Special Operations Forces Medical Handbook

5-146

bleeding and/or infection. An aggressive surgical approach is more likely to cause harm than good, so delay
fasciotomy (see Procedures: Compartment Syndrome Management) as long as feasible.

2. Early, prophylactic, broad-spectrum antibiotic therapy (second-generation cephalosporin – Keex/Ancef) is
   reasonable but not generally recommended. If suction by mouth has been done, prophylax with erythromycin.
   Treat infection, if it develops as appropriate. NOTE: Redness, swelling, pain, and increased warmth in the
   surrounding tissue occur in both envenomation and infection.
   Alternate: Support the airway, maintain adequate oxygenation, ventilation, urine output and blood pressure
   until specific, neutralizing, antivenin can be administered. There is no good evidence supporting that any first
   aid measures aside from those describe herein.
   Primitive: Maintaining airway and urine output will save most patients. An overly aggressive surgical approach
   and resorting to various unproven therapies will cause more harm than good.
   Empiric: In the proper circumstances, assume snakebite with envenomation and observe patient for 4-6 hours
   for development of signs/symptoms. If no signs/symptoms after 6 hours, consider bite w/o envenomation.

Patient Education
General: Do not handle snakes, especially after drinking alcohol.
Activity: Limit activity after bite. May return to activity as tolerated after resolution of symptoms.
Diet: Initially, NPO except for water. Regular diet as tolerated later.
Wound Care: Cleanse wound gently, remove any venom that may be present on the skin. Debride wound in
48-72 hrs if indicated – avoid early, excessive debridement. Watch for infection, which is difcult to distinguish
from envenomation in the early stages.
No Improvement/Deterioration: Return for reassessment for cold or pulseless limb, changes in mental
status, or development of blood in urine and/or decreasing urinary output.

General Characteristics of Venomous and Non-venomous Snakes

Pit Vi pers Corals Rat Snakes, etc.

Round pupil

(Northern Pacific Rattlesnake) (Eastern Coral Snake) (Trans-Pecos Rat Snake)

Elliptical pupil

Nostril

Nostril

Pit

Single row of

subcaudal scales

Double row of

subcaudal scales

Double row of

subcaudal scales

Split anal plate

Anal plate

Keeled scales

Rounded head

Tr iangular head Oval head

Copperheads and

Cottonmouths