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Thu Mar 22 17:10:19 GMT 2012

At the BTGH, over the years, we have had our share of poisonous snake 
bites, from snakes indigenous to the area (to include water moccasin 
snakes, copperhead snakes, rattlesnakes, and coral snakes), to those 
owned by snake handlers, to include all sorts of vipers from Africa, 
India, and Australia (including cobras, etc), to those used and housed 
by companies who own all varieties of poisonous snake in order to make 
pharmaceuticals, to those housed in the local zoo snake house and have 
occassionally bitten the snake handlers.

We have chosen to evaluate each and every snake bite separately and 
have NOT been fans of antivenin for any snake bite, including coral and 
cobra bites.    We DO wide and complete fasciotomies for  ANY 
compartent syndrome, regardless of the cause IF we demonstrate 
increased compartment pressures.     During the past 30+ years we have 
probably done no more than 3-5 fasciotomies in patients with snake 
bites, and those were rattlesnake bites in the forearm or hand.

Should a snake bite victim develope respiratory insufficiency they are 
admitted to the ICU and ventilated for a day  or so..    If they 
develop a coagulopathy, we treat the deficit specifically.

For patients who have received antivenin in OTHER hospitals we see high 
rates of serum sickness several weeks later.     We have had ONE digit 
loss and no extremity losses .     The digit loss was a necrotic finger 
which was necrotic and many hours post bite when the patient came in, 
and it too was a rattlesnake bite .

K Mattox

-----Original Message-----
From: Pradeep Navsaria <Pradeep.Navsaria at uct.ac.za>
To: trauma-list <trauma-list at trauma.org>
Sent: Thu, Mar 22, 2012 4:26 am
Subject: Re: Fasciotomy after viper bites

The treatment of a compartment syndrome, irrespective of cause, is a
fasciotomy!

Pradeep

Trauma Center
Cape Town
>>> Miranda Voss <mvossak at yahoo.co.uk> 2012/03/22 10:56 AM >>>
Dear List Members,

It is still pretty much standard teaching in South Africa that if you
suspect a compartment syndrome after a cytotoxic snake bite, you should
do a fasciotomy. I see that there are now recommendations - particularly
from WHO - that fasciotomy in cytotoxic snake bite should be avoided if
at all possible. I believe the concern is bleeding from associated
coagulopathy, but I am uncomfortable with this. Would anybody here not
do a fasciotomy for a cytotoxic snake bite with limb swelling and pain
on passive stretch of the flexor muscles? We have never measured
compartment pressures because we teach that a suspected compartment
syndrome should be treated with fasciotomy. Does anybody else have a
view? I have seen the pictures on the WHO website of patients bitten by
Asian snakes and needing massive transfusions after "unnecessary"
fasciotomy but they may be dealing with different animals.

Thanks,
Miranda Voss,
Worcester, South Africa.
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Fasciotomy after viper bites