Research Article
Retrospective Analysis of the Demographic and Clinical Features of Snake Bites Followed in the Intensive Care Unit
Abstract
Abstract
Objective: The cases of poisoning due to snake bite are a medical condition that requires an emergency treatment approach, which creates serious health problems that can be seen in our country and all over the world. In the Eastern Anatolia Region, poisoning cases due to the bites of viper snakes, especially from the Viperidae family, are frequently observed. The aim of this study is to examine the treatment modalities of patients treated in our intensive care unit
due to snake bites in and around the city of Elazig province and to present our clinical experience with snake bites.
Material and Methods: Our study included 44 patients who were treated in the anesthesia intensive care clinic with the complaint of snake bite between August 2018 and August 2021. Symptoms, bite sites, clinical stages, need and doses of antivenom, changes in blood biochemistry, length of hospital stay, prognostic characteristics and mortality of these patients exposed to snake bites were retrospectively analysed.
Results: A total of 44 patients, 13 female (29.55%) and 31 male (70.45%), aged between 18-72 years, who were followed up for snake bites, were included in the study. In our study, the severity of poisoning was determined and staging was performed according to the clinical symptoms and laboratory findings of the patients. The snake bites were observed in 1 (2.27%) patients in Stage 0, 18 (40.90%) in Stage 1, 21 (47.7%) in Stage 2, and 4 (9.09%) patients in Stage 3. The patients included in our study were divided into two groups as Stage (0-1) and Stage (2-3) according to their stages, and the antivenom doses taken by these two groups were compared. While total antivenom (4.33±2.18) vials were given to 10 poisoning cases with stage (0-1), total antivenom (7.65±3.03) vials were administered to 25 poisoning cases with stage (2-3).
Conclusion: We believe that early and adequate dose of antivenom treatment in snake bite cases treated in intensive care units can prevent complications that may develop after poisoning and reduce mortality.
Keywords
References
- Vij K. Textbook of Forensic Medicine and Toxicology: Principles and Practice. 5 ed. 2011.Elsevier India.
- Kuru M. Omurgalı Hayvanlar, 5. Baskı. Ankara, Palme Yayıncılık, 1999.
- Demirsoy A. Sürüngenler İçinde: Yaşamın Temel Kuralları Omurgalılar/Amniyota. Ankara: Meteksan; 1992;3-198.
- Büyük Y, Koçak U, Yazıcı YA, Gürpınar SS, Kır Z. Yılan Isırığına Bağlı Ölüm. Türkiye Klinikleri J Foren Med, 2007;4:127-130.
- World Health Organization. Guidelines for the management of snakebites, 2nd edition. Available from: http: //www.who.int/iris/handle/10665/249547. Updated 2016. Accessed June 15, 2018.
- Zehirli Hayvan Isırma ve Sokmaları. T.C. Sağlık Bakanlığı Birinci Basamağa Yönelik Zehirlenmeler Tanı ve Tedavi Rehberleri. Ankara, 2007:14359.
- Mackessy SP. Biochemistry and pharmacology of colubrid snake venoms. Journal of Toxicology-Toxin Review. 2002;21(1):43-83.
- Şahan M, Taşın V, Karakuş A, Özcan O, Eryiğit U4, Kuvandı G et al. Evaluation of patients with snakebite who presented to the emergency department: 132 cases. Turkish Journal of Trauma&Emergency Surgery. 2016;22(4):333-337.
- Macho JR, Schechter WP. Care of patients with environmental injuries. In: Current Critical Care Diagnosis & Treatment, 2nd edition. Edited by Bongard FS, Sue DY. International edition. New York, McGraw-Hill. 200;875-877.
- Kurtoğlu S: Zehirlenmeler: Teşhis ve Tedavi. Kayseri, Erciyes Matbaası 1994:534.
- Bentur Y, Cahana A. Unusual local complications of Vipera palaestinae bite. Toxicon. 2003;41:633-635.
- Kristjansson M, Arbeit RD. Mycobacterium Ulcerans and Osteomyelitis (letter; comment). N Eng J Med. 1993;329(8):582.
