The effects of early treatment with anti-venom on length of hospital stay: Analysis of 46 cases of mamushi bites.

To investigate the effectiveness of mamushi anti-venom, we examined the relationships between the length of hospital stay (LOS) and the anti-venom administration, LOS and intervals of the bite and administration of the anti-venom, and severity of the bite and initial laboratory data. The sample of this study was a total of 46 cases who were admitted for mamushi bite from 2003 to 2013 to our hospital. Data was collected from medical records retrospectively. The average LOS was significantly shorter in those treated with the anti-venom than without the antivenom (6.7 days vs 14.4 days, respectively). Out of the thirty six cases with the anti-venom therapy, the average LOS was significantly shorter if the anti-venom was administered within 6 hours of the bite than when administered after 6 hours (4.8 days vs 10.4 days, respectively). There was a moderate positive correlation between the severity of the bite and increase in ALT initial. Our results suggest that administration of the anti-venom reduces the length of hospitalization, especially when administered within 6 hours of the mamushi bites. A standardized treatment guideline for mamushi bite is anticipated to define appropriate time to administer the anti-venom from the onset, biochemical data to predict severity of the injury at the initial assessment, by collecting patient data.

Feasibility study of immediate pharyngeal cooling initiation in cardiac arrest patients after arrival at the emergency room.

AIM: Cooling the pharynx and upper oesophagus would be more advantageous for rapid induction of therapeutic hypothermia since the carotid arteries run in their vicinity. The aim of this study was to determine the effects of pharyngeal cooling on brain temperature and the safety and feasibility for patients under resuscitation. METHODS: Witnessed non-traumatic cardiac arrest patients (n=108) were randomized to receive standard care with (n=53) or without pharyngeal cooling (n=55). In the emergency room, pharyngeal cooling was initiated before or shortly after return of spontaneous circulation by perfusing physiological saline (5 °C) into a pharyngeal cuff for 120 min. RESULTS: There was a significant decrease in tympanic temperature at 40 min after arrival (P=0.02) with a maximum difference between the groups at 120 min (32.9 ± 1.2°C, pharyngeal cooling group vs. 34.1 ± 1.3°C, control group; P<0.001). The return of spontaneous circulation (70% vs. 65%, P=0.63) and rearrest (38% vs. 47%, P=0.45) rates were not significantly different based on the initiation of pharyngeal cooling. No post-treatment mechanical or cold-related injury was observed on the pharyngeal epithelium by macroscopic observation. The thrombocytopaenia incidence was lower in the pharyngeal cooling group (P=0.001) during the 3-day period after arrival. The cumulative survival rate at 1 month was not significantly different between the two groups. CONCLUSIONS: Initiation of pharyngeal cooling before or immediately after the return of spontaneous circulation is safe and feasible. Pharyngeal cooling can rapidly decrease tympanic temperature without adverse effects on circulation or the pharyngeal epithelium.