Bush Sean P, Kinlaw Shannon B
Department of Emergency Medicine, Brody School of Medicine, East Carolina University, Greenville, NC.
Department of Emergency Medicine, Brody School of Medicine, East Carolina University, Greenville, NC.
Wilderness Environ Med. 2015 Sep;26(3):355-8. doi: 10.1016/j.wem.2015.01.005. Epub 2015 Mar 16.
We describe an illustrative case of pediatric snake envenomation presenting with a tightly wound tourniquet. A 10-year-old boy presented after a snake bite to the right calf. A tourniquet was in place just below the right knee. The species of snake was unknown. The patient was hemodynamically stable, but the entirety of the right leg distal to the tourniquet was discolored. Over concern for a potential venom bolus effect upon tourniquet removal, the decision was made to start a crotaline Fab antivenom infusion and gradually loosen the tourniquet. The patient tolerated the infusion and removal of the tourniquet without signs of anaphylaxis or decompensation. Dynamic improvements were observed in the right leg and wound site that appeared to be the result of vascular congestion. Tourniquets are generally not recommended for snakebites; however, if a tourniquet is already placed, we avoid removal until prepared to manage acute toxicity or immediate hypersensitivity.
我们描述了一例伴有紧缠止血带的小儿蛇咬伤病例。一名10岁男孩右小腿被蛇咬后前来就诊。右膝下方扎着一条止血带。蛇的种类不明。患者血流动力学稳定，但止血带远端的整条右腿均已变色。出于对松开止血带后可能出现毒液推注效应的担忧，决定开始输注抗蝮蛇毒血清并逐渐松开止血带。患者耐受了输注和止血带的移除，未出现过敏反应或失代偿迹象。右腿和伤口部位出现了动态改善，这似乎是血管充血的结果。一般不建议对蛇咬伤使用止血带；然而，如果已经使用了止血带，在准备好处理急性毒性或即刻超敏反应之前，我们避免移除。
