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
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