Monocled Cobra bite - Ventilation & Antivenin HELP

Tue Jul 1 00:13:11 BST 2008

I would bet on supply and demand. Not enough demand to spend the
research dollars

Norman

Norman McSwain Jr, MD FACS
Trauma Director Charity Hospital
Professor of Surgery
Tulane University School of Medicine
504 988 5111

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Errington Thompson 
Sent: Monday, June 30, 2008 2:26 PM
To: 'Trauma &amp; Critical Care mailing list'; ccm-l at ccm-l.org
Subject: RE: Monocled Cobra bite - Ventilation & Antivenin HELP

Why hasn't we made an antivenin for cobras that doesn't have the
problems of
serum sickness?  Why don't we have e. coli bacteria cranking this out?
Is
the problem funding or something else?

Errington C. Thompson, MD
Trauma/Surgical Critical Care
Talk Show Host - WPEK
www.whereistheoutrage.net
Asheville, NC

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]
On Behalf Of KMATTOX at aol.com
Sent: Monday, June 30, 2008 1:20 PM
To: SURGINET at listserv.utoronto.ca
Cc: trauma-list at trauma.org; ccm-l at ccm-l.org
Subject: Monocled Cobra bite - Ventilation & Antivenin HELP 

Our patient continues to improve.   The best advice we would  achieve
via
the 
textbooks, journals, telephone calls, and internet was to  intubate,
support

ventilation, and give antivenin.     Which  we did.   

NOW FOR SPECIFIC SCIENCE.   I have looked hard to answer my  rhetorical 
question regarding antivenin in this particular  case.    From
everything I
have 
read, and now been told from  friends on these three list servers, the
most 
important thing was to support  ventilation until the effects of the
bite
have 
worn off.    I  have followed the conventional wisdom and now given him
genius 
specific  antivenin (6 vials of the stuff).   He sure will develop serum

sickness within 3-6 weeks.   He is now sensitized to horse serum  should
he
need 
antivenin in the future.   So have  I created un necessary problems by
giving him 
antivenin that he really did not  need.   Could I have treated him
better by

merely intubating him and  giving him neostigmine or other drugs.   

>From what I have read in the past 24 hours I really really cannot find

scientific justification for giving the antivenin once I intubated  him.
Because 
it had to be brought in from a distant city, the  antivenin was
administered

several hours after the bite  exposure.      

Can the intellectual clinical scientist on these web  sites give me ANY 
science to support this continuing urban legend of giving  antivenin to
poisonous 
snake bite victims like this one?

Kenneth L. Mattox, MD
Houston

In a message dated 6/30/2008 5:56:52 A.M. Central Daylight Time,  
rangraj at GMAIL.COM writes:

vipers  are different from cobras, with vipers you need to worry about
DIC, 
clotting  factors and such, with cobras its more a matter of ventilating
them 
till they  get better. Which they generally do.You've done the important
thing, 
which is  getting the patient intubated in time.
rangraj

On Mon, Jun 30, 2008 at 3:27 PM, Evgeny S. Pobegalov
<_docpes at gmail.com_ 
(mailto:docpes at gmail.com) > wrote:

Dear  Professor Mattox,

what about renal function of this patient? I have  never seen cobra
bites, but when being in South East Asia I did have some  chances to
see patients bitten by local vipers (as poisonous as cobras  but more
dangerous), and I remember renal failure to be an issue with  them.

--
Evgeny S. Pobegalov,
Russia

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-- 
Lt Col  Rangraj Setlur
Associate Professor
Department of Anaesthesiology and  Critical Care
Armed Forces Medical College
Pune
India 

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