Monocled Cobra bite - Ventilation & Antivenin HELP

[KMATTOX at aol.com]

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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