Tasty Morsels of EM 128 – #FRCEM The great British outdoors or snakes and mushrooms

24 Aug

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…

What snake bites do we need to know?

  • 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
    • hypotension
    • WCC>20
    • 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.

Tell me about mushroom poisoning?

  • 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.


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