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Tue Jul 1 08:15:19 BST 2008

Thx.  I dId get it.    I have appreciated the input aNd dialOgue
Sent via BlackBerry by AT&T

-----Original Message-----
From: "Timothy Craig Hardcastle" <TimothyHar at ialch.co.za>

Date: Tue, 1 Jul 2008 08:01:51 
To: Trauma &amp; Critical Care mailing list<trauma-list at trauma.org>
Subject: RE: FOLLOWUP - Cobra bite

Ken

Did you get that article I attached on snake bites? I'm not sure if the
list sent it through; For cobra bites I would use antivenin. The risk of
serum sickness if overstated. Real incidence is about 20% in SECOND-TIME
administration. I will resend the article to you off-list.

Tim
Dr Timothy C Hardcastle
M.B., Ch.B. (Stell); M. Med (Chir) (Stell); FCS (SA)
Principal Surgeon-Lecturer / Sub-specialist: Trauma and Critical Care
Deputy director: Trauma Unit and Trauma ICU
Inkosi Albert Luthuli Central Hospital / UKZN
800 Bellair Road
Mayville, Durban

Postal: PostNet Suite 27
Private Bag X05
Malvern, 4055
KwaZulu Natal

timothyhar at ialch.co.za 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of KMATTOX at aol.com
Sent: 01 July 2008 03:05
To: ccm-l at ccm-l.org; SURGINET at listserv.utoronto.ca;
trauma-list at trauma.org
Subject: FOLLOWUP - Cobra bite

Thirty (30) hours after admission, our cobra bite (Naja sp sp) patient
is  
doing well and extubated.    I have several clinical and  literature
items to 
share with these three lists.   I duplicate send  as all of these groups
might 
see patients with snake bite and might in some  small way benefit from
my 
observations, which I will attempt to keep as  objective as possible.  

Clinical status:
      The monocled cobra is about 20 inches  long
     The snake struck when a water  dish  was being changed out
       It took 10 minutes for the  ambulance to arrive after the snake
bite
       From snake bite to arrival at the  hospital is now known to be 20

minutes
        The patient was beginning  to feel numb and to have trouble
breathing 
as the ambulance reached the  hospital
            He  was having trouble focusing and taking a breath as he
was put 
on the shock room  table        
          Patient was  intubated immediately upon presentation to the
hospital
        It was 3.5 hours after  arrival at the hospital before the out
of 
town obtained antivenin was given 
        He had almost no local  reaction at the site of the bite
        ALL laboratory tests were  normal and remained normal including 
repeat CBCs and TEGs
        Cardiac and renal status  was unaffected
        He was extubated 24 hours  after admission
        He stated that he  remembered and heard everything.   We gave
him 
sleep level versed  repeatedly during the 24 hours
        When asked to repeat any  conversation that he heard, he cited
he 
heard talking, but could not cite  anything specifically
        He had received 6 amps of  specific antivenin in two of three
amp 
batches
        He has no apparent visual  or neurologic impairment now
        He was not in pain nor  apprehensive during his intubation
        He stated that while he was  intubated he could not feel nor
move his 
lips, hands or feet
        We did give tetanus  prophylaxis and broad spectrum antibiotics 

Snake identification
        We discovered everyone  agrees on the genus of this snake
(Naja), but 
we found at least 4 different  names of species and sub species
associated 
with the Monocled  Cobra.     

        We found strong support  for ventilatory support, but in the 
literature and  internet  recommendations, we could NOT find any
consistent reason why 
antivenin should be  used.    We heard and read many urban legends, and
read 
several  scientific papers with no real comparison and a lot of expert
opinion

        We received many warnings  in the literature and from advisors
that 
we must watch for serum sickness as  they thought it would occur in 3-6
weeks 
in almost every case of antivenin  use.     

k mattox

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FOLLOWUP - Cobra bite