Snakebite induced acute renal failure in emergency

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Snakebite induced acute renal failure Nursing Emergency

[Abstract] Objective snakebite induced acute renal failure patients in the emergency care. Methods A retrospective analysis of five cases of snake bite induced acute renal failure in the clinical manifestations and nursing care, summed up a more practical first aid measures. Results snakebite induced acute renal failure severity and types of snakes,[link widoczny dla zalogowanych], time-related treatment, detoxification and kidney by active support for the emergency treatment with plasma exchange bed, 5 patients were cured. Conclusion snake blood poisoning based on the direct renal toxicity with larger, with a large number of hemolytic toxins lead to the body, so soon after injury, renal failure occurs, timely treatment and plasma exchange is the cause of improving the key to cure .

[Key words] snake bite; acute renal failure; nursing

recent years due to the greenhouse effect caused increase in snake activity, as well as an increase in outdoor activities and people sectors emerged snake makes an increase in cases of snake bite, the Division since June 2004 ~ June 2005 snakebite patients were treated, 10 cases including 4 cases of five Step snake (snake mainly through blood poisoning), and another unidentified snake species in 1 case. Correctly handle the medical staff injuries, active comprehensive treatment, especially for critically ill patients using plasma exchange, 5 patients were cured. Now I have the experience of emergency care on Implementing the report is as follows.

1 clinical data

1.1 General Information Snakebite induced acute renal failure in 5 cases, 3 males and 2 females, aged 20 to 45 years old, the injured area for the fingers, hand or leg. The shortest treatment time 2 h, up to 24 h. Wounds were not dealt with before treatment.

1.2 clinical manifestations of snake bites are often acute onset disease quickly. 5 patients have varying degrees of injury limb swelling, pain, ecchymosis. Have mild or moderate anemia, urine contains red blood cells (+~++++), prolonged prothrombin time, serum creatinine, blood urea nitrogen increased. 2 patients had significant nausea and vomiting, 1 patient had abnormal liver function. The other one case the disease is serious oliguria, hemoglobin dropped to 70g / L, platelets fell to 30 × 109 / L, prothrombin time was 120 s (normal PT 11.0 ~ 14.5 s). Generalized edema associated with a large bruise. WBC 22.0 × 109 / L, creatinine 705 mmol / L, BUN 17.2 mmol / L, conscious, with indications of plasma exchange.

2 first aid

2.1 Local Treatment Because blood has a strong toxic effect of soluble tissue [1], so the wound should be thoroughly debrided, line Wound dressing every day, Vaseline coverage, the injured limb as far as possible in the low 5 ~ 10 cm above the wound with lidocaine at the Bureau of letters, with the use of ice or 33% magnesium sulfate wet compress. All patients were above method can effectively control limb swelling.

2.2 antivenom serum with anti-venom into the body to track the venom of the body and with the combination of the free, and free of toxins, it can be said to cure [2]. Early application is the key, generally 20 ~ 30 min after the bite of the use of the best [3]. Allergy test should be done before using skin test positive to give a small measure fractional injection, and to observe whether the allergic reaction.

2.3 TAT infection control practices and antibiotic use. Bed unit to keep clean and smooth. And oral and skin care, perineal care. Strengthen the aseptic technique, infection prevention and control cross. Edema in severe cases should use the air bed to prevent bedsores, good temperature monitoring.

3 Care

3.1 bleeding snake care Hemorrhagic toxin causes the body to produce bleeding, which led to decreased effective circulating blood volume [4]. Therefore, to limit patient activity, give oxygen. Close observation of patient vital signs, consciousness, urine output, skin bruising, bleeding wound. Establishment of intravenous catheter, added blood volume. Blood routine, prothrombin time to prevent DIC. The operation should be gentle, the puncture point press time should be longer. Instruct patient to cut nails, so as not to scratch the skin. Blood pressure cuff should be promptly removed, so as not to obstruct blood return. If Hb <8 g / dl to consider blood transfusion, make proper care.