- Kerrigan KR. Venomous snakebite in Eastern Ecuador. Am J Trop Med Hyg. 1991;44:93-99.
- Benvenuti LA, Franca FO, Barbaro KC, Nunes JR,Cardoso JL. Pulmonary haemorrhage causing rapid death after Bothrops jararacussu snakebite: A case report. Toxicon. 2003;42(3):331–334.
- Söker M, Haspolat K. Yılan ısırması zehirlenmesi ve tedavisi. Sendrom, 1999;11:33-36.
- Burges JL, Dart RC. Snake venom coagulopathy: Use and abuse of blood products in the treatment of pit viper envenomation. Ann Emerg Med. 1991;20:745-801.
- Jansen PW, Perkin RM, Van Stralen D. Moave Rattlesnake envenomation: Prolonged neurotoxictyand rhabdomyolysis. Ann Emerg Med. 1992;21:322-325.
- Isbister GK, Currie BJ. Suspected snakebite: One year prospective study of emergency departmentpresentations. Emerg Med (Fremantle). 2003;15:160-169.
- Boviatsis EJ, Kouyialis AT, Papatheodorou G, Gavra M, Korfias S, Sakas DE. Multiple hemorrhagic brain infarcts after viper envenomation. Am J Trop Med Hyg. 2003;68(2):253-257.
- Lifshitz M, Maimon N, Livnat S. Walterinnesia aegyptia envenomation in a 22-year-old female: acase report. Toxicon. 2003; 41(4):535–537.
- Wallace JF. Disorders caused by venoms, bites and stings.in: Harrison’s Principles of Internal Medicine, Thirteenth Edition 1994:2467-2473.
- Okur Mİ, Yıldırım AM, Köse R. Türkiye’de zehirli yılan ısırmaları ve tedavisi. Türkiye Klinikleri Tıp Bilimleri Dergisi. 2001;21:528-532.
- Tagwireyi DD, Ball DE, Nhachi CF. Routine prophylactic antibiotic use in the management of snakebite. BMC Clin Pharmacol. 2001;1:4.
- Roberts JR, Otten EJ. Snakebites and other reptiles. In: Goldfrank LR, ed. Goldfrenk’ s Toxicolojic Emergencies. Stamford, CT: Appleton & Lange.1998:1603-1623.
- Scharman EJ, Noffsinger DV. Copperhead Snakebites: Clinical severity of local effects. Annals Emerg Med. 2001;38(1):55-61.
- Açikalin A, Gökel Y. Serum IL-6, TNFα levels in snakebite cases occurring in Southern Turkey. Emerg Med J. 2011;28(3):208-211.
- Davidson TM, Schafer SF. Rattlesnake bites. Guidelines for aggressive treatment. Postgrad Med. 1994;96:107-114.
- Premawardhena AP, de Silva CE, Fonseka MM, Gunatilake SB, de Silva HJ. Low dose subcutaneous adrenaline to prevent acute adverse reactions to antivenom serum in people bitten by snakes: randomised, placebo controlled trial. BMJ. 1999;318(7190):1041-1043.
- Akbulut A. Antivenom tedavi. In: Özgüneş İ, Usluer G, Çolak H, editörler. Klimik 99, 9. Türk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Kongre Kitabı;3-8 Ekim 1999;Antalya, Turkey.S107-111.
- Köse R. Yılan zehirlenmelerinin tedavisi: Yirmi bir olgunun incelenmesi. Ulusal Travma Acil Cerrahi Derg. 2007;13(4):307-312.
- Ertem K, Esenkaya I, Kaygusuz MA, Turan C. Our clinical experience in the treatment of snakebites. Acta Orthop Traumatol Tur. 2005;39(1):54-58.
- Dempfle CE, Kohl R, Harenberg J, Kirschstein W, Schlauch D, Heene DL. Coagulopathy after snake bite by Bothrops neuwiedi: case report and results of in vitro experiments. Blut. 1990;61:369-374.
- Caiaffa WT, Vlahov D, Antunes CM, de Oliveira HR, Diniz CR. Snake bite and antivenom complications in Belo Horizonte, BrazilTrans R Soc Trop Med Hyg. 1994;88:81-85.
