Venomous Snakebite in Thailand II: Clinical Experience

Abstract

<jats:title>Abstract</jats:title> <jats:p>We reviewed a total of 2,525 snakebite patients in Bangkok. Of these, 1,415 were bitten by venomous snakes, 91 by neurotoxic snakes of genus Naja or Bungarus and 1,324 by snakes of family Viperidae or Crotalidae. Seventy-one percent of bites were on the lower extremity. There were two fatal cobra bites; both patients were dead on arrival at the hospital. Bites from vipers caused morbidity but no deaths. Species-specific antivenins are effective in reversing respiratory failure from cobra bites and coagulopathies from bites by Viperidae and Crotalidae snakes. However, early respiratory and wound care will save lives even in the absence of specific cobra and krait antivenin. Care of a snakebite victim should consist of immobilization and bandaging of the bitten limb with elastic bandages during transport to the hospital, early surgical debridement of necrotic tissue, appropriate infusion of antivenin, aggressive respiratory support, management of shock and infection, and peritoneal dialysis or hemodialysis. Incision of bite wounds, suctioning, application of ice, and tourniquets are of no proven value and may be dangerous. All snakebite victims in southeast Asia should survive if they receive early competent care.</jats:p>

Surgery in management of snake envenomation in children

“…All patients with soft tissue necrosis should receive early antivenom therapy as this may reduce the severity and extent of the necrotic area. [9,11] Reports suggest early debridement of the bite area in order to limit the extent of local envenomation; [12][13][14] however, we are not in total agreement with this practice. In our experience, surgery can safely be delayed until a patient has recovered from the hematologic and neurologic toxicity, and it usually takes 48-72 hours.…”

Green pit viper (Trimeresurus albolabris and T. macrops) venom antigenaemia and kinetics in humans

“…Subsequently, venom clearance entered the slow phase with the average half-life over 50 h. When antivenom is unavailable, mechanical ventilation could save patients' lives while waiting for spontaneous cobra venom clearance. 18 However, our data suggest that supportive treatments alone may be inappropriate for severe GPV envenomation because of the long half-life of the venom. In addition, prolonged exposure to weakly toxic venom components may result in gradual consumption of fibrinogen and platelet that may clinically manifest up to 72 h after bites.…”

Snake Bite in South Asia: A Review

“…These traditional measures are strongly contraindicated as they are ineffective and in most cases deleterious. For example, tourniquets cannot be safely left on for long without risking severe local damage including ischemia, necrosis, and gangrene [78],[79].…”