??G????

1
??G???? ?S????????

• G?O?G??S F?????S?S
• ????????S ??T?G???S

2
??G????

• ?O?
• F????

• ??T?O???
• ??????

3
???µata ap? ??ase ast???? pe??????

• S????? 80-90
• G?te? 2-20
• ?????p?? 1-2
• Sp???a ?at????d?a ??a (f?d?a, ??????a, ???????a,
  p??t???a. p?????a?..)

• 1 t?? epe????t?? pe??stat???? st?? ???
• 4.7 e?at. ap? s??????
• 400,000 ap? ??te?
• 250,000 ap? a????p???

4
?? p?? ep????d????

• Rottweiller
• Jack Russell

• German Shepherd
• Bull Terrier

5
S????te??? t?a?µat?sµ?? t?? pa?d??? st? ?ef???
(80) t?? e??????? sta ????a (?ef??? 10)
6
???µata ap?

• ????a???? ßa??te?a t?a?µata ap? t??? s??????
• S????te?e? ???µ??e?? ?????? ap? Pasteurella
  multicida
• ?µfa?????ta? ????te?a se 12 h ??e?, e?? t??
  s????? se 12-48 h
• S????te?a se ???a??e? gt20 et?? ?a? sta ????a

7
?p?p????? ???µ??e??

• ?p? ??te? 50
• ?p? s?????? a????p??? 15-20 (36 ?ta? af??? ta
  ????a 1.4 t? ?ef???)

• ??tta??t?da ?????s? µa?a??? ?st??
• ???d?? a????t?da
• ?ste?µ?e??t?da
• S??a?µ?a
• ???????t?da
• ?p?st?µa e??ef????

8
????????

• ????µ????ß?a?? gt50
• S?????? eµp?????ta? 2.8-3.6 e?d? µ????ß???
• ???t? ae??ß?a a?ae??ß?a
• Staf????????? ???s???? intermedius
• ??ae??ß?a (Fusobacterium, bacterioides)
• Pasteurella multicida canis

9
?d?a?te??t?te?

• G?te?
• S?????
• ?????p??
• ????a
• ????a

• pasteurella multicida (80)
• pasteurella canis (50)
• eikenella corrodens, p??????? st?ept???????, HIV
• Actinobacillus sp
• Halomonas vensuta, Aeromonas hydrophilia,
  Psuedomonas sp Vibrio sp

10
?a?????te? ???d????

• ?????a ??µat??
• ??p?? ??tas? t?? ß??ß??
• ??t?p?s? ß??ß??
• ?a??ste??µ??? f???t?da
• ???s??atast???

11
??G???? ??? ??T?O???S

• F?d??? ???ssa ?a se f?e? ?a? ??? a????p???
• G. ????t??, ?at???? pa???µ??????a 1997

12
?p?d?µ??????a

• 3-23 ???? t?? d??µ?t??
• ?a?d?? ?pe?????e? ???d??e???? pe??ss?te??
• ???d???? ap? ???µ??e??
• ?a d??µata ap? pa?d?? e??a? ????te?? ep???ep? se
  ???µ???
• S?????? ?fe????ta? se ep??et??? s?µpe??f??? ?
  e??t??? ep???µ?a

13
S????te?? e?t?p?s?

• ???s?p?, a????a?

• ???a

14
???µata ap? a????p???

• S????t?ta ???µ???? 18
• ????µ????ß?a?? - 5 e?d? µ????ß???
• ??ae??ß?a 50-60
• Gram (-) 25-45
• Staf?????????, st?ept???????
• Eikonella corrodens
• 25 se t?a?µata ??e?st?? ???????
• Veikonella, bacterioides, fusobacterium

15
??t?µet?p?s? d??µ?t?? ap? ??a

• ??t?µ?s? t?? as?e????
• ?e??p???s? t?? t?a?µat??
• ??t?µ????ß?a?? ?e?ape?a
• ???µ???s? ??e????µ???? a????
• ??t?µ?s? ???d???? ???e??? ???µ??e??
• ??ssa
• ??p?t???? 1 2
• ?pat?t?da B C 3
• HIV 0.3

16
???t?µata

• ???µa ap? ?at????d?? ? ????? ??? ?
• ???a? d??at? ? pa?a???????s? t?? ???? 10 ?µ??e? ?
• ?? ??? p????????e ? ??? ?
• ??s?? ?????? p??ase ap? t? d??µa ?
• ???a? t? ??µa ?a??µµ??? ??a t?ta?? ?
• ???d??e?e? t? ??µa ap? ?pat?t?da B HIV ? (d??µa
  ap? ?????p?)