- Russell FE, Carlson RW, Wainschel J, Osborne AH. Snake venom poisoning in the United States. Experiences with 550 case. JAMA. 1975;233:341-343.
- Glass TG. Early debridement in pit viper bite. Surg Gynecol Obstet. 1973;136:774-776.
- Huang TT, Lynch JB, Larson DL, Lewis SR. The use of excisional therapy in the management of snakebite. Ann Surg. 1974;179:598-607.
- Glass TG. Early debridement in pit viper bites. JAMA. 1976;235:2513-2516.
- Huang TT, Blackwell SJ, Lewis SR. Tissue necrosis in snakebite. Tex Med. 1981;77:53-58.
- Cohen WR, Wetzel W, Kadish A. Local heat and cold application after eastern cottonmouth moccasin (Agkistrodon piscivorus) envenomation in the rat: effect on tissue injury. Toxicon. 1992;30:1383-1386.
- Frank HA. Snakebite or frostbite: what are we doing? An evaluation of cryotherapy for envenomation. Calif Med. 1971;114:25-27.
- Lavonas EJ, Kokko J, Schaeffer TH, Mlynarchek SL, Bogdan GM, Dart RC. Short-term outcomes after Fab antivenom therapy for severe crotaline snakebite. Ann Emerg Med. 2011;57:128-137.
- Dart RC, Seifert SA, Boyer LV, Clark RF, Hall E, McKinney P et al. A randomized multicenter trial of crotalinae polyvalent immune Fab (ovine) antivenom for the treatment for crotaline snakebite in the United States. Arch Intern Med. 2001;161:2030-2036.
- Yin S, Kokko J, Lavonas E, Mlynarchek S, Bogdan G, Schaeffer T. Factors associated with difficulty achieving initial control with crotalidae polyvalent immune fab antivenom in snakebite patients. Acad Emerg Med. 2011;18:46-52.
- Lavonas EJ, Gerardo CJ, O'Malley G, Arnold TC, Bush SP, Banner W et al. Initial experience with Crotalidae polyvalent immune Fab (ovine) antivenom in the treatment of copperhead snakebite. Ann Emerg Med. 2004;43:200-206.
- Blaylock RS. Antibiotic use and infection in snakebite victims. S Afr Med J. 1999;89:874-876.
- Goldstein EJ, Citron DM, Gonzalez H, Russell FE, Finegold SM. Bacteriology of rattlesnake venom and implications for therapy. J Infect Dis. 1979;140:818-821.
- Clark RF, Selden BS, Furbee B. The incidence of wound infection following crotalid envenomation. J Emerg Med. 1993;11:583-586.
- Jarwani B, Jadav P, Madaiya M. Demographic, epidemiologic and clinical profile of snake bite cases. J Emerg Trauma Shock. 2013;6(3):199-202.
- Heiner JD, Bebarta VS, Varney SM, Bothwell JD, Cronin AJ. Clinical Effects and Antivenom Use for Snake Bite Victims Treated at Three US Hospitals in Afghanistan. Wilderness Environ Med. 2013;24(4):412-416.
- Lau YL, KennaAP. Surgical treatment of adder bite. J R SocMed. 1985;78(12):1028-1030.
- Davidson TM, Schafer SF. Rattlesnake bites. Guidelines for aggressive treatment. Postgrad Med. 1994;96:107-114.
- Monzavi MS, Dadpour B, Afshari R. Snakebite management in Iran: Devising a protocol. Journal of Research in Medical Sciences. 2014;19(2):153-163.
Yoğun Bakım Ünitesinde Takip Edilen Yılan Isırması Olgularının Demografik ve Klinik Özelliklerinin Retrospektif Analizi
Abstract
Özet
Amaç: Yılan ısırmasına bağlı zehirlenme olguları, ülkemizde ve tüm dünyada görülebilen ciddi sağlık problemleri oluşturan acil tedavi yaklaşımı gerektiren bir tıbbi durumdur. Doğu Anadolu Bölgesi’nde, özellikle Viperidae ailesinden olan engerek yılanlarının ısırmalarına bağlı zehirlenme vakaları sıklıkla görülmektedir. Bu çalışmadaki amaç, Elazığ ili ve çevresinde yılan ısırması nedeniyle yoğun bakım ünitemizde tedavi gören hastaların tedavi modalitelerini incelemek ve yılan ısırması ile ilgili klinik deneyimlerimizi sunmaktır.
