Department of Emergency Medicine, University of Houston College of Medicine, Houston, Texas.
Department of Emergency Medicine, University of Houston College of Medicine, Houston, Texas.
J Emerg Med. 2023 Mar;64(3):311-314. doi: 10.1016/j.jemermed.2023.01.011. Epub 2023 Mar 14.
Of the 8000-10,000 snake envenomations evaluated in U.S. emergency departments (ED) annually, approximately 1% are due to non-native snakes. We describe a 26-year-old man who was bitten by his captive black mamba (Dendroaspis polylepis) as he was packing it up for transport to another snake collector.
The patient presented to the ED 1 h after being bitten on the forearm, complaining of left arm pain, oral paresthesias, and dyspnea. His vital signs: heart rate 96 beats/min, blood pressure 167/101 mm Hg, temperature 36.7°C (97.9°F), respiratory rate 20 breaths/min, and room air oxygen saturation 100%. Two mildly tender puncture wounds without swelling or ecchymosis were found on the posterior aspect of the forearm. Over the ensuing 30 min his dyspnea worsened, and he developed objective weakness. He was intubated and placed on mechanical ventilation. He was treated with atropine 2 mg for bronchorrhea. Five vials of South African Vaccine Producers (Johannesburg, South Africa) polyvalent antivenom were administered 2.5 h post-bite and the patient was admitted to the intensive care unit. He was extubated 18 h post-envenomation and discharged the following day. He has remained asymptomatic since leaving the hospital. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The primary manifestations of D. polylepis envenomings are neurological. Initial signs may include paresthesias, dysarthria, dysphagia, and ptosis. Progressive descending paralysis leading to respiratory failure develops within 60 min. Muscarinic features are frequently observed. Cardiotoxicity and hematologic laboratory abnormalities may be present. Although pain is common, significant local tissue injury does not occur. In addition to supportive care, several non-native antivenoms are indicated for D. polylepis envenomations. Black mamba envenomings differ from the native snakebites with which U.S. physicians are familiar. Rapid, progressive neurological toxicity and muscarinic features are most common. Treatment consists of supportive care and appropriate antivenom administration.
在美国急诊科每年评估的 8000-10000 例蛇咬伤中，约有 1%是由非本地蛇引起的。我们描述了一名 26 岁的男子，他在将黑曼巴（Dendroaspis polylepis）包装起来运往另一位蛇类收藏家时被自己的圈养黑曼巴咬伤。
患者在被咬伤前臂后 1 小时就诊于急诊科，诉左手臂疼痛、口腔感觉异常和呼吸困难。他的生命体征：心率 96 次/分，血压 167/101mmHg，体温 36.7°C（97.9°F），呼吸频率 20 次/分，室内空气氧饱和度 100%。在前臂后侧面发现两个轻度压痛的穿刺伤口，无肿胀或瘀斑。在接下来的 30 分钟内，他的呼吸困难恶化，并出现客观无力。他被插管并进行机械通气。他接受了 2 毫克阿托品治疗支气管分泌物过多。在咬伤后 2.5 小时给予南非疫苗生产商（约翰内斯堡，南非）多价抗蛇毒血清 5 瓶，患者被收入重症监护病房。他在咬伤后 18 小时拔管，第二天出院。他出院后一直无症状。
为什么急诊医生应该注意这一点？黑曼巴蛇咬伤的主要表现为神经毒性。最初的症状可能包括感觉异常、构音障碍、吞咽困难和上睑下垂。在 60 分钟内会发展为进行性下降性瘫痪，导致呼吸衰竭。经常观察到毒蕈碱样特征。可能存在心肌毒性和血液学实验室异常。虽然疼痛很常见，但不会发生明显的局部组织损伤。除了支持性治疗外，还需要几种非本地抗蛇毒血清来治疗 D. polylepis 蛇咬伤。黑曼巴蛇咬伤与美国医生所熟悉的本地蛇咬伤不同。最常见的是快速、进行性的神经毒性和毒蕈碱样特征。治疗包括支持性治疗和适当的抗蛇毒血清治疗。
