Reid H A
Br Med J. 1978 Jun 17;1(6127):1598-1600. doi: 10.1136/bmj.1.6127.1598.
In 1970-7 17 people in Britain were the victims of 32 bites by foreign venomous snakes. Crotalus atrox caused eight of these bites, Bitis arietans five, and the remaining 19 bites were caused by 12 different species. All the victims were bitten while handling the snake, and 24 bites were incurred by private individuals in their own homes. Poisoning was negligible in 17 of the 32 bites but life-threatening in at least two cases. Thus in the early stages snake bite may be unpredictable as a clinical problem. All victims of snake bite should be observed for at least 12 hours to assess the severity of poisoning and to ensure rational treatment. Local necrosis developed in six cases and resulted in prolonged illness in five of these cases; local incision was carried out and many have been a casual factor. Comprehensive stocks of antivenoms for treating bites by foreign venomous snakes are held by the National Health Services in Liverpool and London. Antivenom is indicated (a) for potentially serious systemic poisoning, as evidenced by hypotension, electrocardiographic changes, neurtrophilia, and acidosis (after viper or elapid bites), abnormal bleeding or non-clotting blood after viper bites; and ptosis or glossopharyngeal palsy after elapid bites; and (b) for bites from snakes whose venom causes local necrosis, to prevent or minimise this unpleasant complication. For effective antivenom treatment intravenous infusion is mandatory.
1970年至1971年期间，英国有17人成为国外毒蛇32次咬伤的受害者。其中8次咬伤由西部菱斑响尾蛇所致，5次由鼓腹咝蝰所致，其余19次咬伤由12个不同物种造成。所有受害者均在处理蛇时被咬伤，其中24次咬伤是私人在自家被咬伤。32次咬伤中有17次中毒情况可忽略不计，但至少有两例危及生命。因此，蛇咬伤作为一个临床问题，在早期可能无法预测。所有蛇咬伤受害者都应至少观察12小时，以评估中毒的严重程度并确保合理治疗。6例出现局部坏死，其中5例病程延长；均进行了局部切开，这在许多情况下是一个偶然因素。利物浦和伦敦的国民医疗服务体系备有用于治疗国外毒蛇咬伤的抗蛇毒血清的全面库存。抗蛇毒血清适用于：(a) 出现潜在严重全身中毒情况，如低血压、心电图改变、中性粒细胞增多和酸中毒（蝰蛇或眼镜蛇科毒蛇咬伤后）、蝰蛇咬伤后异常出血或血液不凝固；眼镜蛇科毒蛇咬伤后上睑下垂或舌咽麻痹；以及(b) 被毒液可导致局部坏死的蛇咬伤，以预防或尽量减少这种令人不适的并发症。为进行有效的抗蛇毒血清治疗，必须进行静脉输注。
