• Michael A Darracq, F Lee Cantrell, Bryan Klauk, and Stephen L Thornton.
• University of California, San Francisco (UCSF) Fresno Medical Education Program, Department of Emergency Medicine, 155N. Fresno Street, Fresno, CA 93701, USA. Electronic address: mike.darracq@gmail.com.
• Toxicon. 2015 Jul 1; 101: 23-6.

BackgroundFasciotomy has been described in the treatment of rattlesnake-envenomation. We sought to compare the characteristics of patients undergoing fasciotomy with those where fasciotomy was discussed but not performed.MethodsA retrospective case-series constructed from a single-statewide-poison-system electronic database for cases of fasciotomy discussion or completion in rattlesnake-envenomation between January 2001 and May 2012. Age, gender, bite location, antivenom administered, compartment pressure measurements, Snakebite Severity Score (SSS) and length of hospitalization (LOS) were recorded. Comparisons were made between fasciotomy completed and where fasciotomy was only discussed.ResultsOne-hundred-five cases of fasciotomy discussion or completion were identified. Fasciotomy was performed in 28 cases (27%). There was no statistically significant difference (p > 0.05) between groups in age, gender, bite site, SSS, and total number of vials of antivenom administered. Only 2 of 28 (7%) had compartment pressure measurements. Patients undergoing fasciotomy spent an additional 2 days in the hospital.ConclusionsFasciotomies continue to take place, without compartment pressure measurements, and without repeat dosing of antivenom. In the absence of clear objective evidence that limb-threatening compartment syndrome occurs despite adequate antivenom administration, fasciotomy does not favorably impact morbidity and may be associated with increased costs for care following rattlesnake envenomation.Copyright © 2015 Elsevier Ltd. All rights reserved.

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