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Xian X, Jiang Z, Ren Y, Tang S, Liu Y, Bai T, Chen F, Ding L, Xu S. Limb circumference measurements contributing to the diagnosis of snake venom-induced compartment syndrome. Heliyon 2024; 10:e37057. [PMID: 39286135 PMCID: PMC11402951 DOI: 10.1016/j.heliyon.2024.e37057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 08/18/2024] [Accepted: 08/27/2024] [Indexed: 09/19/2024] Open
Abstract
Background The present study aimed to investigate the relationship between swollen limb circumference and compartment pressure after a snakebite and to evaluate the diagnostic value of the circumference difference between the healthy and affected sides and the circumference growth rate for snake venom-induced compartment syndrome (CS). Method The study was based on a prospective cohort study of snakebite patients at the emergency department of West China Hospital from May 2021 to October 2022. The snakebite patients were divided into the CS and non-compartment syndrome (NCS) groups. The diagnostic value of the circumference of the swollen limb for the CS after snakebite was evaluated using a receiver-operating characteristic curve analysis, and the cut-off value of the circumference of the swollen limb for CS after snakebite was calculated with sensitivity and specificity. Result The present study enrolled 115 patients with severely swollen limbs after snakebite. The mean age was 59.1 ± 13.6 years, with 58 (50.4 %) female cases and 57 (49.6 %) male cases. There were 33 (28.7 %) cases where the upper limbs were injured and 82 (71.3 %) cases where the lower limbs were injured. These patients were divided into CS (n = 19) and NCS (n = 96) groups. The area under the curve (AUC) for the 15 cm circumference difference and circumferential growth rate of the upper edge of the patella was 0.683 (95 % CI 0.508 to 0.858, P = 0.037), and 0.685 (95 % CI 0.512 to 0.858, P = 0.035). The optimal cut-off values for the 15 cm circumference difference and circumferential growth rate of the upper edge of the patella to distinguish CS and NCS were 2.8 cm (sensitivity = 76.9 %, specificity = 66.7 %) and 7 % (sensitivity = 76.9 %, specificity = 66.7 %), respectively. Conclusion Limb circumference measurement is a non-invasive, convenient, effective, and repeatable bedside test that can assist clinicians in the early detection of suspected snake venom-induced CS in patients exhibiting limb swelling after snake bites.
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Affiliation(s)
- Xiaoyan Xian
- Department of Emergency Medicine, Laboratory of Emergency Medicine, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Zhen Jiang
- Department of Emergency Medicine, Laboratory of Emergency Medicine, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yan Ren
- Department of Emergency Medicine, Laboratory of Emergency Medicine, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Shiyuan Tang
- Department of Emergency Medicine, Laboratory of Emergency Medicine, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yajun Liu
- Department of Emergency Medicine, Laboratory of Emergency Medicine, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ting Bai
- Department of Emergency, Shangjinnanfu Hospital, West China Hospital, Sichuan University, Chengdu, 610044, Sichuan, China
| | - Fang Chen
- Department of Emergency, Shangjinnanfu Hospital, West China Hospital, Sichuan University, Chengdu, 610044, Sichuan, China
| | - Li Ding
- Chengdu institute of biology, Chinese Academy of Sciences, Chengdu, 610299, Sichuan, China
| | - Shuyun Xu
- Department of Emergency Medicine, Laboratory of Emergency Medicine, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Emergency, Shangjinnanfu Hospital, West China Hospital, Sichuan University, Chengdu, 610044, Sichuan, China
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Olin S, Schildt J, Lane M, Odunayo A, Springer C, Call D, Jones S, Geiser D, Millis D, Drum M. The effects of hyperbaric oxygen therapy on snake-bite-associated wounds in dogs. J Vet Emerg Crit Care (San Antonio) 2024; 34:211-221. [PMID: 38761038 DOI: 10.1111/vec.13383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 05/20/2024]
Abstract
OBJECTIVE To assess the effect of hyperbaric oxygen therapy (HBOT) on Crotalinae envenomation-induced wound swelling and severity and pain in dogs, and to describe the safety and complications of HBOT. DESIGN Prospective, randomized, controlled, blinded study (2017-2021). SETTING University teaching hospital, private veterinary practice. ANIMALS Thirty-six client-owned dogs presenting within 24 hours of a confirmed or suspected naturally occurring Crotalinae snake bite injury were enrolled between 2017 and 2021. INTERVENTIONS In addition to the standard of care treatment, dogs received 2 interventions with either HBOT (n = 19) or control (n = 16) within 24 hours of hospital admission. Dogs receiving HBOT were pressurized over 15 minutes (1 psi/min), maintained at a target pressure of 2 atmosphere absolute (ATA) for 30 minutes, and decompressed over 15 minutes. Control dogs received 1 ATA for 1 hour. Local wound swelling, wound severity score, and pain score were assessed at admission, before and after each intervention, and at hospital discharge. MEASUREMENTS AND MAIN RESULTS There was no significant difference in wound swelling (P = 0.414), severity score (P = 1.000), or pain score (P = 0.689) between HBOT and control groups. Pain decreased significantly over time regardless of the study intervention (P < 0.001). There were no major adverse effects associated with either study intervention. CONCLUSIONS HBOT did not significantly alter the short-term recovery from Crotalinae envenomation in this study population. However, the study might be underpowered to detect a significant treatment effect.
