Abstract
Nearly all prior studies to delay onset of systemic toxicity and death after snake bite use a model of distal extremity envenomation. In the first of a series of planned studies using snake venoms with different toxicity profiles, the application of a novel device in a new model of torso envenomation in the setting of Eastern Coral Snake (Micrurus fulvius) venom (a potent neurotoxin) envenomation showed promise by delaying systemic intoxication. In this pilot study, we investigated this novel localizing circumferential compression (LoCC) device’s ability to delay onset of life threatening systemic toxicity after Eastern Diamondback Rattlesnake (Crotalus adamanteus) envenomation, a potent hemotoxic and myotoxic venom. With university approval, four juvenile female pigs (22–25 kg) were anesthetized, sedated, and intubated but not paralyzed to allow for spontaneous respirations. Each animal was injected subcutaneously with 50 mg of C. adamanteus venom in identical preselected areas of the trunk. After 1 min, two treatment animals had the LoCC device applied; two control animals had no intervention. Vital signs were recorded every 10 min for the first 2 h and every 30 min thereafter. Endpoints included cardiovascular collapse (fatal arrhythmia, loss of mean arterial pressure, or pulse) or respiratory arrest (<3 breaths/min, saturation < 80%) or survival to 7 h. The pigs in the treatment group reached an endpoint at an average time of 355 (±65) min compared with control 32 (±3.5) min (p < 0.04). In this pilot study, the LoCC device significantly delayed onset of systemic symptoms and death after torso envenomation with Eastern Diamondback Rattlesnake venom in this model.
Keywords: Snake bite, Novel device, Treatment
Full Text
The Full Text of this article is available as a PDF (186.3 KB).
References
- 1.Litovitz TL, Klein-Schwartz W, White S, Cobaugh DJ, Youniss J, Omslaer JC, Drab A, Benson BE. 2000 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. 2001;19:337–395. doi: 10.1053/ajem.2001.25272. [DOI] [PubMed] [Google Scholar]
- 2.Litovitz TL, Klein-Schwartz W, Rodgers GC, Cobaugh DJ, Youniss J, Omslaer JC, May ME, Woolf AD, Benson BE. 2001 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. 2002;20:391–452. doi: 10.1053/ajem.2002.34955. [DOI] [PubMed] [Google Scholar]
- 3.Watson WA, Litovitz TL, Rodgers GC, Klein-Schwartz W, Youniss J, Rose R, Borys D, May ME. 2002 annual report of the American Association of Poison control Centers Toxic Exposure Surveillance System. Am J Emerg Med. 2003;21:353–421. doi: 10.1016/S0735-6757(03)00088-3. [DOI] [PubMed] [Google Scholar]
- 4.Watson WA, Litovitz TL, Klein-Schwartz W, Rodgers GC, Youniss J, Reid N, Rouse WG, Rembert RS, Borys D. 2003 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. 2004;22:335–404. doi: 10.1016/j.ajem.2004.06.001. [DOI] [PubMed] [Google Scholar]
- 5.Watson WA, Litovitz TL, Rodgers GC, Klein-Schwartz W, Reid N, Youniss J, Flanagan A, Wruk KM. 2004 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. 2005;23:589–666. doi: 10.1016/j.ajem.2005.05.001. [DOI] [PubMed] [Google Scholar]
- 6.Lai MW, Klein-Schwartz W, Rodgers GC, et al. 2005 annual report of the American Association of Poison Control Centers’ National Poisoning and Exposure Database. Clinical Toxicology. 2006;44:803–932. doi: 10.1080/15563650600907165. [DOI] [PubMed] [Google Scholar]
- 7.Sutherland SK, Coulter AR, Harris RD. Rationalisation of first-aid measures for elapid snakebite. Lancet. 1979;1:183–186. doi: 10.1016/S0140-6736(79)90580-4. [DOI] [PubMed] [Google Scholar]
- 8.Hardy DL, Sr, Bush SP. Pressure/immobilization as first aid for venomous snakebite in the United States. Herpetological Review. 1998;29:204–208. [Google Scholar]
