Stiletto Snake Bite -Atractaspis bibroni

[che]

Any update on the patient Fooble?

How is he doing?

[Fooble]

Havn't heard anything else thus far.
Although i was told they were closing the wounds earlier this week.

[WW]

Here's an interesting paper on fasciotomies:

Fasciotomy worsens the amount of myonecrosis in a porcine model of crotaline envenomation
Author(s): Tanen DA, Danish DC, Grice GA, Riffenburgh RH, Clark RF
Source: ANNALS OF EMERGENCY MEDICINE Volume: 44 Issue: 2 Pages: 99-104 Published: AUG 2004
Times Cited: 12 References: 25 Citation MapCitation Map
Conference Information: North American Congress of Clinical Toxicology
Chicago, IL, SEP 09-16, 2003
Abstract: Study objective: We evaluate the efficacy of fasciotomy or crotaline snake antivenom in reducing myonecrosis.

Methods: We used a randomized, blinded, controlled acute animal preparation. Twenty anesthetized swine were injected intramuscularly in the anterior tibiales muscle of both hind limbs with 6 mg/kg of Crotalus atrox venom (total of 12 mg/kg of venom per animal). Immediately after venom injection, the right hind limb underwent fasciotomy. Muscle biopsies were obtained from the fasciotomized hind limb at 0,4, and 8 hours and from the other hind limb at the conclusion of the study(8 hours). In addition, animals received either 8 vials of reconstituted Crotalidae polyvalent immune Fab (ovine) (CroFab; FabAV) or an equal volume of normal saline solution intravenously 1 hour after venom injection. A pathologist blinded to the study determined the percentage of myonecrotic cells in each biopsy. Statistical analysis was performed using repeated measures analysis of variance for compartment pressure. Rank-order methods were used for comparison of myonecrosis between groups.

Results: Biopsies from hind limbs undergoing fasciotomy revealed a progressive increase in the amount of myonecrosis overtime (myonecrosis median at 0,4, or 8 hours [or death]: 0%, 14%, or 14.5%, respectively; P<.001). Comparison of the amount of myonecrosis of biopsies at death or 8 hours revealed that limbs that underwent fasciotomy had significantly more myonecrosis than those that did not (myonecrosis median: 14.5% versus 2.5%, P=.048). No difference was detected in the amount of myonecrosis when FabAV was compared with normal saline solution on final biopsies from either fasciotomy or nonfasciotomy hind limb (myonecrosis median: 10.0% versus 10.0%, P=.64).

Conclusion: Fasciotomy significantly worsens the amount of myonecrosis in a porcine model of intramuscular crotaline venom injection. No change in the amount of myonecrosis was detected with the use of FabAV treatment at the dosages used in this animal model.

[Bushviper]

Wow. I would never have expected that. That is scary. One more reason to hide all scalpels when you talk to the doctor.

[Jamster]

Hey guys, got my stuff straight...

It was polyvalent. The doctor said it was B.arientis antivenom, I then read too hastily and saw only the Bitis part, I didnt read further...Apparently it can be used for Dendroaspis, Bitis(certain) and Naja bites(Indigenous stuff). I read it properly yesterday...thanks Fiona

[Boadicea]

No offence WW (you did not do the experiment after all) but to my mind that study was needless cruelty to pigs - highly intelligent and endearing animals. It always fascinates me how scientists have to conduct cruel and unnecessary experiments on animals when certain things are logically obvious to anyone with two grey cells to rub together. Cutting someone open increases the risk of infection and muscle damage? Duh! No s@#t Sherlock!

What is the stage of child development where they start taking things apart to see what they are made of ? Think its four years old?

Whilst the reported results are of interest they are hardly unpredictable don't you think?

[Boadicea]

Er...no offence intended to you either BV. Just didn't read any further on tis thread because I was too upset about what they did to the pigs. I'll never make a good scientist... or a diplomat

[froot]

How the pig must've suffered was the first thing that crossed my mind, but then I thought about the tasty eisbein they spoilt when they did that. My mind is weird...

[WW]

Some people need to re-read that abstract, as it clearly says "Twenty anesthetized swine were injected intramuscularly in the anterior tibiales muscle of both hind limbs with 6 mg/kg of Crotalus atrox venom" - in other words, they did not feel anything.

And froot: at least the chops would still have been OK - perhaps even extra-tenderised

[Boadicea]

Some people did read the word 'anesthetized' in the abstract the first time and some people's opinion remains the same. Other people should sue the pants off the doctor that did those fasciotomies. The road to hell is paved with good intentions. They are no excuse for poor judgment and blind ignorance.

[Pezulu]

I was tagged by A. Bibroni a few years ago. The pain was immediate, with mild swelling starting as well.
A quick phone call to a Dr. Dirks in Barberton regarding the possible treatment, and he suggested I down a small bottle of Phenergan (anti-histamine) which took care of the pain and swelling almost immediately. The phenergan was obtained from our local rural clinic, and was a 50ml bottle, if I remember correctly. It was taken within 1/2 an hour of the bite.
The joints between the bite site were stiff for a few days, but other than that there was no further pain, swelling or any other symptoms.

If a doctor had suggested that they butcher my arm to the extent that they did this poor chap, I would seriously get a second and third opinion.

[WW]

Some people did read the word 'anesthetized' in the abstract the first time and some people's opinion remains the same. Other people should sue the pants off the doctor that did those fasciotomies. The road to hell is paved with good intentions. They are no excuse for poor judgment and blind ignorance.

Are you talking about the fasciotomies performed on human snakebite patients or the fasciotomies on pigs? I would agree in the case of the former.

As far as I am concerned, the pig experiment was long overdue: fasciotomies have a long history of controversial use in human snakebite victims, some medics supporting them, others opposing them. An animal experiment that goes a considerable way towards providing some real data on the usefulness or otherwise of the procedure should be welcomed if it is performed in an appropriate ethical framework, as appears to have been the case here. The results from the study were actually fairly unexpected, so it is certainly not the case that it was a matter of proving the obvious.

I appreciate that some people are opposed to any and all animal experiments as a matter of principle, which is of course their right. However, for those who do accept the need for animal experimentation where there is a clear need, this particular experiment was timely, useful, and appears to have been conducted as ethically as possible, so I see no problem justifying it.

[Pythonodipsas]

Immediately after venom injection, the right hind limb underwent fasciotomy.

Maybe I don't get the whole picture, but I wonder why they didn't wait for swelling?

[WW]

Immediately after venom injection, the right hind limb underwent fasciotomy.

Maybe I don't get the whole picture, but I wonder why they didn't wait for swelling?

Good question! All I can think is that they might have wanted to prevent any possibility of tissue damage from pre-operative compartment syndrome prior to fasciotomy?

[Bushviper]

Much as I like pigs (I had a pet in the house for almost 10 years) I do understand that this experiment was done under the correct procedures to mimic a human snake bite victim. I would have preferred that they used humans but that is apparently not going to happen any time soon. If the pigs were under anesthetic all the time this would be acceptable. The result is what is important. Having pigs that are writhing in pain would possibly have given different results so I am pretty sure they were never aware of the operation and envenomation.

Now the next most important step is to get the doctors who want to perform these operations to be made aware of the results. That way the pigs will not have died in vain.