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Affiliation(s)
- Shelly Olin
- Department of Small Animal Clinical Science, University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, USA
| | - Julie Schildt
- Department of Small Animal Clinical Science, University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, USA
| | | | - Adesola Odunayo
- Department of Small Animal Clinical Science, University of Florida, Gainesville, Florida, USA
| | - Cary Springer
- Research Computing Support, Office of Information Technology, University of Tennessee, Knoxville, Tennessee, USA
| | - Dana Call
- Neel Veterinary Hospital, Oklahoma City, Oklahoma, USA
| | - Selene Jones
- Allergy Skin and Ear Clinic for Pets, Livonia, Michigan, USA
| | - Dennis Geiser
- Hospital Administration, University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, USA
| | - Daryl Millis
- Department of Small Animal Clinical Science, University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, USA
| | - Marti Drum
- Department of Small Animal Clinical Science, University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, USA
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Spyres MB, Maker G, Aldy K, Wolk BJ, Meadors KE, Christian M, Ruha AM. Compartment Syndrome after Crotalid Envenomation in the United States: A Review of the North American Snakebite Registry from 2013 to 2021 on Behalf of the ToxIC Snakebite Study Group. Wilderness Environ Med 2023; 34:322-327. [PMID: 37474357 DOI: 10.1016/j.wem.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 04/13/2023] [Accepted: 05/16/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Compartment syndrome (CS) is a rare but serious complication after crotalid envenomation in the United States. Few data are available regarding the epidemiology and management of these cases. Significant controversy and misunderstanding over best practices, including measurement of compartment pressures and use of fasciotomy, exist for this syndrome. This study aims to describe presentation and management of suspected CS cases after native snakebite reported to the North American Snakebite Registry (NASBR). METHODS This is an analysis of snakebite cases reported to the Toxicology Investigators Consortium NASBR between January 1, 2013 and December 31, 2021. Cases of native snakebite with documented concern for CS were included. RESULTS Over an 8-y period, 22 cases of suspected CS were identified, representing 1% of all cases reported to the NASBR. Fasciotomies were performed in 41% (n=9) of these cases, most commonly to the upper extremity (67%, n=6). In cases of suspected CS, intracompartmental pressures (ICPs) were rarely measured (23%, n=5) and fasciotomies were performed without measurement of ICPs frequently (56%, n=5). In 1 case, ICPs were measured and found to be low (8 mm Hg) and fasciotomy was avoided. CONCLUSIONS Measurement of compartment pressures in cases of suspected CS was uncommon in cases reported to the NASBR. Fasciotomy was commonly performed without measurement of compartment pressures.
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Affiliation(s)
- Meghan B Spyres
- Department of Internal Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ; Department of Medical Toxicology, Banner-University Medical Center Phoenix, Phoenix, AZ.
| | - Greg Maker
- Department of Internal Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ; Department of Medical Toxicology, Banner-University Medical Center Phoenix, Phoenix, AZ
| | - Kim Aldy
- American College of Medical Toxicology, Phoenix, AZ; Department of Emergency Medicine, Baylor University Medical Center, Dallas, TX
| | - Brian J Wolk
- Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, CA
| | - Kevan E Meadors
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael Christian
- Department of Emergency Medicine, University of Missouri‒Kansas City School of Medicine, Kansas City, MO
| | - Anne-Michelle Ruha
- Department of Internal Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AZ; Department of Medical Toxicology, Banner-University Medical Center Phoenix, Phoenix, AZ
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Bagnall L, Taliaferro D. Venomous Snakebites: Treatment Considerations and the Emergency Department Nurse Practitioners'/Providers' Priorities of Care. Adv Emerg Nurs J 2021; 43:309-323. [PMID: 34699421 DOI: 10.1097/tme.0000000000000374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the United States, 7,000-8,000 people are bitten by a venomous snake each year, out of which approximately 5 die. Although common practice is to treat any and all victims of envenomation with repeated doses of antivenom, this approach is not without its risks. The gold standard for treating venomous snakebites with severe symptoms is antivenom. Although a standardized approach to treating envenomation is needed, it cannot be developed without first delineating current practices. This article discusses the ways in which advanced practice emergency nurses should manage bites from a variety of venomous snakes. It is divided into 4 main sections: (1) the types of venomous snakes found in the United States, their habitat, and the effects of their venom; (2) priorities of care in treating venomous snakebites; (3) preparation and administration of antivenom; and (4) other considerations for the advanced practice emergency department nurse.