Gereç ve Yöntemler: Çalışmamıza Ağustos 2018 ile Ağustos 2021 tarihleri arasında yılan ısırması şikayeti ile yoğun bakım kliniğinde tedavi gören 44 hasta dâhil edildi. Yılan ısırığına maruz kalan bu hastaların semptomları, ısırılan bölgeleri, klinik evreleri, antivenom ihtiyacı ve dozları, kan biyokimyasındaki değişiklikler, hastanede kalış süreleri, prognoz karakteristikleri ve mortaliteleri retrospektif olarak incelendi.
Bulgular: Yılan sokması nedeniyle takip edilen 18-72 yaşları arasında 13 kadın (%29.55) ve 31 erkek (%70.45) olmak üzere toplam 44 hasta çalışmaya dâhil edildi. Çalışmamızda, hastalar klinik semptomlarına ve laboratuvar bulgularına göre zehirlenme şiddeti belirlenerek evrelendirme yapıldı. Evre 0’da 1 (%2.27), Evre 1’de 18 (%40.90), Evre 2’de 21 (%47.7) ve Evre 3’te 4 (%9.09) hastanın yılan ısırması nedeniyle takip edildiği saptandı. Çalışmamıza dâhil edilen hastalar, evrelerine göre Evre (0-1) ve Evre (2-3) olarak iki gruba ayrılarak bu iki grubun aldıkları antivenom dozları karşılaştırıldı. Evre (0-1) olan 10 zehirlenme olgusuna total antivenom (4.33±2.18) vial verilirken, Evre (2-3) olan 25 zehirlenme olgusuna total antivenom (7.65±3.03) vial uygulandı.
Sonuç: Yoğun bakım ünitelerinde tedavi gören yılan ısırması olgularına erken ve yeterli dozda uygulanan antivenom tedavisinin, zehirlenme sonrası gelişebilecek komplikasyonları engelleyebileceği ve mortaliteyi azaltacağı görüşündeyiz.
References
- Vij K. Textbook of Forensic Medicine and Toxicology: Principles and Practice. 5 ed. 2011.Elsevier India.
- Kuru M. Omurgalı Hayvanlar, 5. Baskı. Ankara, Palme Yayıncılık, 1999.
- Demirsoy A. Sürüngenler İçinde: Yaşamın Temel Kuralları Omurgalılar/Amniyota. Ankara: Meteksan; 1992;3-198.
- Büyük Y, Koçak U, Yazıcı YA, Gürpınar SS, Kır Z. Yılan Isırığına Bağlı Ölüm. Türkiye Klinikleri J Foren Med, 2007;4:127-130.
- World Health Organization. Guidelines for the management of snakebites, 2nd edition. Available from: http: //www.who.int/iris/handle/10665/249547. Updated 2016. Accessed June 15, 2018.
- Zehirli Hayvan Isırma ve Sokmaları. T.C. Sağlık Bakanlığı Birinci Basamağa Yönelik Zehirlenmeler Tanı ve Tedavi Rehberleri. Ankara, 2007:14359.
- Mackessy SP. Biochemistry and pharmacology of colubrid snake venoms. Journal of Toxicology-Toxin Review. 2002;21(1):43-83.
- Şahan M, Taşın V, Karakuş A, Özcan O, Eryiğit U4, Kuvandı G et al. Evaluation of patients with snakebite who presented to the emergency department: 132 cases. Turkish Journal of Trauma&Emergency Surgery. 2016;22(4):333-337.
- Macho JR, Schechter WP. Care of patients with environmental injuries. In: Current Critical Care Diagnosis & Treatment, 2nd edition. Edited by Bongard FS, Sue DY. International edition. New York, McGraw-Hill. 200;875-877.
- Kurtoğlu S: Zehirlenmeler: Teşhis ve Tedavi. Kayseri, Erciyes Matbaası 1994:534.
