Yesterday a lady working for a game lodge was busy doing a demo and ended up getting bitten on the leg by a large adult snouted cobra. She was rushed to the local hospital by car and the ambulance met her half-way and rushed her into the hosp[ital. They realised they would not be able to handle a serious bite and transferred her to Pretoria. The first hospital could not accommodate and she ended up a surgical ICU in the city.
By last night her symptoms suddenly got worse and her eyelids were drooping and she was getting weaker. This only started about 7 hours after the bite which is very unusual. I went through late last night and checked on her but I felt she did not look too bad. This morning she could not open her eyes at all and was having trouble swallowing. This is usually a precursor to respiratory failure but her oxygen levels were still well within the normal range.
We decided not to give her antivenom because she is still young and in her career she might need antivenom for a life threatening or serious cytotoxic bite. Being in an ICU we knew they could monitor her progress and act within minutes if required. I had supplied them with enough antivenom and they had it in a fridge in the unit in the event that things went downhill suddenly.
This afternoon our very own Jenna Taylor and Wolfgang Wuster got into a discussion about possibly using neostigmine which basically kick starts the nerves that have been affected. After a few minutes I decided that we should try this for the snouted bite despite it never having been done before that any of us are aware of. WW mailed me the previous research in this regard and I went off to hospital.
I then managed to convince the doctors to have a look at this option and try it. They agreed with me that it was worth a try and this evening we gave the lady a mixture prescribed by Jenna. Within a minute her eyes were open and two minutes later she was swallowing easily. She could focus and looked 100% normal.
I know it could wear off and top ups will be required but I am just glad that in this case it worked. That means that in future in rural areas where they dont have antivenom they can use neostigmine and glycopyrrolate to counter these effects even if it just helps to get the patient to where he can be ventilated.
I am tired from very little sleep and worrying all day riding up and down to check on her but now I am going to go have a beer!