Further Inpatient Care
Admit patients with a significant systemic reaction or with abnormal lab study and/or ECG findings, possibly to a monitored setting.
The bitten extremity should be placed in a well-padded splint and elevated to the patient's heart level or higher to reduce edema.
Institute standard daily wound care, including cleansing, topical antibiotic application, and dressing.
Physical therapy can help speed the return to full function.
Admission for pain control may be warranted.
Further Outpatient Care
All victims of helodermatid bites should be observed in the ED for at least 6 hours.
Reliable patients who are relatively asymptomatic, with normal vital signs and lab findings, can be discharged with instructions to return for any worsening symptoms. A responsible adult should be available to help the patient return if necessary.
Provide instructions for wound care (eg, clean the wounds twice per day with soap and water, followed by peroxide; apply a topical antibiotic ointment and dressing).
Signs and symptoms of wound infection should be discussed with the patient.
Arrange a follow-up appointment for a wound check in 24-48 hours.
Inpatient & Outpatient Medications
Give a prescription for antibiotics (eg, cephalexin) to patients who are being prophylactically treated.
A prescription for a narcotic analgesic, such as hydrocodone, may be appropriate.
Transfer
Transfer of victims with evidence of severe envenoming to a center with experience in dealing with these cases may be prudent. Consultation with an experienced provider is recommended (see Consultations above).
Deterrence/Prevention
Avoid handling or otherwise disturbing venomous lizards.
Because these creatures spend approximately 99% of their lives underground, the opportunity to see one in the wild is a great privilege. The urge to pick up or capture it should be strongly suppressed. These animals are legally protected in all regions in which they occur.
A Gila monster (Heloderma suspectum). Photo by Holly McNally. Complications
Any of the attendant complications of shock may be encountered.
Myocardial infarction may occur.
Coagulopathy is a rare complication.
Wound infections may occur, especially in the setting of a retained tooth.
Necrosis is notably rare.
Allergic or anaphylactic reactions are also rare, but have been described.[2]
Prognosis
The prognosis is excellent for those with a lizard envenomation, although pain may be an issue for many days.
Patient Education
Bitten victims should receive instructions regarding standard wound care, elevation of the bitten extremity, signs and symptoms of infection, and medications to be taken.
Patients should be educated to avoid close interactions with potentially dangerous wildlife in the future.
Mebs D. Clinical toxicology of Helodermatidae lizard bites. In: Handbook of Clinical Toxicology of Animal Venoms and Poisons. 1995: 361-366.
Piacentine J, Curry SC, Ryan PJ. Life-threatening anaphylaxis following gila monster bite. Ann Emer Med. 1986;15:959-961. [Medline].
Bou-Abboud CF, Kardassakis DG. Acute myocardial infarction following a Gila monster (Heloderma suspectum cinctum) bite. West J Med. 1988;148(5):577-579. [Medline].
Preston CA. Hypotension, myocardial infarction, an coagulopathy following gila monster bite. J Emer Med. 1989;7:37-40. [Medline].
Brown DE, Carmony NB. Gila Monster: Facts and Folklore of America's Aztec Lizard. 1991;1-126.
Cantrell FL. Envenomation by the Mexican beaded lizard: a case report. J Toxicol Clin Toxicol. 2003;41(3):241-4. [Medline].
Hooker KR, Caravati EM. Gila monster envenomation. Ann Emerg Med. 1994;24(4):731-735. [Medline].
Kunkel DB. Bites of venomous reptiles. Emerg Med Clin North Am. Aug 1984;2(3):563-77. [Medline].
Kunkel DB, Curry SC, Vance MV, Ryan PJ. Reptile envenomations. J Toxicol Clin Toxicol. 1983-84;21(4-5):503-26. [Medline].
McNally J, Boesen K, Boyer L. Toxicologic information resources for reptile envenomations. Vet Clin North Am Exot Anim Pract. May 2008;11(2):389-401, viii. [Medline].
Miller MF. Gila monster envenomation. Ann Emerg Med. May 1995;25(5):720. [Medline].
Russell FE. Snake Venom Poisoning. Scholium International, Inc;1983:1-562.
Stahnke HL, Heffron WA, Lewis DL. Bite of the Gila monster. Rocky Mt Med J. Sep 1970;67(9):25-30. [Medline].
Streiffer RH. Bite of the venomous lizard, the Gila monster. Postgrad Med. Feb 1 1986;79(2):297-9, 302. [Medline].
Strimple PD, Tomassoni AJ, Otten EJ. Report on envenomation by a Gila monster (Heloderma suspectum) with a discussion of venom apparatus, clinical findings, and treatment. Wilderness Environ Med. May 1997;8(2):111-6. [Medline].
Print
