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Recently saw at case at ULH (Not mine but posted with permission from resident involved) of a young female (18-20yo) flown from OSH for copperhead bite to L foot. Pt had been hiking in the woods with her boyfriend when she felt a stabbing sensation on her foot, looked down and there was a snake. Pt took a picture of it – sure enough it was a copperhead. Labs at OSH wnl, sent to ULH for concern for possible need for antivenin. I realized – being an urban trauma center – we don’t see a lot of snake bites. If you’re from the area, you may not be familiar with our venomous critters.
There are four species of venomous snakes in KY, all pit vipers (triangular heads, heavy bodies, cat-like pupils) – fw.ky.gov
1. Copperhead – extremely common throughout the state, most common envenomation, mildest venom of the four. (As an acquaintance of mine, Jim Harrison of East KY Venom Extraction lab used to say – no recorded history of death from copperhead envenomation in KY history
2. Timber Rattlesnake – found throughout state, potent venom, relatively docile. Dark coloration, have a rattle (obviously)
3. Pygmy Rattlesnake – found in extreme Western KY. Also have a rattle, potent venom
4. Cottonmouth – found in Western KY, potent venom, can be aggressive. Can be mistaken for Eastern Water Snake (common, non-venomous, aggressive water-dwelling snake found throughout KY)
Best identification – hopefully someone took a picture – otherwise, one to two small puncture wounds with increasing swelling and pain are good signs of envenomation. However, approximately 25% of viper envenomations can be dry bites – where snake gives a warning bite, injects no venom.
Signs and Symptoms of snake bite:
Venomous snakes in KY typically have venoms containing cytotoxins and hemotoxins – they break down tissue and can act on coagulations factors
-puncture wounds (usually paired, can be one)
-erythema and swelling
-intense pain at site and increasing proximally
-systemic symptoms can include nausea, vomiting, abdominal pain, vertigo. Altered mental status and hypotension can present as well
First Aid if bitten:
-Walk slowly – increased activity increases circulation of venom
-Elevate affected part: most bites are on distal extremities: feet, hands. More serious complications are associated with bites involving trunk, neck, face
-Wash with soap and water
DO NOT:
-Apply a tourniquet
-Attempt to suck venom from wound
-Apply ice to wound
Medical Work-up for known or suspected envenomation
-ABCs (always the first step)
-Good H&P – observe amount of swelling, movement of affected area. Mark swelling and erythema with marker to observe for progression
-CBC
-Comp
-Coags
-Total CK
-Fibrinogen
-U/A – to look for myoglobinuria
-Consider ABG and lactic acid if signs of systemic toxicity
-Xray to r/o retained teeth
Severe complications
-Rhabdomyolysis – from muscle breakdown from venom
-Compartment syndrome – cannot be diagnosed on clinical exam alone. Venom can cause tingling and paresthesias. If concerned, consult your surgeon
-Thrombocytopenia and coagulopathy – caused by thrombin-like molecules in venom. Treated with antivenom
-Systemic toxicity – can be life-threatening
Treatment:
-Update Tdap if indicated
-Pain control, elevation
-Antivenom if indicated
Antivenin: Always contact your toxicologist prior to giving
-Recommended for moderate to severe envenomations
(http://www.uptodate.com.echo.louisville.edu/contents/image?imageKey=EM%2F53948&topicKey=EM%2F6595&rank=2%7E39&source=see_link&search=snake+bite&utdPopup=true)
-Dosing: Moderate envenomation – 4 to 6 vials (1g each) over 60 min with repeat dose as needed
Severe envenomation – 6 to 9 vials over 60min with repeat dose prn
-Contraindications: papaya allergy (contains enzyme papain)
-Stop if signs of anaphylaxis
Disposition
-Requires antivenom – admission. Complications can include compartment syndrome, delayed coagulopathy (up to 48hrs). May need redosing of antivenom
-Mild envenomation or no symptoms – can be discharged home if pain controlled and no signs of toxicity at 8-12hrs s/p bite. If bitten by rattlesnake or cottonmouth, recommend CBC, PT, fibrinogen at 2-3d and 5-6d after initial bite
Nicely done review, Phil. This is something we don’t see particularly often here so when we do it’s always a learning experience. It certainly was for me. The antivenoms have a sig risk of anaphylaxis (esp in repeat treatment –ex. snakehandlers at zoos). I’m glad my patient didn’t need it.
Smile Lines: How To Get Rid Of Them
Health Conditions
Smile lines, often referred to as perioral rhytides, are common skin changes that occur around the mouth and eyes.
They can be influenced by factors such as genetics, aging, environmental exposure, and lifestyle
choices. Understanding the health conditions that may
contribute to their formation can help individuals take proactive steps toward managing
or preventing them.
—
Condition Spotlight
In this article, we’re shining a light on smile lines—those fine creases and lines that appear around your mouth and eyes.
While they are typically harmless, they can sometimes lead to concerns about aging or loss of youthfulness.
Whether you’re looking for treatment options or want to learn how
to prevent them, read on to find out everything you need
to know.
—
Wellness Topics
Maintaining skin health is essential at any age, and smile lines are just one aspect of how our skin changes over time.
