Tip 1: In tick toxicity, respiratory failure can occur with or without the administration of tick antiserum

In tick toxicity, respiratory failure can occur with or without administration of tick antiserum. Aspiration pneumonia is frequently encountered in patients with lung disease related to tick paralysis. Aspiration pneumonia is attributed to oesophageal, pharyngeal and laryngeal dysfunction, all of which frequently occur in patients with tick paralysis.

Despite its importance, physical examination of the respiratory system in patients with tick paralysis may not clearly identify the underlying abnormalities. Respiratory failure is usually multi-factorial and the clinical signs of respiratory disease are masked by generalised weakness and central respiratory depression. Arterial blood gas analysis and thoracic radiography improve clinical diagnostics.

Tip 2: Careful when Bandaging Limbs

Any bandage that creates more than 30cm of water pressure under it will stop capillary blood flow, cause ischaemia and tissue death. Remember that distal extremities should be bandaged more loosely than higher on the limb because pressure under a bandage is inversely proportional to the diameter so the smaller the diameter of the limb, the greater the pressure created by a bandage.

Tip 3: Doctor – Know your ABCD’s and do you have A CRASH PLAN?

After Airway, Breathing, Circulation, Disability – Check Airway Cardiovascular, Respiratory, Abdomen, Spine, Head, Pelvis, Limbs, Arteries, and Nerves.

Dealing with emergencies requires the astute clinician to be able to multi-task. While all of the above is going on we also need to be getting baseline diagnostics (ideally before fluid resuscitation starts but not essential). The laboratory trends will be essential to implementing the best supportive care for the patient.

Packed Cell Volume (PCV), Total Protein or Total Solids (TP or TS), Blood Urea Nitrogen (BUN) levels and Urine Specific Gravity (USG) are simple tests that can be rapidly performed yet yield valuable information about the patient’s physiological status (particularly hydration and renal/prerenal dysfunction) while waiting for full laboratory results. The only instrumentation needed is a centrifuge with hematocrit capabilities, a refractometer, and a bottle of Azostix reagent strips.

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