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prefer administering HBO therapy for at least six sessions M. Snake bite complicated by acute kidney injury secondary to
in postoperative patients if they can afford it. Prior to necrotizing glomerulonephritis. Saudi J Kidney Dis Transpl 2014;25:1259-62.
the use of HBO therapy, the general surgeon, who used 2. Halesha BR, Harshavardhan L, Lokesh AJ, Channaveerappa PK, Venkatesh
KB. A study on the clinic-epidemiological profi le and the outcome of
glycerine magsulf dressings, treated the majority. If this snake bite victims in a tertiary care centre in Southern India. J Clin
did not improve, this often led to fasciotomies. The Diagn Res 2013;7:122-6.
exact incidence of fasciotomies is not known. A course of 3. Singh V, Digra SK, Slathia SS, Kakkar T. Hemothorax following snakebite.
hyperbaric treatment for 6 days is more expensive than Indian Pediatr 2012;49:242-3.
fasciotomy, surgical charges, postsurgical dressings and 4. Bhalla G, Mhaskar D, Agarwal A. A study of clinical profile of snake bite at
extending patient care combined. As an adjunct to ASV, 5. a tertiary care centre. Toxicol Int 2014;21:203-8.
Harshavardhan L, Lokesh AJ, Tejeshwari HL, Halesha BR, Metri SS. A study
antibiotics, and surgery, HBO therapy can significantly on the acute kidney injury in snake bite victims in a tertiary care centre. J
decrease costs and complications. No studies controlled Clin Diagn Res 2013;7:853-6.
[17]
studies exist that prove the utility of HBO to date. HBO 6. Bosak AR, Ruha AM, Graeme KA. A Case of neurotoxicity following
therapy may possibly work by preventing tissue damage envenomation by the Sidewinder rattlesnake, Crotalus cerastes. J Med
that is not frankly necrotic. HBO therapy and debridement Toxicol 2014;10:229-31.
have their own roles to play in such injuries. Considering 7. Gold BS, Dart RC, Barish RA. Bites of venomous snakes. N Engl J
Med 2002;347:347-56.
the high incidence of snakebites in the Asian population, 8. Lalloo DG, Theakston RD. Snake antivenoms. J Toxicol 2003;41:277-90.
further studies into the effectiveness of HBO therapy for 9. Lavonas EJ, Ruha AM, Banner W, Bebarta V, Bernstein JN, Bush SP,
this clinical condition is warranted. Kerns WP 2nd, Richardson WH, Seifert SA, Tanen DA, Curry SC, Dart RC;
Rocky Mountain Poison and Drug Center, Denver Health and Hospital
Authority. Unified treatment algorithm for the management of
In conclusion, snakebite injuries of the extremities are
more common in Asian countries. Immediate medical care is crotaline snakebite in the United States: results of an evidence-informed
consensus workshop. BMC Emerg Med 2011;11:2.
almost always necessary. The majority of the patients 10. Tanen D, Ruha A, Graeme K, Curry S. Epidemiology and hospital course
with snakebite injuries of the extremity present with of rattlesnake envenomations cared for at a tertiary referral center in
cellulitis, compartment syndrome, and tissue necrosis. Central Arizona. Acad Emerg Med 2001;8:177-82.
Various treatment modalities including HBO therapy, 11. Tanen DA, Danish DC, Grice GA, Riffenburgh RH, Clark RF. Fasciotomy
fasciotomy, surgical debridement, skin grafting, local, worsens the amount of myonecrosis in a porcine model of crotaline
envenomation. Ann Emerg Med 2004;44:99-104.
and distant flaps may be required to provide an effective 12. Schexnayder SM, Schexnayder RE. Bites, stings, and other painful things.
management of such injuries. HBO therapy as an adjunct Pediatr Ann 2000;29:354-8.
is effective in the treatment of snakebite injuries. 13. Lykissas MG, Koulouvaris P, Kostas-Agnantis I, Gkiatas I, Milionis
HJ, Mavrodontidis AN. Snakebites of fingers or toes by Viperidae family
members: an orthopaedic approach. Acta Orthop Belg 2011;77:246-51.
Financial support and sponsorship 14. Anz AW, Schweppe M, Halvorson J, Bushnell B, Sternberg M, Andrew
Nil. Koman L. Management of venomous snakebite injury to the extremities. J
Am Acad Orthop Surg 2010;18:749-59.
Conflicts of interest 15. Rainer PP, Kaufmann P, Smolle-Juettner FM, Krejs GJ. Case report:
There are no conflicts of interest. hyperbaric oxygen in the treatment of puff adder (Bitis arietans) bite.
Undersea Hyperb Med 2010;37:395-8.
16. Bhutani S, Vishwanath G. Hyperbaric oxygen and wound healing. Indian J Plast
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17. Sahni T, Hukku S, Jain M, Prasad A, Prasad R, Singh K. Recent advances in
1. Al Qahtani MA, Altheaby A, Al Anazi T, Al Saad K, Binsalih S, Al Helail hyperbaric oxygen therapy. Med Update 2004;14:632-9.

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