9
- r/o retained fangs/teeth in wounds (examine wounds closely; x-rays)
- update tetanus status prn
- clean wounds with germicidal solution
- leave wounds open & cover with light, sterile dressing
- splint in position of function (well padded) with cotton between fingers/toes
- elevate after antivenom, if indicated, has been started
- can use 1:20 Burow's solution soaks several times/day (15 min per treatment); daily sterile
whirlpool baths
- paint wounds with triple dye (Brilliant Green 1:400; Gentian Violet 1:400; Acriflavine
1:1000) 4 times/wk
-
apply
antimicrobial
ointment
qHS
- hyperbaric oxygen therapy may be useful in cases with severe necrosis
- debride blebs, vesicles, & superficial necrotic tissue @ 2-6 days
- physical therapy (active & passive) should begin early (after the first debridement)
-
prophylactic
antibiotics:
- controversial, but many recommend in all with > minimal envenomation
- use broad spectrum X several days (cephalosporin, ampicillin, tetracycline, or
erythromycin)
8. Monitor:
- extremity circumference q 15 min early, then q 1 hr X 48 hr
- vital signs, mental status
- urine output (dipstick all for blood)
- CBC, coags, UA (monitor any abnormal labs q 1 hr until stabilized)
C.
First Aid Measures in Coral Snake Envenomation:
- none of proven benefit except rest, reassurance, and rapid transportation
- possible use of Australian "pressure/immobilization" technique
D.
Hospital Management of Coral Snake Envenomation:
1. General:
- ABC's (may require aggressive respiratory support)
- 0
2
, monitor
-
2
large
bore
IV's
- cleanse wounds & r/o retained teeth
-
tetanus
prophylaxis
2. Antivenom:
- manufactured by Wyeth Labs (North American Coral Snake Antivenin)
- only designed for use in bites by the Eastern and Texas coral snakes (not the Arizona coral
snake, which has never caused a fatality
)
- remember that Ssx's are frequently delayed - if fang marks are present and the snake has
been identified as a coral snake, antivenom should be given immediately - do not wait for
Ssx's to appear (may be unable to reverse or halt progression at that stage)
- Dosage: 3-6 vials in 500-1000 ml NS or RL IV after skin testing
- should neutralize the maximal dose of venom a coral snake is capable of
delivering
- give 3-5 vials more if Ssx's appear/worsen (rarely require > 10 vials)
- in allergic individuals, it may be better to withhold antivenom and treat
conservatively (ventilatory support)
XI. DISPOSITION:
- admit all pitviper envenomations for > 24 hours
- observe all pitviper "dry bites" for > 6 hr prior to discharge (may then discharge home if no symptoms and
totally normal vital signs for bed rest, elevation of the extremity, & close observation for 24 hrs)
- admit all possible coral snake, Mojave rattlesnake & exotic snake bites for > 24 hours regardless of Ssx's
XII. MORBIDITY AND MORTALITY:
