Fatal intracranial bleedings in a viper bite: A case report / 中华创伤杂志(英文版)

Viper bite envenomation represents a significant occupational hazard among agricultural workers in India. The viper bite envenomation is usually suspected when a patient presents with predominant local symptoms at the bitten site, including pain, swelling, and necrosis. Further, systemic findings such as diffuse intravascular coagulation, hypotension, and shock may alert physicians of viper bite envenomation rather than a neurotoxic snake bite. However, cerebral complications are rare in viper bites but may potentially fatal. Central nervous system involvement in a viper bite is either due to neurotoxins or hemorrhagins present in the venom, which may induce cerebral thrombosis, ischemia, infarction, and hemorrhage. Here we present a case of a previously healthy adult male who succumbed to extensive subarachnoid, intracerebral, and intraventricular hemorrhages involving bilateral cerebral hemispheres following viper snake bite envenomation. This report highlights the importance of anticipating cerebral complications in viper bite envenomation, a rare occurrence. It also emphasizes the need for early antisnake venom administration to prevent and control systemic envenomation and its complications.

Mordeduras de ofidios en mano pediátrica y sus complicaciones locales / Snake bites in pediatric hand and their local complications / Mordidas de serpentes de mão pediátricas e suas complicações locais

Introducción: el envenenamiento por mordedura de ofidios es reconocido como un problema de salud pública según la Organización Mundial de la Salud. La baja incidencia sumada a la diversidad de presentaciones clínicas, edades, topografías afectadas, así como los diferentes protocolos en la bibliografía existente sobre algunos aspectos del tratamiento, hacen difícil el manejo sistematizado de estos pacientes. El objetivo de este trabajo es realizar una revisión sistemática de la literatura sobre mordedura de serpientes en pacientes pediátricos con afectación en mano y miembro superior, haciendo hincapié en la conducta frente las complicaciones loco-regionales. Por importancia y frecuencia destacamos al síndrome compartimental, las flictenas y las infecciones. Metodología: se realizó una búsqueda bibliográfica en MedLine/PubMed con las palabras clave: "Snake Bite hand Children" y "Snake Bite compartimental syndrome". Se incluyeron los artículos publicados en los últimos 10 años (2012 al 2022). Resultados: la búsqueda de artículos ante las palabras "Snake Bite hand Children" resultó en 20 articulos y la busqueda ante las palabras "Snake Bite compartimental syndrome" derivó en 34. Luego de aplicar los criterios de inclusión y exclusión se obtuvieron 30 artículos para el análisis. Conclusiones: la población pediátrica se encuentra más expuesta a las mordeduras por serpientes y a su vez a presentar lesiones más severas. El tratamiento del síndrome compartimental continúa siendo un tema de debate. El veneno inoculado puede simular un síndrome compartimental que puede revertir sin fasciotomías con el tratamiento adecuado. Igualmente, ante síntomas y signos claros de síndrome compartimental se sugiere realizar fasciotomías frente a las graves secuelas potenciales. Ante la aparición de flictenas, el destechado cuidadoso de la misma es un tratamiento adecuado. La mayoría de los autores coinciden con el tratamiento profiláctico con antibioticoterapia.

Introduction: Ophidian bite poisoning is recognized as a public health problem by the World Health Organization. The low incidence added to the diversity of clinical presentations, ages, affected topographies, as well as the different protocols in the existing literature on some aspects of treatment, make the systematized management of these patients difficult. The aim of this work is to carry out a systematic review of the literature on snakebite in pediatric patients with hand and upper limb involvement, with emphasis on the management of loco-regional complications. In terms of importance and frequency, we highlight compartment syndrome, phlyctenas and infections. Methodology: a literature search was carried out in MedLine/PubMed with the keywords: "Snake Bite hand Children" and "Snake Bite compartment syndrome". Articles published in the last 10 years (2012 to 2022) were included. Results: the search for articles with the words "Snake Bite hand Children" resulted in 20 articles and the search for the words "Snake Bite compartment syndrome" resulted in 34 articles. After applying the inclusion and exclusion criteria, 30 articles were obtained for the analysis. Conclusions: the pediatric population is more exposed to snake bites and in turn to present more severe lesions. The treatment of compartment syndrome continues to be a subject of debate. Inoculated venom can simulate a compartment syndrome that can be reversed without fasciotomies with proper treatment. Likewise, in the presence of clear symptoms and signs of compartment syndrome, fasciotomies are suggested because of the serious sequelae generated. In the event of the appearance of phlyctenas, careful unroofing of the phlyctenas would be an appropriate treatment. Most authors agree with prophylactic treatment with antibiotic therapy.

