Fasciotomy in compartment syndrome from snakebite

Kim, Yong Hun; Choi, Jin Hee; Kim, Jiye; Chung, Yoon Kyu

doi:10.5999/aps.2018.00577

Cited by 35 publications

(42 citation statements)

References 15 publications

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“…In the study conducted by Kim YH et al with 158 snakebite cases, 10.8% of the patients needed fasciotomy due to compartment syndrome 19 . In our study, the most common complication developed during treatment was compartment syndrome with a frequency of 9.2%.…”

Section: Discussionmentioning

confidence: 98%

Venomous Snakebites in Children in Southeast Turkey

Oto¹,

Haspolat

2021

Dicle Tıp Dergisi

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Objective: Due to the hot climate of the Southeastern Anatolia Region, snake poisoning is common, which causes serious mortality and morbidity. We aimed to present the clinical course, complications and treatment approaches of patients hospitalized with snakebites.Methods: One-hundred and eight pediatric patients treated in the hospital for snakebites, excluding dry bite, were included in the study during a 5-year period. Gender, age, bite site, month, time, type of intervention in the field, symptoms, laboratory findings, complications, tetanus vaccination and antivenom administration were recorded by reviewing patient files. Results:The patients were aged between 10.2+3 (2-15) years and 72 (66.7%) were males. Seventy-three (67.6%) of patients were from rural areas. The bites were mostly from the lower extremity, at between 12-18 o'clock. Grade 1 patients were excluded from the study. At the time of admission, there were 47 (43%) grade 2 and 31 (28%) grade 3 patients. It was observed that with increased grade, higher levels of white blood cell count, glucose level and hospital stay were seen (p<0.01), and the grade increased as the hospital admission time increased (p:0.024). A negative correlation was found between the length of hospital stay and the platelet level (p=0.016). The most common complications were tissue necrosis (13%) and compartment syndrome (9.2%). There was a positive correlation between grade and compartment syndrome (P=0.001). Antivenom was administered to 80 (74%) of patients. Conclusion:Patients with snakebite poisoning should be transferred to the nearest emergency room quickly so that the management can be carried out in a timely manner. The signs of poisoning can affect not only the bitten area, but also all systems, causing multi-organ failure and even death. Therefore, patients should be frequently evaluated in terms of systemic findings. The efficacy of treatment is enhanced by aggressive supportive care and rapid administration of appropriate neutralizing antivenom.

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Section: Discussionmentioning

confidence: 98%

Venomous Snakebites in Children in Southeast Turkey

Oto¹,

Haspolat

2021

Dicle Tıp Dergisi

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“…Snakebites give cause of concern as they are an occupational hazard for workers in developing countries and their incidence increases with improvements in the quality of life in developed countries (i.e. spending more time in outdoor activities) 93 . In Europe, adult and paediatric emergency cases of snake envenomation are relatively common due to the main Vipera species on the continent: V. berus , V. ammodytes and V. aspis , while the other species are seldom implicated 94 .…”

Section: Discussionmentioning

confidence: 99%

“…A marked elevation of serum creatine kinase is observed during rhabdomyolysis and compartment syndrome 55 . The potential for the missed diagnosis of compartment syndrome in cases of snakebite was initially responsible for liberal use of fasciotomy in the 1960s for the management of snakebites, when a low threshold was set for snakebite‐related compartment syndrome 93 . Besides, for the past decades, the clinical consensus has been that such a low threshold was a cause of unnecessary surgical interventions, and various authors have advocated the use of antivenom in snakebite injuries as absolute indication with fasciotomy performed under strict 93 .…”

Section: Discussionmentioning

confidence: 99%

“…The potential for the missed diagnosis of compartment syndrome in cases of snakebite was initially responsible for liberal use of fasciotomy in the 1960s for the management of snakebites, when a low threshold was set for snakebite‐related compartment syndrome 93 . Besides, for the past decades, the clinical consensus has been that such a low threshold was a cause of unnecessary surgical interventions, and various authors have advocated the use of antivenom in snakebite injuries as absolute indication with fasciotomy performed under strict 93 . Fasciotomy, in case of snakebite, is needed in case of clinical evidence of compartment syndrome and/or intra‐compartmental pressure greater than 40 mmHg (in adults) when haemostatic abnormalities have been corrected.…”

Section: Discussionmentioning

confidence: 99%

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Vipera snakebite in Europe: a systematic review of a neglected disease

