Scientific Letters
Poisonous snakebites: A five-year experience
Mordedura de serpientes venenosas: experiencia durante 5 años
L. Vico Andueza
, L. Martínez Sanchez, J. Martínez Osorio, V. Trenchs Sainz de La Maza, C. Luaces Cubells
Corresponding author
Servicio de Urgencias, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
Read
4443
Timeswas read the article
2062
Total PDF
2381
Total HTML
Share statistics
array:24 [ "pii" => "S2341287915001477" "issn" => "23412879" "doi" => "10.1016/j.anpede.2015.07.013" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "1849" "copyright" => "Asociación Española de Pediatría" "copyrightAnyo" => "2015" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "An Pediatr (Barc). 2015;83:209-11" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1280 "formatos" => array:3 [ "EPUB" => 123 "HTML" => 786 "PDF" => 371 ] ] "Traduccion" => array:1 [ "es" => array:18 [ "pii" => "S1695403315001149" "issn" => "16954033" "doi" => "10.1016/j.anpedi.2015.03.010" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "1849" "copyright" => "Asociación Española de Pediatría" "documento" => "simple-article" "subdocumento" => "cor" "cita" => "An Pediatr (Barc). 2015;83:209-11" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4404 "formatos" => array:3 [ "EPUB" => 119 "HTML" => 3605 "PDF" => 680 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "Mordedura de serpientes venenosas: experiencia durante 5 años" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "209" "paginaFinal" => "211" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Poisonous snakebites: A five-year experience" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Vico Andueza, L. Martínez Sanchez, J. Martínez Osorio, V. Trenchs Sainz de La Maza, C. Luaces Cubells" "autores" => array:5 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Vico Andueza" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Martínez Sanchez" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Martínez Osorio" ] 3 => array:2 [ "nombre" => "V." "apellidos" => "Trenchs Sainz de La Maza" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Luaces Cubells" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341287915001477" "doi" => "10.1016/j.anpede.2015.07.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001477?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403315001149?idApp=UINPBA00005H" "url" => "/16954033/0000008300000003/v1_201509030005/S1695403315001149/v1_201509030005/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341287915001556" "issn" => "23412879" "doi" => "10.1016/j.anpede.2015.08.003" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "1843" "copyright" => "Asociación Española de Pediatría" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "An Pediatr (Barc). 2015;83:211-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2792 "formatos" => array:3 [ "EPUB" => 116 "HTML" => 2208 "PDF" => 468 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Early infantile dysphonia as an alert symptom of juvenile laryngeal papillomatosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "211" "paginaFinal" => "212" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Disfonía infantil precoz como síntoma de alerta de la papilomatosis laríngea juvenil" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 746 "Ancho" => 995 "Tamanyo" => 85639 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Fibre-optic laryngoscopy: lesion of papillomatous appearance, occupying the anterior third of the vocal cords and partially obstructing the glottic lumen.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A.M. Fita, J.A. Díaz Manzano, S.B. Reyes Domínguez, P. Pastor Costa, A. Navarro Mingorance" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A.M." "apellidos" => "Fita" ] 1 => array:2 [ "nombre" => "J.A." "apellidos" => "Díaz Manzano" ] 2 => array:2 [ "nombre" => "S.B." "apellidos" => "Reyes Domínguez" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Pastor Costa" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Navarro Mingorance" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403315001022" "doi" => "10.1016/j.anpedi.2015.03.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403315001022?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001556?idApp=UINPBA00005H" "url" => "/23412879/0000008300000003/v2_201511040058/S2341287915001556/v2_201511040058/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341287915001519" "issn" => "23412879" "doi" => "10.1016/j.anpede.2015.07.017" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "1752" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2015;83:201-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3125 "formatos" => array:3 [ "EPUB" => 184 "HTML" => 2468 "PDF" => 473 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Tufted angiomas in childhood: A series of 9 cases and a literature review" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "201" "paginaFinal" => "208" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Angiomas en penacho en la infancia. Serie de 9 casos yrevisión de la literatura" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 532 "Ancho" => 1301 "Tamanyo" => 79748 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">(A) Tufted angioma in right inner thigh measuring 10<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>cm, present since birth, previous to treatment with 2<span class="elsevierStyleHsp" style=""></span>mg/kg/day of propanolol for 3 months. (B) Four-year followup: the lesion had regressed, leaving behind subcutaneous atrophic tissue.