1/10. occupational injuries with captive lance-headed vipers (bothrops moojeni): experience from a snake farm in brazil.We studied occupational injuries with captive lance-headed vipers (bothrops moojeni) that occurred in a snake farm in south-eastern brazil from February 1981 to May 1999. The risk of injury, taking into account 13 cases of snake-associated injuries (12 of them snake bites) was 2.73 per 10,000 person-days of work, and 3.51 per 100,000 venom extractions. Thirteen cases of injury occurred in seven workers, whereas 18 workers were never injured, suggesting that some individuals have a higher risk of injury than others perhaps due to lack of concentration or overconfidence. Eight episodes of occupational injuries occurring in four technicians, including a case of eye injury due to splashed venom during extraction, are reported. Assessment of whether envenoming occurred was facilitated by knowledge of the snake species and size, history of recent venom extraction and snake feeding, and examination of snake venom glands. hypersensitivity reactions (anaphylaxis and serum sickness) to antivenom are a risk particularly to those workers who were bitten more than once and medicated previously. Antivenom therefore should not be administered to these individuals unless there is clear evidence that envenoming occurred or is likely to have occurred. hypersensitivity to the venom is also a health concern for workers from snake farms.- - - - - - - - - - ranking = 1keywords = sickness, person (Clic here for more details about this article) |
2/10. Coagulopathy after snake bite by bothrops neuwiedi: case report and results of in vitro experiments.Coagulation studies were performed in a patient who had been bitten by a snake of the species bothrops neuwiedi. The patient presented with hemorrhagic necrosis at the envenomization site and considerable bleeding from venous puncture sites. He developed a severe defibrination syndrome with a clottable fibrinogen level of approximately 0.1 g/l. fibrinogen was not measurable by clotting time assay. Fibrin degradation products were greatly elevated. Treatment with antivenom caused an anaphylactic reaction within ten minutes and serum sickness after three days. in vitro experiments revealed that B. neuwiedi venom directly activates Factors II and X, but does not activate factor xiii. In vivo consumption of factor xiii after B. neuwiedi envenomization is ascribed to the action of Factor IIa. At low venom concentrations clotting is initiated by activation of prothrombin by the venom either directly or via Factor X activation. Treatment with heparin might be beneficial in coagulopathy secondary to snake bite by reducing circulating active thrombin. The venom contains thrombin-like proteases which cause slow clotting of fibrinogen, and plasmin-like components causing further proteolysis of fibrinogen and fibrin. Antivenom has no effect on the proteolytic action of the snake venom. The in vivo effects of antivenom are presumably caused by acceleration of the elimination of venom components from the circulation. Intravenous administration of antivenom caused normalization of blood coagulation parameters within 48 h.- - - - - - - - - - ranking = 0.9866971564043keywords = sickness (Clic here for more details about this article) |
3/10. Treatment of envenomation by Echis coloratus (mid-east saw scaled viper): a decision tree.Envenomation by Echis coloratus causes a transient hemostatic failure. Systemic symptoms, hypotension and evident bleeding are rare, with only one reported fatality. In this paper, we examine the decision to treat victims of Echis coloratus by a specific horse antiserum. The decision model considers the mortality of treated and untreated envenomation, and the side effects of antiserum treatment: fatal anaphylaxis, serum sickness and increased risk of death after a possible repeated exposure to horse antiserum in the future. The results of the analysis are not sensitive to variations in the probability of side effects of antiserum treatment. They are sensitive to variations in the risk of bleeding after envenomation, in the degree of reduction of this risk by antiserum treatment and in the risk of dying after an event of bleeding. Prompt administration of antiserum appears to be the treatment of choice if it reduces the risk of bleeding from 23.6% to 20.3% and if 1.6% or more of the bleeding events are fatal. We conclude that presently available data support antiserum treatment of victims of Echis coloratus who present with hemostatic failure, even though the advantage imparted by this treatment appears to be small.- - - - - - - - - - ranking = 0.9866971564043keywords = sickness (Clic here for more details about this article) |
4/10. Envenomation by the Eastern coral snake (Micrurus fulvius fulvius). A study of 39 victims.We gathered data on 39 victims of Eastern coral snake bite over a 12-year period. The most common situation resulting in snakebite was erroneous identification of the snake as the nonpoisonous scarlet king snake. While no patient died, several experienced severe envenomation, including bulbospinal respiratory paralysis. We found that neurologic symptoms may be delayed for 12 hours, and then may be precipitous. Envenomation occurs in 75% of the persons bitten by a coral snake. Antivenin is effective and should be intravenously administered early to patients who have been bitten by a positively identified coral snake, depending on the clinical presentation.- - - - - - - - - - ranking = 0.013302843595702keywords = person (Clic here for more details about this article) |
