CBD : hematotoxin snake bites

Patient profile

Admission date

Information

83

11 2557

 30

30

(Pain score = 4)

: Hypertension , BPH

Family History

Social History

 Vital sign : BT 36 c ,P 72 b/min, RR 20 b/min,

BP 170/91 mmHg
General appearance : A Thai male, good
consciousness E4V5M6,good orientation, no pale,
no jaundice, no cyanosis, no dyspnea
Skin,hair,nails : no peticheae,no ecchymosis
Head
: normal contour ,no lesion , no deformity ,
no mass
Eyes
: no pale conjunctiva , no icteric sclera,
no ptosis

 Cardiovascular system : normal heart rate , rhythm

and characteristic normal S1,S2 , no murmur
,peripheral pulse are full
Extremities : fang mark at 2nd finger right hand
,pulse full and regular ,mild swelling, mild tender

 ABC
Airway patent, no accessory muscle use, no sign
upper airway obstruction
Breathing : RR 20 b/min, normal chest movement
clear both lung , no wheezing
Circulation : BP 170/91 mmHg ,pulse full and
regular, capillary refill < 2 sec

 lab : CBC with plt , VCT, Electrolyte

Admit

CBC
WBC
5.6 10^3/ul
HGB
11.9 g/dl
Hct
37 %
NEUTROPHIL 63.1 %
Lymphocyte 24.1 %
Monocyte 5.7 %
Eosinophil 6.7 %
Basophil
0.4 %

VCT : 18.30 min

PLT
PLT smear
RBC
RDW
MCV
MCH
MCHC
MPV

267 10^3/ul
adequate
4.66
17.2
79
25
32 g/dl
7.8 fl

BUN
Creatinine
Sodium
Potassium
Cholride
CO2

12
0.84
141
4.0
107
25

Order one day

VCT 6 hr
TT booster 1
Admit med
- CXR
- EKG

Continue
Low salt diet
Record v/s
Medication
-Paracetamol (500)
1 tab po prn for pain q 4 hr
-Augmentin(1g) 1x2 po pc

- Lasix 40mg x1 po pc
-Hydralazine 25mg 1x2 po pc
- folic acid 5mg 1x1 po pc
-BCO 1x2 po pc
- xatral XL 1x1 po hs
- finasteride (5) 1x1 po hs

 VCT 2 : 16 min
VCT 3 : 18 min

Progress note
12/12/57
# Malayan pit viper
S :

O : v/s stable
Extremities : 2nd finger
right hand mild swelling,
not tender
A : clinical improve
P : D/C

Order one day

-D/C
-No F/U
-Medication
1. Augmentin(1g)
1x1 po pc
2. Paracetamol (500)
1 tab prn q 6 hr

 :
:

:

Pit viper
thrombin-like
Plt Plt
cross-linked fibrin

Viper
thromboplastin-like
Plt DIC
cross-linked fibrin

 (Pre-hospital treatment First Aid)

:

1.
2.

3. pressure immobilization bandage

55 mmHg ( tourniquet
)
4.

1. ABC :
anaphylaxis
2.
3. tourniquet
4. povidine iodine
5.


6. : vital sign, fang mark
ecchymosis, petechiae

 7.

- Venous clotting time (VCT) 20 WBCT (20 minute whole
blood clotting test
- Complete blood count

-Venous clotting time (VCT) 20 WBCT
-Complete blood count
Blood smear fragmented red cell ( DIC)
-UA
-BUN, creatinine, electrolyte
*
* DIC, , factor X

 1.
(systemic envenoming) hematotoxin
moderate severe Admit
2.
3.
4.

- admit observe 24 f/u UA q 6 hr

VCT 1

2 hrs VCT 2

VCT

Normal

Normal

> 20 min

> 20 min

Normal 2 D/C VCT

2
- VCT VCT 6
24

 2 monovalent mixed
monovalent 7 ( antivenum
)

 1.
microscopic hematuria
2. VCT > 20 min
3.Platelet < 10,000 /ul

 antivenom
30 . (moderate)
50 . (severe)

 VCT 6
VCT VCT

VCT 24
VCT

6
hemodialysis
- clinical uremia
- (fluid overload)
- 1
- creatinine > 10 ml/dL - BUN > 100 mg/dL
- potassium > 7 mEq /L - symptomatic acidosis

- antivenom
-

antivenom


- (platelet concentrate) platelet
1 u/10 kg
- cryoprecipitate fibrinogen 10
15 cryoprecipitate fresh frozen
plasma 15 ml/kg
- packed red cell

1.For treatment :
2.For prophylaxis : necrosis

Antibiotics Gram ve ,Gram +ve Anaerobe

Augmentin

- systemic