Evidence-Based Neurology, medycyna, neurologia, Neurologia
ESSENTIAL ECHOCARDIOGRAPHY, medycyna, kardiochirurgia, Kardiochirurgia
Essential Neurosurgery, medycyna, Neurochirurgia, Neurochirurgia
Ewolucja techniki sekcyjnej – od Virchowa do Virtopsy®, Nauka, MEDYCYNA WETERYNARYJNA, weterynaria sądowa
Essential Echocardiography A Practical Handbook Contemporary Cardiology, medycyna, kardiochirurgia, Kardiochirurgia(1)
Etienne Trocme - Pierwsze Kroki Chrześcijaństwa, Zachomikowane i Od Was, Od Was
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ESBP-Vipera-latasti, Zachomikowane, Survival i zdrowie, Medycyna i zdrowie
[ Pobierz całość w formacie PDF ]STATE TOXINOLOGY SERVICES
Toxinology Dept., Women’s & Children’s Hospital, North Adelaide SA 5006 AUSTRALIA
SNAKEBITE MANAGEMENT OVERVIEW DOCUMENT
www.toxinology.com record number
SN0224
Family
Scientific name combined
Viperidae
Vipera latasti latasti
Common name
Lataste’s Viper , Snub-nosed Viper
Global region in which snake is found
Eastern Europe
CLINICAL OVERVIEW
There is only limited clinical information on
Vipera latasti
, but it is reasonable to consider it similar to other Euro-
African
Vipera
species. On that basis, bites could be expected to cause mild to moderate, occasionally severe local
effects, notably pain, swelling, bruising and uncommonly, blistering. Necrosis, while possible, is unlikely. However
the extent of swelling may cause fluid shifts and secondary shock. Systemic coaguloapthy and secondary renal
failure is possible. As with other European vipers, an allergic-like response of angioneurotic oedema may be seen.
A number of European vipers are now known to cause at least mild neurotoxic symptoms and this porobably
applies to
V. latasti
as well, but major flaccid paralysis is unlikely. Antivenom and supportive therapy are essential
in treatment.
STATE TOXINOLOGY SERVICES
Toxinology Dept., Women’s & Children’s Hospital, North Adelaide SA 5006 AUSTRALIA
SNAKEBITE MANAGEMENT OVERVIEW DOCUMENT
SNAKEBITE MANAGEMENT OVERVIEW DOCUMENT (continued)
Vipera latasti latasti
First aid
1. After ensuring the patient and onlookers have moved out of range of further strikes by the snake, the bitten person should be
reassured and persuaded to lie down and remain still. Many will be terrified, fearing sudden death and, in this mood, they may
behave irrationally or even hysterically. The basis for reassurance is the fact that many venomous bites do not result in
envenoming, the relatively slow progression to severe envenoming (hours following elapid bites, days following viper bites)
and the effectiveness of modern medical treatment.
2. The bite wound should not be tampered with in any way. Wiping it once with a damp cloth to remove surface venom is
unlikely to do much harm (or good) but the wound must not be massaged.
3. All rings or other jewellery on the bitten limb, especially on fingers, should be removed, as they may act as tourniquets if
oedema develops.
4. The bitten limb should be immobilised as effectively as possible using an extemporised splint or sling; if available, crepe
bandaging of the splinted limb is an effective form of immobilisation.
5. If there is any impairment of vital functions, such as problems with respiration, airway, circulation, heart function, these
must be supported as a priority. In particular, for bites causing flaccid paralysis, including respiratory paralysis, both airway
and respiration may be impaired, requiring urgent and prolonged treatment, which may include the mouth to mask (mouth to
mouth) technique of expired air transfer. Seek urgent medical attention.
6. Do not use Tourniquets, cut, suck or scarify the wound or apply chemicals or electric shock.
7. Avoid peroral intake, absolutely no alcohol. No sedatives outside hospital. If there will be considerable delay before
reaching medical aid, measured in several hours to days, then give clear fluids by mouth to prevent dehydration.
8. If the offending snake has been killed it should be brought with the patient for identification (only relevant in areas where
there are more than one naturally occurring venomous snake species), but be careful to avoid touching the head, as even a dead
snake can envenom. No attempt should be made to pursue the snake into the undergrowth as this will risk further bites.
9. The snakebite victim should be transported as quickly and as passively as possible to the nearest place where they can be
seen by a medically-trained person (health station, dispensary, clinic or hospital). The bitten limb must not be exercised as
muscular contraction will promote systemic absorption of venom. If no motor vehicle or boat is available, the patient can be
carried on a stretcher or hurdle, on the pillion or crossbar of a bicycle or on someone's back.
10. Most traditional, and many of the more recently fashionable, first aid measures are useless and potentially dangerous.