Introdução: O envenenamento por mordidas ofídias é reconhecido como um problema de saúde pública pela Organização Mundial da Saúde. A baixa incidência, juntamente com a diversidade de apresentações clínicas, idades, topografias afetadas, bem como os diferentes protocolos da literatura existente sobre alguns aspectos do tratamento, tornam difícil o gerenciamento sistemático desses pacientes. O objetivo deste trabalho é realizar uma revisão sistemática da literatura sobre mordida de cobra em pacientes pediátricos com envolvimento de mãos e membros superiores, com ênfase no gerenciamento de complicações loco-regionais. Em termos de importância e freqüência, destacamos a síndrome compartimental, as flectenas e as infecções. Metodologia: foi realizada uma pesquisa bibliográfica no MedLine/PubMed com as palavras-chave: "Snake Bite hand Children" e "Snake Bite compartment syndrome". Os artigos publicados nos últimos 10 anos (2012 a 2022) foram incluídos. Resultados: a busca de artigos usando as palavras "Snake Bite hand Children" resultou em 20 artigos e a busca das palavras "Snake Bite compartment syndrome" resultou em 34 artigos. Após a aplicação dos critérios de inclusão e exclusão, foram obtidos 30 artigos para análise. Conclusões: a população pediátrica está mais exposta às picadas de cobra e, por sua vez, a lesões mais graves. O tratamento da síndrome compartimental continua a ser motivo de debate. O veneno inoculado pode simular uma síndrome de compartimento que pode ser revertida sem fasciotomias com tratamento apropriado. Da mesma forma, se houver sinais e sintomas claros de síndrome compartimental, são sugeridas fasciotomias por causa das severas seqüelas. Se as flectenas aparecerem, o desenrolamento cuidadoso das flectenas seria um tratamento apropriado. A maioria dos autores concorda com o tratamento profilático com a antibioticoterapia.

Boletim informativo de toxicologia: acidentes ofídicos / Toxicology Fact Sheet: Snakebites

Os acidentes por animais peçonhentos, especialmente os acidentes ofídicos, foram incluídos pela Organização Mundial da Saúde (OMS) na lista das doenças tropicais negligenciadas que acometem, na maioria das vezes, populações pobres que vivem em áreas rurais, devido à gravidade constituem um problema de saúde pública. O sucesso no tratamento do paciente para que os mesmos não gerem sequelas graves, podendo chegar ao óbito, requer atendimento de forma rápida, com o uso adequado do soro específico quando necessário para cada espécie de serpentes e na quantidade recomendada. Em Goiás as principais serpentes que causam acidente são dos gêneros: Bothrops (jararacas), Crotalus (cascavéis) e Micrurus (coral), são considerados acidentes graves que demandam o uso de soros antivenenos específicos

Accidents by venomous animals, especially snakebites, were included by the World Health Organization (WHO) in the list of neglected tropical diseases that affect, most of the time, poor people living in rural areas, due to the seriousness of a public health problem. . Successful treatment of the patient so that they do not generate serious sequelae, which can lead to death, requires quick care, with the appropriate use of specific serum when necessary for each species of snakes and in the recommended amount. In Goiás, the main snakes that cause accidents are of the genera: Bothrops (jararacas), Crotalus (rattlesnakes) and Micrurus (coral), are considered serious accidents that require the use of specific antivenom serums

