Snakebite Follow-up
- Author: Brian James Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Rick Kulkarni, MD more...
Further Inpatient Care
- Admission to the hospital is routine for most envenomation cases. A "dry bite" without envenomation can occur in a significant percentage of cases (50% in coral snake, 25% from pit viper).
- For dry pit viper bites, observe in the emergency department for 8-10 hours; however, often this is not feasible. Patients with severe envenomation need specialized care in the ICU to administer blood products, provide invasive monitoring, and ensure airway protection.
- Observe coral snakebites for a minimum of 24 hours.
- Perform serial evaluations for further grading and to rule out compartment syndrome. Depending on clinical scenarios, measure compartment pressures every 30-120 minutes. Fasciotomy is indicated for pressures greater than 30-40 mm Hg.
- Depending on the clinical severity of the bite, further blood work may be needed, especially clotting studies, platelet count, and fibrinogen level.
Further Outpatient Care
Limit outpatient care to local wound care.
Deterrence/Prevention
Wear protective clothing and never handle snakes.
Complications
- Compartment syndrome is the most frequent complication of pit viper snakebite.
- Local wound complications may include infection and skin loss.
- Cardiovascular complications, hematologic complications, and pulmonary collapse may occur.
- Neurotoxicity with myokymia of the respiratory muscles may lead to respiratory failure and mechanical ventilation.
- Death is rare.
- Prolonged neuromuscular blockade may occur from coral snake envenomation.
- Antivenin-associated complications include immediate (anaphylaxis, type I) and delayed (serum sickness, type III) hypersensitivity reactions.
- Anaphylaxis is an event mediated by immunoglobulin E (IgE), involving degranulation of mast cells that can result in laryngospasm, vasodilatation, and leaky capillaries. Death is common without pharmacological intervention.
- Serum sickness occurs 1-2 weeks after administering antivenin. Precipitation of antigen-immunoglobulin G (IgG) complexes in the skin, joints, and kidneys is responsible for the arthralgias, urticaria, and glomerulonephritis (rarely). Usually more than 8 vials of antivenin must be given to produce this syndrome. Supportive care consists of antihistamines and steroids.
- Newer studies now report a lower incidence (5.4%) of acute hypersensitivity reactions with FabAV.[10]
Prognosis
Full recovery is the rule, though local complications from envenomation may occur. Death occurs in less than 1 bite in 5000.
Patient Education
- For excellent patient education resources, visit eMedicine's Bites and Stings Center. Also, see eMedicine's patient education article Snakebite.
- A new web site (Australian Venom Research Unit) based at the University of Melbourne in Australia comprehensively outlines the species, first aid, and treatment of all venomous creatures indigenous to the region. The web site is easily navigated and sectionally divided for the practitioner, interested epidemiologists, snake fanciers, and children of Australia and the Asia/Pacific region.
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