Paolino

Nicola²,

Pontara

et al. 2020

Acad Dermatol Venereol

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In 2009, snakebites were included in the list of the World Health Organization (WHO) neglected diseases. Dermatological literature lacks current and up-to-date articles about snakebites and their management, despite the fact that dermatologists, especially from rural hospitals, can be called into the emergency room to consult the management of suspected snakebites. In this systematic review, we highlighted the main clinical and laboratory aspects of snakebites from Vipera spp. in Europe, by reviewing 3574 studies initially retrieved from PubMed, Embase and Cochrane CENTRAL databases. Of these, 78 were finally included in the systematic review. We found that the most involved taxon was V. berus in 63.3% and the most involved anatomic site of the bite was the upper limbs 53.1% with fang marks reported in 90.5%. The mean age of the patients was 32.9 years, and bites were slightly more common among males (58.2%). A wound washing was performed in 86.9% of cases before the hospitalization. The most frequently reported grade of envenomation was G2 (42.2%). In addition to local dermatological symptoms (extended erythema, oedema, cutaneous necrosis, hives, purpura, petechiae, acute compartment syndrome), numerous systemic symptoms have also been reported, including fatigue (14.4%), pain (75.3%), fever (49.2%), direct anaphylactoid reaction (5.3%), anxiety (60.8%), cranial nerve neurotoxicity (14.8%), dysesthesia/paraesthesia (7.9%), vomiting (33.7%), abdominal pain (23.3%), diarrhoea (15.4%), dyspnoea (6.3%), proteinuria (10.6%) and haematuria (9.3%). Secondary infections were present in 3.5% and disseminated intravascular coagulation in 3.1% of cases, and fasciotomy was performed in 4.2% cases, while an amputation in 6.9%. Only 0.9% of patients died. Antivenom was administered in 3053 cases. In conclusion, there is a pressing need for robust multi-centre randomized control trials, standardized protocol for snakebite management and antivenom administration across Europe and a National snakebite register for each European country.

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“…Although much has been learned about compartment syndrome in recent decades, many questions and controversies surrounding its diagnosis and treatment have remained. Most studies consider measurement of the ICP as an important tool for diagnosis, with a pressure higher than 30 mmHg as significant of compartment syndrome [27]. Many authors recommend the use of a delta pressure (ΔP) which is defined as the difference between the diastolic blood pressure and measured compartment pressure.…”

Section: Discussion:-mentioning

confidence: 99%

A Retrospective Study of 16 Cases of Acute Compartment Syndrome Following Snakebite

Lemsanni¹,

Najeb²,

Chafik³

et al. 2020

IJAR

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Acute compartment syndrome after snakebite is considered to be quite rare and there is still a lot of controversy in regard to its diagnosis and management as it has been reported by the little available medical literature on the topic. It is in this context that our series assumes importance as we report our experience relating to management and outcome of 16 consecutive cases of compartment syndrome from snakebites. A 15-year retrospective study was conducted on all adult patients with compartment syndrome following snakebites, who were admitted between April 2005 and December 2019 in our institution. Due to non-availability of equipment to measure intracompartmental pressure, the diagnosis of compartment syndrome was based on clinical judgment. There were 10 (62.5%) male and 6 (37.5%) female, with a mean age of 32.1 ± 7.8 years. Bite site was mostly in the lower limbs (62.5%). Based on clinical severity, 2 (12.5%), 10 (62.5%) and 4 (25%) patients were classified into classes I, II, and III, respectively. FAV-Afrique® antivenom was administered to 12 (75%) patients in doses ranging from 1 to 5 vials by patients. Fasciotomy was performed in all cases and the median time from admission to surgery was 5.8 hours (range: 4– 9hours). The mean hospital stay was 16 days and follow-up of patients has shown good results: normal limb function was regained in all cases. In summary, acute compartment syndrome following snakebite is not rare in our context and must be treated by performing early fasciotomy without any delay after diagnosis.

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Fasciotomy in compartment syndrome from snakebite

Cited by 35 publications

References 15 publications

Venomous Snakebites in Children in Southeast Turkey

Venomous Snakebites in Children in Southeast Turkey

Vipera snakebite in Europe: a systematic review of a neglected disease

A Retrospective Study of 16 Cases of Acute Compartment Syndrome Following Snakebite

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