- 作者：Subramanian Senthilkumaran ; MD&lowast ; ; maniansenthil@yahoo.co.in ; Ramachandran Meenakshisundaram ; MD&dagger ; ; Ponniah Thirumalaikolundusubramanian ; MD&Dagger ;
- 关键词：Russell viper ; hemorrhagic pericardial effusion ; cardiac arrest ; revived
- 刊名：Journal of Emergency Medicine
- 出版年：2012
- 期刊代码：156_07364679
- 类别：med
- 出版时间：March, 2012
- 卷：42
- 期：3
- 页码：288-290
- 文件大小：266 K
Background
Coagulopathy after snake bite is well known; however, cardiac tamponade as a manifestation of coagulopathy is rare.Objective
To report a case of pericardial hemorrhage with cardiac tamponade after Russell viper bite.
Case Report
A 26-year-old man developed breathlessness after being bitten by a Russell viper. The clinical and laboratory follow-up of this case confirmed the clinical diagnosis of toxin-induced disseminated intravascular coagulation. Interestingly, pericardial hemorrhage with large pericardial effusion was evident clinically as well as on electrocardiogram and echocardiogram, as an initial presentation without any other bleeding manifestations. The patient developed cardiac arrest and was revived with cardiopulmonary resuscitation. Emergency pericardiocentesis was carried out. He was given fresh frozen plasma in addition to snake antivenin along with symptomatic management. On the third day of hospitalization, the patient鈥檚 clinical and laboratory profile returned to normal and he was discharged on the fifth day.
Conclusion
Pericardial hemorrhage may be due to toxin-induced myocardial damage or pericardial vessel injury coupled with coagulopathy, possibly in conjunction with vasculitis or endothelial damage. Practitioners and physicians should suspect and search for pericardial effusion in snake bite victims who develop breathlessness, and treat it vigorously in addition to antivenin therapy.