Emergency & clinical flowcharts
| Signs and symptoms1 |
Emergency medical treatment |
Identification of the cause |
Antivenom2 | |||
| Possible cause |
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| Nausea, vomiting, abdominal pain, diarrhoea, urticaria, angio-oedema, bronchospasm, arterial hypotension (autopharmacological effects of the venom including anaphylaxis) | Treatment of anaphylactic/ anaphylactoid reactions |
1. Morphological identification (Fig. 4.49 for differentiation from terrestrial snakes and fish)
2. Narrowing down the cause with the aid of indirect criteria:
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| Generalised oedema → hypovolaemia → hypovolaemic shock (autopharmacological effect of the venom: increased capillary permeability) | Treatment of the hypovolaemia/hypovolaemic shock | |||||
| Pulmonary oedema, cerebral oedema (autopharmacological effect of the venom: increased capillary permeability) |
Treatment of the non-cardiogenic pulmonary oedema, treatment of the cerebral oedema | |||||
| Extensive local swelling possibly involving the trunk → hypovolaemia → hypovolaemic shock (local effect of the venom: regionally increased capillary permeability) |
Treatment of the hypovolaemia/hypovolaemic shock |
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| Systemic bleeding → hypovolaemia → haemorrhagic shock (haemostatic effects of the venom) | Treatment of the haemorrhage-induced hypovolaemia/ haemorrhagic shock | |||||
| Intracranial bleeding → focal neurological deficits, coma, meningismus (haemostatic effects of the venom) | Treatment of intracranial bleeding | |||||
| Cranial nerve deficits, paralysis of the skeletal musculature including the respiratory musculature → respiratory insufficiency, respiratory failure (neurological effects of the venom) |
Treatment of the respiratory insufficiency/respiratory failure:
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| Astrotia stokesii (=Hydrophis stokesii) |
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| Myalgia, painful musculature with active and passive movement and upon pressure, urine colour, ECG changes, signs of paralysis, renal failure (muscular effect of the venom: rhabdomyolysis) |
Treatment of the hyperkalaemia, prevention and treatment of the acute renal failure, treatment of the respiratory insufficiency/respiratory failure
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Astrotia stokesii (=Hydrophis stokesii) |
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| Myocardial symptoms, cardiac dysrhythmias, ischaemia (ECG), cardiac insufficiency, heart failure (usually secondary, rarely primary cardiac effects of the venom) |
Treatment of the cardiac disturbance | |||||
| Acute renal failure (usually secondary, rarely primary renal effects of the venom) |
Treatment of the acute renal failure | |||||
| No or insufficient clinical data | ||||||
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Genera3 Acalyptophis |
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| 1 |
See also the Clinical flowchart as a guide to the dynamics of envenoming. |
| 2 | See "Essentials of the management of envenoming and poisoning: 9. How is the appropriate antivenom chosen? When is it administered?" |
| 3 | These cases are also dealt with in accordance with the corresponding problem-oriented section "Diagnosis & Treatment". |