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Affiliation(s)
- Lisa Bagnall
- University of Florida, Gainesville (Dr Bagnall); and College of Doctoral Studies, University of Phoenix, Phoenix, Arizona (Dr Taliaferro)
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No Change in the Use of Antivenom in Copperhead Snakebites in Ohio. Wilderness Environ Med 2021; 32:315-321. [PMID: 34301478 DOI: 10.1016/j.wem.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 03/08/2021] [Accepted: 03/25/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Historically, copperhead snake (Agkistrodon contortrix) envenomations were not treated with antivenom owing to related adverse events and little benefit. However, recent studies have shown improved outcomes with antivenom use. We hypothesized that the frequency of antivenom use for copperhead envenomation in Ohio has increased as benefits of administration became more widely known. METHODS All copperhead snakebites reported to the Ohio poison control centers from 2006 through 2016 were compiled. Antivenom use, bite severity, and disposition were abstracted. A nonparametric test for trend was used to evaluate changes over time for the number of patients treated with antivenom and patient disposition. Logistic regression was used to assess the odds of admission vs discharge with antivenom administration, bite severity, age, and sex as independent variables. RESULTS Ninety-eight patients reported copperhead snakebites to the poison control centers. The test of trend showed no change in the proportion of patients treated with antivenom by year (P=0.42). There was no difference in the proportion of patients discharged home (P=0.38) per year. Logistic regression showed antivenom use was associated with an odds ratio for admission of 46.7 (95% CI: 7.3-296.4). CONCLUSIONS The frequency of antivenom use for copperhead bites did not significantly increase between 2006 and 2016. Administration of antivenom was associated with a large increase in the odds of admission to the hospital, even when controlling for bite severity. Further education regarding the benefits and safety of antivenom may increase its use for copperhead snakebites, but may lead to an increase in hospital admissions.
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Román-Domínguez L, Neri-Castro E, Vázquez López H, García-Osorio B, Archundia IG, Ortiz-Medina JA, Petricevich VL, Alagón A, Bénard-Valle M. Biochemical and immunochemical characterization of venoms from snakes of the genus Agkistrodon. Toxicon X 2019; 4:100013. [PMID: 32550570 PMCID: PMC7285990 DOI: 10.1016/j.toxcx.2019.100013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/28/2019] [Accepted: 07/23/2019] [Indexed: 12/12/2022] Open
Abstract
In the present work, venoms from five species of the genus Agkistrodon were evaluated in terms of their enzymatic (Phospholipase A2 and caseinolytic) and biological (edema forming, hemorrhagic, procoagulant and lethal) effects. Horses were used to produce monovalent hyperimmune sera against each of three venoms (A. bilineatus, A. contortrix and A. piscivorus) and their neutralizing potency, expressed as Median Effective Dose (ED50), was determined against the venoms of all five species. In terms of PLA2 and caseinolytic activities, all venoms are extremely homogeneous. PLA2 activity is high, while caseinolytic activity is low when in contrast with that of the rattlesnake Crotalus simus. On the other hand, biological activities showed marked interspecific differences, particularly between the species from Mexico and those from the United States. Mexican species displayed higher edema-forming, hemorrhagic and lethal effects than US species, while none of the species studied presented procoagulant activity. All three monovalent hyperimmune sera showed good neutralizing potency against the analyzed venoms. Nonetheless, we observed relevant immunochemical differences among the venoms using ELISA and Western Blot assays. We conclude that the venoms of A. piscivorus (USA) and A. bilineatus would be ideal to use as immunogens for the production of a polyvalent antivenom with good neutralizing potency against the venoms of all the species of the genus.
