Severe Snakebite Envenoming in Intensive Care

Abstract

Snakebites by exotic venomous snakes can cause serious or even life-threatening envenoming. In Europe and North America most victims are breeders, with a few snakebites from wild native American rattlesnakes. The envenomed victims may present in organ and/or system failure with muscle paralysis, respiratory failure, circulatory instability, acute kidney injury, severe coagulation disorder, and local disability - compartment syndrome and necrosis. Best managed by close collaboration between clinical toxicology and intensive care, most severe envenomings are managed primarily by intensive care physicians. Due to the low incidence of severe envenoming, the clinical course and correct management of these cases are not intrinsically familiar to most physicians. This review article summarizes the clinical syndromes caused by severe envenoming and the therapeutic options available in the intensive care setting.

Analysis of hemocoagulation tests for prediction of venom-induced consumption coagulopathy development after Viperidae bite

“…The results of this study confi rm an elevation in D-dim levels soon after the bite to be the fi rst marker of impending VICC. Targeted antivenom therapy based on the elevations in D-dim may become an important point in intensive care of the envenomed patient (12).…”

Successful Management of Cardiac Arrest Following Cobra Bite: A Case Report from a Rural Critical Care Unit in India

“…Neuroparalysis leading to type II respiratory failure is the most important cause of morbidity and mortality in victims bitten by venomous snakes of Elapidae family. Severity of envenomation and progression to respiratory failure is related to several factors such as dose of venom injected, potency of venom, anatomic location of bite, age, health, size and possibly immune status of victim, and the nature and timely intervention [2,4,9]. In all such patients, timely administration of ASV and institution of cardio-respiratory support is associated with an excellent outcome [3,4].…”

“…Severity of envenomation and progression to respiratory failure is related to several factors such as dose of venom injected, potency of venom, anatomic location of bite, age, health, size and possibly immune status of victim, and the nature and timely intervention [2,4,9]. In all such patients, timely administration of ASV and institution of cardio-respiratory support is associated with an excellent outcome [3,4]. It is concluded mechanical ventilatory support is a lifesaving procedure in patients of snake bite manifestation signs of bulbar and respiratory paralysis and timely institution can prevent hypoxic injury to brain [5].…”

“…In most serious cases the envenomed victim may present in organ and/or system failure, muscle paralysis, respiratory failure, hemodynamic instability, acute kidney injury, coagulation disorder (venom-induced consumption coagulopathy, VICC) and severe local injury due to necrosis and compartment syndrome. Severe envenomation and its serious complications requiring organ and systems support should be treated in the intensive care setting [2,3,4]. We herewith report a case of snake bite which developed cardiac arrest following severe neurotoxic envenomation was managed successfully in our critical care.…”

The risk of exotic venomous snakes to public health in Brazil

“…The hobby of breeding exotic snakes has generated a health problem, with numerous cases of snakebites around the world, mainly in North America and Europe; this is because some breeders are acquiring venomous species 1 , 2 , 3 , 4 . Between 2005 and 2011, 258 cases of snakebites involving 61 species of exotic venomous snakes were recorded in the United States, which is an average of 37 cases per year 3 .…”