I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.
You can find more things on the FRCEM on this site here.
It’s very late and I couldn’t find a neat way to title this but I figure these are tox things that you might run into in the great British outdoors. Though not so much in Ireland with St Patrick and all that…
- the only known venomous snake is the European adder (I have no idea if they’ll be affected by Brexit but as I said it’s very late…)
- vipera berus
- causes envenomation in about 50% of bites
- pain and swelling at the bite site followed by abdo pain, V & D and low BP
- management is resting the limb (though the OHEM doesn’t mention the fancy aussie type bandages)
- antivenom can be given for (as per Toxbase)
- anaphylactic type reactions
- severe systemic features inc abdo pain and vomiting
- elevated CK
- ECG changes
- metabolic acidosis
- significant swelling at site of bite
- RCEM 2017 lists it as a required antidote for all EDs
- For exotic snakes PHE holds an extensive stock.
- the ones we’re worried about are the amanita phalloides (death cap)
- rapid symptoms (typically V and D) is reassuring
- in amanita
- delayed V&D (>6hrs)
- followed by liver and renal failure
- Supportive is the mainstay of care and charcoal might play a role early
- The coprinus species famously has a disulfiram like effect.