- 9.Bush S, Green S, Laack T, Hayes W, Cardwell M, Tanen D. Pressure immobilization delays the mortality and increased intracompartment pressure after artificial intramuscular rattlesnake envenomation in a porcine model. Ann Emerg Med. 2004;44:599–604. doi: 10.1016/j.annemergmed.2004.06.007. [DOI] [PubMed] [Google Scholar]
- 10.Sutherland SK, Coulter SK. Early management of bites by the eastern diamondback rattlesnake (Crotalus adamanteus): studies in monkeys (Macaca fascicularis) Am J Trop Med Hyg. 1984;30:497–500. doi: 10.4269/ajtmh.1981.30.497. [DOI] [PubMed] [Google Scholar]
- 11.Gill KA. The evaluation of cryotherapy in the treatment of snake envenomization. South Med J. 1970;63:552–556. doi: 10.1097/00007611-197005000-00016. [DOI] [PubMed] [Google Scholar]
- 12.Bush SP, Hegewald KG, Green SM, et al. Effects of a negative pressure venom extraction device (Extractor) on local tissue injury after artificial rattlesnake envenomation in a porcine model. Wilderness Environ Med. 2000;11(3):180–188. doi: 10.1580/1080-6032(2000)011[0180:eoanpv]2.3.co;2. [DOI] [PubMed] [Google Scholar]
- 13.Dart RC, Gustafson RA. Failure of electric shock treatment for rattlesnake envenomation. Ann Emerg Med. 1991;20:659–661. doi: 10.1016/S0196-0644(05)82389-3. [DOI] [PubMed] [Google Scholar]
- 14.Johnson EK, Kardong KV, Mackessy SP. Electric shocks are ineffective in treatment of lethal effects of rattlesnake envenomation in mice. Toxicon. 1987;25:1347–1349. doi: 10.1016/0041-0101(87)90013-4. [DOI] [PubMed] [Google Scholar]
- 15.Tun-Pe, Muang-Muang-Thwin, Myint-Myint-Than, Aye-Aye-Myint, Kyaw-Myint, Thein Than The efficacy of compression immobilization technique in retarding spread of radiolabeled Russell’s viper venom in Rhesus monkeys and ‘‘mock venom’’ NaI131 in human volunteers. Southeast Asian J Trop Med Public Health. 1994;25:349–353. [PubMed] [Google Scholar]
- 16.Howarth DM, Southee AE, Whyte IM. Lymphatic flow rates and first aid in simulated peripheral snake or spider envenomation. Med J Aust. 1994;161:695–700. [PubMed] [Google Scholar]
- 17.Anker RL, Straffon WG, Loiselle DS, Anker KM. Snakebite: comparison of three methods designed to delay uptake of “mock venom. Aust Fam Physician. 1983;12:365–368. [PubMed] [Google Scholar]
- 18.Tun-Pe, Sann-Mya, Aye-Aye Myint, NuNu Aung, Khin Aye Kyu, OO Tin Field trial of efficacy of local compression immobilization first-aid technique in Russell’s viper (Daboia russelii siamensis) bite patients. Southeast Asian J Trop Med Public Health. 2000;31:346–348. [PubMed] [Google Scholar]
- 19.German BT, Hack JB, Brewer K, Meggs WJ. Pressure–immobilization bandages delay toxicity in a porcine model of eastern coral snake (Micrurus fulvius fulvius) envenomation. Ann Emerg Med. 2005;45:603–608. doi: 10.1016/j.annemergmed.2004.11.025. [DOI] [PubMed] [Google Scholar]
- 20.Tanen D, Danish DC, Grice GA, Riffenburgh RH, Clark RF. Fasciotomy worsens the amount of myonecrosis in a porcine model of crotaline envenomation. Ann Emerg Med. 2004;44:99–104. doi: 10.1016/j.annemergmed.2004.01.009. [DOI] [PubMed] [Google Scholar]
- 21.Zamudio KR, Hardy DL, Sr, Martins M, Greene HW. Fang tip spread, puncture distance, and suction for snake bite. Toxicon. 2000;38:723–728. doi: 10.1016/S0041-0101(99)00182-8. [DOI] [PubMed] [Google Scholar]
- 22.Vohra R, Cantrell FL, Williams SR. Fasciculations after rattlesnake envenomations: a retrospective statewide poison control system study. Clinical Tox. 2008;46:117–121. doi: 10.1080/15563650701638925. [DOI] [PubMed] [Google Scholar]
- 23.LoVecchio F, Pizon AF, Wallace KL, Kunkel DB. Myokymia after snake envenomation in Arizona. Wilderness Environ Med. 2005;16:116–117. doi: 10.1580/1080-6032(2005)16[116:maseia]2.0.co;2. [DOI] [PubMed] [Google Scholar]