Characteristics of venomous snakebites in Herzegovina

To investigate the degree to which primary and secondary care physicians in the Herzegovina region follow the protocols recommended in the literature for treatment of patients bitten by a venomous snake. Weretrospectively examined hospital records of all patients treated at theDepartment of Infectious Diseases, Mostar University Hospital, for intoxication following a venomous snakebite in the 1997-2002 period. The data on demographic characteristics, clinical presentation, therapy protocols, and final outcome were collected for each patient. From 1997 to 2002, 43 men (60.5%) and 28 women (33.4%)were treated at our Department for a venomous snakebite. The greatest number of snakebites occurred in persons older than 60 (chi-square=12.44, df=3, p=0.006) and during the summermonths (chi-square=8.12, df=1, p=0.004). More than half of the patients (38, or 53.5%)were bitten on the hand. The commonest symptoms and signs of the local envenomation were pain (97.1%) and swelling (87.3%), whereas general symptoms were tachycardia (39.4%), nausea (33.8%), and vomiting (28.1%). Also, 56 patients (78.8%) experienced anxiety and fear. The primary care protocol recommended in the literature (antibiotics, tetanus antitoxin, snakebite antiserum, and immobilization) was given to only 2 patients (2%). However, there were no lethal outcomes. Development of a precise evidence-based protocol for prehospitalmanagement of venomous snakebite is needed in the Herzegovina region, followed by educational efforts targeted at primary care physicians.