{'fraction_non_alphanumeric': 0.018556701030927835, 'fraction_numerical': 0.024054982817869417, 'mean_word_length': 5.1155462184873945, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Extracorporeal techniques in the treatment of poisoned patients

intracerebral haemorrhage was suspected and further blood was taken for coagulation studies prior to the administration of a further 6000 units of tiger snake antivenom and 4 units of fresh frozen plasma. The INR was 19.1, the APTI greater than 300 and the platelet count 226 x 10'1L. 60 minutes after the seizure the patient lost consciousness and the right pupil became dilated. Decorticate posturing was present. The patient was intubated and given 500 mL of 20% mannitol solution and 12 mg of dexamethasone by intravenous infusion. Following a further 3000 units of antivenom and a total of 10 units of fresh frozen plasma, the INR was 2.7 and the APTI 59 seconds. While arrangements were made to transfer the patient to a neurosurgical centre, both pupils became dilated and unreactive. After transfer, a computed tomographic scan of the head confirmed the presence of a massive right intracerebral haemorrhage. Supportive care was withdrawn the following day when the diagnosis of brain death was established. At autopsy, there was a massive right intracerebral haemorrhage, with rupture into the right lateral ventricle, and further small haemorrhages in the right basal ganglia and cerebellum. The brain was oedematous, and there was both right tentorial and subfalcial herniation. The remainder of the organs were normal. We believe this case raises two important practical points in the management of tiger snake bite. Firstly, we would caution against the subcutaneous or especially the intravenous use of adrenaline before the administration of antivenom in those with a coagulopathy. Hypertension following the administration of adrenaline can be unpredictable and it may have been a factor in causing cerebral haemorrhage in this patient. Secondly, we would suggest that the presence of a severe coagulopathy soon after a tiger snake bite is an indicator of severe envenomation. We would suggest that extra ampoules of antivenom be administered early in such cases. Over-reliance on additional timeconsuming tests of coagulation when coagulopathy already exists may delay the administration of the higher doses of antivenom required. We would stress the importance of prompt treatment once an assessment of the likelihood and severity of envenomation has been made. Bruce H McGarity, MB BS Physician Geoffrey P Marshall, FRACGP Director. Accident and Emergency Bathurst Base Hospital. Bathurst. NSW 2795 John A Loadsman, MB BS Anaesthetic Registrar Susan J Carr, MB BS Pathology Registrar Clive G Harper, FRCPA Professor of Neuropathology Royal Prince Allred Hospital. Camperdown. NSW 2050 1 Tibballs J. Henning RD. Sutherland SK. Kerr AR Fatal cerebral haemorrhage after tiger snake (Nctectus scutatus) envenomation MedJAus11991. 154275·276 2 Sutherland SK. Australian animal toxins Melbourne Oxford University Press. 1983 194·205