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A.M. Victoria Martínez, L. Cubells Sánchez, A. Esteve Martínez, J.R. Estela Cubells, I. Febrer Bosch, V. Alegre de Miquel, V. Oliver Martínez" "autores" => array:7 [ 0 => array:2 [ "nombre" => "A.M." "apellidos" => "Victoria Martínez" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Cubells Sánchez" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Esteve Martínez" ] 3 => array:2 [ "nombre" => "J.R." "apellidos" => "Estela Cubells" ] 4 => array:2 [ "nombre" => "I." "apellidos" => "Febrer Bosch" ] 5 => array:2 [ "nombre" => "V." "apellidos" => "Alegre de Miquel" ] 6 => array:2 [ "nombre" => "V." "apellidos" => "Oliver Martínez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403314005116" "doi" => "10.1016/j.anpedi.2014.10.018" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403314005116?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001519?idApp=UINPBA00005H" "url" => "/23412879/0000008300000003/v2_201511040058/S2341287915001519/v2_201511040058/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letters</span>" "titulo" => "Poisonous snakebites: A five-year experience" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "209" "paginaFinal" => "211" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L. Vico Andueza, L. Martínez Sanchez, J. Martínez Osorio, V. Trenchs Sainz de La Maza, C. Luaces Cubells" "autores" => array:5 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Vico Andueza" "email" => array:1 [ 0 => "lvico@hsjdbcn.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Martínez Sanchez" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Martínez Osorio" ] 3 => array:2 [ "nombre" => "V." "apellidos" => "Trenchs Sainz de La Maza" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Luaces Cubells" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Urgencias, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mordedura de serpientes venenosas: experiencia durante 5 años" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Snakebite is an unusual reason for visits to Emergency Departments. This may lead to uncertainty about its treatment, and especially on the use of a very specific, expensive antidote with limited distribution and potential adverse effects.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a> Given the potential gravity of the situation, we need to know the most appropriate therapeutic approach.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present a study of a series of clinical cases carried out in the Emergency Department of a third-level Maternity and Children's Hospital, describing the cases of snakebite reported between January 2011 and December 2013, with the aim of detecting the points that could be improved when dealing with them, in the light of their outcomes and the new recommendations.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A total of five patients came for consultation, one in 2011 and the rest in 2013. All of them had previously visited another health centre and only one came to our hospital in the first 12<span class="elsevierStyleHsp" style=""></span>h after being bitten. At the time of their arrival all the patients presented grade 2 envenomation. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the classification of symptoms after snakebite.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> lists the clinical features of the patients included in the study. The five patients were hospitalised. Blood tests were performed on all of them to rule out secondary complications, with normal results. Initially, conservative treatment was pursued. However, the four cases recorded in 2013 progressed poorly, deteriorating to grade 3, at which point the antiophidic serum (Viperfav<span class="elsevierStyleSup">®</span>) was administered. Two patients required fasciotomy to be performed for compartment syndrome. The administration of the antiophidic serum did not result in adverse reactions, and the treatment brought favourable outcome. Only the case in 2011 had a favourable outcome with the initial medical treatment, without requiring antivenom.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The snakes that most commonly produce envenomation in the Iberian Peninsula belong to the Viperinae family (vipers).<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,4,5</span></a> However, management of bites will depend on the degree of envenomation the patient shows, regardless of its aetiology.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Firstly, an initial assessment will be made, using the ABCDE algorithm.