A case report of human intoxication due to a snakebite by the opisthoglyphous dipsadid Thamnodynastes lanei Bailey, Thomas & Silva-Jr, 2005

Abstract We present a case of human intoxication due to a snakebite by the opisthoglyphous dipsadid Thamnodynastes lanei. A 26-year-old man was bitten on the right hand and was not medicated. Bleeding lasted a few seconds, while paresthesia, chills, and headache persisted for up to 10 hours. The pain disappeared after a week, and the edema, itching, and prickling persisted for another 3 days. Although this patient's symptoms were typical of bites by South American opisthoglyphous snakes, they persisted longer than those of bites by some congeneric species. Our report adds a species to the list of medically relevant snakes.

Severe tissue complications in patients of Bothrops snakebite at a tertiary health unit in the Brazilian Amazon: clinical characteristics and associated factors

Abstract INTRODUCTION: Snakebites in the Brazilian Amazon are caused mostly by snakes from the Bothrops genus and envenomated patients may suffer from tissue complications. METHODS: This study aimed to identify risk factors for severe tissue complications (STC) in patients with Bothrops snakebite in the Amazonas state, Brazil. RESULTS: Snakebites that were classified as severe and affected female patients with comorbidities presented greater risks of developing STCs. In addition, hospitalizations of patients with STC exceeded 5 days. CONCLUSIONS: Clinical and epidemiological characteristics can prove essential for assessing the evolution of STC and clinical prognosis of patients with Bothrops snakebites.

Hemorrhagic stroke following viper bites and delayed antivenom administration: three case reports from the Western Brazilian Amazon

Abstract Snakebites were included by the World Health Organization in their list of neglected diseases. In Latin America, most snakebites are caused by species of the Viperidae family, notably by the genus Bothrops. Bothrops atrox accounts for 90% of the cases of envenoming in the Brazilian Amazon. In this report, we present a series of three cases of snakebites that evolved with hemorrhagic stroke due to delays in the access to antivenom in the Brazilian Amazon, being fundamental for diagnosis to validate the clinical suspicion and make decisions that would improve the treatment and prognosis of the patients.

Envenomation by an opisthoglyphous snake, Erythrolamprus aesculapii (Dipsadidae), in southeastern Brazil

Abstract Snakebites by aglyphous or opisthoglyphous snakes are common in Brazil. We report a case of snakebite by the opisthoglyphous Erythrolamprus aesculapii. The victim presented with pain, edema, and bleeding at the bite site, along with erythema, similar to a Bothrops envenomation. In this type of snakebite, if the snake is not brought to the hospital, the victim may receive unnecessary serum therapy, with the risk of adverse reactions to the antivenom. The possibility of reducing after-effects with anti-inflammatory drugs and early antibiotic therapy for secondary infection need to be further investigated, preferably in multicenter studies, while observing good clinical practice.

A case of envenomation caused by Oxybelis fulgidus (Serpentes, Colubridae) in Brazilian Amazon

Abstract A case of a bite inflicted by Oxybelis fulgidus in the wilds of Amazon is reported. The patient was a 67-year-old man who presented with dizziness, tachycardia and local pain, with erythema and bleeding in his left arm. The venom of Oxybelis fulgidus, a neotropical rear-fanged snake, contains one of the four three-finger toxins already isolated from colubrid snakes, called fulgimotoxin. He was treated with oral analgesics and returned to the ambulatory in 48 hours, with good evolution. We report tirst authenticated case of adult Oxybelis fulgidus with signs of mild local envenoming without evidence of systemic envenoming.