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Affiliation(s)
- Luis Román-Domínguez
- Instituto de Biotecnología, Universidad Nacional Autónoma de México. Av. Universidad # 2001 Colonia Chamilpa. CP: 62210. Cuernavaca, Morelos, Mexico
- Facultad de Ciencias Biológicas, Universidad Autónoma del Estado de Morelos. Av. Universidad # 2001 Colonia Chamilpa. CP: 62210. Cuernavaca, Morelos, Mexico
| | - Edgar Neri-Castro
- Instituto de Biotecnología, Universidad Nacional Autónoma de México. Av. Universidad # 2001 Colonia Chamilpa. CP: 62210. Cuernavaca, Morelos, Mexico
| | - Hilda Vázquez López
- Instituto de Biotecnología, Universidad Nacional Autónoma de México. Av. Universidad # 2001 Colonia Chamilpa. CP: 62210. Cuernavaca, Morelos, Mexico
| | - Belem García-Osorio
- Instituto de Biotecnología, Universidad Nacional Autónoma de México. Av. Universidad # 2001 Colonia Chamilpa. CP: 62210. Cuernavaca, Morelos, Mexico
| | - Irving G. Archundia
- Instituto de Biotecnología, Universidad Nacional Autónoma de México. Av. Universidad # 2001 Colonia Chamilpa. CP: 62210. Cuernavaca, Morelos, Mexico
| | - Javier A. Ortiz-Medina
- Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán. Km 15.5, Carretera Mérida-Xmatkuil. C.P: 97315. Mérida, Yucatán, Mexico
- Unidad de Manejo para la Conservación de la Vida Silvestre Tsáab Kaan. Km. 2.8, Carretera Baca-Dzemul, C.P. 97450. Baca, Yucatán, Mexico
| | - Vera L. Petricevich
- Facultad de Medicina. Universidad Autónoma del Estado de Morelos. Calle Leñeros S/N, Colonia Vista Hermosa. CP: 62290. Cuernavaca, Morelos, Mexico
| | - Alejandro Alagón
- Instituto de Biotecnología, Universidad Nacional Autónoma de México. Av. Universidad # 2001 Colonia Chamilpa. CP: 62210. Cuernavaca, Morelos, Mexico
| | - Melisa Bénard-Valle
- Instituto de Biotecnología, Universidad Nacional Autónoma de México. Av. Universidad # 2001 Colonia Chamilpa. CP: 62210. Cuernavaca, Morelos, Mexico
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Baumgartner KT, Fishburn SJ, Mullins ME. Current Management of Copperhead Snakebites in Missouri. MISSOURI MEDICINE 2019; 116:201-205. [PMID: 31527942 PMCID: PMC6690278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The past two decades have seen changes to the management of copperhead snakebites. We review the current use of antivenom, analgesics, and laboratory testing as well as the declining role of surgical management.
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Affiliation(s)
- Kevin T Baumgartner
- Kevin T. Baumgartner, MD, is a senior resident in emergency medicine and will begin a fellowship in medical toxicology in July 2019. Steven J. Fishburn, MD, MSCR, is a fellow in medical toxicology and a specialist in occupational medicine. Michael E. Mullins MD, FACEP, FAACT, is an associate professor in emergency medicine at Washington university school of Medicine in St. Louis. He serves as an attending emergency physician at Barnes-Jewish Hospital and a medical toxicology consultant at Barnes-Jewish Hospital and Saint Louis Children's Hospital
| | - Steven J Fishburn
- Kevin T. Baumgartner, MD, is a senior resident in emergency medicine and will begin a fellowship in medical toxicology in July 2019. Steven J. Fishburn, MD, MSCR, is a fellow in medical toxicology and a specialist in occupational medicine. Michael E. Mullins MD, FACEP, FAACT, is an associate professor in emergency medicine at Washington university school of Medicine in St. Louis. He serves as an attending emergency physician at Barnes-Jewish Hospital and a medical toxicology consultant at Barnes-Jewish Hospital and Saint Louis Children's Hospital
| | - Michael E Mullins
- Kevin T. Baumgartner, MD, is a senior resident in emergency medicine and will begin a fellowship in medical toxicology in July 2019. Steven J. Fishburn, MD, MSCR, is a fellow in medical toxicology and a specialist in occupational medicine. Michael E. Mullins MD, FACEP, FAACT, is an associate professor in emergency medicine at Washington university school of Medicine in St. Louis. He serves as an attending emergency physician at Barnes-Jewish Hospital and a medical toxicology consultant at Barnes-Jewish Hospital and Saint Louis Children's Hospital
