5
SEVERITY GRADING:
Severity:
nonenvenomation mild
moderate
severe
Fang Marks:
+/-
+
+
+
Pain: none
moderate
severe
severe
Edema: none
minimal
moderate
severe
(0-15cm)
(15-30cm)
(>30cm)
1
Erythema: none
+
+
+
Ecchymosis: none
+/-
+
+
Systemic Ssx's:
none
none
mild
early, severe
Labs:
NL
NL
mildly abnormal
very abnormal
1
may be minimal swelling if IM or IV envenomation
IX. LABORATORY ANALYSIS: Important in pitviper envenomations (no major changes noted with coral snake
bites):
- CBC; Platelet Count
- Type & Cross-Match (Get ASAP)
- PT/PTT/TT; Fibrinogen Levels; FSP's/d-dimer; Bleeding/Clotting Times; Clot Retrax Time
-
Electrolytes/BUN/Cr; Liver Fxn Tests; CPK
-
Cardiac
Markers
-
Urinalysis
- Arterial Blood Gases, ECG & CXR if moderate or severe or significant co-morbidity
X. MANAGEMENT OF SNAKE VENOM POISONING:
A.
First Aid Measures in Pitviper Envenomation:
1.
?? Kill the Snake and Bring it in for Identification:
- only vital to identify the snake when Mojave rattlesnake or coral snake bites are a
possibility as management is altered
- risk of a second bite to the victim or rescuer (decapitated snake heads can "bite" up to 1 hr
after killed - reflex)
- should never delay transportation of the victim
2.
Remove any Jewelry that could become a Tourniquet
3.
Calm,
Reassure: to decrease heart rate and circulation of venom
4.
Constriction Band (CB):
- controversial (not a tourniquet; avoid total occlusion of vascular supply to the extremity)
- does decrease venom spread, BUT potential risk of increased local complications (never
studied
- might consider if > 60 min. to medical care and bitten by a potentially lethal snake (e.g.
large rattlesnake)
- should be > 1/2 inch wide
- apply 5-10 cm proximal to swelling (or above proximal joint) and step-wise
advancement periodically to keep ahead of progressing edema
- apply only tight enough to occlude lymphatic & superficial venous return
- no benefit when applied > 30 minutes after bite
- maintain CB until antivenom is started (when indicated)
5.
Incision and Suction (I&S):
- NO incisions - increased risk of infection/necrosis; damage to vital structures;
hemorrhage
-
suction
controversial:
- NO proof of significant venom return
- might increase tissue loss at the bite site
6. Rest
and
Immobilization:
- put victim at rest and splint extremity in position of function, at or just below heart level
- allow room for swelling in splint
