Trimeresurus stejnegeri is the major hemorrhagic, venomous snake species in Taiwan. The venom can cause bleeding due to abnormal blood coagulation. In addition, the toxicity can not only damage soft tissues, such as skin, muscle, etc., but also causing bite wound pain, burning sensation and swelling. However, systemic bleeding symptoms or compartment syndrome were rare to seen. The clinical treatment is injecting anti-venom serum. The serum injection can cause allergic reactions, including pruritus, fever, nausea, vomiting, a few bronchospasm, angioedema, but is rare anaphylactic shock.
This article mainly describes our emergency caring experience for a middle-age male suffering from anti-venom serum induced anaphylactic shock with complicating compartment syndrome undergoing emergent decompression surgery.
Methods:
During the nursing period from 2017/10/29 20:39 to 22:00, we evaluated the patient with Gordon's eleven health function, and found some health problems including "change in tissue perfusion", "impaired tissue integrity", "acute pain" and "anxiety". In order to prevent further progression, we adopted an integrated care model to monitor the course of anaphylactic shock and compartment syndrome. We also used physical assessment techniques and timely nursing intervention to relieve his pain and discomfort.
Results:
We helped the patient to understand more about the disease and current treatment to reduce his anxiety.
Conclusion:
The common parts of bitten by snakes are hands and feet. Before medical treatment, the affected limb should take below the level of heart. After the anti-venom serum is given, elevating the affected limb higher than the heart to promote blood returning. When 6P symptoms appear, be alert to the compartment syndrome, and an emergency surgery for fasciotomy should be performed. This case shows that injection of anti-venom serum is the main treatment for venomous bites, but Epinephrine should be given when anaphylactic shock occurs. Other drugs, such as anti-histamine, corticosteroid and vasopressor, may be also considered to be given.
We hope that by sharing this care experience, our nursing colleagues can know better about how to help this kind of patients overcome physical or psychological crisis, and also improve the quality of emergency care and patient satisfaction.