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Kempema J, Watanabe B, Potter A, Williams M. Bites, Stings, and Envenomations. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0140-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Li M, Xie ZH, Yu AY, He DP. Increased Efficacy of Antivenom Combined with Hyperbaric Oxygen on Deinagkistrodon acutus Envenomation in Adult Rats. Chin Med J (Engl) 2018; 131:323-329. [PMID: 29363648 PMCID: PMC5798054 DOI: 10.4103/0366-6999.223840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Snakebites are a neglected threat to global human health with a high morbidity rate. The present study explored the efficacy of antivenom with hyperbaric oxygen (HBO) intervention on snakebites, which could provide the experimental basis for clinical adjuvant therapy. METHODS Male Sprague-Dawley rats (n = 96) were randomized into four groups: the poison model was established by injecting Deinagkistrodon acutus (D. acutus) venom (0.8 LD50) via the caudal vein; the antivenom group was injected immediately with specific antivenom via the caudal vein after successful establishment of the envenomation model; and the antivenom + HBO group was exposed to HBO environment for 1 h once at predetermined periods of 0 h, 4 h, 12 h, and 23 h after antivenin administration. Each HBO time point had six rats; the control group was left untreated. The rats in the experimental group were euthanized at the corresponding time points after HBO therapy, and brain tissue and blood were harvested immediately. Hematoxylin and eosin (H&E) staining was used to investigate the pathological changes in the rat brain. Immunohistochemistry (IHC), real-time polymerase chain reaction (PCR), and Western blotting were used to detect the expression of Nestin mRNA and protein in the subventricular zone (SVZ) of the brain. The levels of coagulation function (prothrombin time, activated partial thromboplastin time [APTT], and fibrinogen) and oxidation/antioxidation index (malondialdehyde [MDA] and superoxide dismutase [SOD]) were analyzed. Data were analyzed using one-way analysis of variance. RESULTS The brain tissue from rats in the poison model was observed for pathological changes using H&E staining. Tissues showed edema, decreased cell number, and disordered arrangement in the SVZ in the snake venom group. The antivenom - HBO intervention significantly alleviated these observations and was more prominent in the antivenom + HBO group. The serum levels of SOD and MDA in the snake venom group were increased and the antivenom - HBO intervention further increased the SOD levels but significantly decreased the MDA levels; however, this was enhanced within 1 h after HBO administration (MDA: F = 5.540, P = 0.008, SOD: F = 7.361, P = 0.000). Activated partial thromboplastin time (APTT) was significantly abnormal after venom administration but improved after antivenom and was even more significant in the antivenom + HBO group 5 h after envenomation (F = 25.430, P = 0.000). Only a few nestin-positive cells were observed in the envenomation model. The expression levels were significant in the antivenom and antivenom + HBO groups within 1 and 5 h after envenomation and were more significant in the antivenom + HBO group as determined by IHC, real-time PCR, and Western blotting (P < 0.05). D. acutus envenomation has neurotoxic effects in the brain of rats. CONCLUSIONS Antivenin and HBO, respectively, induced a neuroprotective effect after D. acutus envenomation by attenuating brain edema, upregulating nestin expression in SVZ, and improving coagulopathy and oxidative stress. The intervention efficacy of antivenom with HBO was maximum within 5 h after envenomation and was more efficacious than antivenom alone.
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Affiliation(s)
- Mo Li
- Department of Emergency, The First Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou 563003, China
| | - Zhi-Hui Xie
- Department of Hyperbaric Oxygen, The First Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou 563003, China
| | - An-Yong Yu
- Department of Emergency, The First Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou 563003, China
| | - Dong-Po He
- Department of Emergency, The First Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou 563003, China
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Copperhead Envenomation Resulting in a Rare Case of Hand Compartment Syndrome and Subsequent Fasciotomy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e396. [PMID: 26090286 PMCID: PMC4457259 DOI: 10.1097/gox.0000000000000367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 03/27/2015] [Indexed: 11/29/2022]
Abstract
Copperhead bites account for nearly 40% of all snakebites in the United States. Although common, these bites are rarely severe, and most are treated with supportive care and antivenom. We describe the first reported case of a copperhead envenomation resulting in a hand compartment syndrome with measured elevated compartment pressures that necessitated fasciotomy of the hand. Our case underscores the importance of vigilance in the diagnosis and management of copperhead envenomation.
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Lack of Coagulopathy After Copperhead Snakebites. Ann Emerg Med 2015; 65:404-9. [DOI: 10.1016/j.annemergmed.2014.08.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/06/2014] [Accepted: 08/04/2014] [Indexed: 11/19/2022]
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