TAILIEUCHUNG - Critical Care Obstetrics part 57

Critical Care Obstetrics part 57 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Overdose Poisoning and Envenomation During Pregnancy Table Snake envenomation during pregnancy by type of snake and maternal effects US 1999. Type of snake No. Minor effect Moderate effects Major effects No. follow-up Copperhead 2 2 100 0 0 0 Rattlesnake 3 2 67 0 1 33 0 Nonpoisonous 8 3 37 0 0 5 63 Unknown snake 5 3 60 1 20 0 1 20 Total 18 10 56 1 5 1 5 6 34 Minor effects are signs or symptoms developing from the exposure but minimally bothersome and generally resolving without residual disability. A moderate effect is one that is more pronounced or prolonged than minor effects usually requiring some form of treatment. Major effects are life-threatening signs or symptoms of the exposure that result in significant disability or disfigurement. Reproduced by permission from Toxic Exposure Surveillance System TESS . Exposures in Pregnant Women 1999. AAPCC 2000. USA include the rattlesnakes Sistrurus and Crotalus spp. and the moccasins snakes cotton-mouths Agkistrodon piscivorus and copperheads Agkistrodon contortrix . Overall rattlesnakes cause two-thirds of all bites by identified venomous snakes in the USA. Venom usually is injected into subcutaneous tissue via fangs occasionally intramuscular or intravenous injection can occur. Dry bites no envenomation occur in as many as 50 of strikes. Venom generally is composed of several digestive enzymes and spreading factors which result in local and systemic injury. The venom may be cytotoxic hematotoxic neurotoxic rhab-domyolytic cardiotoxic nephrotoxic or may cause an autoimmune reaction complement activation . In general viper Crotalidae spp. venom is mainly cytotoxic whereas elapid venom is mainly neurotoxic colubrid venom predominantly hemotoxic and sea snake venom chiefly myotoxic 174 . S ubdivision of symptoms into local autopharmacological antihemostatic neurological muscular cardiac and renal effects help to stage the patient. In conjunction with information on geographical distribution habitat and behavior of

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