Alert Never give the victim alcoholic drinks or stimulants because they speed venom absorption. Never apply ice to a snakebite because it will increase tissue damage.
❑ Record the signs and symptoms of progressive envenomation and when they develop. Most snakebite victims are hospitalized for only 24 to 48 hours. Treatment usually consists of antivenin administration, but minor snakebites may not require antivenin. Other treatments include tetanus toxoid or tetanus immune globulin; various broad-spectrum antibiotics; and, depending on respiratory status, severity of pain, and the type of snakebite, acetaminophen, codeine, morphine, or meperidine. (Opioids are contraindicated for the treatment of coral snakebites.)
Necrotic snakebites usually need surgical debridement after 3 or 4 days. Intense, rapidly progressive edema requires fasciotomy within 2 or 3 hours of the bite; extreme envenomation may require amputation of the limb and subsequent reconstructive surgery, rehabilitation, and physical therapy.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Poisoning:
Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))
Depending on poison: airway management, CPR, poison antidote, patient placed on left side, supportive care (I.V. fluid replacement, oxygen therapy, seizure precautions)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Vomiting:
Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))
Advise patients to replace fluid losses to avoid dehydration. If vomiting is persistent, administer an antiemetic; consider hospitalizing the patient for I.V. fluid replacement or parenteral nutrition therapy. Advise patients suffering from migraine headaches that vomiting may be a prodromal symptom and that they should take antimigraine medication.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Salmonellosis:
Treatment
(Handbook of Diseases)
Antimicrobial therapy for typhoid, paratyphoid, and bacteremia depends on the organism’s sensitivity. It may include amoxicillin, chloramphenicol and, if the patient is severely toxemic, cotrimoxazole, ciprofloxacin, or ceftriaxone. Localized abscesses may also need surgical drainage.
Enterocolitis requires a short course of antibiotic treatment only if it causes septicemia or prolonged fever. Other treatments include bed rest and replacement of fluids and electrolytes. Camphorated opium tincture, kaolin with pectin, diphenoxylate hydrochloride, codeine, or small doses of morphine may be necessary to relieve diarrhea and control cramps in patients who must remain active.
CLINICAL TIP: Dietary modifications may be helpful to replace electrolytes that are lost because of diarrhea. Dairy products should be restricted; instead, patients should follow the BRAT diet (bananas, rice, apples, and toast). Infants should continue to breast-feed and receive electrolyte replacement solutions.
CLINICAL TIP: A small number of persons infected with salmonellosis will develop Reiter’s syndrome, which manifests itself through joint pain, eye irritation, and painful urination and can lead to chronic arthritis. Antibiotic therapy has proven ineffective in this complication.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Snakebites, poisonous:
Treatment
(Handbook of Diseases)
Prompt, appropriate first aid can reduce venom absorption and prevent severe symptoms.
❑ If possible, identify the snake, but don’t waste time trying to find it.
❑ Place the victim in the supine position to slow venom metabolism and absorption.
❑ Don’t give the victim any food, beverage, or medication orally.
❑ Authorities disagree about what constitutes appropriate prehospital care. Some recommend against placing a constrictive tourniquet (band) on the affected limb unless the victim is far from a medical facility.
❑ Whether you apply a tourniquet or not, immediately immobilize the victim’s affected limb below heart level, and instruct the victim to remain as quiet as possible.
❑ If a tourniquet is applied, the victim or the person applying the tourniquet should check the victim’s distal pulses regularly and loosen the tourniquet slightly as needed to maintain circulation.
CLINICAL TIP: Remember that the goal of applying a tourniquet is to obstruct lymphatic drainage, not blood flow. The use of a tourniquet in prehospital care is controversial.
❑ When indicated, apply the tourniquet so that it’s slightly constrictive, obstructing only lymphatic and superficial venous blood flow. Apply the band about 4" (10 cm) above the fang marks or just above the first joint proximal to the bite. The tourniquet should be loose enough to allow a finger between the band and the skin. After the tourniquet is in place, don’t remove it until the victim is examined by a physician.
Caution: Don’t apply a tourniquet if more than 30 minutes has elapsed since the bite. Keep in mind also that total tourniquet time shouldn’t exceed 2 hours and that the use of a tourniquet shouldn’t delay antivenin administration. Remember: Loss of a limb is possible if a tourniquet is too tight or if tourniquet time is too long.
