Hypotension
\nHypotension can have a number of causes, particularly loss of circulating volume
\ndue to haemorrhage and vasodilation due to the action of the venom or direct effects
\non the heart. Test for hypovolaemia by examining the blood pressure lying down and
\nsitting up, to establish postural hypotension. Usually crystalloids are used for volume
\nexpansion. However, there is no conclusive trial evidence to support a preference for
\ncolloids or crystalloids.
\nIn cases where increased generalised capillary permeability has been established,
\na vasoconstrictor such as dopamine can be used, dose being is 5 – 10\u03bc \/kg\/minute
\nin normal saline or glucose solutions as IV drip. The fl ow rate may be adjusted to
\nmaintain blood pressure adequately. Rarely Russell\u2019s Viper bites are known to cause
\nacute pituitary and \/ or adrenal insuffi ciency. This condition may also contribute to
\nshock. Hence, this entity has to be remembered while dealing with hypotension in
\nsnakebite as these cases require long term follow up.
\nPersistent or Severe bleeding
\nIn the majority of cases the timely use of ASV will stop systemic bleeding. However
\nin some cases the bleeding may continue to a point when further appropriate treatment
\nshould be considered. The major point to note is that clotting must be re-established
\nbefore additional measures are taken. Adding clotting factors, fresh frozen plasma(FFP), cryoprecipitate or whole blood in the presence of un-neutralised venom will
\nincrease the amount of degradation products with the accompanying risk to the renal
\nfunction. Plasmapheresis has been used successfully in such situation.
\nRenal Failure and ASV
\nRenal failure is a common complication of Russell\u2019s viper and Hump-nosed pit viper
\nbites. The contributory factors are intravascular haemolysis, DIC, direct nephrotoxicity,
\nand hypotension and rhabdomyolysis.
\nRenal damage can develop very early in cases of Russells Viper bite and even when
\nthe patient arrives at hospital soon after the bite, the damage may already have been
\ndone. Studies have shown that even when ASV is administered within 1-2 hours after
\nthe bite, it is incapable of preventing ARF. Declining renal parameters require referral
\nto a higher centre with access to dialysis. Peritoneal dialysis could be performed in
\nsecondary care centres.
\nSurgical issues
\nThe surgical issues observed in snake bite cases are
\n\u2022 Ulcer following snakebite
\n\u2022 Necrosis of the skin and underlying tissues
\n\u2022 Gangrene of the toes and fi ngers
\n\u2022 Debridement of necrotic tissues
\n\u2022 Compartment syndrome and others
\nPractitioner while dealing a case of snake bite with one or other surgical
\nissues has been informed to remember the following and keep the patient
\nand the care givers accordingly.
\nFasciotomy does not remove or reduce any envenomation.<\/p>\n","protected":false},"excerpt":{"rendered":"
Hypotension Hypotension can have a number of causes, particularly loss of circulating volume due to haemorrhage and vasodilation due to the action of the venom or direct effects on the heart. Test for hypovolaemia by examining the blood pressure lying down and sitting up, to establish postural hypotension. Usually crystalloids are used for volume expansion. […]<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":21,"menu_order":4,"comment_status":"open","ping_status":"open","template":"","meta":{"footnotes":""},"class_list":["post-39","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/pages\/39","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/comments?post=39"}],"version-history":[{"count":0,"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/pages\/39\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/pages\/21"}],"wp:attachment":[{"href":"https:\/\/doctorbruno.info\/snake-bite-scorpion-sting-protocol\/wp-json\/wp\/v2\/media?parent=39"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}