Snake bites: Difference between revisions
No edit summary |
|||
| Line 23: | Line 23: | ||
==Management== | ==Management== | ||
{{Snake bite local treatment}} | |||
===Supportive care=== | |||
*IVF and pressors if needed for hypotension | |||
*Blood components rarely needed | |||
*Treatment mainly depends upon the presence of an [[Envenomation|envenomation]] | *Treatment mainly depends upon the presence of an [[Envenomation|envenomation]] | ||
*Indications: | *Indications: | ||
**Progression of local injury - pain, swelling, ecchymosis | **Progression of local injury - pain, swelling, ecchymosis | ||
| Line 31: | Line 37: | ||
*Irrigation of the wound is necessary regardless of the type of snake bite | *Irrigation of the wound is necessary regardless of the type of snake bite | ||
*Debridement and removal of devitalized tissue may be necessary for severe bites | *Debridement and removal of devitalized tissue may be necessary for severe bites | ||
===Antivenom=== | |||
*Snake specific treatments depend upon [[Coral snake]] or [[Crotaline (Pit Vipers)|Pit viper]] envenomations | *Snake specific treatments depend upon [[Coral snake]] or [[Crotaline (Pit Vipers)|Pit viper]] envenomations | ||
Revision as of 23:31, 9 May 2017
Background
- An average of 5000 native venomous snakebites are reported to US poison centers annually[1]
- In the United States, snake bites can be organized into Crotaline (Pit Vipers) and Elapidae (Coral Snakes)
- Crotalidae family also includes rattlesnakes, Sistrurus and Agkistrodon species (water moccasins and copperheads).[2]
- Risk Factors: "The 'T's" Testosterone, Tequila, Tshirt, Tattoos, Toothless, Teasing, Trailer park, Truck
Venom
- Snake venom is a mixture of proteins, peptides, lipids, and metal ions.
- Many bites can be "dry bites" where not venom is released, about ~1/4
Clinical Features
- Local injury - punctures marks from fangs not always visible, erythema, and edema
- Ooze at fang mark reliable sign of envenomation
- Nausea/vomiting
Differential Diagnosis
Envenomations, bites and stings
- Hymenoptera stings (bees, wasps, ants)
- Mammalian bites
- Closed fist infection (Fight bite)
- Dog bite
- Marine toxins and envenomations
- Toxins (ciguatera, neurotoxic shellfish poisoning, paralytic shellfish poisoning, scombroid, tetrodotoxin
- Stingers (stingray injury)
- Venomous fish (catfish, zebrafish, scorpion fish, stonefish, cone shells, lionfish, sea urchins)
- Nematocysts (coral reef, fire coral, box jellyfish, sea wasp, portuguese man-of-war, sea anemones)
- Phylum porifera (sponges)
- Bites (alligator/crocodile, octopus, shark)
- Scorpion envenomation
- Reptile envenomation
- Spider bites
Evaluation
- Clinical Diagnosis
Management
Local Care
- Do:
- Remove all jewelry
- Mark the leading edge of erythema/edema
- Do not:
- Attempt to suck out the venom
- Place the affected part in cold water
- Use a tourniquet or wrap
- Antivenom is first line treatment for compartment syndrome; fasciotomy is last resort if elevated pressures persist.
Supportive care
- IVF and pressors if needed for hypotension
- Blood components rarely needed
- Treatment mainly depends upon the presence of an envenomation
- Indications:
- Progression of local injury - pain, swelling, ecchymosis
- Coagulopathy - elevated PT/PTT/INR, low fibrinogen, thrombocytopenia
- Systemic effects - hypotension, altered mental status, nausea and vomiting, paresthesias
- Always provide supportive care and treat local effects of any wounds
- Irrigation of the wound is necessary regardless of the type of snake bite
- Debridement and removal of devitalized tissue may be necessary for severe bites
Antivenom
- Snake specific treatments depend upon Coral snake or Pit viper envenomations
Disposition
- All snake bites with evidence of envenomations should have a period of observation and possible hospitalization
- Old bites can be assessed an discharged if no evidence of envenomation.