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Common ECG changes after venomous bite ?
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by pygmybait on March 12, 2006
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Hi guys. I'm currently working on a training video for my Fire /Rescue department here in North Florida.
I am curious to hear what, if any, ECG changes have been noted in the field by some of my fellow paramedics.
I have read that the changes are generally non specific and may include AV blocks with ST elevation or depression,T wave inversion and QT prolongation and the like. I have also read that some changes in V2 can mimic an anterior infarct.
I am guessing that most of these changes would be seen in more rural areas and after severe envenomation due to the fact that most transport times are fairly short here in the United States and such changes would take some time to manifest.
So fellow medics, or anyone in the know for that matter,..what changes have you personally seen or have reliable knowledge of out there in the field?
Also, if anyone would like to add their local envenomation protocols (per standng protocols or online medical direction), that would be cool too. I'm interested to see how different municipalities handle these emergencies.
Thanks for looking and for any info that you can pass along!
Matt
- Once I'm done, if any of you are interested, I can probably burn a copy of the DVD and send it out to see what you all think.
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RE: Common ECG changes after venomous bite ?
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by emtnurse on March 12, 2006
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I have only treated 1 snake bite in the field. It was nothing major, just a copperhead bite on top of a mans foot. I know he was in alot of pain and did not require crofab. But he was on morphine push 4mg q 2hrs at the hospital where I also got to take care of him. We put him on telemetry and he had no caridac changes in the field or hospital. We ran him in all leads and no changes. He did have some elevated T waves but that was because his potassium was a little high. Where I live we never see serious envenomations. Chris Harper, Im sure has some pretty good experience with this kind of subject. Look foward to seeing your DVD. Bryan
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RE: Common ECG changes after venomous bite ?
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by pygmybait on March 12, 2006
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I kind of figured that a bite from a contortrix wouldn't really have enough "punch" to cause the changes I'm looking for. I've had several bites from pygmies and one from a Canebrake (where I was the "bitee") and never once had any changes. The Canebrake was a juvi, by the way.
I am thinking that said changes are going to be more obvious with Eastern and Western Diamondbacks and some of the larger pitvipers (Cottonmouths and Timbers for instance).
Chris Harper- you have any experience with this stuff??? : )
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RE: Common ECG changes after venomous bite ?
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by Chris_Harper on March 12, 2006
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There are very few species that have cardiotoxins that work directly on nerve conduction. The ones that I can think of right offhand are the Gaboon viper and the Black mamba, both of which cause sometimes bizarre arrhythmias, especially the latter. The bushmaster can directly cause bradycardia; and the burrowing asp (of the mid-east) causes coronary vasoconstriction, and therefore can be a direct cause of an MI.
Of course there are many species that will cause hypoxia and therefore make the myocardium irritable and lead to pvc's etc. If a Canebrake gets you, it can cause a very rapid drop in blood pressure (read=shock), and therefore any arrhythmias associated with profound shock can be expected.
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RE: Common ECG changes after venomous bite ?
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by Anti-VenomMan on March 12, 2006
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We had 93 envenomations last year with no cardiac changes from the native snakes. However the native scorpions normally cause tachacardia (120 to 140) pass the anxiety of the event. With healty people this is no problem but cardiac pt's could show st depressions but I haven't seen it yet. As far as protocals I'll be glad to discuss this with you just give me a call Monday- Thursday 0700 to 1700 @ (786) 229-0430
Lt Charles Seifert
Maimi-Dade Fire Rescue
Venom Response Team
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RE: Common ECG changes after venomous bite ?
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by pygmybait on March 13, 2006
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Awesome. Thanks guys.
This is exactly the sort of stuff I was looking for.
Lieutenant, I'll try to find the time to call you either today ro tomorrow. I appreciate the offer!
Matt
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RE: Common ECG changes after venomous bite ?
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by Chris_Harper on March 13, 2006
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I also found out from Elda Sanchez Ph.D. of the NTRC, that some of the "formerly known as viridis" complex [helleri] have cardiotoxins, but they aren't found across the board, even within the same species. I haven't found out exactly what these cardiotoxins do though. I'll keep looking. Apparently there was a paper published recently on this topic.
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RE: Common ECG changes after venomous bite ?
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by LongDucDong on March 13, 2006
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Very interesting!!! Im rather new to snakes so please forgive me if this sounds stupid! hahaha Er, I should say Im rather new to researching venom...
Doesnt C. adamanteus possess more of a cytotoxic venom than neurotoxic? I see alot of responses from EMTs here that say they noticed little or no changes in ECG readings, probably because the venom attacks the tissue rather than the central nervous system. Am I correct in thinking this?
Without getting too off topic, I saw Lt.Charles Seifert's reply and am wondering what native scorpion specie he is referring to. Would this pertain to Centruroides (the only indigenous scorpion genus that has a good possibility of enciting anaphlyactic shock) gracilis or margaritatus or henzti? Just curious what specie you have noticed ECG fluctuations in.
Sorry once again if this appears off-topic in areas.
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RE: Common ECG changes after venomous bite ?
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by toddg on March 13, 2006
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I'm not sure if this is off topic but BGF did wirte about the effects of an invenomation he recieved from a Staphen's banded snake. I believe he stated that he blacked out initially and upon regaining conciousness, the only noted symptom was a drop in blood preasure (somewhere around 80 over 40) which lasted aprox. 18 hours before it started to dissapate.
toddg
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RE: Common ECG changes after venomous bite ?
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by toddg on March 13, 2006
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Sorry I should've looked for this before I replied, anyhow, here's the story in his own words...
The first Stephen's banded snake (Hoplocephalus stephensi) that I collected promptly bit me the first time I attempted to milk it. I looked up the clinical effects but not much was known as there were no well-documented cases of such a snakebite. As far as anyone knew, Stephen's banded snakes were not considered dangerous. I clearly discounted this as my body hit the ground seconds after the bite. I regained consciousness quickly, got a pressure bandage on and took off for the hospital.
Upon arrival 15 minutes after the bite, my blood was completely unable to clot, my blood pressure was 87/36 and my heart rate was 42. Despite this, I was completely conscious. Twelve hours after the bite, my blood pressure and heart rate were unchanged and my blood still wouldn't clot. This was despite the administration of many vials of tiger snake antivenom (the closest match because there was not and still is not a specific antivenom for Hoplocephalus envenomations). This had all of us quite worried. Eighteen hours after the bite, however, the symptoms finally began to reverse.
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