Poison Snake Bites

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Dr Wigle

Suggest you get a copy of the publication "Management of Envenomation in Southern Africa" by Pantanowitz and Muller (SAIMR) since most of the snakes you refer to are found here. You may be suprised at the good, easy to apply regimes that are based on studies of over one thousand bite victims!

Tim
Dr TC Hardcastle
M.B.Ch.B(Stell); ATLS(I), DSTC(I); M.Med(Surg)(Stell); FCS(SA)
General Surgeon (Sections Trauma / ICU)
Dept. General Surgery
University of Stellenbosch / Tygerberg Hospital
PO Box 19063, 7505
Operational Head: Diana, Princess of Wales Trauma Centre
Program Coordinator: Emergency Medicine
Intern Rotation Coordinator: Surgery
 
tch at sun.ac.za <mailto:tch at sun.ac.za> 
2 Lorient Close
Vredekloof
Brackenfell
7560, W. Cape
South Africa
Cell: +27824681615
Home: +27219813098
Work: +27219384911 pager 0302


-----Original Message-----
From: Richard Wigle MD FACS [mailto:rlwigle at yahoo.com]
Sent: Monday, September 20, 2004 6:37 AM
To: Trauma & Critical Care mailing list
Subject: Re: Poison Snake Bites


As I'm sure others (especially Dr Mattox who has published
on the subject if I'm not mistaken) will point out
antivenin is not without it's risks and complications

As you know snake venoms are popularly divided into
neurologic and hematologic types. This is a vast
oversimplification and one I've always thought dangerous as
all snake venoms (with perhaps the exception of the sea
snakes and the colubrids) are complex toxins which contain
components representattive of all types of activity.
Species may vary in predominence of one or the other. Your
cobra, for example, is an elapid and generally thought of
as having a "neurologic" venom however they also usually
pack a tremendous ncrotic effect

In terms of administering anti venon I have always taught
to look at teh patient. If they exhibit class III or IV
symptoms (ie systemic symptoms- hypotension, tachycardia,
diaphoresis, nausea etc) I use antivenom. If they have any
neurologic signs (ptosis, weakness, diplopia, fasiculation)
I treat.

For a grade I or II I would look at the individual injury
and determine how much loss of function will result (ie a
bite in the hand will be more likely to be treated than one
in the calf)

Grade 0 (no evenomation)obviously need no treatment except
observation

Colubrid snakes are a different situation altogether

R Wigle MD FACS
LTC USA MC
sometimes jungle explorer

--- Mohamed al Malik <traumawon at yahoo.com> wrote:

> 
> I am new to this web site.   I hope to learn and
> communicate from time to time.   I am at large private
> hospital in the Los Angeles area and work as a general
> surgeon, but like trauma.    I also work in the ICU.    
> I have trained in different countries, and lived in even
> more.     
> 
> On a critical care web site, they are discussing
> poisonous snake bites.   I had been taught to give
> antivenum to all patients with any suspision of a
> poisonous snake bite, and use lots.     Some of the
> critical care doctors, suggested to give antivenum only
> for symptoms.    They were discussing a cobra bite.   
> 
> What do trauma doctors on this list think
> 
> Mo
> 
>  
> 
>  
> 
>  
> 
>  
> 
>  
> 
> 
> 		
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