domenica 30 ottobre 2011

A snake bite

Yesterday we have received a female patient with signs of envenomation after a snake bite in the left medium finger.
The relatives came with the snake which had been previously killed.
Examining the reptile we have classified it as a puffadder which belong to the family of cobra (Elapidae).
The finger had clear signs of the fangs and was swollen and bluish. The general conditions of the patient were good although she was complaining of severe pain and numbness on the affected area. She was also reporting intense asthenia and palpebral ptosis. Those symptoms were clear sing of initial neurotoxicity of the venom.
Heart and lungs were ok and there were no signs of anaphylaxis.
We have immediately admitted the patient for monitoring and treatment.
We have offered a booster dose of tetanus toxoid; we have covered the patient with antibiotics and we have given IV steroids.
Actually the fangs of the poisonous snakes often carry tetanus spores; another important complication is local infection with very destructive cellulites and necrosis. Another danger, above when fingers or toes are involved is the possibility of compartmental syndrome with rapid loss of function due to ischaemia and nerve damage. It is therefore important to avoid tourniquets and compressive dressings; it is also mandatory to perform surgical detention when finger is under pressure.
It would have been the case of giving antivenom, but unfortunately we do not have it.
We have also protected the patient with iv fluids and lasix (possible kidney damage secondary to poisoning).
Because Elapidae can cause blood clotting disorders and bleeding, we have administered Vit K im, and we have instructed our nurses to be on the watch for signs of haemorrhage. To prevent any GIT bleeding, we have covered the patient with iv ranitidine.
The poison can still cause severe and life threatening arrhythmias and the patient is followed up with ECG.
Even daily urinalysis is for us an important tool (together with Creatinine and Urea tests) to detect possible myoglobinuria, which leads to rapid kidney failure.
But our main fear in the case of puffadder poisoning, is a progression of the neuromuscular damage which can lead to paralysis, asphyxia and collapse.
We hope to be able to save the life of the patient.

Br. Dr. Giuseppe Gaido 

Nessun commento:

Chaaria è un sogno da realizzare giorno per giorno.

Un luogo in cui vorrei che tutti i poveri e gli ammalati venissero accolti e curati.

Vorrei poter fare di più per questa gente, che non ha nulla e soffre per malattie facilmente curabili, se solo ci fossero i mezzi.

Vorrei smetterla di dire “vai altrove, perché non possiamo curarti”.

Anche perché andare altrove, qui, vuol dire aggiungere altra fatica, altro sudore, altro dolore, per uomini, donne e bambini che hanno già camminato per giorni interi.

E poi, andare dove?

Gli ospedali pubblici hanno poche medicine, quelli privati sono troppo costosi.

Ecco perché penso, ostinatamente, che il nostro ospedale sia un segno di speranza per questa gente. Non ci sarà tutto, ma facciamo il possibile. Anzi, l’impossibile.

Quello che mi muove, che ci muove, è la carità verso l’altro, verso tutti. Nessuno escluso.

Gesù ci ha detto di essere presenti nel più piccolo e nel più diseredato.

Questo è quello che facciamo, ogni giorno.

Fratel Beppe Gaido

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