The management of upper extremity pit viper wounds

Area of Science:

• Toxicology
• Herpetology
• Emergency Medicine

Background:

• Rattlesnake bites, particularly to the upper extremity and hand, result in significant complications including tissue necrosis, joint stiffness, and loss of sensibility.
• A high clinical complication rate (32%) was observed in 56 human cases, necessitating further investigation into effective treatment strategies.

Purpose of the Study:

• To evaluate the efficacy of various treatment regimens for pit viper envenomations.
• To determine the effectiveness of antivenom and corticosteroid treatments in an animal model of rattlesnake venom injection.

Main Methods:

• Development of an animal model using sublethal intramuscular injections of Crotalus atrox venom in New Zealand white rabbits.
• Monitoring of tissue reaction, including swelling and hemorrhage, to assess treatment efficacy.

Main Results:

• Antivenom and combined antivenom-steroid treatments significantly reduced swelling and hemorrhage (P < 0.05).
• No treatment modality, including antivenom and steroids, was able to completely prevent tissue necrosis.
• Clinical and laboratory findings suggest injectable medications are insufficient for preventing necrosis in pit viper envenomations.

Conclusions:

• Current injectable treatments, including antivenom, are not fully effective in preventing tissue necrosis following pit viper envenomations.
• Operative treatment should be considered as an adjunct to other therapies for managing severe envenomations.