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SPRINGFIELD NEWS LEADER (Missouri) 04 April 04 Quick care saves girl bitten by snake
St. Louis (AP): A little girl on a fishing trip with her family nearly lost her arm after she was bitten by a poisonous snake that she had reached down to pet or pick up.
Dezaray Brown, 3, and her family, of Crane, were returning to their car after a day of fishing March 27 in southwest Missouri.
She was walking down a trail when she noticed a snake on the ground. She reached down for it, and it bit her, said her father, Joseph Brown.
Her hand immediately started swelling.
Her parents drove to the nearest gas station and called 911. The paramedics feared the child might go into cardiac arrest because she weighed less than 40 pounds. She was taken by helicopter to a hospital in Springfield, where she was treated with three bags of antivenin, but her hand and right arm continued to swell.
Early the next day, she was taken by helicopter to Cardinal Glennon Children's Hospital in St. Louis, where doctors performed emergency surgery to relieve the swelling.
A week later, the little girl was spirited and feeling better. Dr. Zakir Sabry performed another surgery Friday to close the incisions made during the first surgery. Dezaray was expected to go home this weekend.
"She could have lost her life" if she had not received prompt medical attention, Sabry said. Last summer, six children bitten by poisonous snakes were treated at Cardinal Glennon.
Experts say snakes are now coming out of hibernation, just as people are heading outdoors for hiking, fishing and camping.
Southwest Missouri is home to five different species of venomous snakes, said Jeff Ettling, curator of reptiles at the St. Louis Zoo. The most common is the copperhead, which is probably the snake that bit Dezaray, her father said.
Ettling advises people to wear protective shoes and walk with heavy steps in areas where snakes are found — lakes, ponds, creeks, bluffs and ledges. He warned against placing hands under rocks or logs, where a snake may be resting.
Ettling said snakes do not attack people but will strike in self-defense.
Dezaray's mother, Rhonda Brown, said her daughter had learned her lesson: "She doesn't want anything to do with (snakes)."
"We thought we were being careful," said Joseph Brown, 27. His daughter, the youngest of four children, frequently goes hunting and fishing with her father.
Quick care saves girl bitten by snake

They should have continued antivenin therapy until swelling began to subside. There is seldom if ever a need for fasciotomy (incisions to relieve pressure from swelling) as snakebite treatment. Only reason I don't say never is that I don't like the word.

~~Greg~~

It appears to be the standard treament in the the states,fasciotomy.It would be interesting to see if they actually made an atempt to measure the compartment pressure.Even if it was elevated they still would have time for aggressive AV treatment and possible use of osmotic diuretics.Its amazing how quickly the body recovers after neutralizing the venom.Hope she's doing well.
John

I'm sure she's doing fine, but her arm will be scarred for life.

I was treated for a pretty serious Agkistrodon bite in '91. The doctor told me, before doing anything to determine compartment pressure, that he was going to "make some longitudinal incisions in the forearm to relieve pressure to prevent nerve damage." I told him that was a fasciotomy & that I'd walk out of his flippin' hospital before that happened. He backed down & did some monitoring of the swelling. I was released two days later, with no further treatment, & no scars, and zero lasting damage from the cottonmouth bite.

~~Greg~~
Florida's Venomous Snakes

While it may be rarely used, a fasciotomy is still somewhat common in cases of extreme swelling from what I've read and heard. The new series they have.. Venom ER had one on the original program before they actually started the series. It was pretty nasty looking. But it saved the guy's arm which otherwise would have been amputated. As it was he lost considerable muscle mass in that arm from necrotic tissue if I remember correctly.
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Lucien

1.1 Columbian Redtail Boa (BCI)(Sutekh and Isis)
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They may have done this becasue it was on a CHILD and her pain tolerance may have been over the top, and rather than ply her with a slew of pain-killing drugs, they decided to try the cutting method. I'm wondering whether they simply cut her arm open to relieve swelling or did they remove muscle and tissue also? I'm also wondering why they felt the need to send her to St. Louis since there are quite competent doctors and hospital facilities in the Springfield-Branson area, and these people are from the area. Hopefully she'll have a minimal hairline scar!

Fasciotomy is never implicated in a properly treated snake envenomation.
Also, Fasciotomy and "small hairline scar" do not go together in the same sentence.
I have a real nice video Doctor Glass made when he first pioneered the procedure for use in snake envenomation in South Texas.
The only reason to perform the proceedure in my opinion is to add that extra 10-15,000 dollars to the doc bill.
My 2 cents
taphillip
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It's what you learn AFTER you know it all that counts!

Terry