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Extreme treatment ? extreme procedure ?
Link

Hi;

No, I did not see it till you brought it to my attention. Fasciotomys are a very drastic proceedure, one used in only the most extreme circumstances. Normally they are not needed because of the short time to get Antivenom on board. Because of the very long delay in treatment the attending physicians felt it was required to save the hand.

This link will get you a recient paper regarding current medical feeling about the use of this proceedure. I found it on Venom Doc's forum ( Thanks Bryan )

Cheers!!

Al

Faciotomy PDF

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The more people I meet...the better I like my venomous snakes.

Al: You might be surprised to hear that fasciotomies are not always used in the most extreme cases. My doctor wanted to perform one on me several years ago for a cottonmouth bite. I threatened to leave the hospital before allowing that, & he backed off. I was released a couple of days later. I have no nerve damaged caused by swelling, which is the reason for a fasciotomy. In fact, I have zero residual effect from the bite.

It is my opinion that a good percentage of fasciotomies used in the treatment of snakebite are unnecessary.

~~Greg~~

I hate to always be defending the doc's but what if he decided against the fasciotomy and you suffered much more severely than you did? Now you may not be the sue happy type person but I doubt you'd be at all happy about it.

Away from the MD's and to the DVM's (what I know better), I can say that as I sit here at 4AM that one or two of our patients might get by without their current iv fluids. It'd save them money right? I will also say that I am in good conscience about keeping them on fluids. What if.... There are way to many what if's in medicine and the effects of underestimating them can be dramatic. Thus doctors will use their expertise to their fullest capacity in every case if given the option.

Joey:

Did you read the paper by Dr. Dart? If not, please do so. Many of the Physicians I spoke with at the Biology of Rattlesnakes symposium that Fasciotomies almost never need to be done. Look how far that goes up the arm of that kid? How do you justify that? Cleaning dead & necrotic tissue out of the wound, yes, that make good medical sense. One of the doc's at the symposium said that fasciotomies were "Good Money Makers" for the surgeons.

No question about that looking at all the proceedures needed to close the wound!

Al
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The more people I meet...the better I like my venomous snakes.

Its very rare that a fasciotomy has to be performed on a snake bite victim, unless the bite involves digits or the anterior tibial compartment. Its imperative that if the surgeon suspects elevated compartment syndrome that he/she physicaly measures the comparment pressure, elavated pressure,depending on local protocols could be in the region of 30-40mmHg(normaly less in children). If prssure is elevated then there are other options before the surgeon can sharpen his knife. Increase the dosage of antivenom, limb elevation, the use of osmotic diuretics. Normaly aggresive treatment with antivenom reduces compartment pressure. Its important for the surgeon to remember to check that all haemostatic abnormalities have been corrected, it would be quite embarrassing to have the patient bleed to death.
regards
John

My computer wouldn't let me view the initial picture. I agree that being paid by the procedure is a conflict of interests. I'm not that familiar with the US medical system (or canadian one for that matter )but I was under the impression that the hospital gets paid by the procedure from either the insurer or the government, but that the hospital pays the doctor the same salary no matter the workload. Either way, being a "professional" is supposed to eliminate the need for doing unecessary procedures in holding medical practice above money. I do realize that some doc's may be crooks, but in dealing with vets I"ve found the huge majority to hold this proffesionalism true. In fact I havn't come across any vet who actually did unecessary procedures just for the money. (And I've actually worked for a vet who DID view money over animals, but wouldn't cross that line)

To be clear, I don't know what went on, or the MD's experience, but I doubt he read that paper from the rattlesnake symposium either and was just doing his best. Where could I find the articles as I unfortunetly wasn't able to attend?

>>I hate to always be defending the doc's but what if he decided against the fasciotomy and you suffered much more severely than you did? Now you may not be the sue happy type person but I doubt you'd be at all happy about it.
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>>Away from the MD's and to the DVM's (what I know better), I can say that as I sit here at 4AM that one or two of our patients might get by without their current iv fluids. It'd save them money right?

But what's the down side to the IV? Probably nothing. The fasciotomy makes skin grafts, multiple surgeries and many months of physical therapy necessary. I'd imagine opening someone's arm like that raises the possibility of massive infection. The arm will never be as strong as it was without a functioning fascia (does it regererate? I doubt it) and it will be disfigured for life. All of that "just in case"? Sounds like grounds for malpractice to me...

On the practical side for the doctor, you're probably right that it's a lot easier for one person to say after he's lost a limb that it was the doctor's fault for NOT performing a common procedure than for 100 people to prove that they're needlessly disfigured and bankrupt because the doctor DID perform a common procedure properly. The research of a few venom specialists probably won't hold up against decades of medical precident in court. That doesn't make it suck any less...

Joey, you can "What if" all you want. The fact remains that my doctor would have performed an unnecessary fasciotomy on my right forearm if I did not have the background that I do in snakebite treatment. I am not a doctor. Never will be. I have studied venomous snakes & snakebite for a lot longer than a lot of the people on this forum have been alive. I am glad the man finally listened to me, & that I did not have to check myself out of the hospital. Had I done that, my insurance probably would not have covered what had been done up to that point.
I still would have left without the operation.

Stay safe. ~~Greg~~

I'm not questioning the fact that you know more about snakebite treatment then any one particular MD as this is but one tiny aspect of what they need to know. It is a large aspect of what you need to know being a hot keeper. I am all for sharing this knowledge with your doctor and was just pointing out that a lack of experience isn't grounds for questioning someones professionalism. I'm sure the doctor's number one priority was saving your life. Pain, disfigurement, cost all fell into place far below that.
Also please keep in mind that I still havn't seen the picture. I had no idea that the mentioned procedure was done in such a large scale.

Did anyone else notice that he was bitten by atrox in Yosemite Nat park? Thats got to be the first sighting of atrox in that area!