❑ If the patient is more than 30 minutes away from a facility, wash the skin over the fang marks. Within 1 hour of a pit viper bite, make an incision through the fang marks about ½" (1.3 cm) long and ⅛" (0.3 cm) deep. Be especially careful if the bite is on the hand, where blood vessels and tendons are close to the skin surface.
Using a bulb syringe — or, if no other means is available, mouth suction — apply suction for up to 2 hours in the absence of antivenin administration.
Remember: An incision and suction are effective only in pit viper bites and only within 1 hour of the bite and if transport time to an emergency facility would exceed 30 minutes. Mouth suction is contraindicated if the rescuer has oral ulcers, if the victim is close to a medical facility, or if antivenin can be given promptly.
❑ Never give the victim alcoholic drinks or stimulants because they speed venom absorption. Never apply ice to a snakebite because it will increase tissue damage.
❑ Record the signs and symptoms of progressive envenomation and when they develop. Most snakebite victims are hospitalized for only 24 to 48 hours. Treatment usually consists of antivenin administration, but minor snakebites may not require antivenin. Other treatments include tetanus toxoid or tetanus immune globulin; various broad-spectrum antibiotics; and, depending on respiratory status, severity of pain, and the type of snakebite, acetaminophen, codeine, morphine, or meperidine. (Opioids are contraindicated in coral snakebites.)
Necrotic snakebites usually need surgical debridement after 3 to 4 days. Intense, rapidly progressive edema requires fasciotomy within 2 to 3 hours of the bite; extreme envenomation may require amputation of the limb and subsequent reconstructive surgery, rehabilitation, and physical therapy.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Vomiting:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Draw blood to determine fluid, electrolyte, and acid-base balance. (Prolonged vomiting can cause dehydration, electrolyte imbalances, and metabolic alkalosis.) Have the patient breathe deeply to ease his nausea and help prevent further vomiting. Keep his room fresh and clean smelling by removing bedpans and emesis basins promptly after use. Elevate his head or position him on his side to prevent aspiration of vomitus. Continuously monitor his vital signs and intake and output (including vomitus and liquid stools). If necessary, administer I.V. fluids or have the patient sip clear liquids to maintain hydration.
Because pain can precipitate or intensify nausea and vomiting, administer pain medications promptly. If possible, give these by injection or suppository to prevent exacerbating associated nausea. If an opioid is used to treat pain, monitor bowel sounds and flatus and bowel movements carefully because they slow down GI motility and may exacerbate vomiting. If you administer an antiemetic, be alert for abdominal distention and hypoactive bowel sounds, which may indicate gastric retention. If this occurs, insert a nasogastric tube.
Patient teaching
Advise the patient to replace fluid losses to avoid dehydration. Inform the patient suffering from migraine headaches that vomiting may be a prodromal symptom; advise him to take antimigraine medication should vomiting occur.
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Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Vomiting:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Have the patient breathe deeply to ease his nausea and help prevent further vomiting. Advise him to replace fluid losses to avoid dehydration. A patient suffering from migraine headaches should be advised that vomiting may be a prodromal symptom and antimigraine medication should be taken.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Vomiting:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Draw blood to determine fluid, electrolyte, and acid-base balance.
▪ Keep the patient's room clean smelling by removing bedpans and emesis basins promptly after use.
▪ Elevate the patient's head or position him on his side to prevent aspiration of vomitus.
▪ Monitor vital signs and intake and output (including vomitus and liquid stools).
▪ If necessary, administer I.V. fluids, or have the patient sip clear liquids to maintain hydration.
▪ Because pain can precipitate or intensify nausea and vomiting, administer pain medications promptly.
▪ Insert a nasogastric tube, as ordered.
Patient teaching
▪ Teach the patient deep-breathing exercises to ease nausea.
▪ Explain the importance of replacing fluid losses.
▪ Teach the patient about dietary restrictions and how to advance the diet.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Salmonella Gastroenteritis:
Treatment of Invasive Disease
(Pediatric Infectious Disease)
Patients with invasive salmonella disease should always be treated. An
increasing percentage of isolates are resistant to ampicillin and
trimethoprim-sulfamethoxazole (Bactrim), traditionally the front-line
antibiotics for treatment of this organism. Treatment is usually initiated with
a third-generation cephalosporin such as cefotaxime or ceftriaxone.
Second-generation cephalosporins and gentamicin are not considered efficacious,
although
in vitro assays may show sensitivity. Fluoroquinolones such as ciprofloxacin are
frequently used for treatment of invasive salmonella disease, particularly in
developing countries.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Infectious Disease, 2004
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