A chance to cut is not always a chance to cure- fasciotomy in the treatment of rattlesnake envenomation: A retrospective poison center study.
BACKGROUND
Fasciotomy has been described in the treatment of rattlesnake-envenomation. We sought to compare the characteristics of patients undergoing fasciotomy with those where fasciotomy was discussed but not performed.


METHODS
A retrospective case-series constructed from a single-statewide-poison-system electronic database for cases of fasciotomy discussion or completion in rattlesnake-envenomation between January 2001 and May 2012. Age, gender, bite location, antivenom administered, compartment pressure measurements, Snakebite Severity Score (SSS) and length of hospitalization (LOS) were recorded. Comparisons were made between fasciotomy completed and where fasciotomy was only discussed.


RESULTS
One-hundred-five cases of fasciotomy discussion or completion were identified. Fasciotomy was performed in 28 cases (27%). There was no statistically significant difference (p > 0.05) between groups in age, gender, bite site, SSS, and total number of vials of antivenom administered. Only 2 of 28 (7%) had compartment pressure measurements. Patients undergoing fasciotomy spent an additional 2 days in the hospital.


CONCLUSIONS
Fasciotomies continue to take place, without compartment pressure measurements, and without repeat dosing of antivenom. In the absence of clear objective evidence that limb-threatening compartment syndrome occurs despite adequate antivenom administration, fasciotomy does not favorably impact morbidity and may be associated with increased costs for care following rattlesnake envenomation.
University of California, San Francisco (UCSF) Fresno Medical Education Program, Department of Emergency Medicine, 155N. Fresno Street, Fresno, CA 93701, USA. Electronic address: mike.darracq@gmail.com.
Michael A
MA
Darracq
California Poison Control System-San Diego Division, University of California San Francisco, University of California San Diego Department of Emergency Medicine, San Diego, CA, USA.
F Lee
FL
Cantrell
University of Kansas Medical Center, Department of Emergency Medicine, Kansas City, KS, USA.
Bryan
B
Klauk
University of Kansas Medical Center, Department of Emergency Medicine, Kansas Poison Control System, Kansas City, KS, USA.
Stephen L
SL
Thornton
D000293:Adolescent; D000328:Adult; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use; D003161:Compartment Syndromes / Q000175:diagnosis / Q000628:therapy; D003435:Crotalid Venoms / Q000037:antagonists & inhibitors / Q000633:toxicity; D017839:Crotalus / Q000378:metabolism*; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012909:Snake Bites / Q000188:drug therapy* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
D000997:Antivenins; D003435:Crotalid Venoms
Antivenom; Fasciotomy; Rattlesnake envenomation; Toxicology