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> As for specific treatment of the bite, the wound will always be cleaned and treated with antiseptic, the analgesia will be administered and the tetanus vaccination record will be checked.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,5,6</span></a> Systematic use of antibiotics is controversial and it is currently recommended to be administered only if superinfection is suspected.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a> Similarly, the use of antihistamines and corticosteroids is not indicated, as their efficacy has not been demonstrated.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a> The use of antiophidic serum has a particularly important place in therapeutic management. The most commonly used serum in Spain is Viperfav<span class="elsevierStyleSup">®</span>. This contains heterologous proteins obtained by immunising horses.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2,4</span></a> The classic recommendations were to reserve the use of antivenom for cases of grade 3 envenomation, due to their potential risk of anaphylaxis. However, the thorough purification process by which the serum currently available (Viperfav<span class="elsevierStyleSup">®</span>) is obtained makes it a safe antidote with low allergenicity.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2,4</span></a> For this reason, the latest treatment recommendations for venomous snakebites set forth by the Spanish Panel of Experts in December 2012 indicate early use of serum in cases of grade 2 envenomation.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,4,5</span></a> Moreover, it is considered the treatment of choice for compartment syndrome, leaving fasciotomy for cases that do not respond after administration of the antidote.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,4,5</span></a> Since the new recommendations appeared at the same time as the cases presented here, the hospital's current protocol, which did not include them, was followed in these cases. The review of the cases led to the updating of the protocol.</p><p id="par0030" class="elsevierStylePara elsevierViewall">As regards to additional tests, a blood analysis needs to be performed to rule out associated complications such as thrombocytopaenia, fluid and electrolytic imbalances or renal insufficiency.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4–6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Finally, all patients require hospital observation to monitor their progress (grade 0: 6<span class="elsevierStyleHsp" style=""></span>h; grade 1: minimum 24<span class="elsevierStyleHsp" style=""></span>h; grades 2 and 3: admission to hospital or Intensive Care Unit depending on severity).<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,4,5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, we want to emphasise that in 2013 we witnessed a peak of incidence of venomous snakebites in our department, as well as greater severity and poorer progress. Moreover, we have observed a tendency for patients treated conservatively to deteriorate, and therefore, in line with the new recommendations, we consider that earlier use of antiophidic serum could avoid subsequent poor progress. In addition, we have found that side effects of the antiophidic serum in the form of allergic reactions are infrequent, and that other drugs used in our patients (corticosteroids and antihistamines) did not prevent the progression of local inflammation.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Vico Andueza L, Martínez Sanchez L, Martínez Osorio J, Trenchs Sainz de La Maza V, Luaces Cubells C. Mordedura de serpientes venenosas: experiencia durante 5 años. An Pediatr (Barc). 2015;83:209–211.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Degree of envenomation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical manifestations \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Grade 0 (dry bite) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fang marksMild or non-existent painNo local or systemic symptoms \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Grade 1 (mild envenomation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Moderate/intense painLocal inflammatory oedemaAbsence of general symptoms \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Grade 2 (moderate envenomation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Widespread or rapidly progressive oedema (to the ends of the extremity)Ecchymosis, painful local adenopathies, lymphangitis, blisters, necrosisModerate general symptomsNeurological symptoms: palpebral ptosis, accommodation deficit, ophthalmoplegia, diplopia, dysarthria, dysphagia, paralysis of the orbicularis oris, lethargy, vertigo or pareses \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Grade 3 (severe envenomation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Intense local reaction extending beyond the extremitySevere general symptomsSevere neurological symptoms \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab940511.