5-144
Respiratory If anaphylaxis: Elapidae/Hydrophidae: Elapidae/Hydrophidae:
Bronchospasm/respiratory Respiratory paralysis/arrest, Respiratory paralysis/arrest
arrest Elapidae/ death can last up to a week. Death,
Hydrophidae: May if it occurs, tends to occur
produce early respiratory early
paralysis/arrest but
usually delayed
Cardiovascular Anaphylaxis may cause Hypotension, shock, diffuse Usually no long term
hypotension/shock. ecchymosis, significant complications
Crotalidae: Diffuse swelling
bleeding, 3rd spacing,
hypotension, shock.
Elapidae: Arrhythmias,
cardiac arrest
GI All: Vomiting Elapidae/Hydrophidae: Usually no long term
Diarrhea complications
Neuro Elapidae/Hydrophidae: Elapidae/Hydrophidae: ↓Range of motion
Difficulty focusing; Muscular incoordination, (ROM), weakness,
paralysis of the eye twitching, muscle paralysis numbness, burning/tingling
muscles, eyelids; difficulty (include respiratory muscles); sensation
opening mouth, speaking, altered mental status, coma
swallowing, paralysis of
the jaw and tongue
Renal Usually no early renal Crotalidae: Gross hematuria. Crotalidae: Renal failure or
problems Hydrophidae: Reddish-brown recovery
urine
Soft Tissue Crotalidae: Usually two Crotalidae: Significant Crotalidae: Usually no long
fang punctures at site of swelling, tissue necrosis, term morbidity, but
bite, rapid onset of petechiae, ecchymosis, compartment syndrome, tissue
swelling bullae– local & poss. diffuse necrosis, ↓ROM may occur
Using Advanced Tools: Lab: Hematocrit, urinalysis and 12-lead EKG to assess renal and cardiac complica-
tions. Blood transfusion: type and crossmatch as required.
Assessment
Differential Diagnosis - Non-venomous snakebite; venomous bite from animal other than a snake; other
sources of intoxication.
Plan
Treatment Goals: rapid transport to hospital-level care, delay progress of envenomation and alleviate early
symptoms.
Primary
- Ensure airway is patent and adequate -- if not, secure airway. If hypoxic and/or hypoventilating, apply O 2
and assist respirations, prevent aspiration (lay the patient on their side), intubate as required. - Start an IV in all snakebitten patients (in an unbitten extremity). Fluid resuscitation to support blood
pressure and maintain urine output (see below). Drink water as tolerated but otherwise NPO. NO
ALCOHOL! Be prepared for shock. - Monitor vital signs with pulse oximetry and cardiac monitoring if available. Treat arrhythmias per ACLS
guidelines – NOTE: Muscle breakdown may release significant potassium, so consider hyperkalemia if