactions, has a prolonged time course of 24-36 hrs |
|
|
Term
| What are symptoms of anaphylaxis? |
|
Definition
| Hypotension or shock from widespread vasodilation of dysrhythmia, respiratory distress from bronchospasm or laryngeal edema, gastrointestinal and uterine muscle contraction, flushing, pruritis, urticaria, angioedema, low BP is key characteristic |
|
|
Term
| Describe skin testing for allergic reactions |
|
Definition
| Less expensive, more sensitive, more commonly used, good for IgE-mediated allergies developing within 2 hrs of eating the suspected food |
|
|
Term
| What is the significance of C1-esterase inhibitor deficiency in allergic reactions? |
|
Definition
| Measuring a serum C4 level is an easy screening test for C1-esterase inhibitor deficiency/hereditary angioedema (low result is positive test), used for patients suffering from recurrent angioedema |
|
|
Term
| What are the steps in treating allergic reactions? |
|
Definition
| Asses airway, breathing, and circulation, give epinephrine in cases of anaphylaxis, give antihistamines (H1 and H2 receptor antagonists) as first line agents, corticosteroids, B-adrenergic agonists for bronchospasm, and IV fluids if hypotensive |
|
|
Term
| What procedure should be followed for the discharge of patients with anaphylaxis? |
|
Definition
| Monitored for up to 24 hrs, discharged with injectable epinephrine and educated about possible recurrence of symptoms |
|
|
Term
| How is hereditary angioedema (HAE) passed on? |
|
Definition
|
|
Term
| What are the targets of hereditary angioedema? |
|
Definition
| Usually involves extremities but may involve any external body surface as well as mucosal surfaces, frequently associated with attacks of severe abdominal pain due to swelling of GI submucosa |
|
|
Term
| What are some important things to be aware of with hereditary angioedema? |
|
Definition
| Symptoms become severe over 36 hrs then regress over the next 36 hrs, high incidence of lethal complications, associated with low levels of C1 inhibitor, histamine has NO ROLE in this condition |
|
|
Term
| How is hereditary angioedema trated? |
|
Definition
| Intravenous fresh frozen plasma, commercial C1-INH concentrates (often unavailable), IV fluids, close monitoring of airway (be ready for intubation or tracheotomy) |
|
|
Term
| What people are candidates for skin testing with venom? |
|
Definition
| Any person older than 16 yrs who has experienced a systemic/anaphylactic reaction to a suspected Hymenoptera insect |
|
|
Term
| Brown recluse spiders (violin spiders) have what type of venom? |
|
Definition
| Cytotoxic which affects the cellular tissue around the area of the bite, composed of a collection of hemolytic enzymes that destroy cell membranes, leads to breakdown of skin, fat, and blood vessels |
|
|
Term
| Necrosis of the skin occurs in what percentage of brown recluse bites? |
|
Definition
|
|
Term
| Describe the early symptoms of a brown recluse bite |
|
Definition
| Usually painless and initially go unnoticed, most bites do not cause serious systemic symptoms |
|
|
Term
| Describe the late symptoms of a brown recluse bite |
|
Definition
| May cause long-lasting tissue damage, can have blue-white halo (bulls-eye) surrounding a central area of necrosis (central area is key to proper diagnosis), wound may spread outward and develop severe necrotic lesions with deep wide borders (less frequent), areas with greater adipose more likely to develop severe necrosis |
|
|
Term
| Describe how brown recluse bites are initially managed |
|
Definition
| Get basic lab studies including renal and coagulation studies, diagnosis is made by careful history and physical exam, serious manifestations manifest in 6-8 hrs |
|
|
Term
| How are brown recluse bites treated? |
|
Definition
| Cleanse with soap and water, tetanus immunization, antibiotics for secondary infections, frequent follow up, wound debridement (possibly in OR), all aptients with systemic signs should be admitted and monitored closely |
|
|
Term
| Describe black widow spiders |
|
Definition
| Shiny black with a reddish hourglass shape on the underside of her abdomen, female is most venomous spider in north america |
|
|
Term
| What kind of venom is used by black widow spiders? |
|
Definition
|
|
Term
| What type of symptoms occur as a result of a black widow bite? |
|
Definition
