Point‐of‐care testing in snakebite: An envenomed case with false negative coagulation studies

Cubitt, Mya; Armstrong, Jason; McCoubrie, David; White, Julian; Williams, Vaughan; Isbister, Geoffrey K.

doi:10.1111/1742-6723.12089

Cited by 8 publications

(8 citation statements)

References 5 publications

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“…The D‐dimer level is usually elevated by 100–1000 times the assay cut‐off in VICC, and modest increases, in the absence of other indications of envenoming, must be interpreted with caution. Point‐of‐care devices for measuring INR or D‐dimer have been found to give false negative results in VICC and should not be used 18 . Results of whole blood clotting tests are also frequently misleading in snakebite, 19 and glass tubes required for this test are not available in Australia.…”

Section: Investigationsmentioning

confidence: 99%

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Snakebite in Australia: a practical approach to diagnosis and treatment

Isbister

Brown

Page

et al. 2013

Medical Journal of Australia

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103

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Snakebite is a potential medical emergency and must receive high-priority assessment and treatment, even in patients who initially appear well. Patients should be treated in hospitals with onsite laboratory facilities, appropriate antivenom stocks and a clinician capable of treating complications such as anaphylaxis. All patients with suspected snakebite should be admitted to a suitable clinical unit, such as an emergency short-stay unit, for at least 12 hours after the bite. Serial blood testing (activated partial thromboplastin time, international normalised ratio and creatine kinase level) and neurological examinations should be done for all patients. Most snakebites will not result in significant envenoming and do not require antivenom. Antivenom should be administered as soon as there is evidence of envenoming. Evidence of systemic envenoming includes venom-induced consumption coagulopathy, sudden collapse, myotoxicity, neurotoxicity, thrombotic microangiopathy and renal impairment. Venomous snake groups each cause a characteristic clinical syndrome, which can be used in combination with local geographical distribution information to determine the probable snake involved and appropriate antivenom to use. The Snake Venom Detection Kit may assist in regions where the range of possible snakes is too broad to allow the use of monovalent antivenoms. When the snake identification remains unclear, two monovalent antivenoms (eg, brown snake and tiger snake antivenom) that cover possible snakes, or a polyvalent antivenom, can be used. One vial of the relevant antivenom is sufficient to bind all circulating venom. However, recovery may be delayed as many clinical and laboratory effects of venom are not immediately reversible. For expert advice on envenoming, contact the National Poisons Information Centre on 13 11 26.

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Section: Investigationsmentioning

confidence: 99%

“…Point-of-care devices for measuring INR or Ddimer have been found to give false negative results in VICC and should not be used. 18 Results of whole blood clotting tests are also frequently misleading in snakebite, 19 and glass tubes required for this test are not available in Australia.…”

Section: Editorial P 723mentioning

confidence: 99%

Snakebite in Australia: a practical approach to diagnosis and treatment

Isbister

Brown

Page

et al. 2013

Medical Journal of Australia

Self Cite

103

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“…The pathophysiology of frostbite consists of vasoconstriction, crystal formation and cellular dehydration. 1 Crystal formation is both extracellular and intracellular that bs_bs_banner Emergency Medicine Australasia (2014) 26, 208-213…”

Section: Frostbite Caused By Liquid Co 2 Exposurementioning

confidence: 99%

“…Dear Editor, The article by Cubitt et al was indeed interesting. 1 Today, point-of-care (POC) of prothrombin time/INR is increasingly used to monitor patients, especially those on vitamin K antagonists. In this context, we would like to highlight limitations of the device in relation to snake envenomation.…”

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confidence: 99%

“…3 When the results fall outside this range, by default these devices have a tendency to report them as normal values, despite significant derangement because of snake envenomation, as observed in this report. 1 We wish to report our observation carried out in paired samples of 18 patients, who were severely envenomated by Russell's viper. It was observed that there was significant discrepancy between INR results measured at a reference laboratory and POC testing.…”

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