Treatment of a 41-year old female patient bitten by a viper conducted at the emergency department – A case report

Abstract

Abstract Introduction Vipera berus is the only species of venomous viper found in Poland, especially in Bieszczady. Cases of such bites in this country are rare and mortality does not exceed 1%. Most viper bites are dry bites with hardly any symptoms and do not require any hospital treatment; however, viper venom contains a complex mixture of proteolytic enzymes such as hyaluronidase, phospholipase A2, cardiotoxins and presynaptic neurotoxins, which can be very dangerous for the victim. Thus, if symptoms exacerbate in the victim, observation and hospital treatment become a necessity. Aim The aim of this paper was to present the importance and validity of multi-diagnostic procedure and treatment at the Hospital Emergency Department (ED) in the case of viper bite and to describe the effect of viper venom on the human body. The diagnosis, management and care leading to the fast recovery of the patient are discussed. Materials and methods This study presents a case report involving a patient admitted to the ED in the Provincial Specialist Hospital in Olsztyn, following a viper bite. Results and discussion V. berus bites are rare in Poland, occasionally causing severe complications. Most bites are asymptomatic. Much less likely to develop are wide ranges of symptoms caused by toxins contained in the viper venom, including serious hypotension, cardiac arrhythmias, irritation of the central nervous system, heart rhythm disturbances, multiple organ dysfunction, pulmonary edema, disseminated intravascular coagulation syndrome, and anaphylactic shock. A typical viper bite involving extremities results in edema and ischemia of the distal parts of extremities with peripheral nerve damage. Due to a variety of possible complications, for patients with emerging symptoms, hospitalization becomes necessary in order to implement multidisciplinary treatment. The units predisposed to provide adequate care are EDs which ensure proper medical staff as well as diagnostic and monitoring facilities and access to appropriate treatment. Particular importance is given to controlling blood pressure, coagulation function, swelling of the bite area and the peripheral circulation. Specific treatment consists of administering specific antitoxin against viper venom. In symptomatic treatment, besides the use of anticoagulants, corticosteroids, antibiotics and antitetanic anatoxin, surgical procedures are also considered. Conclusions Rapid and well-coordinated medical assistance at the ED helps to avoid complications and facilitates faster recoveries in patients bitten by vipers.