- Bentur Y, Cahana A. Unusual local complications of Vipera palaestinae bite. Toxicon. 2003;41:633-635.
- Kristjansson M, Arbeit RD. Mycobacterium Ulcerans and Osteomyelitis (letter; comment). N Eng J Med. 1993;329(8):582.
- Kerrigan KR. Venomous snakebite in Eastern Ecuador. Am J Trop Med Hyg. 1991;44:93-99.
- Benvenuti LA, Franca FO, Barbaro KC, Nunes JR,Cardoso JL. Pulmonary haemorrhage causing rapid death after Bothrops jararacussu snakebite: A case report. Toxicon. 2003;42(3):331–334.
- Söker M, Haspolat K. Yılan ısırması zehirlenmesi ve tedavisi. Sendrom, 1999;11:33-36.
- Burges JL, Dart RC. Snake venom coagulopathy: Use and abuse of blood products in the treatment of pit viper envenomation. Ann Emerg Med. 1991;20:745-801.
- Jansen PW, Perkin RM, Van Stralen D. Moave Rattlesnake envenomation: Prolonged neurotoxictyand rhabdomyolysis. Ann Emerg Med. 1992;21:322-325.
- Isbister GK, Currie BJ. Suspected snakebite: One year prospective study of emergency departmentpresentations. Emerg Med (Fremantle). 2003;15:160-169.
- Boviatsis EJ, Kouyialis AT, Papatheodorou G, Gavra M, Korfias S, Sakas DE. Multiple hemorrhagic brain infarcts after viper envenomation. Am J Trop Med Hyg. 2003;68(2):253-257.
- Lifshitz M, Maimon N, Livnat S. Walterinnesia aegyptia envenomation in a 22-year-old female: acase report. Toxicon. 2003; 41(4):535–537.
- Wallace JF. Disorders caused by venoms, bites and stings.in: Harrison’s Principles of Internal Medicine, Thirteenth Edition 1994:2467-2473.
- Okur Mİ, Yıldırım AM, Köse R. Türkiye’de zehirli yılan ısırmaları ve tedavisi. Türkiye Klinikleri Tıp Bilimleri Dergisi. 2001;21:528-532.
- Tagwireyi DD, Ball DE, Nhachi CF. Routine prophylactic antibiotic use in the management of snakebite. BMC Clin Pharmacol. 2001;1:4.
- Roberts JR, Otten EJ. Snakebites and other reptiles. In: Goldfrank LR, ed. Goldfrenk’ s Toxicolojic Emergencies. Stamford, CT: Appleton & Lange.1998:1603-1623.
- Scharman EJ, Noffsinger DV. Copperhead Snakebites: Clinical severity of local effects. Annals Emerg Med. 2001;38(1):55-61.
- Açikalin A, Gökel Y. Serum IL-6, TNFα levels in snakebite cases occurring in Southern Turkey. Emerg Med J. 2011;28(3):208-211.
- Davidson TM, Schafer SF. Rattlesnake bites. Guidelines for aggressive treatment. Postgrad Med. 1994;96:107-114.
- Premawardhena AP, de Silva CE, Fonseka MM, Gunatilake SB, de Silva HJ. Low dose subcutaneous adrenaline to prevent acute adverse reactions to antivenom serum in people bitten by snakes: randomised, placebo controlled trial. BMJ. 1999;318(7190):1041-1043.
- Akbulut A. Antivenom tedavi. In: Özgüneş İ, Usluer G, Çolak H, editörler. Klimik 99, 9. Türk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Kongre Kitabı;3-8 Ekim 1999;Antalya, Turkey.S107-111.
- Köse R. Yılan zehirlenmelerinin tedavisi: Yirmi bir olgunun incelenmesi. Ulusal Travma Acil Cerrahi Derg. 2007;13(4):307-312.
- Ertem K, Esenkaya I, Kaygusuz MA, Turan C. Our clinical experience in the treatment of snakebites. Acta Orthop Traumatol Tur. 2005;39(1):54-58.
- Dempfle CE, Kohl R, Harenberg J, Kirschstein W, Schlauch D, Heene DL. Coagulopathy after snake bite by Bothrops neuwiedi: case report and results of in vitro experiments. Blut. 1990;61:369-374.