These include local cauterization, incision, excision, amputation, suction by mouth, vacuum pump or syringe, combined
incision and suction ("venom-ex" apparatus), injection or instillation of compounds such as potassium permanganate, phenol
(carbolic soap) and trypsin, application of electric shocks or ice (cryotherapy), use of traditional herbal, folk and other
remedies including the ingestion of emetic plant products and parts of the snake, multiple incisions, tattooing and so on.
STATE TOXINOLOGY SERVICES
Toxinology Dept., Women’s & Children’s Hospital, North Adelaide SA 5006 AUSTRALIA
SNAKEBITE MANAGEMENT OVERVIEW DOCUMENT
SNAKEBITE MANAGEMENT OVERVIEW DOCUMENT (continued)
Vipera latasti latasti
Clinical summary
Bites by
Vipera
species generally cause local effects, sometimes systemic effects. Only a few species have been studied, either
for venom activity or clinical effects. The following comments are based on clinical experience with those species commonly
causing bites. In the past, in Europe at least, there has been a common misconception that viper bites are rare and usually
minor. More recent studies have shown that bites are not rare in many areas and that major, even lethal envenoming can occur.
A typical
Vipera
bite causes local pain and rapid local effects, including swelling, bruising, sometimes extensive haemorrhaging
into the skin with massive bruising and potentially severe fluid shifts that can cause hypovolaemic shock. This is especially true
in smaller children, who are most at risk of a fatal outcome. Local necrosis can occur at the bite site, though this is probably not
common.
Systemic effects are generally limited to general symptoms, such as headache, nausea, vomiting and abdominal pain, plus a
coagulopathy of variable severity. Systemic bleeding can occur, but is uncommon. Secondary renal damage can occur,
particularly if there is shock. Rarely there may be multisystem organ failure. Myolysis and paralysis do not occur for most
species, the exception being
Vipera ammodytes
, whose venom contains presynaptic neurotoxins, capable of causing significant
flaccid paralysis, though this effect is not common or is usually minor. A number of other
Vipera
species have now been
reported to cause very minor paralytic signs, notably ptosis, but not more extensive paralysis and certainly not respiratory
paralysis.
At least for
Vipera berus
and
Vipera aspis
, possibly other
Vipera
species as well, envenoming may cause early angioneurotic
oedema-like effects, with facial swelling. The cause of this effect is uncertain, but it is characteristic of envenoming by these
snakes and is not expected from envenoming by other snake species, except as a true allergic phenomena in those previously
bitten and even then it is rare.
STATE TOXINOLOGY SERVICES
Toxinology Dept., Women’s & Children’s Hospital, North Adelaide SA 5006 AUSTRALIA
SNAKEBITE MANAGEMENT OVERVIEW DOCUMENT
SNAKEBITE MANAGEMENT OVERVIEW DOCUMENT (continued)
Vipera latasti latasti
Treatment summary
Vipera
bites are probably common in many parts of the range and are potentially severe. All cases should be urgently
assessed and admitted. Children are at increased risk, particularly from hypovolaemic shock secondary to fluid shifts into the
bitten limb.
Insert an IV line and give an initial IV fluid load, more if hypovolaemic shock is developing. Carefully monitor fluid input/output
and renal function. Especially in children, beware late pulmonary oedema as fluid sequestered in the bitten limb is
reabsorbed.
Antivenom (when available) is appropriate for all but mild local envenoming, because of the potential for both major local
effects and systemic effects, including coagulopathy. Some experts list the following as indications for antivenom therapy:
- Circulatory shock
- Protracted or recurring GIT symptoms
- Progressive local reaction likely to involve whole limb or beyond
- Less severe circulatory effects + leukocytosis >20x10 9 / metabolic acidosis / increased CK / haemolysis / ECG changes /
coagulopathy
- neurological symptoms, including paralysis (partial) or CNS depression.
If available to recently developed ovine F(ab)’ antivenom (ViperaTab; Protherics) appears to be the most effective, safe
antivenom, but it is expensive and the short half life of F(ab)’ means repeated doses may be needed for recurrent
envenoming. Initial dose is 2 vials IV, but a further 2 vials may be needed. A variety of other equine antivenoms covering
Vipera
species, or selected species, are available in some countries within the range of one or more
Vipera
species. All
these antivenoms should be given IV, with adrenaline and resuscitation equipment ready. None are specific for
Vipera
latasti
.
STATE TOXINOLOGY SERVICES
Toxinology Dept., Women’s & Children’s Hospital, North Adelaide SA 5006 AUSTRALIA
SNAKEBITE MANAGEMENT OVERVIEW DOCUMENT
[ Pobierz całość w formacie PDF ]
