Unified treatment algorithm for the management of crotaline snakebite in the United States: results of an evidence-informed consensus workshop

<p>Abstract</p> <p>Background</p> <p>Envenomation by crotaline snakes (rattlesnake, cottonmouth, copperhead) is a complex, potentially lethal condition affecting thousands of people in the United States each year. Treatment of crotaline envenomation is not standardized, and significant variation in practice exists.</p> <p>Methods</p> <p>A geographically diverse panel of experts was convened for the purpose of deriving an evidence-informed unified treatment algorithm. Research staff analyzed the extant medical literature and performed targeted analyses of existing databases to inform specific clinical decisions. A trained external facilitator used modified Delphi and structured consensus methodology to achieve consensus on the final treatment algorithm.</p> <p>Results</p> <p>A unified treatment algorithm was produced and endorsed by all nine expert panel members. This algorithm provides guidance about clinical and laboratory observations, indications for and dosing of antivenom, adjunctive therapies, post-stabilization care, and management of complications from envenomation and therapy.</p> <p>Conclusions</p> <p>Clinical manifestations and ideal treatment of crotaline snakebite differ greatly, and can result in severe complications. Using a modified Delphi method, we provide evidence-informed treatment guidelines in an attempt to reduce variation in care and possibly improve clinical outcomes.</p

Serum levels of cytokines in patients envenomed by Tityus serrulatus scorpion sting

Seventeen patients stung by Tityus serrulatus scorpion were classified as mild (pain at the site of the sting, n = 6), moderate (local pain and one of the following manifestations: vomiting, psychomotor agitation, prostration, sweating, tachypnea, tachycardia and mild arterial hypertension, n = 10) and severe cases (equal moderate cases plus cardiac failure; pulmonary edema and shock, n = 1), Venous blood was sampled for biochemical and hematological analysis and for IL-alpha, IL-6, IL-10, TNF-alpha. IFN-gamma and GM-CSF ELISAs at the lime of hospital admission, 6 h (moderate and severe cases); and 12, 18, 36 and 72 h (severe case) later. Ten age-matched healthy volunteers were used as control. Increased serum levels of IL-1 alpha was noticed in all patients, high levels of IL-6, IFN-gamma and GM-CSF were observed only in a patient with severe envenomation. Our data suggest that a systemic inflammatory response-like syndrome is triggered during severe envenomation caused by T. serrulatus sting and that release of cytokines may be involved in this response. (C) 1999 Elsevier Science Ltd. All rights reserved.3781155116

A violência contra a mulher atendida em unidade de urgência: uma contribuição da enfermagem La violencia contra la mujer atendida en unidad de urgencia: una contribuición de la enfermería The violence against woman who is attended in an unit of urgency: a nursing contribution

INTRODUÇÃO: A violência na atualidade tem se comportado como um sério problema de saúde pública, e os serviços de urgência têm se constituído em porta de entrada para mulheres agredidas. Por essa razão, objetivou-se, com o presente trabalho, levantar os casos de violência contra a mulher atendidos em uma unidade de urgência no ano de 2004. MÉTODO: Estudo quantitativo, descritivo, retrospectivo, realizado em Teresina (PI), no Serviço de Pronto-Socorro do Hospital Getúlio Vargas, com amostra populacional de 100 casos selecionados por amostragem sistemática, tendo por instrumento um formulário com perguntas fechadas. RESULTADOS: A violência apresentou alta magnitude entre as mulheres usuárias dos serviços de pronto-atendimento, mas com elevada taxa de subnotificação quanto ao tipo de agressor (89%) e causas da violência sem registro (80%) CONCLUSÕES: Concluiu-se que os registros de violência foram maiores nos casos em que as mulheres apresentaram marcas físicas; foi expressivo o número de subnotificação de agressores. Finalmente, é conveniente que os profissionais que atendem mulheres vítimas da violência doméstica sejam treinados para identificar, acolher e registrar corretamente os casos de violência.<br>INTRODUCCIÓN: La violencia en la actualidad se ha comportado como un serio problema de salud pública, y los servicios de urgencia se han constituido como puerta de entrada para las mujeres agredidas. Por lo tanto, fue objetivado, con el actual trabajo, levantar los casos de violencia contra la mujer, atendidos en una unidad de urgencia en el año de 2004. MÉTODO: Estudio cuantitativo, descriptivo, retrospectivo, realizado en Teresina (Piauí - Brasil), en el Servicio Médico de Urgencia del hospital de Getúlio Vargas, con muestra poblacional de 100 casos seleccionadas por el muestreo sistemático, teniendo por instrumento un formulario con preguntas cerradas. RESULTADOS: La violencia presentó alta magnitud entre las mujeres que usaban los servicios médicos de emergencia, pero con elevada taza de subnotificación cuanto el tipo de agresor (89%) y causas de la violencia sin registro (80%). CONCLUSIONES: Se concluye que los registros de violencia habían sido mayores en los casos donde las mujeres habían presentado marcas físicas; era expresivo el número de subnotificación de agresores. Finalmente, es conveniente que los profesionales que cuidan de las mujeres víctimas de la violencia doméstica sean entrenados para identificar, acoger y registrar correctamente los casos de violencia.<br>INTRODUCTION: The violence in the present time has behaved as a serious problem of public health, and the urgency services have constituted itself as a door of entrance for attacked women. Therefore, it was objectified, with the present work, to raise the cases of violence against the woman who is attended in a unit of urgency in the year of 2004. METHOD: Quantitative, descriptive, retrospective study, carried through in Teresina (Piauí - Brazil), the Emergency Medical Service of the Getúlio Vargas Hospital, with population sample of 100 cases selected for systematic sampling, having for instrument a form with closed questions. RESULTS: The violence presented high dimension among the using women of the emergency medical services, but with raised tax of under notification about the type of aggressor (89%) and causes of the violence without register (80%). CONCLUSIONS: It is concluded that the violence registers had been bigger in the cases where the women had presented physical marks; the number of under notification of aggressors was expressive. Finally, it is convenient that the professionals who take care of to women victims of the domestic violence are trained to correctly identify, receive and register the violence cases

Acute-phase reactions, including cytokines, in patients bitten by Bothrops and Crotalus snakes in Brazil

Thirty-one patients bitten by venomous snakes in Botucatu area (State of São Paulo - Brazil), sixteen by Bothrops spp. and fifteen by Crotalus durissus terrificus, were studied. The group comprised twenty-nine males and two females, ranging from fourteen to sixty-three years of age (mean 33 ± 15). Leukocytosis with neutrophilia and lymphopenia, increase of mucoproteins and C-reactive protein, decrease of total serum protein and albumin, were observed on the first day after the accident. In addition, increased serum levels of the cytokines IL-6 and IL-8, but not of IL-1b and TNF-a, were observed. The alterations were generally more intense in patients bitten by Crotalus durissus terrificus than by Bothrops spp. It is concluded that these snakebite envenomations closely resemble an acute trauma, inducing a typical acute-phase response.Ministério da Ciência, Tecnologia, Inovações e Comunicações/[Proc. 300.398/88-3]/CNPq/BrasilFundação para o Desenvolvimento da UNESP/[Proc. 239/91]/FUNDUNESP/BrasilUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto Clodomiro Picado (ICP