Prediction of Compartment Syndrome after Protobothrops mucrosquamatus Snakebite by Diastolic Retrograde Arterial Flow: A Case Report. 2022

Yueh-Tseng Hou, and Meing-Chung Chang, and Ching Yang, and Yu-Long Chen, and Po-Chen Lin, and Giou-Teng Yiang, and Meng-Yu Wu
Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan.

Post-snakebite compartment syndrome (PSCS) is an uncommon but dangerous condition. Compartment syndrome-like symptoms after snakebite by Protobothrops mucrosquamatus (P. mucrosquamatus) are not effective in guiding fasciotomy. Objective evaluation of intracompartmental pressure measurements in patients with suspected PSCS is recommended. However, there is a lack of consensus regarding PSCS and indications for surgical intervention, including the threshold value of chamber pressure. In addition, intracompartmental pressure measurements may not be readily available in all emergency service settings. Measuring intracompartmental pressure in all snakebite patients for early diagnosis of PSCS is impractical. Therefore, identifying risk factors, continuous real-time monitoring tools, and predictive factors for PSCS are important. Sonography has proved useful in identifying the location and extension of edema after a snakebite. In this study, we attempted to use point-of-care ultrasound to manage PSCS in real-time. Here, we describe a rare case of snakebite from P. mucrosquamatus. PSCS was considered as diastolic retrograde arterial flow (DRAF) was noted in the affected limb with a cobblestone-like appearance in the subcutaneous area, indicating that the target artery was compressed. The DRAF sign requires physicians to aggressively administer antivenom to salvage the limb. The patient was administered 31 vials of P. mucrosquamatus antivenom, and fasciotomy was not performed. DRAF is an early sign of the prediction of PSCS.

UI MeSH Term Description Entries
D003161 Compartment Syndromes Conditions in which increased pressure within a limited space compromises the BLOOD CIRCULATION and function of tissue within that space. Some of the causes of increased pressure are TRAUMA, tight dressings, HEMORRHAGE, and exercise. Sequelae include nerve compression (NERVE COMPRESSION SYNDROMES); PARALYSIS; and ISCHEMIC CONTRACTURE. FASCIOTOMY is often used to decompress increased pressure and eliminate pain associated with compartment syndromes. Compartment Syndrome
D004487 Edema Abnormal fluid accumulation in TISSUES or body cavities. Most cases of edema are present under the SKIN in SUBCUTANEOUS TISSUE. Dropsy,Hydrops,Anasarca
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000997 Antivenins Antisera used to counteract poisoning by animal VENOMS, especially SNAKE VENOMS. Anti-Venin,Anti-Venom,Antivenin,Antivenom,Anti-Venins,Anti-Venoms,Antivenoms,Anti Venin,Anti Venins,Anti Venom,Anti Venoms
D001158 Arteries The vessels carrying blood away from the heart. Artery
D012909 Snake Bites Bites by snakes. Bite by a venomous snake is characterized by stinging pain at the wound puncture. The venom injected at the site of the bite is capable of producing a deleterious effect on the blood or on the nervous system. (Webster's 3d ed; from Dorland, 27th ed, at snake, venomous) Envenomation, Snakebite,Snake Envenomation,Snake Envenoming,Snakebite Envenoming,Snakebites,Bite, Snake,Envenomation, Snake,Envenoming, Snake,Envenoming, Snakebite,Snake Bite,Snake Envenomations,Snake Envenomings,Snakebite,Snakebite Envenomation,Snakebite Envenomations,Snakebite Envenomings

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