| Abdominal pain similar to appendicitis, pancreatitis, or peptic ulcer, muscle spasms, pinprick sensation followed by minimal local swelling and erythema, dull crampy pain in 1st hr, usually pain starts in chest in upper extremity bite and abdomen in lower extremity bite, patient is usually hypertensive, abdomen becomes boardlike, tremors, leg cramps, dizziness, restlessness, HTN |
|
|
Term
| How does black widow bites affect adults and children differently? |
|
Definition
| Symptoms usually abate after a few hours in adults, course in children may be more serious and sometimes critical, adults with preexisting hypertension, cardiovascular disease, or cerebrovascular disease are at greater risk |
|
|
Term
| How are muscle spasms caused by black widow bites treated? |
|
Definition
|
|
Term
| When is lactrodectus antivenom recommended for black widow bites? |
|
Definition
| For patients under 16 and over 65, pregnant women, reserved for serious cases |
|
|
Term
| What effect can black widow bites have on pregnancy? |
|
Definition
| May cause abruptio placenta and/or fetal demise, anti-venom is recommended |
|
|
Term
| What species of scorpion is dangerous to humans in the US? |
|
Definition
| Centrutoides Exilicauda - the "bark scorpion" |
|
|
Term
| What type of venom is used by scorpions? |
|
Definition
| Varying concentrations of various toxins, the most potent of which is a neurotoxin. Leads to prolonged, repetitive firing of somatic, sympathetic, and parasympathetic neurons, results in over-excitation symptoms |
|
|
Term
| What is the primary cause of death due to a scorpion sting? |
|
Definition
| Occurs during the first 24 hrs after sting and are secondary to respiratory or cardiovascular failure, children and elderly at greatest risk |
|
|
Term
| What are the initial symptoms of a bark scorpion sting? |
|
Definition
| Sharp, burning pain at the site, feels like an "electric current" which may persist for weeks. Patients usually experience 4/5: mydriasis (most common), nystagmus, hyperventilation, restlessness, dysphagia |
|
|
Term
| What sympathetic signs are seen as a result of a bark scorpion sting? |
|
Definition
| Hyperthermia, HTN, tachypnea, tachycardia, arrhythmia |
|
|
Term
| What parasympathetic signs are seen as a result of a bark scorpion sting? |
|
Definition
| Bradycardia, hypotension, bronchoconstriction, miosis, dysphagia, loss of bowel control, generalized weakness |
|
|
Term
| What are the somatic signs seen as a result of a bark scorpion sting? |
|
Definition
| Rigid spastic muscles, twitching, clonus, and contractions, paresthesias are very common, alternation epithotonos and opisthotonus (abnormal body position) |
|
|
Term
| What symptoms are seen in children as a result of a bark scorpion sting? |
|
Definition
| Similar to adult symptoms but more severe and protracted, more restlessness |
|
|
Term
| What is the usual mode of death by bark scorpion sting? |
|
Definition
| Respiratory failure (most common), anaphylaxis, bronchoconstriction, bronchorrhea, pharyngeal secretions, diaphragmatic paralysis, multiorgan failure plays a large rol in deaths |
|
|
Term
| How is a scorpion sting treated? |
|
Definition
| Ice bags and transport to a hospital, IV valium for muscle spasms, supportive therapy, avoid narcotics and barbiturates, anti-venom in severe cases |
|
|
Term
| What are the 4 species of dangerous snakes in the US? |
|
Definition
| Coral snake, copperhead, cottonmouth water mocassin, and rattlesnakes |
|
|
Term
| What are the initial symptoms of a rattlesnake bite? |
|
Definition
| Severe pain is the initial symptom followed by swelling that progresses proximally, petechiae, edema, arythema, ecchymosis, serous or hemorrhagic bullae |
|
|
Term
| What are the later symptoms of rattlesnake bites? |
|
Definition
| Necrosis of the skin and subQ, bloody wound drainage, numbness/tingling around mouth, muscle fasciculations, rapid pulse, visual disturbances |
|
|
Term
| What is the common cause of death due to rattlesnake bite? |
|
Definition
| Disruption of the coagulation mechanism, leading to hemorrhage, massive pulmonary edema, severe hypotension due to 3rd spacing and hemorrhage, compartment syndrome |
|
|
Term
| What kind of prehospital treatment should be done to snake bite victims? |
|
Definition
| Remove rings, bracelets, or constricting items from affected extremity, apply light mildly constricting bandage about 2" above bite to restrict lymphatic flow (but not blood flow, loose enough to slip a finger under), leave bandage on until anti-venom is given |