Epidemiological study of snakebite cases in Brazilian Western Amazonia

Abstract INTRODUCTION Brazil has the largest number of snakebite cases in South America, of which the large majority is concentrated in the Midwest and North. METHODS In this descriptive observational study, we assessed the epidemiological and clinical snakebite cases referred to the Centro de Medicina Tropical de Rondônia from September 2008 to September 2010. RESULTS We followed up 92 cases from admission until discharge, namely 81 (88%) men and 11 (12%) women, with a mean age of 37 years, and mainly from rural areas (91.3%). The snakebites occurred while performing work activities (63%) during the Amazon rainy season (78.3%). The vast majority of individuals presented from the Porto Velho microregion (84.7%). Approximately 95.6% of the snakebites were caused by snakes of the genus Bothrops, followed by two lachetics and two elapidics cases. Surgery was performed in 10 cases (9 fasciotomies in the lower limb and 1 amputation). No deaths were reported in this study, but 4 cases (4.3%) developed sequelae in the lower limb. CONCLUSIONS This study can contribute to a better understanding of envenomation in the state of Rondônia and thus can be useful for identifying real conditions that can increase the incidence of snakebites in this region. Moreover, the study results can serve as a basis for improving educational campaigns designed to prevent these types of snakebites, as well as for preserving snakes.

True or false coral snake: is it worth the risk? A Micrurus corallinus case report

Background Bites provoked by the genus Micrurus represent less than 1% of snakebite cases notified in Brazil, a tiny fraction compared with other genus such as Bothrops and Crotalus, which together represent almost 80% of accidents. In addition to their less aggressive behavior, habits and morphology of coral snakes are determinant factors for such low incidence of accidents. Although Micrurus bites are rare, victims must be rescued and hospitalized in a short period of time, because this type of envenoming may evolve to a progressive muscle weakness and acute respiratory failure. Case Presentation We report an accident caused by Micrurus corallinus involving a 28-year-old Caucasian sailor man bitten on the hand. The accident occurred in a recreational camp because people believed the snake was not venomous. The victim presented neurological symptoms 2 h after the accident and was taken to the hospital, where he received antielapidic serum 10 h after the bite. After the antivenom treatment, the patient presented clinical evolution without complications and was discharged 4 days later. Conclusions We reinforce that it is essential to have a health care structure suitable for the treatment of snakebite. Besides, the manipulation of these animals should only be carried out by a team of well-equipped and trained professionals, and even so with special attention.

Caracterización clínico-epidemiógica de mordedura de serpiente en el Hospital Regional Santa Teresa de Comayagua, 2014-2015 / Clinical-epidemiological characterization of snakebite at the Hospital Regional Santa Teresa de Comayagua, 2014-2015

Antecedente. La mordedura por serpiente o accidente ofídico consiste en una lesión cutánea, seguida de la inoculación de sustancias tóxicas con daño a los tejidos y condicionante de alteraciones fisiopatológicas locales y sistémicas de gravedad variable. Objetivo. Describir las características clínicas y epidemiológicas de las mordeduras de serpiente en el Hospital Regional Santa Teresa, Comayagua, enero 2014 ­ diciembre 2015. Metodología. Estudio descriptivo transversal. De 58 casos hospitalizados, solo se obtu - vieron expedientes clínicos de 36 (62.1%). Las variables incluyeron datos clínico-epidemiológicos, características del ofídeo, atención pre-hospitalaria e intrahospitalaria, y antecedentes personales patológicos. La información recolectada fue ingresada en base de datos Epiinfo versión 7.1.5 (CDC, Atlanta). Los resultados se presentan como frecuencias, porcentajes, rangos y promedios. La información personal de los casos se manejó confidencialmente. Resultados. De 36 pacientes, 33.3%(12) eran adolescentes entre 11-19 años, la afectación por sexo fue de 50% (18), obteniendo una relación de 1:1. 22.2%(8) se identificó al cascabel como el ofideo que produjo mayores afectaciones, la localización anatómica más afectada fue el miembro inferior izquierdo en un 33.3%(12), el 66.7%(24) pre - sentó Lesión grado I - leve según la clasificación de Christopher Rodning y Audebert. 77.8%(28) recibió administración de antiofídico. 97.2%(35) obtuvo mejoría al egreso. No se reportaron casos de mortalidad. Discusión: La mordedura de serpiente es un motivo de consulta poco habitual en los servicios de urgencias. Esto puede comportar dudas sobre su tratamiento, especialmente sobre el uso de un antídoto muy específico, caro, con escasa distribución y potenciales efectos adversos...(AU)

