Rushton William F, Rivera Jessica V, Brown Julie, Kurz Michael Christopher, Arnold Justin
Office of Medical Toxicology, Department of Emergency Medicine, University of Alabama-Birmingham, Birmingham, AL, USA.
Alabama Poison Information Center, Children's of Alabama, Birmingham, AL, USA.
Clin Toxicol (Phila). 2021 Mar;59(3):256-259. doi: 10.1080/15563650.2020.1788053. Epub 2020 Jul 4.
Crotalinae (pit viper) envenomations are frequently encountered in North American emergency departments. Cases can be complicated by ambiguity in initial species identification as well as timing and duration of current antivenin treatment. Recently, thromboelastography (TEG) has emerged as an enhanced real-time monitoring parameter for snake envenomations that may aid in management of venom-induced consumptive coagulopathy.
A 61-year-old snake handler presented with severe coagulopathy and hypofibrinogenemia following envenomation from her pet eastern diamondback rattlesnake (). Her coagulopathy transiently improved with Crotalidae Polyvalent Immune Fab (Ovine) (FabAV) but would repeatedly rebound following cessation of antivenin over the next 10 days. Serial TEGs were successfully utilized to identify and corroborate fibrinolysis while predicting clot formation prior to routine coagulation studies.
Traditional coagulation parameters have not always been ideal when treating severe coagulopathy from pit viper envenomations and may not identify active fibrinolysis for several hours. In this case of envenomation, TEG proved to be useful in demonstrating improvements in clotting function prior to standard laboratory measures, which further guided antivenin therapy.
北美急诊科经常遇到响尾蛇科（蝰蛇）咬伤事件。病例可能因初始物种鉴定的模糊性以及当前抗蛇毒血清治疗的时间和持续时间而变得复杂。最近，血栓弹力图（TEG）已成为一种增强的实时监测参数，用于蛇咬伤，可能有助于管理毒液引起的消耗性凝血病。
一名61岁的蛇类饲养员被其宠物东部菱斑响尾蛇咬伤后出现严重凝血病和低纤维蛋白原血症。她的凝血病通过多价抗蛇毒血清（羊）（FabAV）暂时得到改善，但在接下来的10天内停止使用抗蛇毒血清后会反复反弹。连续的血栓弹力图被成功用于识别和证实纤维蛋白溶解，同时在常规凝血研究之前预测凝块形成。
在治疗蝰蛇咬伤引起的严重凝血病时，传统的凝血参数并不总是理想的，可能需要几个小时才能识别出活跃的纤维蛋白溶解。在这个响尾蛇咬伤的病例中血栓弹力图被证明有助于在标准实验室检测之前显示凝血功能的改善，这进一步指导了抗蛇毒血清治疗。
