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RE: Urutu Snake Bite
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by emtnurse on February 3, 2005
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I really hate to hear about the loss of your child. I know this doesnt make things any better, but I am truly sorry. I cant beleive that crofab was used on this kind of bite. But on the other hand, you CAN push morphine for the pain of a venomous snake bite. Only if it is indicated. You have to monitor the heart rate and respiratory rate beofre pushing. Another thing, the hospital I work at, 90% of the residents here, know nothing about crofab nor how to administer it. The majority know nothing about venomous snakes/ bites. The area I live in, we only have 2 types of venomous snakes and bites are VERY rare. Only treated one in 6 years. Yhere is only 1 doctor I would let treat me at my facility. All of your level 1 trauma centers carry crofab, but here it is rarely used. I really do wish you the best on finding unanswered questions. And again, I am deeply sorry for the loss of your daughter. Bryan
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RE: Urutu Snake Bite
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by CAISSACA on February 3, 2005
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First, my sincere condolences on your loss.
regarding the treatment you describe, I fully agree with Bryan Fry's assessment. A number of Central and South American antivenoms that cover a range of species of Bothrops are available, and many, such as Instituto Butantan's Soro Antibotropico are demonstrably highly effective in neutralising the venoms of most species of Bothrops, including (at least in mouse tests) Bothrops alternatus. *Any* antivenom covering *any* species of Bothrops would have been preferable to CroFab in these circumstances.
I cannot judge what efforts staff at the hospital made to (i) obtain information on the appropriate treatment of bites from outside, and (ii) to obtain an appropriate antivenom. However, unless they can demonstrate that they made all reasonable efforts to obtain that information and an appropriate antivenom, then they are, in my view, guilty of gross negligence. The legal implications are fairly obvious.
For your information, there is a very thorough chapter on envenomations by South American pitvipers and their treatment by Prof. David Warrell, probably the world's leading authority on snakebite, in the two-volume set "Venomous Reptiles of the Western Hemisphere", by Campbell & Lamar (Cornell Univerity Press).
Regards,
Dr. Wolfgang Wüster
Lecturer in Zoology, University of Wales Bangor
http://biology.bangor.ac.uk/~bss166/
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