出血性毒蛇咬傷通常在12 小時內會出現症狀. 如果當地的毒蛇咬傷會造成全身性肌肉溶解, 建議觀察24 小時(?), 出院前測量CK. 最 ...急診小醫師https://dictionary.cambridge.org/zht/日誌相簿影音好友名片201606251556蛇咬傷到院前處置?野外醫學＿登山醫學2021-05-15最近新冠肺炎疫情爆發,各地急診被塞爆台中榮總臨床毒物科台灣毒蛇咬傷診斷與治療2019-03-18編輯蛇咬傷之後.應觀察多久.才能排除毒蛇咬傷?Up-to-date上面寫,無症狀的患者,如果懷疑是神經性毒蛇咬傷.應觀察24小時(但急診教科書Rosen第八版寫6-8小時)有輕微症狀(疼痛,腫脹)觀察12小時如果沒有惡化可出院出血性毒蛇咬傷通常在12小時內會出現症狀. 如果當地的毒蛇咬傷會造成全身性肌肉溶解,建議觀察24小時(?),出院前測量CK. 最好是讓病患觀察過夜,不要傍晚或晚上放回家. Asymptomatic(drybite)—Asignificantproportionofsnakebitesdonotresultinenvenomation.Patientswithoutclinicalfeaturesoflocalorsystemicenvenomationshouldbecloselyobservedbeforedischargefrommedicalattention.Thetimerequiredforobservationinhospitalbeforedischargeofanasymptomaticpatientwithpossibleenvenomationdependsuponthevenompropertiesofthelocalsnakefaunaandthelevelofclinicalandlaboratoryexpertiseavailable[26].Clinicianswhoareunfamiliarwiththemanagementofsnakebiteshouldseekexpertconsultationwithaclinicaltoxinologist,poisoncontrolcenter,orphysicianexperiencedinmanagementofsnakebitesintheregion.(See'Additionalresources'below.)Importantconsiderationsincludethefollowing[16,17]:●Patientswithunknownsnakebitesinregionswithneurotoxicsnakespeciesmaywarrantprolongedobservation(upto24hourspost-bite).●Snakevenomsthatcauseisolatedcoagulopathywillusuallydosowithin12hoursafterenvenomation.●Inlocationswheresnakebitecancausesystemicmyolysis,observationupto24hoursandpre-dischargemeasurementofcreatinekinasemaybewarranted.●Ingeneral,itiswisetoobservesuspectedsnakebitepatientsovernight,ratherthandischargethemintheeveningoratnight,aslocalresourcesallow.下面這段是急診的教科書的內容 ROSENpage801(電子書908). Disposition病患動向.如果臨床上無明顯中毒跡象,非毒蛇或蝮蛇,可觀察6-8小時,但某些毒蛇的毒性可能在8小時之後才出現,如果觀察八小時都沒有出現毒性徵象,可讓病患離院.建議給予破傷風疫苗.傷口處理指引,約24-48小時回診追蹤.需衛教病患哪些是遲發性症狀,需回急診評估.  Ifnoenvenomationisevidentafterclinicalexaminationandthe snakewaseithernonvenomousorapitviper,thevictimcan beobservedfor6to8hours.Withsomesnakebites,however, toxicitymaybedelayedbyupto8hours.Ifnosignofenvenomation isseenafter8hours,thepatientmaybedischarged.These pati