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Wed Jul 2 22:17:15 BST 2008

Cobras are usually neurotoxic, spitting cobras will instead give you
extensive necrosis of the tissues. If there has been no local damage you
will probably have none developing. Coagulopthy is not a feature of cobra
envenomation. Rapid paralysis is rare, the cobra must have been very angry
and disturbed to have injected so much venom. Probably some of the poison
was injected directly in a blood vessel.
Repeat dosage of antivenom is worth a try, as well as prostigmine. Keep him
on the ventilator until his paralysis reverses.
Peter

-----Messaggio originale-----
Da: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
Per conto di KMATTOX at aol.com
Inviato: lunedì 30 giugno 2008 5.20
A: trauma-list at trauma.org
Cc: SURGINET at listserv.utoronto.ca; ccm-l at ccm-l.org
Oggetto: Monocled Cobra bite

For the endemic and usual kinds of poisonous snake bites in the United  
States I have always proposed to be very sparingly in using  antivenin.
Today we 
received a patient arriving less than 40  minutes after being bitten on the 
finger by a monocled cobra.     He breeds and raises these snakes and his 
business is known to the authorities  and the game warden near his house.

Shortly after arrival his respiration just stopped and he was  intubated.   
He was sedated as if he had been given a muscle  relaxant.   His BP,clotting

studies were basically normal.    His TEG was normal.     He required no  
pressors.    He had basically NO swelling or discoloration  at the site of
the bite 
as we usually see in US poisonous  snakes.     We called around the country 
and the  consensus was that he should receive specific antivenin.    The  
closest antivenin was 1/4 the way across Texas (None in Houston or
Galveston),  so 
it was flown here and he has received 6 vials of Naja specific  antivenin.

He is in the ICU and being supported with the  usual ICU care.   

The reason I am posting this is for several reasons:  

1.    Cobra bites are RARE in the United States
2.    I find that cobra breeders and sellers are fairly  common in the
United 
States
3.    I found that the NEUROLOGIC paralysis was rapid  and sure, and the 
hematological and coagulopathies effects of the antivenin  were not seen.   
4.    Several of you on this web site have seen cobra  bites.     

I am seeking wisdom and advice as well as long range outcomes  and effects.

   I feel certain that we will  receive a large variety of opinion and 
advice.   We will receive and  welcome any and all and will weigh all advice
against 
his clinical  course.   

Thanks in advance.     

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