TY - JOUR
T1 - Compartment Syndrome after Crotalid Envenomation in the United States
T2 - A Review of the North American Snakebite Registry from 2013 to 2021 on Behalf of the ToxIC Snakebite Study Group
AU - Spyres, Meghan B.
AU - Maker, Greg
AU - Aldy, Kim
AU - Wolk, Brian J.
AU - Meadors, Kevan E.
AU - Christian, Michael
AU - Ruha, Anne Michelle
N1 - Publisher Copyright:
© 2023 Wilderness Medical Society
PY - 2023/9
Y1 - 2023/9
N2 - Introduction: Compartment syndrome (CS) is a rare but serious complication after crotalid envenomation in the United States. Few data are available regarding the epidemiology and management of these cases. Significant controversy and misunderstanding over best practices, including measurement of compartment pressures and use of fasciotomy, exist for this syndrome. This study aims to describe presentation and management of suspected CS cases after native snakebite reported to the North American Snakebite Registry (NASBR). Methods: This is an analysis of snakebite cases reported to the Toxicology Investigators Consortium NASBR between January 1, 2013 and December 31, 2021. Cases of native snakebite with documented concern for CS were included. Results: Over an 8-y period, 22 cases of suspected CS were identified, representing 1% of all cases reported to the NASBR. Fasciotomies were performed in 41% (n=9) of these cases, most commonly to the upper extremity (67%, n=6). In cases of suspected CS, intracompartmental pressures (ICPs) were rarely measured (23%, n=5) and fasciotomies were performed without measurement of ICPs frequently (56%, n=5). In 1 case, ICPs were measured and found to be low (8 mm Hg) and fasciotomy was avoided. Conclusions: Measurement of compartment pressures in cases of suspected CS was uncommon in cases reported to the NASBR. Fasciotomy was commonly performed without measurement of compartment pressures.
AB - Introduction: Compartment syndrome (CS) is a rare but serious complication after crotalid envenomation in the United States. Few data are available regarding the epidemiology and management of these cases. Significant controversy and misunderstanding over best practices, including measurement of compartment pressures and use of fasciotomy, exist for this syndrome. This study aims to describe presentation and management of suspected CS cases after native snakebite reported to the North American Snakebite Registry (NASBR). Methods: This is an analysis of snakebite cases reported to the Toxicology Investigators Consortium NASBR between January 1, 2013 and December 31, 2021. Cases of native snakebite with documented concern for CS were included. Results: Over an 8-y period, 22 cases of suspected CS were identified, representing 1% of all cases reported to the NASBR. Fasciotomies were performed in 41% (n=9) of these cases, most commonly to the upper extremity (67%, n=6). In cases of suspected CS, intracompartmental pressures (ICPs) were rarely measured (23%, n=5) and fasciotomies were performed without measurement of ICPs frequently (56%, n=5). In 1 case, ICPs were measured and found to be low (8 mm Hg) and fasciotomy was avoided. Conclusions: Measurement of compartment pressures in cases of suspected CS was uncommon in cases reported to the NASBR. Fasciotomy was commonly performed without measurement of compartment pressures.
KW - fasciotomy
KW - intracompartmental pressure
KW - rattlesnake
UR - http://www.scopus.com/inward/record.url?scp=85165341006&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85165341006&partnerID=8YFLogxK
U2 - 10.1016/j.wem.2023.05.007
DO - 10.1016/j.wem.2023.05.007
M3 - Article
C2 - 37474357
AN - SCOPUS:85165341006
SN - 1080-6032
VL - 34
SP - 322
EP - 327
JO - Wilderness and Environmental Medicine
JF - Wilderness and Environmental Medicine
IS - 3
ER -