ENVIRONMENTAL EMERGENCIES■ Local petechiae or ecchymosis
■ Bullae (may be hemorrhagic)
■ Systemic toxicity
■ Oral paresthesias
■ Metallic taste
■ Fasciculations
■ Tachycardia and hypotension
■ Anaphylaxis
■ Coagulopathy
■ Thrombocytopenia, elevated PT, decreased fibrinogen
TREATMENT
■ Prehospital:
■ Immobilize extremity in neutral position.
■ No incision and suction
■ No tourniquet
■ Minimize physical activity, if possible, but seek medical care immediately
even if it means hiking out of deep wilderness.
■ Mark leading edge of tenderness/swelling to follow progression.
■ Aggressive supportive care, wound care, tetanus prophylaxis
■ Prophylactic antibiotics are notindicated.
■ Correct coagulopathy as needed.
■ Elevate extremity and immobilize.
■ Treat anaphylaxis aggressively.
■ Antivenom
■ A newer sheep-derived antivenom (CroFab) is available (less antigenic
than the polyvalent horse serum antivenom).
■ Watch closely for allergic reaction.
■ Indications include severe local effects or systemic illness (see Table 13.5).
■ Serum sickness can sometimes occur following administration.
FIGURE 13.3. Local toxicity from rattlesnake envenomation.
(Courtesy of Sean P. Bush, MD as reproduced, with permission, from Knoop KJ, Stack LB,
Storrow AB.Atlas of Emergency Medicine, 2nd ed. New York: McGraw-Hill, 2002:528.)
Compartment syndrome is
rare as venom is in SQ tissue
not fascial compartments.