Snake Bite (part 1): recognition

20 Oct

Epidemiology:anklebite

Most common venomous snakes in the U.S.

  • Rattlesnakes, Water moccasins (cottonmouths), Copperheads
  • Venomous = Triangular shaped head, elliptical pupils

 

Local Toxicity

  • Swelling, pain, ecchymosis, tissue necrosis and blistering
    • Proteolytic  

 

Systemic Toxicity

  • Coagulopathy
    • Thrombocytopenia
    • Thrombin-like glycoproteins in venom

 

  • Rhabdomyolysis
    • Enzymatic tissue damage adjacent to the bite.
    • Renal Failure

 

  • Compartment Syndrome
    • Subcutaneous edema

 

  • Other:
    • Hypotension, respiratory distress, oral paresthesia’s
    • Abdominal pain, vomiting and dizziness

 

Primarycopperhead

  • Airway, Breathing, Circulation
    • Angioedema, Bleeding, Hypotension

 

Secondary

  • Wound Site:
    • Swelling, pain, ecchymosis, tissue necrosis and blistering
  • Systemic Signs:
    • Oral paresthesias, refractory vomiting, abdominal pain and neurotoxicity

 

Lab Studies:

  • Coagulopathy
    • PT/PTT, INR
    • Fibrinogen
    • D-dimer
  • BMP, CBC
  • CK
  • EKG

Signs of envenomation: 

  • Prolonged PT
  • Decreased Fibrinogen or Platelets

 

Submitted by Christina Brown.

 

References: 

  • Walter FG, Chase PB, Fernandez MC, McNally J. Venomous snakes. In: Haddad and Winchester’s Clinical Management of Poisoning and Drug Overdose, 4th, Shannon MW, Borron SW, Burns MJ (Eds), Saunders, Philadelphia 2007. p.399.
  • Lavonas EJ, Ruha AM, Banner W, et al. Unified treatment algorithm for the management of crotaline snakebite in the United States: results of an evidence-informed consensus workshop. BMC Emerg Med 2011; 11:2.
  • American College of Medical Toxicology, American Academy of Clinical Toxicology, American Association of Poison Control Centers, et al. Pressure immobilization after North American Crotalinae snake envenomation. J Med Toxicol 2011; 7:322.
  • American College of Medical Toxicology, American Academy of Clinical Toxicology, American Association of Poison Control Centers, et al. Pressure immobilization after North American Crotalinae snake envenomation. Clin Toxicol (Phila) 2011; 49:881.
  • Yip L. Rational use of crotalidae polyvalent immune Fab (ovine) in the management of crotaline bite. Ann Emerg Med 2002; 39:648.
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