Handling serums

An important case for using serums is food poisoning (Botulism), for which a serum called "Botulinum Antitoxin" is used. The treatment using serums prepared by modern immunization methods for snake, scorpion, spider bites, and others is called "Venom Immunotherapy," which is a safe and effective treatment, especially in cases where there is a reaction or allergy to the serum itself before immune treatment, or during pregnancy. The use of serums, due to the antibodies they contain to prevent certain infectious diseases, is called "Immunoprophylaxis."

Antisnake Venom Serum

It is worth noting that snake venom is 50% poisonous and 50% non-poisonous 

The patient is initially evaluated in the hospital in an observation room where symptoms, if present, are divided into

·  Snake bite causing bleeding - Haemorrhagic

·   Paralytic snake bite

haemorrhagic snake bite

Clinical  picture

Laboratory tests

➡️ The following tests are performed on the patient urgently 

(Complete blood count, kidney function, blood sugar, prothrombin time and concentration - INR)

Complete bleeding profile: It is done for the patient every 104 hours regularly and includes:

• Platelet count.

• INR.

• Prothrombin time and concentration.

• Fibrinogen level.

Medical Management

First: Minimal cases

·  The patient is placed under medical observation for 24 hours

·  The above-mentioned laboratory tests are performed, with a warning to perform a complete  bleeding profile.

·  The affected limb  (the site of the sting)  is monitored every hour, and it is examined gently and carefully, and the size of the swelling and redness at the site of the sting is determined with each time the examination is performed

·  Alert to deal with the development of the condition if it deteriorates to  Mild - Moderate Severe) by giving the necessary intravenous solutions and also giving the anti-venom serum as will be mentioned later

·  Symptomatic cases that include (Sever-Moderate Mild)

·  The affected limb should be  fully extended and elevated to avoid increased swelling

·  Adequate  intravenous satanic crystalloid is given to support circulation and maintain  urine output at least 1 ml/kg/hr.

·  Giving antivenom to snakes in the following cases:

• In cases of circulatory collapse and heart rhythm disturbances.
• Severe reduction in platelet count.
• Occurrence of convulsions and muscle disturbances.
• Local deterioration of swelling and redness.
• Moderate-Severe cases with moderate to severe effects.
• Mild cases with local deterioration of the sting or the occurrence of general symptoms or disturbance in previous lab test results.
• Severe bleeding cases.
• Platelet count < 50,000 / mm³.
• INR > 3.
• Prothrombin time and concentration > 50 seconds.
• Fibrinogen level < 75 mg/DL. 

Basic indications for giving serum

• Circulatory disorder.
• Coagulation disorder due to low platelet count.
• Neurotoxic muscle poisoning.
• Development and increase of swelling.
• In moderate to severe cases.
• Mild cases with exacerbation of local injury and abnormal lab results.
• Severe bleeding cases:
• Platelet count > 50,000 / mm³.
• INR > 3.
• Prothrombin time and concentration > 50 seconds.
• Fibrinogen level > 75 mg/DL.

Important note

·  The serum is not given as a preventive measure for normal cases with no or few symptoms .

·  No doses of serum for children and young children

·  A sensitivity test is performed on the serum before it is given

Serum dose

It may be necessary to repeat the dose of the serum, typically ranging from 0.5 to 10 ampoules at once, for the purpose of stabilizing the patient's condition.

A sensitivity test for the serum is conducted before administration. If allergic reactions appear in the patient, corticosteroids and adrenaline are given.

The solution is administered very slowly over a period of 5 hours.

Thirdly, severe bleeding cases

Blood transfusion or its derivatives, such as plasma and platelets, are required as follows:

• Red blood cell transfusion: According to a decrease in hemoglobin levels below 8g/dL, with a therapeutic dose of 105- 1/ kg.
• Fresh frozen plasma transfusion: The recommended therapeutic dose for adults is 15 mL/kg in cases of severe bleeding that cannot be controlled, in addition to prolonged PT+PTT.
• Platelet transfusion: In cases of platelet count below 30,000 platelets.

Secondly, paralytic snake bite:

Clinical picture​

All symptoms are neurological, including:

• Tongue heaviness
• Numbness and tingling
• Double vision
• Difficulty swallowing
• Muscle weakness
• Hoarseness
• Weakness of the eye muscles
• Muscle twitches
• Weakness and paralysis of respiratory muscles

Close medical observation for 24 hours is necessary unless coral snake bite is ruled out.

Medical  Management

• Clean the bite site and perform necessary surgical cleaning.
• Administer necessary antibiotics intravenously.
• Physical therapy in case of joint stiffness in the affected limb.
• The patient may require intubation and placement on a ventilator if respiratory muscles are affected.

Give the serum as follows:

·  The serum is given to patients who have neurological symptoms and signs

·  The vaccine is intended for patients who are suspected of having been bitten by a coral snake, even without symptoms

• The loading dose: 3-5 vials, repeated until reaching 10 vials.

Ant spider Venom Serum

Widow Spider or the  Brown Spider , which secrete neurotoxins like snake venom

Its bite causes pain like pinpricks, and leaves a mark that is a blue bruise and a sore in the middle, surrounded by circles; giving it the shape of a target for shooting training , with muscle cramps in the arm or foot, stiffness in the abdominal muscles, high temperature and pressure, profuse sweating, agitation and vomiting

Treatment protocol for dealing with scorpion stings

First aid:

• Reassure the victim and try to keep them calm.
• Remove the stinger, if present, using a flat object such as a card, not a sharp object. Avoid using tweezers as they can squeeze the sting site, increasing venom secretion into the bloodstream.
• Wash the sting site with soap and water and remove any rings, watches, or jewelry from the affected area as it may swell.
• A gauze bandage can be applied above the sting site, ensuring it is tied lightly to close only the vein, not the artery, to avoid compromising blood flow to the parts below the sting.
• Apply ice wrapped in cloth to the sting site for 10 minutes, then remove it for another 10 minutes. Repeat this to prevent swelling and reduce venom absorption into the bloodstream.
• Do not use painkillers unless advised by a doctor.
• Record the vital signs of the patient, particularly pulse, respiration, and blood pressure.

Assessing the patient's condition in terms of severity:

Notes:

The dose should be increased in the following cases:

·  Head, neck or shoulder injury

·  If the period of time between the infection and the treatment is long, a maximum of 10 ampoules

A skin allergy test must be performed before giving the serum as follows:

➡️ 0.1-0.2 ml of the serum diluted in a ratio of 1:10 is injected into the skin. A positive result appears as a rash that may be surrounded by redness within 30 minutes

➡️ The solvent is stored at the same temperature as the refrigerator, from 2 to 8 degrees

Signs of improvement:-

·  A regularization of rapid heartbeats and their return to their normal rate

·  warmth in cold extremities

·  Restore normal blood pressure

·  Respiratory rate returns to normal