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Degree of envenomation by snakebite.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">LH, left hand; RH, right hand; ULE, upper left extremity; URE, upper right extremity; ♂, male; ♀, female.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex, age and date \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anatomical site \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time since bite \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical presentation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Initial management \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Initial progress \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Fasciotomy \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Antiophidic serum \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Final outcome \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Case 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">♂, 10 years, April 2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1st finger LH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Grade 2 (purplish oedema ULE) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Blood analysis, antibiotic, corticosteroid, antihistamine, analgesia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Good \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Good \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="10" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Case 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">♂, 5 years, April 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3rd finger RH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Grade 2 (oedema and ecchymosis URE) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Blood analysis, antibiotic, analgesia, tetanus prophylaxis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Compartment syndrome (grade 3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">At 24<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">At 36<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Good \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="10" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Case 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">♂, 8 years, April 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4th finger LH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Grade 2 (purplish oedema ULE, lymphangitis, self-limited vomiting) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Blood analysis, antibiotic, analgesia, tetanus prophylaxis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oedema spread to thorax (grade 3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">At 24<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Good \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="10" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Case 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">♂, 2 years, April 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Interdigital space 1st–2nd fingers RH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Grade 2 (purplish oedema URE, lymphangitis) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Blood analysis, antibiotic, corticosteroid, antihistamine, analgesia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oedema spread to thorax (grade 3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">At 48<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Good \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="10" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Case 5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">♀, 10 years, July 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2nd finger RH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Grade 2 (oedema and ecchymosis finger, haematoma proximal 1/3 arm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Blood analysis, antibiotic, corticosteroid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Compartment syndrome (grade 3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">At 24<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">At 48<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Good \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab940512.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical presentation and management of venomous snakebites treated in the Paediatric Emergency Department.