17
F???t?da t?a?µat?? 1. ???s?µ? 2. ?????s? 3.
?a?a??sµ?? 4. S?????s?
18
F???t?da t?a?µat??

• ?fa??es? ????? s?µ?t??
• ???s?µ? µe ?f???? ?e??, sap???? a?t?s?pt???
• ??e?e???s? t?? t?a?µat??
• ?????s? µe 150 mL NS ? RL (??? ta ßa??? t?a?µata)
• ?fa??es? ?e???µ???? ?st??
• ?a????te?s? µe ?p?a a?a???f?s?
• S???af? (p???µa se t?a?µa ?efa???, ??? t??
  ?e????)
• ?????s? a????t?p???s? t?? ????? ??SS

19
???f??a?? se d??µata ap? ??a

• ??t?ß??t???
• ?a ?????e?ta? a?t?ß??s? se ??a ta d??µata, e?t??
  e?e???? p?? pa???s?????ta? gt72 h ?a? de? ?????
  s?µe?a ???µ????
• ???µ?d? t?a?µata ?d??? se ?st?, t????te?
  a????se??
• ??a?µata se p??s?p?, ???a ?e???t??? ???a?a
• ??tetaµ??a t?a?µata µe ??d?µa s???????
• ?a?aµe??µ??a t?a?µata
• ???s??atesta?µ??a ?t?µa
• ??ta??? - s?????? de? ??e???eta? ap? ?at????d?a
• ??ssa

20
??t?ß??t??? a?????? ep??????

• ?µ?????????? ??aß???a????
• ???µe??p??µ? s???faµe???a????
• ?efa??sp????e? e????? f?sµat??
• ????daµ?????
• Ge?taµ?????
• ?µp???????? s???µpa?t?µ?
• ???a?s?????? - ??aß???a????

21
???f??a?? se d??µata ap? a????p???

• ??t?ß??t???
• ??a?µa ??e?st?? ???????
• ??a?µa se p??s?p? ????a
• ?a??? t?a?µata
• ?a?aµe??µ??a t?a?µata
• ???s??atesta?µ??a ?t?µa
• ??ta??? - s?????? de? ??e???eta?
• ?pat?t?da ?

22
???s?p???s? ??a t?ta??

• ?? ?t?µ? ??e? eµß???aste? ?a?????? gt 3 d?se??
• ??a?µa µ???? ?a?a?? Td µ??? gt10 et?a
• ?a?? t?a?µa Td µ??? gt5 et?a
• ?? ?t?µ? de? ??e? eµß???aste? ?a?????? (lt3
  d?se??) ? de? ??????e?
• ??a?µa µ???? ?a?a?? µ??? Td
• ?a?? t?a?µa TIG Td
• Td Tetanus Diphtheria toxoids
• TIG Tetanus Immune Globulin 3,000-6000 U

23
? ??ssa se a????p???, s?????? ????a ??a,
d?a???????
24
???f??a?? ap? ??ssa

• ???µa ap? ???st? ????? ??? pa?a???????s? t??
  x 10 ?µ??e?
• ??? t? ??? pa?aµe??e? ????? de? e?de????ta?
  p??f??a??
• ??? ?µ?? ??s?se? p??pe? ?a ???e? a?t???ss????
  ???? eµß????
• ???µa ap? ????a ??a, ???te??de? ?a ???eta?
  p??f??a??
• ?a ?t?µa se ???d??? epaf?? µe ??ssa ?a
  eµß???????ta? p????pt???

25
???s?p???s? ??a ??ssa

• ????? p??????µe?? eµß???asµ?
• ?????e?ta? RIG HDCV (1?, 3?, 7?, 14? 28?
  ?µ??a)
• ?e p??????µe?? eµß???asµ?
• ?????e?ta? µ??? HDCV (1? 3? ?µ??a)
• RIG Rabies Immune Globulin 20 iu/Kg (1/2 t?p???
  1/2 st? ????t?)
• HDCV Human Diploid Cell Vaccine 1 ml st?
  de?t?e?d?

26
??de??e?? e?sa????? se ??s???µe??

• S?st?µat???? e?d???se?? ???µ????
• ???sß??? a????se??, te???t?? ?st??
• ???s??atat???
• ?a??? d??µata ?????
• ?????? epa?????t???? ep?µßas??
• ?a??? d??µata ap? ?????p?

27
?S????????

• ?????p?da
• ?µe??pte?a
• ?????e?
• S???p???
• ??pet?
• ???d??e?d? Pit Vipers
• ???a??e?d? Coral Snakes
• ??a t?? ???assa?

28
T??at?? ap? ts?µp?µata

• 50
• 14

• 30
• 6 ???p?

