Management of venomous snake bites

Abstract

Introduction: Ophidic accidents still constitute a serious health problem for some rural populations in Colombia. Although health assistance has improved its services during the last two decades, there were two deaths by ophidism at Hospital San José de Maicao (HSJM) during 2004. These events were consistent with an increase rate in ophidic accidents all around the country.

Methods: We performed a case series study including all the reported ophidic accidents presented at HSJM from February 2004 to October 2005, in order to describe the management of these patients as well as their complications.

Results: 21 patients who assisted to the HSJM emergency room with ophidic poisoning from February 2004 to October 2005 were included in the series. Ophidic identification was trustable only in 61.9% of the cases, all by Bothrops. Mean time between the ophidic accident and hospital admission was 13 hours. One accident was iatrogenic, ordered by a Shaman. There were two deaths in patients who didn’t receive the antiophidic serum. Eight of the fifteen patients who received antivenom serum presented anaphylaxis after its injection (53.3%). Mortality by ophidic accidents was of 0.9 deaths per 100 000 inhabitants among hospital influence area.

Discussion: Time between the ophidic accident and hospital admission, worsens the clinical picture and prognosis of it. A correct classification of ophidic accident allows only one antiophidic serum injection, with a consequent decrease in anaphylaxis reactions by the lack of previous sensitizations of the patient. All patients with ophidic accidents should be treated at an intensive care unit because of potential systemic complications of it.