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Experience in the management of patients with snakebut at the Hospital General of Tampico
Abstract
The first aid treatment and medical management for snakebites are two poorly studied areas in medicine. In our hospital, the prevalence of patients with snakebites is very important. Both the morbidity as well as the mortality rates in these patients are very high when treated with the standard procedure prescribed by the Secretaria de Salubridad y Asistencia (SSA). For that reason we have conducted a retrospective study to evaluate the evolution of patients treated with the treatment prescribed by the Health Department, and also a prospective study to evaluate the results of another treatment consisting of the administration of multiple doses of antiviper serum in accordance with Christopher and Rodning scale. Our results show a remarkable drop in the morbidity and death rates in patients treated with multiple doses of antiviper serum as opposed to those treated with the procedure suggested by the SSA. Antiviper serum is the only one most specific treatment for snakebites, and should be administered in multiple doses depending on the degree of poisoning.
Envenomation by snakebite is a health problem in Mexico.
To review the treatment and complications of rattlesnake bites in 79 children.
The variables studied were age, sex, season, hour, signs, symptoms, and complications during 1977 to 1996 (group I) and 1997 to 2006 (group II). Hospitalization time and antivenom type, including polyvalent equine antiviperin serum and a [F(ab')2] antivenom (fabotherapic), were also studied. Results. Most incidents (35%) occurred within the perimeter of children's homes and 8.8% took place inside homes; 40.5% of the children were females; and most snakebites occurred during the summer (70.8%). Members of groups I and II received polyvalent equine antiviperin serum and fabotherapy, respectively. Hospitalization time was less in group II members (P < .0001). The complications in group I members included hypoprothrombinemia and hypofibrinogenemia (P < .0001).
Hospitalization time, complications, and treatment cost were less in patients undergoing fabotherapy.
In Mexico, we do not know the exact number of cases and the magnitude of health damage conditioned by poisonous rattlesnake bites, and little relative information exists in pediatric population.
To inform on continued follow-up of 55 patients at a children's hospital, and to propose a therapeutic sequence adequate for children.
We reviewed clinical records and variables were origin, age, sex, time of year, previous care measures, time passed, hospital treatment complications and care cost.
Rattlesnake bite occurred around the home at times and at times inside the home in rural areas; we did not observe any noticeable difference in gender; snake variety most involved was Crotalus atrox, anatomic site most injured were the lower extremities in 78%. Prior to admission, 50% received insufficient antivenom serum doses; the most frequent complication was hematologic in 69%. One patient died with multiple organ failure and disseminated intravascular coagulation (DIC). The treatment protocol that we have recommended since 1986 at the Hospital Infantil del Estado de Sonora, revised and modified in 1996, reduced hospital stay from 15 to 5 days.
The protocol used avoided further complications and had a favorable influence on cost reduction.
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