- Email: [email protected]
237. Snakebite Survivors Club: Ten-year, retrospective review of Crotaline envenomations in Central California
Abstracts Toxins 2012 / Toxicon 60 (2012) 95–248
hospital stay >2days (aOR: 19.5; 95% CI: 2.0 – 192.3) as independent risk factors of high cost of care. Conclusion: Most cases of snake bite occur in young productive farmers and could impact local food production. Delay in presentation associated with unorthodox, harmful practices, could result in prolonged hospital stay and high cost of care.
Fig. 1. A. Haematoma from bite on the buttocks; B. Leg swelling; C. Cellulitis and gangrene; D. Bleeding diathesis. Keywords: Access, cost of care, Echis ocellatus, envenomation, Nigeria 10.1016/j.toxicon.2012.04.237
predominance (83% male victims). Upper extremity bites were more common (32/41 upper vs 10/42 lower extremity). One victim sustained bilateral bites to the hands. Thirty-five patients (85%) were admitted, with an average length of stay 2.12 days. The longest hospitalization was 15 days. There were no fatalities. The average time from bite to ED presentation was 164 minutes. Bites occurred during every month except November, with the majority occurring during spring and summer months and peaking in June (12/42 cases). Most bites occurred in the hours between noon and 8 pm. The amount of antivenom given ranged from 2 to 35 vials (average, 9 vials). Interfacility transfers were common in our study population: thirteen (32%) patients were transferred into our emergency department for a higher level of care, and 3 (7%) were transferred out (two because of insurance requirements, and one for higher level of Pediatric ICU care). There were no surgical interventions in our study group. Intoxication did not appear to play a major role in this population as only 3 patients (7%) were found to be acutely intoxicated: one with cannabis and amphetamines, 1 with alcohol, and 1 with opioids. Conclusions: In Central California, Crotaline envenomations occurred mainly in adult males. Dry bites, or bites not requiring antivenom administration, were uncommon, comprising only 10% of bites in this study population. Contrary to popular and clinical beliefs, substance abuse and/or alcohol intoxication did not appear to play a role in the majority of patients. Care providers and snakebite specialists should also be aware that snakebite patients are often transferred between facilities, a finding that may be useful in informing future first aid protocols and research. We hope these findings add concrete data and help correct some common misconceptions about snakebites in Central California. Keywords: Snakebites, epidemiology, interhospital transfers 10.1016/j.toxicon.2012.04.238
237. Snakebite Survivors Club: Ten-year, retrospective review of Crotaline envenomations in Central California
238. Incidence and Management of Snakebite in Northern Central African Republic
Susanne Spano 1, Fernando Macias 1, Brandy Snowden 1, Rais Vohra 1, 2
Séverine Gras 1, Gaëtan Plantefève 2, Jean-Philippe Chippaux 3
1
UCSF-Fresno Medical Center, Fresno, CA, USA California Poison Control System, Fresno-Madera Division, Madera, CA USA E-mail address: [email protected] (R. Vohra). 2
Objective: We investigated clinical patterns of Crotaline envenomation presenting to a tertiary-care academic hospital in Central California over a 10-year period. Methods: An IRB-approved, retrospective chart review was conducted on all patients diagnosed with snakebite from December 2000 to December 2010. Data abstracted: demographics, anatomic location of bite, comorbid conditions and intoxicants, length of stay, antivenom dose, laboratory results, and complications or procedures. Results: There were 46 snakebite cases admitted over the study period. Five were “dry bites;” the remaining cases (41/46) received antivenom. There was a male
217
1 Département d'Anesthésie - Réanimation, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France 2 Réanimation Polyvalente, CH Victor Dupouy, Argenteuil, France 3 UMR 216 “Mère et enfant face aux infections tropicales”, Institut de Recherche pour le Développement and Université Paris Descartes, Sorbonne Paris Cité, Faculté de Pharmacie, Cotonou, Bénin E-mail address: [email protected] (J.-P. Chippaux).
