RESPIRATORY COMPROMISE IN PATIENTS WITH RATTLESNAKE ENVENOMATION

Introduction: Respiratory compromise (defined as airway obstruction or bronchospasm) following rattlesnake envenomation is an uncommon yet potentially lethal complication. We were interested in determining the frequency of respiratory compromise in patients (pts) treated for rattlesnake envenomation. The medical indications for intubation were also determined. Methods: A retrospective chart review of all pts treated by medical toxicologists at a tertiary referral hospital between 7/1994 and 11/2000. Findings: Out of 294 total pts, 289 charts were reviewed (3 pts were excluded because of enrollment in an experimental protocol, 2 charts were not located). Two hundred fourteen pts (74%) received Crotalidae Polyvalent Antivenin (Wyeth-Ayerst). Of all pts, 21 (7%) had clinical evidence of respiratory compromise: 3/21 pts (1%) developed venom-induced anaphylaxis and 18/21 pts (6%) developed antivenin-induced respiratory compromise (2 with facial swelling, 1 with nasal congestion, 15 with wheeze or bronchospasm which resolved with medications). Thirteen out of 289 pts (4.4%) were intubated following rattlesnake envenomation (1 for venom-induced anaphylaxis, 1 for tongue envenomation, 1 for alcohol withdrawal requiring propofol infusion, and 10 for surgical fasciotomy, dermotomy, or wound care). No one was intubated for antivenin-induced complications. There were no deaths. Conclusion: Only 2 of 289 pts were intubated as a direct consequence of rattlesnake envenomation, no one required intubation for antivenin-induced hypersensitivity reactions. The majority of intubations were done electively for surgical procedures requiring general anesthesia.
Brooks DE, Ruha A-M, Graeme KA, Tanen DA, Curry SC. Department of Medical Toxicology, Good Samaritan Regional Medical Center, Phoenix, [...]