Medical Treaiment 



Electrolyte Balance 



Because of the acute changes associated with 

 the tissue damafre produced by tlie venom, and 

 the loss of blood and intracellular fluid which 

 may occur, changes in electrolj'te and fluid bal- 

 ance should be treated immediately. 



Analgesic 



Aspirin or codeine may be used to alleviate 

 pain. Morphine may be used if the pain is 

 severe, but should be avoided in near shock condi- 

 tions or when there is a respiratoiy deficit. Local 

 "blocks" with procaine and topically applied lo- 

 tions or ointments are rai'ely etfective. The 

 affected part should be kejit out of a completely 

 dependent position so as not to accentuate pain. 



Respiratory Failure 



At the first sijjns of respiratory distress, o.wjjen 

 should be given, and preparations made to apply 

 intermittent positive pressui-e ai'tificial respira- 

 tion. A tracheostomy may be indicated, particu- 

 larly if trismus, laryngeal spasm, and excessive 

 salivation are i)resent. "While drugs have been 

 given to stimulate the respiratory centers, they 

 have not proved of particular value. 



Renal Shutdown 



The routine emei'gency measures for the treat- 

 ment of renal shutdown should be followed. 

 Shock, fluid restriction, electrolytic balance, diet, 

 and administration of digitalis nnist be con- 

 sidered. Renal dialysis may be necessary. Peri- 

 toneal dialysis is of little value. 



Sedation 



Mild sedation with i)henobarbital is definitely 

 indicated in all severe bites, and where respiratoi-y 

 failure is not a problem. Sedation will ustially 

 reduce the amount of narcotic necessary to con- 

 trol the pain. 



Care of the Wound 



The wound shoidd 1)0 cleansed and covered 

 with a sterile dressing. The dressing should be 

 changed frequently when large amounts of exu- 



date are present. Everj- attempt should be made 

 to keep the wound and dressing dry. Avoid 

 fasciotomy. Only when circulation is seriously 

 threatened should a fasciotomy be done. 



Other Measures 



1. AntihiKfamineii are of no value during the 

 acute stages of the poisoning. They can be used 

 subsequently to control tlie lesser allergic mani- 

 festations provoked by the venom or horse serum. 



•1. Afro//inr can be used as a parasympatho- 

 lytic drug. 



3. Amnion!)/, injected info the wound, is con- 

 traindicated. The injection of potassium per- 

 manganate, formaldehyde, gold salts, ef cetera^ 

 into the injured area, or elsewhere, is of no value 

 and should not be attempted. 



4. C'ortieoKteroifh are probably of little value 

 during the acute stages of viper venom poisoning, 

 and indeed their use may be contraiiulicated when 

 antivenin is being administered. They might be 

 used as a single dose treatment for shock, if no 

 other sj)ecific antishock drug is available. In 

 elapid venom poisoning they appear to have 

 found some widespread use, although the clinical 

 evidence in sui)]iort of their administration in 

 this type of ]ioisoning is not at i)resent convinc- 

 ing. They might be used in elapid venom poison- 

 ing, liut here again ca\itiou should be exercised if 

 antivenin is to be given sinniltaneously. 



The corticosteroids are the drugs of choice in 

 combating any late or severe manifestations of 

 the allergic resjjonse provoked by the venom or 

 horse serum. Tn most cases these manifestations 

 do not appear until .'? to 5 days following admin- 

 istration of antivenin. 



5. Cryofheropi/ should be avoided. Keeping 

 the injured part cool (40-50° F.) for several days 

 (and the patieiu warm) may be of some value, 

 but freezing the extremity or keei)ing it immersed 

 in ice water for days is iu)t ivconnnended. 



C). EDTA (ethylenediaminetetraacetic acid) 

 lias been suggested as an agent for combating the 

 tissue effects jiroduced by certain viper venom 

 enzymes. Preliminary experimental studies have 

 indicated that 0.025 to 0.05 molar EDTA in 

 saline, when injected m the area of the injury, 

 retards the development of necrosis and certain 

 other tissue changes. There is no known contra- 



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