Selamat Muhamad Akmal, Choon Lee Kee, Shamsuddin Sazwan Reezal
Department of Emergency and Trauma, Hospital Sultan Haji Ahmad Shah, Pahang, Malaysia.
Turk J Emerg Med. 2025 Jan 2;25(1):55-58. doi: 10.4103/tjem.tjem_60_24. eCollection 2025 Jan-Mar.
Snake-related injury (SRI) is one of the most common medical emergencies encountered in tropical countries such as Malaysia. The majority of snake bites are nonvenomous, while the less common venomous snakebite can cause major disability or even death. There are 16 pit viper species documented in Malaysia which can be categorized based on their habitat. We report a case of a 41-year-old male who presented to a district hospital 1 h after being bitten twice by a pit viper snake () on the left side of his face. He was given green pit viper anti-venom (GPAV). He later underwent an emergency tracheostomy due to progressive local swelling causing upper airway obstruction and required a second regime of antivenom. In our opinion, early recognition of snake species, clinical syndrome, and life-threatening conditions in patients with SRI is important. While careful clinical, laboratory, and patient observation is important in determining the need for anti-venom, a life-saving procedure such as intubation, in this case, should not be delayed. From our experience, SRI at the head with progressive swelling to zone 2 of the neck may signal a red flag to the attending clinician for the possibility of impending upper airway obstruction.
蛇咬伤相关损伤（SRI）是马来西亚等热带国家最常见的医疗急症之一。大多数蛇咬伤无毒，而较罕见的毒蛇咬伤可导致严重残疾甚至死亡。马来西亚记录有16种蝰蛇，可根据其栖息地进行分类。我们报告一例41岁男性病例，其在面部左侧被一条蝰蛇（）咬伤两次后1小时就诊于一家地区医院。他接受了绿蝰蛇抗蛇毒血清（GPAV）治疗。后来，由于局部肿胀进行性加重导致上呼吸道梗阻，他接受了紧急气管切开术，并且需要第二轮抗蛇毒血清治疗。我们认为，早期识别SRI患者的蛇种、临床综合征和危及生命的情况很重要。虽然仔细的临床、实验室和患者观察对于确定是否需要抗蛇毒血清很重要，但在这种情况下，像插管这样的救命程序不应延迟。根据我们的经验，头部SRI且肿胀进展至颈部2区可能向主治医生发出红旗信号，提示即将发生上呼吸道梗阻的可能性。