Background: Snakebite represents a serious public health problem in sub-Saharan Africa. Methods: A retrospective study was conducted in Paoua hospital (northern CAR) for 27 months to assess the incidence and severity of snakebites. A team of Médecins Sans Frontières (MSF) is working in this hospital the resources of which are better than the average of sub-Saharan facilities. Results: 842 people were registered for snakebite of which 825 were included in the study. The seasonal
hospital stay >2days (aOR: 19.5; 95% CI: 2.0 – 192.3) as independent risk factors of high cost of care. Conclusion: Most cases of snake bite occur in young productive farmers and could impact local food production. Delay in presentation associated with unorthodox, harmful practices, could result in prolonged hospital stay and high cost of care.
Fig. 1. A. Haematoma from bite on the buttocks; B. Leg swelling; C. Cellulitis and gangrene; D. Bleeding diathesis. Keywords: Access, cost of care, Echis ocellatus, envenomation, Nigeria 10.1016/j.toxicon.2012.04.237
predominance (83% male victims). Upper extremity bites were more common (32/41 upper vs 10/42 lower extremity). One victim sustained bilateral bites to the hands. Thirty-five patients (85%) were admitted, with an average length of stay 2.12 days. The longest hospitalization was 15 days. There were no fatalities. The average time from bite to ED presentation was 164 minutes. Bites occurred during every month except November, with the majority occurring during spring and summer months and peaking in June (12/42 cases). Most bites occurred in the hours between noon and 8 pm. The amount of antivenom given ranged from 2 to 35 vials (average, 9 vials). Interfacility transfers were common in our study population: thirteen (32%) patients were transferred into our emergency department for a higher level of care, and 3 (7%) were transferred out (two because of insurance requirements, and one for higher level of Pediatric ICU care). There were no surgical interventions in our study group. Intoxication did not appear to play a major role in this population as only 3 patients (7%) were found to be acutely intoxicated: one with cannabis and amphetamines, 1 with alcohol, and 1 with opioids. Conclusions: In Central California, Crotaline envenomations occurred mainly in adult males. Dry bites, or bites not requiring antivenom administration, were uncommon, comprising only 10% of bites in this study population. Contrary to popular and clinical beliefs, substance abuse and/or alcohol intoxication did not appear to play a role in the majority of patients. Care providers and snakebite specialists should also be aware that snakebite patients are often transferred between facilities, a finding that may be useful in informing future first aid protocols and research. We hope these findings add concrete data and help correct some common misconceptions about snakebites in Central California. Keywords: Snakebites, epidemiology, interhospital transfers 10.1016/j.toxicon.2012.04.238
237. Snakebite Survivors Club: Ten-year, retrospective review of Crotaline envenomations in Central California
238. Incidence and Management of Snakebite in Northern Central African Republic
Susanne Spano 1, Fernando Macias 1, Brandy Snowden 1, Rais Vohra 1, 2
Séverine Gras 1, Gaëtan Plantefève 2, Jean-Philippe Chippaux 3
1
UCSF-Fresno Medical Center, Fresno, CA, USA California Poison Control System, Fresno-Madera Division, Madera, CA USA E-mail address: [email protected] (R. Vohra). 2
Objective: We investigated clinical patterns of Crotaline envenomation presenting to a tertiary-care academic hospital in Central California over a 10-year period. Methods: An IRB-approved, retrospective chart review was conducted on all patients diagnosed with snakebite from December 2000 to December 2010. Data abstracted: demographics, anatomic location of bite, comorbid conditions and intoxicants, length of stay, antivenom dose, laboratory results, and complications or procedures. Results: There were 46 snakebite cases admitted over the study period. Five were “dry bites;” the remaining cases (41/46) received antivenom. There was a male
217
1 Département d'Anesthésie - Réanimation, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France 2 Réanimation Polyvalente, CH Victor Dupouy, Argenteuil, France 3 UMR 216 “Mère et enfant face aux infections tropicales”, Institut de Recherche pour le Développement and Université Paris Descartes, Sorbonne Paris Cité, Faculté de Pharmacie, Cotonou, Bénin E-mail address: [email protected] (J.-P. Chippaux).
Background: Snakebite represents a serious public health problem in sub-Saharan Africa. Methods: A retrospective study was conducted in Paoua hospital (northern CAR) for 27 months to assess the incidence and severity of snakebites. A team of Médecins Sans Frontières (MSF) is working in this hospital the resources of which are better than the average of sub-Saharan facilities. Results: 842 people were registered for snakebite of which 825 were included in the study. The seasonal