|
|
Term
| How should a snake bite be treated? |
|
Definition
| Wash with soap and water, keep limb below heart, basic lab with coagulation studies, mark area of edema frequently, watch for compartment syndrome, antivenom is the only proven theory - CroFab, critical treatment |
|
|
Term
| When should you use anti-venom for snake bites? |
|
Definition
| At first sign of envenomation, anti-venom prevents further damage but does not reverse damage |
|
|
Term
| What 3 factors determine and guide treatment of snake bites? |
|
Definition
| Local effects, coagulation abnormality, and systemic effects (hypotension is most concerning) |
|
|
Term
| How is CroFab administered? |
|
Definition
| Initial dose is 4-6 vials, no adjustment for pediatric patients, watch for allergic reactions, reevaluate and repeat if necessary |
|
|
Term
| What are the initial symptoms of a bark scorpion sting? |
|
Definition
| Sharp, burning pain at the site, feels like an "electric current" which may persist for weeks. Patients usually experience 4/5: mydriasis (most common), nystagmus, hyperventilation, restlessness, dysphagia |
|
|
Term
| What sympathetic signs are seen as a result of a bark scorpion sting? |
|
Definition
| Hyperthermia, HTN, tachypnea, tachycardia, arrhythmia |
|
|
Term
| What parasympathetic signs are seen as a result of a bark scorpion sting? |
|
Definition
| Bradycardia, hypotension, bronchoconstriction, miosis, dysphagia, loss of bowel control, generalized weakness |
|
|
Term
| What are the somatic signs seen as a result of a bark scorpion sting? |
|
Definition
| Rigid spastic muscles, twitching, clonus, and contractions, paresthesias are very common, alternation epithotonos and opisthotonus (abnormal body position) |
|
|
Term
| What symptoms are seen in children as a result of a bark scorpion sting? |
|
Definition
| Similar to adult symptoms but more severe and protracted, more restlessness |
|
|
Term
| What is the usual mode of death by bark scorpion sting? |
|
Definition
| Respiratory failure (most common), anaphylaxis, bronchoconstriction, bronchorrhea, pharyngeal secretions, diaphragmatic paralysis, multiorgan failure plays a large rol in deaths |
|
|
Term
| How is a scorpion sting treated? |
|
Definition
| Ice bags and transport to a hospital, IV valium for muscle spasms, supportive therapy, avoid narcotics and barbiturates, anti-venom in severe cases |
|
|
Term
| What are the 4 species of dangerous snakes in the US? |
|
Definition
| Coral snake, copperhead, cottonmouth water mocassin, and rattlesnakes |
|
|
Term
| What are the initial symptoms of a rattlesnake bite? |
|
Definition
| Severe pain is the initial symptom followed by swelling that progresses proximally, petechiae, edema, arythema, ecchymosis, serous or hemorrhagic bullae |
|
|
Term
| What are the later symptoms of rattlesnake bites? |
|
Definition
| Necrosis of the skin and subQ, bloody wound drainage, numbness/tingling around mouth, muscle fasciculations, rapid pulse, visual disturbances |
|
|
Term
| What is the common cause of death due to rattlesnake bite? |
|
Definition
| Disruption of the coagulation mechanism, leading to hemorrhage, massive pulmonary edema, severe hypotension due to 3rd spacing and hemorrhage, compartment syndrome |
|
|
Term
| What kind of prehospital treatment should be done to snake bite victims? |
|
Definition
| Remove rings, bracelets, or constricting items from affected extremity, apply light mildly constricting bandage about 2" above bite to restrict lymphatic flow (but not blood flow, loose enough to slip a finger under), leave bandage on until anti-venom is given |
|
|
Term
| How should a snake bite be treated? |
|
Definition
| Wash with soap and water, keep limb below heart, basic lab with coagulation studies, mark area of edema frequently, watch for compartment syndrome, antivenom is the only proven theory - CroFab, critical treatment |
|
|
Term
| When should you use anti-venom for snake bites? |
|
Definition
| At first sign of envenomation, anti-venom prevents further damage but does not reverse damage |
|
|
Term
| What 3 factors determine and guide treatment of snake bites? |
|
Definition
| Local effects, coagulation abnormality, and systemic effects (hypotension is most concerning) |
|
|
Term
| How is CroFab administered? |
|
Definition
| Initial dose is 4-6 vials, no adjustment for pediatric patients, watch for allergic reactions, reevaluate and repeat if necessary |
|
|
