WHO东南亚区毒蛇伤救治指南3.pptVIP

Treatment in the dispensary or hospital Rapid primary clinical assessment and resuscitation(ABCDE approach) Airway Breathing (respiratory movements) Circulation (arterial pulse) Disability of the nervous system (level of consciousness) Exposure and environmental control (protect from cold, risk of drowning etc.) Four useful initial questions: i. “In what part of your body have you been bitten?” ii. “When and under what circumstances were you bitten?” iii. “Where is the snake that bit you?” iv. “How are you feeling now?”  Early clues that a patient has severe envenoming Snake identified as a very dangerous one. Rapid early extension of local swelling from the site of the bite. Early tender enlargement of local lymph nodes, indicating spread of venom in the lymphatic system. Early systemic symptoms Early spontaneous systemic bleeding. Passage of dark brown/black urine. Physical examination Examination of the bitten part: The extent of swelling, Lymph nodes draining the limb, oedematous, cold, immobile and with impalpable arterial pulses and etc.      General examination:vital sign, consciousness,asymmetrical pupils,chemosis ,discoid haemorrhages,kidney region tenderness,neurological signs, test eye and eyelid movements    Do not assume that snake bitten patients are unconscious or even irreversible “brain dead” just because their eyes are closed, they are unresponsive to painful stimuli or have fixed dilated pupils. They may just be paralysed! Investigations/laboratory tests 20-minute whole blood clotting test (20WBCT)  Platelet count,White blood cell count Blood film:Fragmented red cells (“helmet cell”, schistocytes) are seen when there is microangiopathic haemolysis. Plasma/serum:May be pinkish or brownish if there is gross haemoglobinaemia or myoglobinaemia. Biochemical abnormalities: Aminotransferases and muscle enzymes Arterial blood gases and pH (Warning: Arterial puncture is contraindicated in