It was in the early 90's and I was an ER nurse at Sunnybrook Health Sciences Center in Toronto, Canada.
Sitting at Triage early one Sunday morning, my mind dulled by inadequate sleep the night before, I was interrupted by a young man of the ‘skin-head persuasion’ who was in a panic. “Ya gotta help me!” he shouted. “I've been bitten by a Black Naja Cobra" He showed me his very swollen finger. A red bandana was tightly wrapped around his wrist as a tourniquet. I didn’t know a lot about snake bites back then and had no idea of what a "Black Naja Cobra" was, but I did know that if the bitten area has a gross local reaction, and the snake was called a "cobra" - you've got yourself a big problem.
As I was taking him back into the ER, I learned that ‘Randy’ raised “Black Naja Cobras” as pets and he was "helping" one of them to "him shed his skin" when he was bitten. He didn't happen to have any anti-venom as he procured these snakes illegally from Africa and the seller did not supply him with any. “You know how it is”, he said. I didn’t. I'm no snake expert but I would think snake-lovers everywhere should have some basic rules like Rule #1 - Do not help a venomous snake shed its skin - they 've being doing it for centuries alone. Rule #2 - If you own venomous snakes, and if you must help them shed their skin - have anti-venom available.
Supportive treatment was initiated including oxygen and IV Fluids. When I got the ER doc’s attention, orders for tons of blood work spewed - chemistry, hematology, clotting panels, bleeding studies and ABG’s. Black Naja Cobra…was its venom neurotoxic, hemotoxic, cardiotoxic or what?
At the time, our doctor could choose from text, microfiche or expert resources. He called The Metropolitan Toronto Zoo and knowing that the chances were slim anybody who knew anything about anything would be at the zoo on a Sunday morning, he explained the situation then asked the zoo operator to get a hold of the person in charge of exotic snakes. Within a few minutes, the 'snake person' called back and following a brief conversation, the appropriate anti-venom was secured and The Metro Toronto Police were alerted to deliver it to us.
I got pulled from Triage.
Randy’s blood work had come back and we found out that his pet's venom had a profound anticoagulant effect. His clotting mechanisms were failing rapidly.
Randy’s blood work had come back and we found out that his pet's venom had a profound anticoagulant effect. His clotting mechanisms were failing rapidly.
When the anti-venom arrived, the ER doc turned to me and casually said, “OK, Joan, go for it." Trying to disguise the 'edge' in my response to that ridiculous statement, I said"How?"
Clueless on how to administer this stuff, we found the directions in the box.
Anti-venom or ‘anti-venin’, (as it was labeled on the packaging) was to be administered via IV drip and based on kilograms of body weight. The anti-venom was derived from various species of cobra. I clearly remember myself and another nurse having to draw up at least ten vials or so and mix them in 500 ml of NS. A skin test was to be performed first in order to check for a possible allergic reaction. “And if he's allergic...then what?’ I asked. The doc ordered steroids and benadryl and told me to skip the skin test as we would have to wait an additional twenty minutes for results to be read accurately. I began the drip. The anti-venom would infuse over thirty minutes and then repeat blood work would be collected.
The response to the anti-venom was truly remarkable. By the time the infusion was completed, Randy’s post anti-venom blood work had improved significantly and within a few hours, it had returned to normal limits. Unfortunately, his finger had become blackened and necrotic. I learned later that week that Randy had lost his hand secondary to gangrene. Plastic surgeons said that the tourniquet he had applied to his arm might possibly have slowed the transport of the venom but that it caused pooling of it in his arm and worsened the tissue damage.
That same day, as I was wheeling him out of the ER, Randy was repositioning himself on stretcher and that’s when I saw the back of his head. Although at first glance, his head appeared clean-shaven, it wasn’t until he sat up that I noticed the hair on the back of his head was shaped in the form of a cobra’s head.
Anti-venom or ‘anti-venin’, (as it was labeled on the packaging) was to be administered via IV drip and based on kilograms of body weight. The anti-venom was derived from various species of cobra. I clearly remember myself and another nurse having to draw up at least ten vials or so and mix them in 500 ml of NS. A skin test was to be performed first in order to check for a possible allergic reaction. “And if he's allergic...then what?’ I asked. The doc ordered steroids and benadryl and told me to skip the skin test as we would have to wait an additional twenty minutes for results to be read accurately. I began the drip. The anti-venom would infuse over thirty minutes and then repeat blood work would be collected.
The response to the anti-venom was truly remarkable. By the time the infusion was completed, Randy’s post anti-venom blood work had improved significantly and within a few hours, it had returned to normal limits. Unfortunately, his finger had become blackened and necrotic. I learned later that week that Randy had lost his hand secondary to gangrene. Plastic surgeons said that the tourniquet he had applied to his arm might possibly have slowed the transport of the venom but that it caused pooling of it in his arm and worsened the tissue damage.
That same day, as I was wheeling him out of the ER, Randy was repositioning himself on stretcher and that’s when I saw the back of his head. Although at first glance, his head appeared clean-shaven, it wasn’t until he sat up that I noticed the hair on the back of his head was shaped in the form of a cobra’s head.
Nice.
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