5/10. Circulating immune complexes, complement activation kinetics and serum sickness following treatment with heterologous anti-snake venom globulin.Consecutive serum and plasma samples, from a patient receiving 100 ml polyvalent horse anti-venom globulin after a rattlesnake bite, were analysed for circulating immune complexes (IC) and activation of complement factors. IC were determined by two independent methods, a complement consumption assay and a Clq-binding assay. Rapidly rising levels of complement-fixing circulating IC were detected as early as 4--5 days after the serum treatment and distinct IC-activity was recorded in both assays on day 8 when clinical symptoms of serum sickness were observed. The IC remained in circulation for at least 5 weeks. Signs of intravascular C-activation in the form of low C3, C4 and C5 values was noted on day 1 after treatment. Factor B was demonstrable 3--4 days after the snake bite and this factor and C3c attained a peak around day 8, just before maximal suppression of native C3 and C4. 14 days after the globulin treatment C3c and B were declining rapidly while C3 and C4 approached normal values first 36 days after treatment. An increase in heterophilic antibodies to sheep erythrocytes was observed after treatment with anti-venom globulin.- - - - - - - - - - ranking = 4.9334857820215keywords = sickness (Clic here for more details about this article) |
6/10. Venomous snakebite in a patient allergic to horse serum.The management of snake envenomation is a clinical challenge. The definitive therapy, antivenin, is potentially harmful and should not be used indiscriminately. However, the morbidity and mortality from the envenomation usually outweigh any adverse reactions to the antivenin therapy. Most reactions can be divided into two general categories: type I (immediate hypersensitivity) reaction, which may be life-threatening, and the more common type III (immune complex) reaction characterized by serum sickness. It is vital to evaluate the patient's potential for developing adverse reactions from antivenin and to be prepared to provide appropriate therapy. The administration of epinephrine and antihistamines can be lifesaving in type I reactions, while steroids and antihistamines can ameliorate type III reactions.- - - - - - - - - - ranking = 0.9866971564043keywords = sickness (Clic here for more details about this article) |
7/10. Adder (Vipera berus) bites: a case report and review of the management for emergency medical personnel.Few doctors working in the accident and emergency (A&E) department will have had experience in the management of adder (Vipera Berus) bites. While such events are uncommon, and rarely fatal, prompt correct management undoubtedly helps in reducing mortality and morbidity. Various isolated case reports (Watson & Harland, 1977; Gerard & Pugh, 1982; Jones & Clegg, 1985) and larger reviews (Reid, 1976; Pesson & Irestedt 1981; Hawley, 1988, 1990) have appeared in non A&E related journals. Following our own recent experience we felt it timely to report our case and review the management.- - - - - - - - - - ranking = 0.053211374382808keywords = person (Clic here for more details about this article) |
8/10. Naja naja cobra bite.Most venomous snakes in the united states are of the Crotalidae family. Another family of snakes, the elapidae, are not so common, but their bites may be a threat to zoo keepers and persons who have exotic snakes as pets. Because elapidae envenomation is not common, signs and symptoms of such envenomation may not be recognized. elapidae venom, because of a curare-like property, can produce respiratory compromise followed by death within 10 minutes. Antivenin, cholinesterase inhibitors, and mechanical ventilation are treatments to consider in such envenomations. Unlike Crotalidae antivenin, elapidae antivenin may not confer protection against species not used in its preparation. Identification of the involved snake, by family and specie, should be an early priority. Correct management of the envenomated patient is dependent on the prompt administration of the most specific antivenin available when indicated.- - - - - - - - - - ranking = 0.013302843595702keywords = person (Clic here for more details about this article) |
9/10. Envenoming by Chinese krait (bungarus multicinctus) and banded krait (B. fasciatus) in myanmar.A retrospective study of 8 cases of envenoming by Chinese krait (bungarus multicinctus) and one banded krait (B. fasciatus) in southern myanmar is reported. Chinese krait bite produced minimal local reactions, except in one person bitten on the lip which resulted in local swelling. Onset of neurotoxic symptoms occurred 2.5-6 h after the bite, and the interval between bite and death ranged from 12-30 h. Three deaths were due to respiratory failure. Four mildly envenomed cases recovered spontaneously without assisted ventilation. One severely envenomed patient recovered after 8 d intensive respiratory care. Cobra (Naja kaouthia) antivenom had no value in reversing neurotoxic symptoms. Anticholinesterase injection given to one patient failed to improve neurotoxic symptoms. The bite of banded krait (B. fasciatus) resulted in neurotoxic envenoming within 2 h after the bite, with minimal local reactions. The victim died of respiratory failure 14 h after the bite.- - - - - - - - - - ranking = 0.013302843595702keywords = person (Clic here for more details about this article) |
10/10. 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 = 0.013302843595702keywords = person (Clic here for more details about this article) |
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