- Caiaffa WT, Vlahov D, Antunes CM, de Oliveira HR, Diniz CR. Snake bite and antivenom complications in Belo Horizonte, BrazilTrans R Soc Trop Med Hyg. 1994;88:81-85.
- Russell FE, Carlson RW, Wainschel J, Osborne AH. Snake venom poisoning in the United States. Experiences with 550 case. JAMA. 1975;233:341-343.
- Glass TG. Early debridement in pit viper bite. Surg Gynecol Obstet. 1973;136:774-776.
- Huang TT, Lynch JB, Larson DL, Lewis SR. The use of excisional therapy in the management of snakebite. Ann Surg. 1974;179:598-607.
- Glass TG. Early debridement in pit viper bites. JAMA. 1976;235:2513-2516.
- Huang TT, Blackwell SJ, Lewis SR. Tissue necrosis in snakebite. Tex Med. 1981;77:53-58.
- Cohen WR, Wetzel W, Kadish A. Local heat and cold application after eastern cottonmouth moccasin (Agkistrodon piscivorus) envenomation in the rat: effect on tissue injury. Toxicon. 1992;30:1383-1386.
- Frank HA. Snakebite or frostbite: what are we doing? An evaluation of cryotherapy for envenomation. Calif Med. 1971;114:25-27.
- Lavonas EJ, Kokko J, Schaeffer TH, Mlynarchek SL, Bogdan GM, Dart RC. Short-term outcomes after Fab antivenom therapy for severe crotaline snakebite. Ann Emerg Med. 2011;57:128-137.
- Dart RC, Seifert SA, Boyer LV, Clark RF, Hall E, McKinney P et al. A randomized multicenter trial of crotalinae polyvalent immune Fab (ovine) antivenom for the treatment for crotaline snakebite in the United States. Arch Intern Med. 2001;161:2030-2036.
- Yin S, Kokko J, Lavonas E, Mlynarchek S, Bogdan G, Schaeffer T. Factors associated with difficulty achieving initial control with crotalidae polyvalent immune fab antivenom in snakebite patients. Acad Emerg Med. 2011;18:46-52.
- Lavonas EJ, Gerardo CJ, O'Malley G, Arnold TC, Bush SP, Banner W et al. Initial experience with Crotalidae polyvalent immune Fab (ovine) antivenom in the treatment of copperhead snakebite. Ann Emerg Med. 2004;43:200-206.
- Blaylock RS. Antibiotic use and infection in snakebite victims. S Afr Med J. 1999;89:874-876.
- Goldstein EJ, Citron DM, Gonzalez H, Russell FE, Finegold SM. Bacteriology of rattlesnake venom and implications for therapy. J Infect Dis. 1979;140:818-821.
- Clark RF, Selden BS, Furbee B. The incidence of wound infection following crotalid envenomation. J Emerg Med. 1993;11:583-586.
- Jarwani B, Jadav P, Madaiya M. Demographic, epidemiologic and clinical profile of snake bite cases. J Emerg Trauma Shock. 2013;6(3):199-202.
- Heiner JD, Bebarta VS, Varney SM, Bothwell JD, Cronin AJ. Clinical Effects and Antivenom Use for Snake Bite Victims Treated at Three US Hospitals in Afghanistan. Wilderness Environ Med. 2013;24(4):412-416.
- Lau YL, KennaAP. Surgical treatment of adder bite. J R SocMed. 1985;78(12):1028-1030.
- Davidson TM, Schafer SF. Rattlesnake bites. Guidelines for aggressive treatment. Postgrad Med. 1994;96:107-114.
- Monzavi MS, Dadpour B, Afshari R. Snakebite management in Iran: Devising a protocol. Journal of Research in Medical Sciences. 2014;19(2):153-163.
There are 52 citations in total.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Araştırma Makaleleri |
| Authors | |
| Early Pub Date | November 1, 2022 |
| Publication Date | November 2, 2022 |
| Submission Date | October 27, 2021 |
| Acceptance Date | January 3, 2022 |
| Published in Issue | Year 2022 Volume: 17 Issue: 3 |