29
?µe??pte?a

• ????sse?, sf??e?, s???????, µ??µ????a
• ?e??p?? 25 ???at??/?t??
• µ???sse? 50
• s???????, sf??e? 50
• ??d???se??
• ???e??????
• ??af??a?t????
• ??????? (sp???a)

• Sf??a
• ????ssa

30
????t???a e?t?µ??

• F?sf???p?s? ?
• ?a???????d?s?
• ?e??t???
• ??t????? 5
• Se??t?????
• ?staµ???
• ??et????????

31
??d???se??

• ??p????
• ????, ?a?st???? p????
• ???sµ??
• ??d?µa
• ?p?f?a?? ae?a????? se d??µata se ???ssa/f?????a

• S?st?µat????
• ?????t?? ???sµ??
• ???d?s?
• ?????µa
• Ge???e?µ??? ??d?µa

32
??af??a??a

• S?ßa??? e?d???se??
• ??d?µa ??????a, ap?f?a?? ae?a?????
• ??????spasµ??, d?sp???a
• S?ßa?? ?p?tas?
• S????t?ta 11-29 ???? t?? a?t???
• T??at?? 0.09-0.45 / ?t?? / e?at. p????sµ??

33
??t?µet?p?s? a?af??a??a?

• ?a afa??e?ta? t? ?e?t?? µe ?aß?da
• ???????, µ??a????? ae??sµ??
• ??p???t?s? se ??s? Shock
• ?d?e?a????
• ?fa?µ??? ALS e?? ??e?aste?

34
?? ts?µp?µa t?? µ???ssa?
35
S???p???

• ????pa????
• ?a????e????

• 40 e?d? st?? ???
• 2 e?d? st?? ????da
• ???? ??a e??a? d???t??? ?a?at?f??? (Centuroides
  sculpturatus)

36
?s?µp?µa s???p???

• ??p??? s?µpt?µata
• ??d?µa, f?e?µ???
• p????, ?pe?e?a?s??s?a
• S?st?µat???? e?d???se??
• ?????e?????? - ?a?t?a, eµet??, ef?d??se??,
  s?e??????a, ß?ad??a?d?a, ?p?tas?
• ?d?e?e?????? - ta???a?d?a, ta??p???a, ?p??tas?,
  ?a?d?a?? a?ep???e?a
• ???efa????? s?????e? - d?p??p?a, d?s?atap?s?a,
  d?s????a st?? ?µ???a
• S????s?, spasµ??, ?atap????a, a?ap?e?st???
  a?ep???e?a

37
?s?µp?µa s???p???

• ??t?µet?p?s?
• S?µpt?µat???, µ? e?d???
• ??d??? a?t?d?t? ?p?? ?p???e?
• p?. Arizona State University (National Venomous
  Desert Animal Study Center)

38
F????
39
?p?d?µ??????a

• 3.000.000 d??µata / ?t?? st?? ??sµ?
• 18 ap? d???t????d? f?d?a (pit vipers 75,
  e?ap?d?e?d? 25)
• 150.000 ???at?? / ?t?? (75 st?? ??d?e?)
• 45,000 d??µata/?t?? st?? ???
• 8,000 ap? d???t????d? f?d?a
• 9-15 ???at??/?t??
• 50 t?? ??µ?t?? lt20 et??
• 100 d??µata/?t?? st?? ????da
• ?p? d???t????d? f?d?a ?
• T??at?? ?

40
????t????d? f?d?a st?? ???

• Rattlesnake
• Water moccasin (cotton mouth)

• Copperhead
• Coral snake (Elapid)

41
????t????d? f?d?a st?? ????da ???? ? VIPERA

• ?mmodytes
• Ursinii

• ?spis
• Berus

42
?? d????µa t?? ?????
43
????t???a

• ??af????? a?????a µe t? e?d?? t?? e?pet??
• ????µa
• ?????p??te??e?
• ?eta???p??te??e?
• G????p??te??e?
• ??p?d?a
• ????e?e?? aµ??e?
• ??e??e?a aµ?????a
• ?????a?e? ??s?e?

44
???se?? t??????

• ??tta??t??????
• ???at?? ap? a?µ???a???? shock, ARDS, ???
• ?? d???t???? t?? e??d??e?d?? (pit vipers)
  p???a?e? t?p??? ?????s?, a???µ??? d?ape?at?t?ta
  t?? a??e??? ?a? a?µ???s?
• ?e???t??????
• ???at?? ap? a?ap?e?st??? ?atast???
• ?? d???t???? t?? e?ap?d?e?d?? (coral snakes)
  p???a?e? ?e???t?????t?ta

45
???µa ap? ????

