Laboratory evaluation in Crotaline or Elapid Snakebite
CBC, PT, PTT, INR, Fibribogen levels - performed ASA then repeated after 12h
platelet count
Creatine kinase
Serum electrolytes
BUN, Creatinine
ECG - >50y
ABG - if with respi compromise
Critical actions - First aid
- Retreat well beyond striking range. Many victims are bitten again while trying to capture the snake.
- Remain calm. Movement will increase venom absorption.
- Immobilize the extremity in a neutral position below the level of the heart.
- Ensure prompt transport to a medical facility whether or not there are signs of envenomation.
- Constriction bands (see text) can be applied if there is no nearby medical facility.
*pressure immobilization (bandage sa wound itself) - for elapid snake bites
Critical actions - ED
- Anti venom if with progression of symptoms (local, hematologic or systemic)
- FabAV (4-6 vials) repeat if no initial controls achieved, if yes, 2 vials doses at 6, 12, and 18h after initial control
- Mark the bite wound borders Q30mins
- repeat labs Q4
*elapid - as product instruction, dilute 1:10
others: IV fluids, vasopressors, blood products, wound management, tetanus immunization
If compartment syndrome occurs:
• Elevate limb.
• Administer mannitol, 1–2 grams/kg IV over 30 min.
• Simultaneously administer additional antivenom over 60 min.
*If elevated compartment pressure persists for another 60mins - do fasciotomy
Disposition
Observe for at least 6 to 8 hours in the ED before determining disposition
- Dry bite - may discharge
- advise to return if with pain, swelling or bleeding develops
Admit - if with severe or life-threatening bites
ICU
Ward - mild to moderate envenomations
