title: Presentation and Management of Venomous Snakebites: Should All Patients Be Transferred to a Tertiary Referral Hospital?
abstract: Venomous snakebites may be difficult to manage because of the varied clinical presentations that may lead to uncertainty regarding the most appropriate medical and surgical management. Frequently, snakebite victims are referred from smaller rural hospitals to larger tertiary centers offering more specialized services and care. A retrospective chart review was performed using medical records from both adult and pediatric hospitals in a rural state over a 7-year period (January 2004 to January 2011) to investigate the utility of intensive care and specialized medical services offered at tertiary referral centers. The results demonstrated that presentation of venomous snakebites is the same in adults and children as well as the management. The results also demonstrated that the use of supportive care and antivenin alone was successful in the management of the vast majority of snakebites. Most snakebite victims recovered with nonsurgical care; thus surgical intervention is rarely warranted. These findings demonstrate that snakebite victims may not need referral to a tertiary center, if the primary local hospital has supportive care capacity and familiarity with antivenin usage.
authors: Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. virion919@yahoo.com.
authors: Val H
authors: VH
authors: Irion
authors: James
authors: J
authors: Barnes
authors: Brooke E E
authors: BE
authors: Montgomery
authors: Larry J
authors: LJ
authors: Suva
authors: Corey O
authors: CO
authors: Montgomery
mesh_terms: D000328:Adult; D017677:Age Distribution; D017836:Agkistrodon; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use*; D002648:Child; D015331:Cohort Studies; D005260:Female; D006780:Hospitals, Rural; D006801:Humans; D007362:Intensive Care Units; D035002:Lower Extremity; D008297:Male; D010360:Patient Transfer; D012017:Referral and Consultation; D012189:Retrospective Studies; D012621:Seasons; D017678:Sex Distribution; D012909:Snake Bites / Q000453:epidemiology / Q000628:therapy*; D062606:Tertiary Care Centers; D061665:Time-to-Treatment; D014481:United States / Q000453:epidemiology; D034941:Upper Extremity
chemical_list: D000997:Antivenins