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Depending on poison: airway management, CPR, poison antidote, patient placed on left side, supportive care (I.V. fluid replacement, oxygen therapy, seizure precautions)
Source: Professional Guide to Diseases (Eighth Edition), 2005
Patient positioned lying down, with bitten limb placed lower than heart; surgical debridement; antivenin; I.V. fluids; blood products; endotracheal intubation and mechanical ventilation; analgesics
Source: Professional Guide to Diseases (Eighth Edition), 2005
Prompt, appropriate first aid can reduce venom absorption and prevent severe symptoms.
❑ If possible, identify the snake, but don’t waste time trying to find it.
❑ Place the victim in the supine position to slow venom metabolism and absorption.
❑ Don’t give the victim any food, beverage, or medication orally.
❑ Authorities disagree about what constitutes appropriate prehospital care. Some recommend against placing a constrictive tourniquet (band) on the affected limb unless the victim is far from a medical facility.
❑ Whether you apply a tourniquet or not, immediately immobilize the victim’s affected limb below heart level, and instruct the victim to remain as quiet as possible.
❑ If a tourniquet is applied, the victim or the person applying the tourniquet should check the victim’s distal pulses regularly and loosen the tourniquet slightly as needed to maintain circulation. Remember that the goal of applying a tourniquet is to obstruct lymphatic drainage, not blood flow.
❑ When indicated, apply the tourniquet so that it’s slightly constrictive, obstructing only lymphatic and superficial venous blood flow. Apply the band about 4(10 cm) above the fang marks or just above the first joint proximal to the bite. The tourniquet should be loose enough to allow a finger between the band and the skin. After the tourniquet is in place, don’t remove it until a physician has examined the victim.
❑ If the patient is more than a few hours away from a hospital, wash the skin over the fang marks. Within 5 to 15 minutes of a pit viper bite, make an incision through the fang marks about ½"(1.3 cm) long and ⅛"(3.2 mm) deep. Be especially careful if the bite is on the hand, where blood vessels and tendons are close to the skin surface.
Using a bulb syringe — or, if no other means is available, mouth suction — apply suction for up to 1 hour in the absence of antivenin administration.
❑ Record the signs and symptoms of progressive envenomation and when they develop. Most snakebite victims are hospitalized for only 24 to 48 hours. Treatment usually consists of antivenin administration, but minor snakebites may not require antivenin. Other treatments include tetanus toxoid or tetanus immune globulin; various broad-spectrum antibiotics; and, depending on respiratory status, severity of pain, and the type of snakebite, acetaminophen, codeine, morphine, or meperidine. (Opioids are contraindicated for the treatment of coral snakebites.)
Necrotic snakebites usually need surgical debridement after 3 or 4 days. Intense, rapidly progressive edema requires fasciotomy within 2 or 3 hours of the bite; extreme envenomation may require amputation of the limb and subsequent reconstructive surgery, rehabilitation, and physical therapy.
Source: Professional Guide to Diseases (Eighth Edition), 2005
Prompt, appropriate first aid can reduce venom absorption and prevent severe symptoms.
❑ If possible, identify the snake, but don’t waste time trying to find it.
❑ Place the victim in the supine position to slow venom metabolism and absorption.
❑ Don’t give the victim any food, beverage, or medication orally.
❑ Authorities disagree about what constitutes appropriate prehospital care. Some recommend against placing a constrictive tourniquet (band) on the affected limb unless the victim is far from a medical facility.
❑ Whether you apply a tourniquet or not, immediately immobilize the victim’s affected limb below heart level, and instruct the victim to remain as quiet as possible.
❑ If a tourniquet is applied, the victim or the person applying the tourniquet should check the victim’s distal pulses regularly and loosen the tourniquet slightly as needed to maintain circulation.
CLINICAL TIP: Remember that the goal of applying a tourniquet is to obstruct lymphatic drainage, not blood flow. The use of a tourniquet in prehospital care is controversial.
❑ When indicated, apply the tourniquet so that it’s slightly constrictive, obstructing only lymphatic and superficial venous blood flow. Apply the band about 4" (10 cm) above the fang marks or just above the first joint proximal to the bite. The tourniquet should be loose enough to allow a finger between the band and the skin. After the tourniquet is in place, don’t remove it until the victim is examined by a physician.
Caution: Don’t apply a tourniquet if more than 30 minutes has elapsed since the bite. Keep in mind also that total tourniquet time shouldn’t exceed 2 hours and that the use of a tourniquet shouldn’t delay antivenin administration. Remember: Loss of a limb is possible if a tourniquet is too tight or if tourniquet time is too long.
❑ If the patient is more than 30 minutes away from a facility, wash the skin over the fang marks. Within 1 hour of a pit viper bite, make an incision through the fang marks about ½" (1.3 cm) long and ⅛" (0.3 cm) deep. Be especially careful if the bite is on the hand, where blood vessels and tendons are close to the skin surface.
Using a bulb syringe — or, if no other means is available, mouth suction — apply suction for up to 2 hours in the absence of antivenin administration.
Remember: An incision and suction are effective only in pit viper bites and only within 1 hour of the bite and if transport time to an emergency facility would exceed 30 minutes. Mouth suction is contraindicated if the rescuer has oral ulcers, if the victim is close to a medical facility, or if antivenin can be given promptly.
❑ Never give the victim alcoholic drinks or stimulants because they speed venom absorption. Never apply ice to a snakebite because it will increase tissue damage.
❑ Record the signs and symptoms of progressive envenomation and when they develop. Most snakebite victims are hospitalized for only 24 to 48 hours. Treatment usually consists of antivenin administration, but minor snakebites may not require antivenin. Other treatments include tetanus toxoid or tetanus immune globulin; various broad-spectrum antibiotics; and, depending on respiratory status, severity of pain, and the type of snakebite, acetaminophen, codeine, morphine, or meperidine. (Opioids are contraindicated in coral snakebites.)
Necrotic snakebites usually need surgical debridement after 3 to 4 days. Intense, rapidly progressive edema requires fasciotomy within 2 to 3 hours of the bite; extreme envenomation may require amputation of the limb and subsequent reconstructive surgery, rehabilitation, and physical therapy.
Source: Handbook of Diseases, 2003
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