1/5. Human envenomation by the South American opisthoglyph Clelia clelia plumbea (Wied).A 4-year-old girl was hospitalized 10 hr after having been envenomated by a 1.4 m Clelia clelia plumbea, a colubrid. Although the patient exhibited pronounced edema and local hemorrhage, she did not manifest systemic symptoms. Because the attending physician viewed the case as a possible bothrops bite, anti-bothrops antivenom (FUNED) was administered. All local symptoms disappeared gradually over a period of 3 days.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. Severe coagulopathy after a bite from a 'harmless' snake (Rhabdophis subminiatus).European physicians may occasionally be confronted with cases of snake venom poisoning. The increasing interest in snakes as pets has unfortunately resulted in the importation of a number of venomous snakes. We here report the third known case in the medical literature of a patient who was exposed to severe coagulopathy after being bitten by a 'harmless' ringsnake (Rhabdophis subminiatus). The prolonged bleeding diathesis and the complete depletion of fibrinogen observed in our patient are consistent with the presence of a factor x activator in the venom, as has been described in a murine model. In agreement with the two previous case reports, we found no evidence of severe organ damage, despite active intravascular coagulation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/5. Fatal rattlesnake envenomation in arizona: 1969-1984.Case histories of the last nine fatalities (1969-1984), in which the cause of death on the State of arizona Certificate of Death was snakebite, were reviewed. Six males and three females ranged in age from 2 to 77 years, and were bitten between 0800-2100 hours from April to September. Bites in three adult males were "illegitimate" and of these, two were by captive Mojave rattlesnakes, crotalus s. scutulatus. The latter two victims had been bitten previously and remained at home, refusing treatment. In the other seven victims, the snakes involved were not identified. However, all localities where bites occurred were within the geographical and altitudinal range for crotalus atrox and C. s. scutulatus. The apparent cause of death was prolonged hypotension with major organ system failure in five, intestinal hemorrhage in one, and was unknown in three. Major organs were involved as follows: cardiac failure (two); noncardiac pulmonary edema (two); renal failure (two); unconsciousness with airway obstruction and brain damage (two); and coagulopathy with multiple hemorrhage sites (one). Seven of the nine deaths appeared to be preventable. Four delayed going to a medical facility and six did not have hypotension corrected. Antivenin was not administered early (first four hours) or in adequate amounts (10 vials or more) because of delayed arrival in five or physician's decision in four. Pre-existing cardiac disease contributed to death of two victims. Rattlesnake bite victims should not delay travel to a medical facility and hypotension must be treated aggressively and appropriately.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/5. Severe tiger snake envenomation in a wilderness environment.A 44-year old bushwalker was envenomed in an isolated area late in the afternoon, and a succession of difficulties with his rescue resulted in his not reaching hospital until nearly 24 hours later. This case highlights the problems of prolonged delays before treatment for envenomation, and points to the advantages of physician-staffed emergency helicopter services carrying snake antivenoms into the field.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/5. Successful treatment of neurotoxic king cobra envenomation in Myrtle Beach, south carolina.The growing trend toward the collection of exotic snakes by private collectors increases the likelihood that emergency physicians will face the challenge of treating an exotic envenomation. We report a case involving a professional reptile handler who sustained an extremity bite from a king cobra (Ophiophagus hannah ). Rapid, progressive neurotoxicity developed as manifested clinically by bulbar and respiratory paralysis requiring endotracheal intubation and mechanical support. After infusion of Thai red cross Society monospecific king cobra antivenin, all neurologic sequelae rapidly resolved within 7 hours after the bite. In treating an exotic envenomation, the emergency physician should contact personnel at the regional poison control center or local zoo. Both are prepared to assist the physician by facilitating the timely acquisition of exotic antivenins and by arranging consultation with experts experienced in the management and treatment of exotic envenomations.- - - - - - - - - - ranking = 3keywords = physician (Clic here for more details about this article) |