Caracterización de pacientes con mordedura de serpiente atendidos en Hospital Tela, Atlantida / Characterization of patients with snake bite treated in Tela, Atlántida Hospital

Según la Organización Mundial de la Salud, se estima que anualmente suceden unos 5 millones de accidentes por mordedura de serpiente con 100 000 fallecimientos y cerca del triple de casos de amputación y discapacidad permanente. En el departamento de Atlántida, Honduras, la mordedura de serpiente se ha relacionado con la actividad agrícola, específicamente, con el cultivo de palma africana. Objetivo: Describir las características epidemiológicas y demográficas de pacientes que sufrieron mordedura de serpiente atendidos en el Hospital Tela, Atlántida. Material y Métodos: Estudio descriptivo, retrospectivo y transversal realizado durante el periodo comprendido del año 2013 al 2015 en el Hospital Tela. Universo, 92 casos con diagnóstico de mordedura de serpiente, de los cuales se excluyeron 8 casos por no cumplir criterios de inclusión, se obtuvo una muestra de 84 casos. La recolección de datos se obtuvo de los expedientes clínicos. Resultados: Del total de casos estudiados, la incidencia fue de 32(38.1%) casos en el 2015, 20(23.8%) en el 2014 y 32(38.1%) en el 2013. El rango de edad de los pacientes oscilaba entre los 2 a 75 años, con edad media de 28 años. De los 84 casos estudiados, 25(29.8%) eran menores de 18, 53(63.1%) se encontraban entre los 18-60 y 6(7.1%) eran mayores de 60 años. Se encontró 40(47.6%) casos del sexo femenino y 44(52.4%) masculino. 82(97.6%) eran del departamento de Atlántida y 2 eran procedentes del departamento de Yoro. 52(61.9%) pacientes afirmaron haber sido mordido por serpiente de la especie Bothrops asper (Barba Amarilla), los pies fueron los sitios anatómicos de mayor frecuencia afectados 55(65.5%), con predominio del pie izquierdo. Conclusión: La frecuencia de mordeduras de serpiente fue de 84 casos entre los años 2013-2015, siendo la población del municipio de Tela la más afectada, con 68% de los casos...(AU)

Infrared thermography to diagnose and manage venomous animal bites and stings

Abstract INTRODUCTION Infrared imaging (IR) is a noninvasive technique that quantifies body surface temperature, producing a digital color image. IR has been used to study diseases in which skin temperature can reflect the presence of inflammation. METHODS This was an observational pilot study of eight patients envenomed by snakes, spiders, and scorpions. All patients were examined using a thermal camera. RESULTS In all cases, we obtained infrared images that corroborated clinical findings indicating localized effects of venom, specifically inflammation. CONCLUSIONS IR has potential for use as a research, diagnostic, and monitoring tool for localized effects of animal venoms.

Severe coagulopathy and transient hypertension following a Rhabdophis subminiatus bite: a case report

Abstract: Because the majority of colubrid species are considered harmless to human beings, colubrid snakebites are rarely reported. However, the venom of Rhabdophis, which is part of the Colubridae family, is procoagulant and leads to severe coagulopathy. Here, we present a case of disseminated intravascular coagulation with enhanced fibrinolysis following a Rhabdophis bite. Although coagulopathy can be treated effectively with the specific Rhabdophis antivenom, this antivenom is not widely available in Indonesia. We also found transient hypertension secondary to the colubrid venom, an unusual finding.

