FOLLOWUP - Cobra bite

Tue Jul 1 11:09:08 BST 2008

That is the percentages I remember - I'll check on the details, got them
somewhere. See article

Tim
Dr Timothy C Hardcastle
M.B., Ch.B. (Stell); M. Med (Chir) (Stell); FCS (SA)
Principal Surgeon-Lecturer / Sub-specialist: Trauma and Critical Care
Deputy director: Trauma Unit and Trauma ICU
Inkosi Albert Luthuli Central Hospital / UKZN
800 Bellair Road
Mayville, Durban

Postal: PostNet Suite 27
Private Bag X05
Malvern, 4055
KwaZulu Natal

timothyhar at ialch.co.za 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Dr Ross Hofmeyr
Sent: 01 July 2008 11:02
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: FOLLOWUP - Cobra bite

Hi Tim,

Please send the article to me, too.  I've been reading around this issue
and
trying to get clarity.

What is your source for the incidence of serum sickness?  There seems to
be
a HUGE variation in quoted rates for both immediate (allergic) and
delayed
(serum sicknesss) response to antivenom.

R.

Dr Ross Hofmeyr
Expedition Leader  & Doctor
South African National Antarctic Expedition

> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-
> bounces at trauma.org] On Behalf Of Timothy Craig Hardcastle
> Sent: 01 July 2008 06:02 AM
> To: Trauma &amp; Critical Care mailing list
> Subject: RE: FOLLOWUP - Cobra bite
> 
> Ken
> 
> Did you get that article I attached on snake bites? I'm not sure if
the
> list sent it through; For cobra bites I would use antivenin. The risk
of
> serum sickness if overstated. Real incidence is about 20% in
SECOND-TIME
> administration. I will resend the article to you off-list.
> 
> Tim
> Dr Timothy C Hardcastle
> M.B., Ch.B. (Stell); M. Med (Chir) (Stell); FCS (SA)
> Principal Surgeon-Lecturer / Sub-specialist: Trauma and Critical Care
> Deputy director: Trauma Unit and Trauma ICU
> Inkosi Albert Luthuli Central Hospital / UKZN
> 800 Bellair Road
> Mayville, Durban
> 
> Postal: PostNet Suite 27
> Private Bag X05
> Malvern, 4055
> KwaZulu Natal
> 
> timothyhar at ialch.co.za
> 
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of KMATTOX at aol.com
> Sent: 01 July 2008 03:05
> To: ccm-l at ccm-l.org; SURGINET at listserv.utoronto.ca;
> trauma-list at trauma.org
> Subject: FOLLOWUP - Cobra bite
> 
> Thirty (30) hours after admission, our cobra bite (Naja sp sp) patient
> is
> doing well and extubated.    I have several clinical and  literature
> items to
> share with these three lists.   I duplicate send  as all of these
groups
> might
> see patients with snake bite and might in some  small way benefit from
> my
> observations, which I will attempt to keep as  objective as possible.
> 
> Clinical status:
>       The monocled cobra is about 20 inches  long
>      The snake struck when a water  dish  was being changed out
>        It took 10 minutes for the  ambulance to arrive after the snake
> bite
>        From snake bite to arrival at the  hospital is now known to be
20
> 
> minutes
>         The patient was beginning  to feel numb and to have trouble
> breathing
> as the ambulance reached the  hospital
>             He  was having trouble focusing and taking a breath as he
> was put
> on the shock room  table
>           Patient was  intubated immediately upon presentation to the
> hospital
>         It was 3.5 hours after  arrival at the hospital before the out
> of
> town obtained antivenin was given
>         He had almost no local  reaction at the site of the bite
>         ALL laboratory tests were  normal and remained normal
including
> repeat CBCs and TEGs
>         Cardiac and renal status  was unaffected
>         He was extubated 24 hours  after admission
>         He stated that he  remembered and heard everything.   We gave
> him
> sleep level versed  repeatedly during the 24 hours
>         When asked to repeat any  conversation that he heard, he cited
> he
> heard talking, but could not cite  anything specifically
>         He had received 6 amps of  specific antivenin in two of three
> amp
> batches
>         He has no apparent visual  or neurologic impairment now
>         He was not in pain nor  apprehensive during his intubation
>         He stated that while he was  intubated he could not feel nor
> move his
> lips, hands or feet
>         We did give tetanus  prophylaxis and broad spectrum
antibiotics
> 
> 
> Snake identification
>         We discovered everyone  agrees on the genus of this snake
> (Naja), but
> we found at least 4 different  names of species and sub species
> associated
> with the Monocled  Cobra.
> 
>         We found strong support  for ventilatory support, but in the
> literature and  internet  recommendations, we could NOT find any
> consistent reason why
> antivenin should be  used.    We heard and read many urban legends,
and
> read
> several  scientific papers with no real comparison and a lot of expert
> opinion
> 
>         We received many warnings  in the literature and from advisors
> that
> we must watch for serum sickness as  they thought it would occur in
3-6
> weeks
> in almost every case of antivenin  use.
> 
> k mattox
> 
> 
> 
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