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Volume 58
Issue 8
10.3390/medicina58080996
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Case Report

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

by
Yueh-Tseng Hou
1,2,
Meing-Chung Chang
3,4,
Ching Yang
1,2,
Yu-Long Chen
1,2,
Po-Chen Lin
1,2,
Giou-Teng Yiang
1,2 and
Meng-Yu Wu
1,2,*
1
Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan
2
Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
3
Division of Plastic Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan
4
Division of Plastic Surgery, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
*
Author to whom correspondence should be addressed.
Medicina 2022, 58(8), 996; https://doi.org/10.3390/medicina58080996
Submission received: 28 June 2022 / Revised: 19 July 2022 / Accepted: 23 July 2022 / Published: 26 July 2022
(This article belongs to the Special Issue Emergency Medicine and Emergency Room Medical Issues)
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Abstract

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.
Keywords: Post-snakebite compartment syndrome; diastolic retrograde arterial flow; Protobothrops mucrosquamatus; fasciotomy Post-snakebite compartment syndrome; diastolic retrograde arterial flow; Protobothrops mucrosquamatus; fasciotomy

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MDPI and ACS Style

Hou, Y.-T.; Chang, M.-C.; Yang, C.; Chen, Y.-L.; Lin, P.-C.; Yiang, G.-T.; Wu, M.-Y. Prediction of Compartment Syndrome after Protobothrops mucrosquamatus Snakebite by Diastolic Retrograde Arterial Flow: A Case Report. Medicina 2022, 58, 996. https://doi.org/10.3390/medicina58080996

AMA Style

Hou Y-T, Chang M-C, Yang C, Chen Y-L, Lin P-C, Yiang G-T, Wu M-Y. Prediction of Compartment Syndrome after Protobothrops mucrosquamatus Snakebite by Diastolic Retrograde Arterial Flow: A Case Report. Medicina. 2022; 58(8):996. https://doi.org/10.3390/medicina58080996

Chicago/Turabian Style

Hou, Yueh-Tseng, Meing-Chung Chang, Ching Yang, Yu-Long Chen, Po-Chen Lin, Giou-Teng Yiang, and Meng-Yu Wu. 2022. "Prediction of Compartment Syndrome after Protobothrops mucrosquamatus Snakebite by Diastolic Retrograde Arterial Flow: A Case Report" Medicina 58, no. 8: 996. https://doi.org/10.3390/medicina58080996

APA Style

Hou, Y.-T., Chang, M.-C., Yang, C., Chen, Y.-L., Lin, P.-C., Yiang, G.-T., & Wu, M.-Y. (2022). Prediction of Compartment Syndrome after Protobothrops mucrosquamatus Snakebite by Diastolic Retrograde Arterial Flow: A Case Report. Medicina, 58(8), 996. https://doi.org/10.3390/medicina58080996

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