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European viper envenomings: assessment of Viperfav<span class="elsevierStyleSup">®</span> and other symptomatic treatments" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Boels" 1 => "J.F. Hamel" 2 => "M. Bretaudeau Deguigne" 3 => "P. Harry" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Toxicol (Phila)" "fecha" => "2012" "volumen" => "50" "paginaInicial" => "189" "paginaFinal" => "196" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Informe Público de Evaluación de Tecnologías Sanitarias IPE 2012/68. Intoxicaciones por mordeduras de ofidios venenosos. I Panel de expertos en España; Madrid" ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2012" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Kasturiratne" 1 => "A.R. Wickremasinghe" 2 => "N. de Silva" 3 => "N.K. Gunawardena" 4 => "A. Pathmeswaran" 5 => "R. Premaratna" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pmed.0050218" "Revista" => array:5 [ "tituloSerie" => "PLoS Med" "fecha" => "2008" "volumen" => "5" "paginaInicial" => "e218" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18986210" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Novedades en el envenenamiento por mordedura de víbora" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Martín" 1 => "S. Nogué" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2015" "volumen" => "144" "paginaInicial" => "132" "paginaFinal" => "136" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Picaduras y mordeduras de animales" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Calzada" 1 => "J. Payeras" 2 => "J.M. Quintillá" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Urgencias en Pediatría: Protocolos diagnósticos-terapéuticos Hospital Universitari Sant Joan de Déu" "paginaInicial" => "731" "paginaFinal" => "748" "edicion" => "5th ed." "serieFecha" => "2014" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Snakebites worldwide: management [Monografía en Internet]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. White" 1 => "A.C. Cheng" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:2 [ "titulo" => "UpToDate" "serieFecha" => "2014" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008300000003/v2_201511040058/S2341287915001477/v2_201511040058/en/main.assets" "Apartado" => array:4 [ "identificador" => "38181" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008300000003/v2_201511040058/S2341287915001477/v2_201511040058/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001477?idApp=UINPBA00005H" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 11 | 19 |
| 2024 October | 37 | 35 | 72 |
| 2024 September | 39 | 30 | 69 |
| 2024 August | 63 | 72 | 135 |
| 2024 July | 38 | 28 | 66 |
| 2024 June | 50 | 25 | 75 |
| 2024 May | 36 | 43 | 79 |
| 2024 April | 35 | 23 | 58 |
| 2024 March | 38 | 24 | 62 |
| 2024 February | 31 | 37 | 68 |
| 2024 January | 28 | 23 | 51 |
| 2023 December | 22 | 16 | 38 |
| 2023 November | 20 | 27 | 47 |
| 2023 October | 26 | 26 | 52 |
| 2023 September | 24 | 18 | 42 |
| 2023 August | 31 | 21 | 52 |
| 2023 July | 36 | 34 | 70 |
| 2023 June | 28 | 24 | 52 |
| 2023 May | 42 | 31 | 73 |
| 2023 April | 20 | 19 | 39 |
| 2023 March | 33 | 23 | 56 |
| 2023 February | 26 | 13 | 39 |
| 2023 January | 14 | 17 | 31 |
| 2022 December | 31 | 25 | 56 |
| 2022 November | 46 | 33 | 79 |
| 2022 October | 24 | 47 | 71 |
| 2022 September | 25 | 33 | 58 |
| 2022 August | 31 | 50 | 81 |
| 2022 July | 25 | 48 | 73 |
| 2022 June | 29 | 28 | 57 |
| 2022 May | 27 | 40 | 67 |
| 2022 April | 23 | 30 | 53 |
| 2022 March | 41 | 48 | 89 |
| 2022 February | 22 | 28 | 50 |
| 2022 January | 29 | 41 | 70 |
| 2021 December | 24 | 45 | 69 |
| 2021 November | 26 | 47 | 73 |
| 2021 October | 44 | 60 | 104 |
| 2021 September | 20 | 47 | 67 |
| 2021 August | 16 | 40 | 56 |
| 2021 July | 23 | 32 | 55 |
| 2021 June | 18 | 41 | 59 |
| 2021 May | 30 | 27 | 57 |
| 2021 April | 50 | 51 | 101 |
| 2021 March | 32 | 24 | 56 |
| 2021 February | 12 | 13 | 25 |
| 2021 January | 23 | 15 | 38 |
| 2020 December | 16 | 16 | 32 |
| 2020 November | 25 | 21 | 46 |
| 2020 October | 14 | 19 | 33 |
| 2020 September | 23 | 18 | 41 |
| 2020 August | 8 | 12 | 20 |
| 2020 July | 15 | 19 | 34 |
| 2020 June | 28 | 10 | 38 |
| 2020 May | 20 | 21 | 41 |
| 2020 April | 18 | 17 | 35 |
| 2020 March | 26 | 16 | 42 |
| 2020 February | 19 | 15 | 34 |
| 2020 January | 13 | 10 | 23 |
| 2019 December | 20 | 16 | 36 |
| 2019 November | 12 | 14 | 26 |
| 2019 October | 27 | 14 | 41 |
| 2019 September | 20 | 8 | 28 |
| 2019 August | 21 | 17 | 38 |
| 2019 July | 29 | 22 | 51 |
| 2019 June | 17 | 16 | 33 |
| 2019 May | 22 | 14 | 36 |
| 2019 April | 22 | 29 | 51 |
| 2019 March | 21 | 23 | 44 |
| 2019 February | 27 | 21 | 48 |
| 2019 January | 27 | 18 | 45 |
| 2018 December | 31 | 27 | 58 |
| 2018 November | 48 | 27 | 75 |
| 2018 October | 49 | 28 | 77 |
| 2018 September | 22 | 13 | 35 |
| 2018 August | 2 | 0 | 2 |
| 2018 June | 5 | 0 | 5 |
| 2018 May | 5 | 0 | 5 |
| 2018 April | 13 | 0 | 13 |
| 2018 March | 13 | 0 | 13 |
| 2018 February | 9 | 0 | 9 |
| 2018 January | 8 | 0 | 8 |
| 2017 December | 7 | 0 | 7 |
| 2017 November | 12 | 0 | 12 |
| 2017 October | 8 | 0 | 8 |
| 2017 September | 12 | 0 | 12 |
| 2017 August | 14 | 0 | 14 |
| 2017 July | 16 | 0 | 16 |
| 2017 June | 20 | 6 | 26 |
| 2017 May | 14 | 2 | 16 |
| 2017 April | 12 | 5 | 17 |
| 2017 March | 6 | 0 | 6 |
| 2017 February | 7 | 4 | 11 |
| 2017 January | 5 | 4 | 9 |
| 2016 December | 24 | 3 | 27 |
| 2016 November | 36 | 7 | 43 |
| 2016 October | 29 | 6 | 35 |
| 2016 September | 24 | 4 | 28 |
| 2016 August | 32 | 5 | 37 |
| 2016 July | 12 | 2 | 14 |
Show all
