title: Pressure immobilization delays mortality and increases intracompartmental pressure after artificial intramuscular rattlesnake envenomation in a porcine model.
abstract: OBJECTIVE
  We determine the effect of pressure immobilization on mortality and intracompartmental pressure after artificial intramuscular Crotalus atrox envenomation in a porcine model.
  
  
  METHODS
  We prospectively studied 20 pigs using a randomized, controlled design. After anesthesia, C atrox venom (20 mg/kg) was injected with a 22-gauge needle 10 mm deep into the tibialis anterior muscle of the hind leg. Pigs were randomized to receive either pressure immobilization (applied 1 minute after envenomation and maintained throughout the duration of the experiment) or no pressure immobilization. We measured time to death, intracompartmental pressure before venom injection and at 2 hours after injection, and leg circumference at a standardized location before injection and immediately postmortem. Duration of survival was compared using Kaplan-Meier survival analysis.
  
  
  RESULTS
  The dose of venom resulted in 100% mortality. The median survival was longer in the pressure immobilization group (191 minutes, range 140 to 240 minutes) than in the control group (median 155 minutes, range 119 to 187 minutes). The difference between the groups was 36 minutes (95% confidence interval [CI] 2 to 64 minutes; P =.0122). The mean intracompartmental pressures were 67+/-13 mm Hg+/-SD with pressure immobilization and 24+/-5 mm Hg without pressure immobilization. The difference between groups was 43 mm Hg (95% CI 32 to 53 mm Hg). The mean circumferences were 14.3 cm in the pressure immobilization group and 19.1 cm in the control group. The difference between groups was -4.8 cm (95% CI -5.7 to -3.9 cm).
  
  
  CONCLUSIONS
  Compared with control animals without treatment, the pressure immobilization group had longer survival, less swelling, and higher intracompartmental pressures after artificial, intramuscular C atrox envenomation in our porcine model.
authors.affiliation: Department of Emergency Medicine (Laack), Loma Linda University School of Medicine, Medical Center and Children's Hospital, Loma Linda, CA, USA. sbush@ahs.llumc.edu
authors.forename: Sean P
authors.initials: SP
authors.lastname: Bush
authors.forename: Steven M
authors.initials: SM
authors.lastname: Green
authors.forename: Torrey A
authors.initials: TA
authors.lastname: Laack
authors.forename: William K
authors.initials: WK
authors.lastname: Hayes
authors.forename: Michael D
authors.initials: MD
authors.lastname: Cardwell
authors.forename: David A
authors.initials: DA
authors.lastname: Tanen
mesh_terms: D000818:Animals; D003161:Compartment Syndromes / Q000209:etiology*; D003435:Crotalid Venoms / Q000008:administration & dosage; D017839:Crotalus; D004195:Disease Models, Animal; D005260:Female; D005392:First Aid / Q000379:methods; D007103:Immobilization / Q000009:adverse effects / Q000379:methods*; D007273:Injections, Intramuscular; D011312:Pressure / Q000009:adverse effects; D011897:Random Allocation; D012909:Snake Bites / Q000150:complications / Q000401:mortality / Q000628:therapy*; D013552:Swine; D013997:Time Factors
chemical_list: D003435:Crotalid Venoms