一位31歲男性以肢體腫脹及血泡為表現

<p>治療毒蛇咬傷的最有效方法，是根據咬傷毒蛇種類及時給予適當的抗蛇毒血清。本文描述一位31歲男性在進行溯溪時，右手指疑似被咬傷，患部腫脹且周邊皮膚呈現瘀青色。雖然病人沒有看到任何蛇類，但從持續肢體腫脹及瘀青研判應為出血性毒蛇咬傷，因此給予出血性抗蛇毒血清進行治療。在急診治療期間，病人有胸悶症狀，於是施打蛇毒血清後收治住院。由於肢體腫脹Blaylock分類為嚴重，且有血泡/水泡，病人非常擔心。筆者根據文獻資料及臨床經驗，評估蛇毒種類及注意毒液近端擴散速率，與醫師溝通評估血清劑量，持續觀察傷口狀況及監測肢體腫脹壓力，陪伴病人安心度過毒蛇咬傷恢復過程。此案例歸納毒蛇咬傷病人照護重點，包含鑑別診斷、正確使用抗蛇毒血清進行治療、血泡/水泡傷口照顧，及監測肢體腫脹是否達到筋膜切開的時機。此外也討論了超音波監測介入可行性，並探討毒蛇咬傷與心血管疾病的相關性。希望這個案例可以做為未來臨床專科護理師在照顧毒蛇咬傷病人時的參考。</p> <p> </p><p>The most effective treatment for venomous snake bites is the timely administration of appropriate antivenom based on the type of snake involved. This article describes a 31-year-old man who was suspected of being bitten on his right finger while river tracing. The affected area was swollen and the surrounding skin showed bruised. Although the patient did not see a snake, the persistent limb swell-ing and bruising suggested a hemorrhagic venomous snake bite, so hemorrhagic antivenom was ad-ministered. During emergency treatment, developed chest tightness and was subsequently admitted to the hospital after receiving antivenom therapy. This patient was very worried about his limb swelling was classified as severe based on the Blaylock classification, and blood blisters/vesicles had developed. Based on literature and clinical experience, the author assessed the type of snake venom and the prox-imal diffusion rate of the venom, and collaborated with physicians to determine the appropriate an-tivenom dosage. Continuous wound evaluation and limb swelling pressure monitoring were performed to guide management and support the patient throughout the recovery process. This case highlights key aspects of venomous snake bite management, including differential diagnosis, appropriate antiven-om administration, wound care for blood blisters/vesicles, and monitoring for limb swelling progres-sion to determine the need for fasciotomy. Additionally, the feasibility of ultrasound-guided monitor-ing and the potential correlation between snake bites and cardiovascular complications are discussed. We hope that this case serves as a reference for future nurse practitioners in the management of snake bite patients.</p> <p> </p>