Caracterización de pacientes que sufrieron mordedura de serpiente, atendidos en Hospital Público de Juticalpa, Olancho / Characterization of snakebite patients treated at the public hospital of Juticalpa, Olancho

La mordedura de serpiente es un problema mundial con incidencia de 2.5 millones de casos anuales, en Honduras se registran 700 casos al año; en el departamento de Olancho el accidente ofídico se relaciona con la actividad agrícola, siendo causa de morbimortalidad. Objetivo: Describir las características epidemiológicas y demográficas de pacientes que sufrieron mordedura de serpiente atendidos en el Hospital San Francisco de Asís, Juticalpa, Olancho. Material y Métodos: Se realizó un estudio descriptivo, retrospectivo y transversal. El universo fue de 76 casos por mordedura de serpiente en el periodo enero 2014-diciembre 2015; la muestra fue 59 expedientes clínicos. La recolección de datos se obtuvo mediante aplicación de instrumentos obteniéndose la información de los expedientes clínicos. Resultados: la distribución de los 59 casos reportó 36(61%) y 23(39%) casos, para los años 2014 y 2015 respectivamente; la media de edad fue 24 años, los pacientes menores de 18 años fueron 27(45.8%) y 32(54.2%) mayores. El promedio de hospitalización de 2.6 días. Los sitios anatómicos más afectados fueron: píe izquierdo 14(23.7%) y píe derecho 13(22%); la medición del sitio anatómico afectado se realizó en 43(72.8%) de los casos. El tiempo transcurrido desde el momento de la mordedura hasta la aplicación del suero antiofídico fue menor de 2 horas en 9(15%) casos; entre 3-8 horas en 23(39%) y mayor de 8 horas en 27(46%). Conclusión: La frecuencia de mordeduras de serpiente fue de 36 casos en el 2014 y 23 en 2015. Las zonas de mayor procedencia de personas afectadas fueron Catacamas y Dulce Nombre de Culmí. La actividad de mayor riesgo para sufrir accidente ofídico en el hombre es la agricultura y en las mujeres las actividades peridomiciliares. La mayor frecuencia de casos se presentó en los meses de agosto, septiembre y octubre en ambos años...(AU).

Epidemiology of snakebites in Kédougou region (eastern Senegal): comparison of various methods for assessment of incidence and mortality

Although considered a public health issue in Senegal, the actual incidence and mortality from snakebite are not known. In the present study, an epidemiological survey was carried out in Kédougou region, southeastern Senegal, where envenomations, particularly by Echisocellatus, are frequent and severe. Methods Three sources of data were used: records from health centers and reports by health professionals; traditional healers; and household surveys. Results The annual incidence and mortality provided by health centers were 24.4 envenomations and 0.24 deaths per 100,000 population, respectively. The annual incidence recorded by traditional healers was 250 bites per 100,000 inhabitants, but the number of deaths was unknown. Finally, the household surveys reported an annual incidence of 92.8 bites per 100,000 inhabitants and an annual mortality rate of 2.2 deaths per 100,000 inhabitants. The differences in incidence and mortality between the different methods were explained by significant bias, resulting in particular from the complex patient's healthcare-seeking behavior. The incidence provided by health records should be used to specify the immediate quantitative requirements of antivenoms and places where they should be available first. Conclusion Mandatory reporting of cases would improve the management of envenomation by simplifying epidemiological surveys. Patients' preference for traditional medicine should prompt health authorities to urge traditional healers to refer patients to health centers according to defined clinical criteria (mainly edema and bleeding or neurotoxic symptoms). Finally, household surveys were likely to reflect the actual epidemiological situation. Poison Control Center of Senegal should continue its work to sensitize stakeholders and train health staff.

