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Snake bite mimicking brain death
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by tigers9 on June 12, 2008
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Interesting article. Does this mean that sometimes medical personnel my pull the plug too soon on venomous bite victims?
In most cases of venomous related death, do the people just die in the hospital while the treatment is ongoing, or is the plug pulled on the ventilator, etc…?
Z
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http://7thspace.com/headlines/284325/snake_bite_mimicking_brain_death.html
Snake bite mimicking brain death
A 6 year old girl woke up with pain and increasing swelling over the left hand and difficulty in breathing. On examination, she had swelling of the left forearm and hand, flaccid quadriparesis and was in respiratory failure requiring mechanical ventilation.
Two clean puncture wounds were identified on the left thumb. A provisional diagnosis of snake bite with severe envenomation was made and she was given anti snake venom therapy.
Over a period of about 4 hours her weakness progressed. She became areflexic, developed internal and external ophthalmoplegia and loss of other brain stem reflexes mimicking brain death.
Mechanical ventilation was continued despite features suggestive of brain stem dysfunction. About 36 hours after ventilation she showed a flicker of movement of her fingers and gradually the power improved.
She was weaned off the ventilator and extubated after 5 days. External ophthalmoplegia is an established association with cobra envenomation, but, this combination of internal and external ophthalmoplegia can mimic brain death and pose a dilemma to the caregivers regarding continuation of therapy.
Author: Joseph John, Bahubali D Gane, Nishad Plakkal, Rajeswari Aghoram and Sowmya Sampath
Credits/Source: Cases Journal 2008, 1:16
Published on: 2008-06-12
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RE: Snake bite mimicking brain death
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by Cro on June 12, 2008
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It means that most medical folks are not familiar with snake bites, or what to expect from a bite.
That is why it is so important that folks who have been bitten by a snake insist that their doctors contact knowledgeable envenomation specialists, toxicologists, poison control centers, etc...
The average doctor goes through his whole career and never has to treat a snake bite. Do you really want treatment by someone who is trying to remember what he was supposed to learn in the 10 minutes that they covered snake bite, back 15 years ago when the doctor was in med school ?
Best Regards John Z
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RE: Snake bite mimicking brain death
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by LarryDFishel on June 12, 2008
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There are numerous stories of people recovering from elapid bites well after their doctor had at least discussed pulling the plug. In a situation where they do pull the plug it's nearly impossible to go back and determine for certain whether the person might have lived if they'd been given a few more days, but I think we can safely say it's happened a few times.
I know of at least one case where I suspect a hospital probably let someone die because they stopped adminstering AV when they got to the reccomended max dosage printed on the package without knowing that it is common practice in extreme cases to use 2-3 times the max dose...
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RE: Snake bite mimicking brain death
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by JoeCrotalid on June 12, 2008
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Most physicians will flat out tell you that they don't have experience with snakebites-the good doctors anyway. You always run into some who are arrogant and think they don't need to call anyone for assistance and those are usually the cases that end in bad outcomes.
I've run into a few in my career who will sit there an argue because they think because they are the physician and no one else could possibly know more. But other doc's I have worked with will have the ED staff call me at 3 am when I'm off home in bed even for a simple bite. Those are the doctors in my opinion that are worth something because they are willing to admit their limitations.
There are many toxins that affect the central nervous system including the neurotoxins of many elapids, but brain death must be declared by 2 physicians (usually an attending and a neurologist or neuro surgeon) before a ventilator can be withdrawn which usually involves an EEG and brain stem testing. The one case I am familar with that Sean Bush took care of involved a man who developed a massive stroke after envenomation by a Mojave despite huge amounts of antivenom. The stroke involved the brain stem and the patient died. Many elapid envenomations in other countries are ventilated through the envenomation if possible due to the lack of antivenom availability as shown by Dr. David Warrell in various cases due to the paralysis caused by the neurotoxins.
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