Health Guide

The World Health Organization (WHO) estimates there are up to 1.8 million bites from venomous snakes annually worldwide, causing 20,000-90,000 deaths. Snake venom has been described as a "soup of antigens" and comprises a variety of protein and nonprotein substances. Most crotalid venom contains a mixture of metalloproteinases, collagenase, phospholipase, and hyaluronidase that can cause myonecrosis and dermatonecrosis. Multiple venom components, such as serine proteases, disintegrins, metalloproteinases, and C-type lectinlike proteins, produce a variety of hematologic effects, resulting in coagulopathy, platelet aggregation, platelet activation or platelet inhibition, or increased coagulation, leading to thrombotic complications. The goals of pharmacotherapy in the treatment of snakebite are to alleviate pain, prevent paralysis, minimize tissue damage, correct hematologic toxicity, and maintain adequate perfusion. Severity of Envenomation Dry bites: These occur w...

HTN Emergency is when a patient has high blood pressure (especially if >180/120mmhg) with features of progressive or impending end organ damage. Monitor, support ABCs, check vital signs, start oxygen if SPO2 is <94% establish IV access and send samples for CBC, UECS, urinalysis (for proteinuria) and PDT if applicable. Obtain/review 12 lead ECG, perform a brief, targeted history and physical exam, Consult a physician or obstetrician for eclampsia. Neurological emergencies:  Hypertensive Encephalopathy-Reduce MAP immediately by 20%-25%.  Drugs- labetalol, nicardipine, nitroprusside. Acute ischemic stroke-In patients with markedly raised blood pressure-(>220/120) who do not receive fibrinolysis, a  reasonable goal is to lower blood pressure by 25% in the first 24 hours after onset of stroke.  With indication for fibrinolysis with a bp >185/110mmhg, reduce MAP by 15% in the first hour.  Drugs- labetalol, nicardipine, nitroprusside. If BP...

Status epilepticus is >5 minutes of continuous seizures or ≥ 2 discrete seizures between which there is incomplete recovery of consciousness.  If patient has a history of seizures,maintain ABCs,monitor vitalk signs,start oxygen if SPO2 <94%. Check RBS. If it is a first time seizure,send samples for MPS,UEC,HIV,urinalysis if pregnant or postpaturm. If pregnant or postpaturm,load with IV magnesium sulphate 4gm diluted in 100ml NS over 15minutes.Continue with an infusion of 2gm/hr. If patient is a known epileptic or has had >1 seizure,send samples for UECS,MPS,Urinalyusis if pregnant or postpaturm,antiepileptic drug(AED) levels as applicable. If epileptic and non-compliant to medication,resume regular AED or if unknown,load PO/IV;phenytoin 20mg/kg OR Na Valproate 40mg/kg if on ARVS. For all the above patients; Patients with typical recurrent seizures related to previously treated epilepsy or eclamptic patients are unlikely to have lifethreatening structural lesion...