Adverse Cardiovascular Events after a Venomous Snakebite in Korea

PURPOSE: Although cardiac involvement is an infrequently recognized manifestation of venomous snakebites, little is known of the adverse cardiovascular events (ACVEs) arising as a result of snakebite in Korea. Accordingly, we studied the prevalence of ACVEs associated with venomous snakebites in Korea and compared the clinical features of patients with and without ACVEs. MATERIALS AND METHODS: A retrospective review was conducted on 65 consecutive venomous snakebite cases diagnosed and treated at the emergency department of Wonju Severance Christian Hospital between May 2011 and October 2014. ACVEs were defined as the occurrence of at least one of the following: 1) myocardial injury, 2) shock, 3) ventricular dysrhythmia, or 4) cardiac arrest. RESULTS: Nine (13.8%) of the 65 patients had ACVEs; myocardial injury (9 patients, 13.8%) included high sensitivity troponin I (hs-TnI) elevation (7 patients, 10.8%) or electrocardiogram (ECG) determined ischemic change (2 patients, 3.1%), and shock (2 patient, 3.1%). Neither ventricular dysrhythmia nor cardiac arrest was observed. The median of elevated hs-TnI levels observed in the present study were 0.063 ng/mL (maximum: 3.000 ng/mL) and there was no mortality in the ACVEs group. Underlying cardiac diseases were more common in the ACVEs group than in the non-ACVEs group (p=0.017). Regarding complications during hospitalization, 3 patients (5.4%) in the non-ACVEs group and 3 patients (33.3%) in the ACVEs group developed bleeding (p=0.031). CONCLUSION: Significant proportion of the patients with venomous snakebite is associated with occurrence of ACVEs. Patients with ACVEs had more underlying cardiac disease and bleeding complication.

Ocular Manifestations of Venomous Snake Bite over a One-year Period in a Tertiary Care Hospital

PURPOSE: Ocular manifestations in snake-bite injuries are quite rare. However, the unusual presentations, diagnosis and their management can pose challenges when they present to the ophthalmologist. Early detection of these treatable conditions can prevent visual loss in these patients who are systemically unstable and are unaware of their ocular condition. To address this, a study was conducted with the aim of identifying the various ocular manifestations of snake bite in a tertiary care center. METHODS: This is a one-year institute-based prospective study report of 12 snake bite victims admitted to a tertiary hospital with ocular manifestations between June 2013 to June 2014, which provides data about the demographic characteristics, clinical profiles, ocular manifestations, and their outcomes. RESULTS: Twelve cases of snake bite with ocular manifestations were included of which six were viper bites, three were cobra bites and three were unknown bites. Six patients presented with bilateral acute angle closure glaucoma (50%), two patients had anterior uveitis (16.6%) of which one patient had concomitant optic neuritis. One patient had exudative retinal detachment (8.3%), one patient had thrombocytopenia with subconjunctival hemorrhage (8.3%) and two patients had external ophthalmoplegia (16.6%). CONCLUSIONS: Bilateral angle closure glaucoma was the most common ocular manifestation followed by anterior uveitis and external ophthalmoplegia. Snake bite can result in significant ocular morbidity in a majority of patients but spontaneous recovery with anti-snake venom, steroids and conservative management results in good visual prognosis.

Snakebite in Korea: A Guideline to Primary Surgical Management

PURPOSE: Snakebite is an emergency which causes local symptoms such as pain and edema around the bite. Systemic symptoms may also develop, such as dizziness or renal failure, and may even cause death. The purpose of this research was to assess the validity and safety of snakebite protocol for surgery when treating snakebite patients. MATERIALS AND METHODS: Retrospective research was performed on patients who were admitted after being treated at the emergency center from January 2008 to December 2012. When necessary, debridement was also performed, and 46 of 111 patients (41.4%) underwent debridement. Those who had received debridement without antivenom administration due to a positive skin reaction test were classified as group A, and group B received antivenom and delayed debridement. We reviewed the emergency and admission charts of the patients in each group and recorded and compared their age, sex, bite site, severity of local and general symptoms, time to receive antivenin, and complications. RESULTS: Of the ten patients (21.7%) in group A, two (66.6%) developed cellulites, and one of them experienced skin necrosis, resulting in a skin graft. In group B, there were 36 patients (78.2%), 19 (52.7%) of whom developed cellulitis. Skin necrosis occurred in two patients, and one of these patients received a skin graft. Compartment syndrome was found in one patient, and fasciotomy and a skin graft were performed. CONCLUSION: The treatment protocol implemented to treat snakebite patients admitted to the emergency center during this research was safely and properly followed during surgical treatment.