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Old 08-27-2006, 13:58   #15
swatsurgeon
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Join Date: Jul 2004
Location: Phoenix, AZ
Posts: 880
In the civilian world, we don't (no one should) treat prophylactically. We treat when there are specific symptoms, and/or laboratory value changes that indicate chemical changes to the bodies ability to clot. Observation is a key but lab testing is needed to verify problems. We don't treat edema (swelling) or pain with anti-venom, we do treat neulogic changes, perform compartment fasciotomies when indicated and monitor closely. It helps tremendously if we know the snake type as it allows for a better prediction for the need for cro-fab.
Below is a foot bitten by a copperhead, 3 bites, initial day and next day. Outside hospital gave cro-fab with normal labs but saw the degree of edema and spent $9000 needlessly. I have yet to treat a copperhead bite with cro-fab. but would treat the local eastern diamond back rattler...he's a bad player. Again, know the snake before presuming the need to treat.

ss
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'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )

Education is the anti-ignorance we all need to better treat our patients. ss, 2008.

The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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