• ??p??? ?atast??f?
• ????µ??? d?ape?at?t?ta
• ??µ???s?
• ?????
• ????de?t??? ??d?µa
• ????µ?se??
• ??µ???a????? ??ste?

46
???µa ap? ????
47
???µata ap? ????

• ?d??aµ?a, ef?d??se??, ?a?t?a, eµet??
• ?a???a?d?a, ?p?tas?, shock
• ??d???se?? ???
• ??µ???a??e? ?????
• ??µat?µes?, µ??a??a, a?µat????a
• ??µ?d?e?, eµß???, ?e????????? s?µpt?µata

48
???µa ap? Coral Snake

• ??af?? ??d?µa
• ???d?asµa ???? ap? t? d????µa
• ????? ad??aµ?a

• S?a??????a
• ??s?atap?s?a
• ??ata?a??? ?µ???a? ??as??
• ??ap?e?st??? ?atast???
• Shock

?? pe??ss?te??? ???at?? s?µßa????? ????
a?ap?e?st???? a?ep???e?a? e?t?? 36 ????
49
??t?µet?p?s? f?d?fa??µ????

• ??at???s? t?? ??µat?? se ??eµ?a a????s?a
• ????????e?ape?a
• ??af?? pe??des? ?e?t???? ( )
• ?a?a??sµ?? pe??des? t?? t?a?µat??
• ?????t?p???s? da???µ???? ????? se ?aµ???te?? ??s?
• ?etaf??? se ??s???µe??
• ??t??f???? ????

50
??t?µet?p?s? f?d?fa??µ????

• ??? efa?µ??ete !!!
• ????
• ?e??des? gt 60 mm Hg
• ????µ? ap?µ???s?
• ??e?t???? ?e?µa
• ??? p??spa?e?te !!!
• ?a ß?e?te t? f?d?
• ?a t? µetaf??ete ???ta?? st? ??s???µe??

51
??t? ??? ????

• ??de????ta?
• ?e???t?????t?ta
• ??ata?a??? p????
• ?a?d?a??e?a??? d?ata?a???
• ??ata?a??? s??e?d?s??
• ??d?µa gt 50 t?? ?????
• ?a???? epe?te???µe?? ??d?µa
• ???µata se ????a p?d?a

• ?????e?ta?
• 20-30 mL, IV, IM e?t?? 4 h, ????? t?? eµf???s?
  e?d???se??
• ???s??? ??a t?? ???d??? a?t?d??se??
  ?pe?e?a?s??s?a?
• ?a p????e?ta? test e?a?s??s?a? ?a ?p???e?
  d??at?t?ta a?t?µet?p?s?? t?? a?af??a??a?

52
?????pt??? µ?t?a ?at? t?? f?d???

• ?p?te?, µa???? ???t?? pa?te????a
• ???s? fa??? t? ???ta
• ?t?p?µata st? ?daf?? ?at? t? ß?d?sµa
• ???s??? p?? ?a??µaste t? p?????µe
• ???state?t??? d??t?a se ???te???? d?aß??s? st??
  e????

53
??G???? ??? ?O? ??S T???SS?S
54
Coelenterates

• ??d??se? Jellyfish, Portuguese man-of-war
• ??µat???ste?? sta p????µ?a
• ??t????, ?a?st???? p????
• ???????, a?µ???a????? ß??ße?
• ?a?t?a, eµet??
• ???et??, ?????
• ??sp???a, s????µ??
• ?p?tas?, shock

55
??? ts?µp??e ?? µ?d??se?
56
???s??? µ?? t?? pat?te ?a? t?? p???ete µe ta
????a????dete??ste t?? ??µat???ste?? µe a????? ?
??d??fa?µ?ste t?p??? pe??p???s????s??? ??a
eµf???s? a?af??a??a?
57
Sting ray ? sa????

• ???t??sµa µe t? µa???? ???? t??
• ????ste t? t?a?µat?sµ??? µ???? se ?est? ?e??

58
Scorpionfish ? s???pa??a

• ????? d???t????de? µe ta a?????a t??
• ?e? ?p???e? a?t?d?t? !
• ????ste aµ?s?? t? t?a?µat?sµ??? µ???? se ?est?
  ?e??

59
??????

• ????ste aµ?s?? t? t?a?µat?sµ??? µ???? se ?est?
  ?e??
• ?p?µa????ete ta a?????a µe ??d? ? ?e?????????
  t??p?

60
Ta??ss?? f?d?

• ????? aµf?ß???a ap? ta p?? ep????d??a ??a t??
  ??ea??? (e?t?? t?? pet???a???)
• ????a?e? t? ???at? µ???? 25 !

61
Sµ???a
62

• ??????S?O G?? ??? ???S??? S?S