By adopting a holistic approach to wellness—such as
eating a balanced diet, staying hydrated, and
protecting your skin from harmful UV rays—you can not only reduce
the appearance of smile lines but also promote overall skin health.
—
Product Reviews
When it comes to treating smile lines, there are numerous products and treatments available on the market.
From over-the-counter creams to advanced cosmetic procedures, each option has its own set of benefits and
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aesthetic goals.
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Featured Programs
Explore our featured programs designed to help you achieve a more youthful and radiant
appearance. Whether it’s a comprehensive skincare regimen or a surgical procedure, these programs are tailored to address the unique needs of
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Featured
Discover what’s new in the world of beauty and wellness
with our featured content. From groundbreaking treatments to expert
insights, this is your go-to destination for staying informed and ahead of the curve.
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Lifestyle Quizzes
Test your knowledge and have some fun with our lifestyle quizzes!
Understanding how your habits and environment influence smile lines can be both educational and entertaining.
See if you can spot the factors contributing to their formation and learn ways to mitigate them.
—
Health News
Stay updated on the latest developments in health and wellness with our health news section. From research findings to
trends in aesthetic medicine, this is where you’ll find everything you need to stay
informed.
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This Just In
Don’t miss out on our “This Just In” section for timely updates and important announcements.
Whether it’s new treatment options or exclusive
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Top Reads
Check out our top reads to dive deeper into subjects that matter most to you.
From expert advice on smile lines to tips for maintaining a glowing complexion, these articles are guaranteed to keep you engaged and educated.
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Video Series
Explore our video series for visual and interactive content that makes learning about smile lines and treatments more enjoyable.
Watch experts discuss treatment options, see demonstrations,
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Find Your Bezzy Community
Join the Bezzy community to connect with others who are passionate about wellness and beauty.
Share your experiences, ask questions, and learn from like-minded individuals who are on a journey to improve their appearance and overall well-being.
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—
How Can I Get Rid of My Smile Lines?
If you’re noticing smile lines appearing or
deepening over time, you may be considering treatment options to address them.
Whether you prefer non-invasive methods or more advanced
procedures, there are several ways to reduce their
visibility and rejuvenate your skin.
—
What causes smile lines?
The formation of smile lines is influenced by a combination of
factors. Genetic predisposition plays a significant role, as
does environmental exposure such as prolonged sun exposure.
Aging also contributes, as the skin loses elasticity and begins to show signs of wear.
Lifestyle choices like smoking, excessive alcohol consumption, and
poor skincare habits can exacerbate these lines.
—
What are my treatment options?
When it comes to treating smile lines, you have a variety of choices depending on your goals and preferences.
Injectable fillers, such as hyaluronic acid or collagen-based products, can plump the skin and reduce the appearance of lines.
Botox is another popular option, as it works by temporarily relaxing the muscles that cause wrinkling.
Surgical procedures, like facial reconstruction or lip augmentation, are more
invasive but may provide longer-lasting results.
Laser treatments and collagen induction therapy (CIT) are also effective options for
certain individuals.
—
Injectable fillers
Injectable fillers are a popular choice for those looking to smooth
out smile lines without undergoing surgery. These products work
by filling in the grooves created by the lines, restoring volume
and elasticity to the skin.
—
Botox
Botox is a neuromuscular agent that temporarily blocks the
contraction of facial muscles, reducing the formation of fine lines and wrinkles.
It’s widely used for its ability to provide a more youthful and
refreshed appearance.
—
Surgery
For those seeking a more permanent solution, surgical options such as facelifts or lip
augmentation may be considered. These procedures involve repositioning or tightening of the facial tissues to
reduce lines and improve contour.
—
Laser treatments
Laser therapy is another effective option for treating smile lines.
It works by targeting the deep layers of skin to promote
collagen production, which strengthens and lifts the skin, reducing the appearance
of lines and wrinkles.
—
Collagen induction therapy (CIT)
CIT is a minimally invasive procedure that encourages the skin to produce its own collagen over time.
This natural approach can help revitalize the skin and
reduce the visible signs of aging.
—
OTC creams
Over-the-counter creams containing ingredients like retinol or
hyaluronic acid can be effective in treating smile
lines, especially when used consistently over time. These products are typically gentle enough
for daily use and can provide noticeable results without the need for invasive treatments.
—
Home light treatment
Home light therapy devices are becoming increasingly popular for their ability to stimulate
collagen production and improve skin elasticity. These devices emit wavelengths of light that penetrate the skin, encouraging
it to repair itself and reduce the appearance of
lines.
—
How can I prevent smile lines?
While some factors contributing to smile lines cannot be controlled,
there are several preventive measures you can take to minimize
their formation. Protecting your skin from UV damage by wearing sunscreen and wide-brimmed hats is
essential. Maintaining a healthy lifestyle, including a balanced diet rich in vitamins A and C, can also support skin health.
Regular skincare with products containing antioxidants and hydration boosters can help preserve
your skin’s elasticity and reduce the development of lines.
—
The takeaway
Smile lines are a natural part of aging, but with advances in cosmetic treatments, there are now more options
than ever to minimize their appearance. Whether you prefer non-invasive methods like injectables or more intensive procedures such as surgery, it’s important to consult with a qualified professional to determine the best approach for your individual needs.
—
How we reviewed this article:
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