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Tue Sep 21 04:23:30 BST 2004

Tim

In Zimbabwe where I lived for many years the commonest injury was the
'tourniquet bite' rather than the snake bite. Anyone who thought they
had been bitten immediately had a tourniquet applied and developed
distal swelling. 

The majority of envenomations were due to cytotoxic snakes eg puff
adder, night adder etc. The combination of tourniquet plus cytotoxic
bite was usually disastrous. Our policy was to release the tourniquet,
observe and treat on its merits. If the snake was brought in for
identification then antivenom may be given in large amounts for
neurotoxic bites. The majority of venomous bites occurred in amateur
snake handlers.

One enthusiastic expatriate doctor read an article in the Lancet about
electric shock treatment and brought his car around to the Casualty
Department and zapped every 'snake bite' that he was called for until we
pointed out to him that the majority were not venomous and the article
was dubious.

Matt Oliver
Bendigo
Australia

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Hardcastle Tim, Dr
<tch at sun.ac.za>
Sent: 20 September 2004 15:18
To: Trauma & Critical Care mailing list
Subject: RE: Poison Snake Bites

Mo

Cobra bites are common in South Africa - we have the Rinkhals (Spitting
cobra) and the Cape Cobra, up in the mountains around Cape Peninsula.

There is NO justification to not give antivenin to a patient with a bite
from a Neurotoxic snake. If it was definitely a Cobra, then polivalent
antivenin (SAIMR) should be administered ASAP. The alternative is only
DEATH!!!!! You need to give lots of it (around 20 ampoules, both to
adult or child) The same applies to definite Puff Adder (Cytotoxic)
bites. The hematoxic snakes (Tree Snake = Boomslang) need a special
univalent antivenin, which must be flown in on requirement from a
central store in Johannesburg. Fortunately you have 24hours before
symptoms show up!

Regards
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: Mohamed al Malik [mailto:traumawon at yahoo.com]
Sent: Monday, September 20, 2004 2:35 AM
To: trauma-list at trauma.org
Subject: Poison Snake Bites

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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