Snake bites - Revision history

Rossdonaldson1: /* See Also */

2021-03-17T17:08:42Z

ClaireLewis at 21:56, 28 September 2019

2019-09-28T21:56:23Z

← Revisión anterior		Revisión del 21:56 28 sep 2019
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	*Local injury - punctures marks from fangs not always visible; erythema, and edema		*Local injury - punctures marks from fangs not always visible; erythema, and edema
	*Ooze at fang mark reliable sign of envenomation		*Ooze at fang mark reliable sign of envenomation
	*Nausea/vomiting		*[[Nausea/vomiting]]

	==Differential Diagnosis==		==Differential Diagnosis==
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	===Supportive care===		===Supportive care===
	*[[IVF]] and [[pressors]] if needed for [[hypotension]]		*[[IVF]] and [[pressors]] if needed for [[hypotension]]
	*[[Blood]] components rarely needed		*[[pRBCs\|Blood]] components rarely needed
	*Treatment mainly depends upon the presence of an [[Envenomation\|envenomation]]		*Treatment mainly depends upon the presence of an [[Envenomation\|envenomation]]
	*Indications:		*Indications:
	**Progression of local injury - pain, swelling, ecchymosis		**Progression of local injury - pain, swelling, ecchymosis
	**Coagulopathy - elevated PT/PTT/INR, low fibrinogen, thrombocytopenia		**[[Coagulopathy]] - elevated PT/PTT/INR, low fibrinogen, thrombocytopenia
	**Systemic effects - hypotension, altered mental status, nausea and vomiting, paresthesias		**Systemic effects - [[hypotension]], [[altered mental status]], [[nausea and vomiting]], [[paresthesias]]
	*Always provide supportive care and treat local effects of any wounds		*Always provide supportive care and treat local effects of any wounds
	*Irrigation of the wound is necessary regardless of the type of snake bite		*Irrigation of the wound is necessary regardless of the type of snake bite

Mfeigley: /* Background */

2018-06-05T20:21:47Z

Background

← Revisión anterior		Revisión del 20:21 5 jun 2018
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	===Venom===		===Venom===
	*Snake venom is a mixture of proteins, peptides, lipids, and metal ions.		*Snake venom is a mixture of proteins, peptides, lipids, and metal ions.
	*Many bites can be "dry bites" where ~~not~~ venom is released, about ~1/4		*Many bites can be "dry bites" where no venom is released, about ~1/4

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Supportive care */

2017-09-28T21:09:38Z

Supportive care

← Revisión anterior		Revisión del 21:09 28 sep 2017
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	===Supportive care===		===Supportive care===
	*IVF and pressors if needed for hypotension		*[[IVF]] and [[pressors]] if needed for [[hypotension]]
	*Blood components rarely needed		*[[Blood]] components rarely needed
	*Treatment mainly depends upon the presence of an [[Envenomation\|envenomation]]		*Treatment mainly depends upon the presence of an [[Envenomation\|envenomation]]
	*Indications:		*Indications:
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	*Irrigation of the wound is necessary regardless of the type of snake bite		*Irrigation of the wound is necessary regardless of the type of snake bite
	*Debridement and removal of devitalized tissue may be necessary for severe bites		*Debridement and removal of devitalized tissue may be necessary for severe bites
	*Evidence does not support use of empiric antibiotics to prevent secondary infection <ref>Gold B.. Bites of venomous snakes. N Engl J Med. 2002;347(5):347-56.</ref>		*Evidence does not support use of empiric [[antibiotics]] to prevent secondary infection <ref>Gold B.. Bites of venomous snakes. N Engl J Med. 2002;347(5):347-56.</ref>
	*Compartment syndrome has been documented with crotaline envenomation but current literature does not support use of fasciotomy. <ref> Cumpston KL. Is there a role for fasciotomy in Crotalinae envenomations in North America? PMID: 21740134 </ref> Treatment should focus on antivenom.		*[[Compartment syndrome]] has been documented with crotaline envenomation, but current literature does not support use of fasciotomy. <ref> Cumpston KL. Is there a role for fasciotomy in Crotalinae envenomations in North America? PMID: 21740134 </ref> Treatment should focus on antivenom.

	===Antivenom===		===Antivenom===

Rossdonaldson1: /* Evaluation */

2017-09-28T21:08:46Z

Evaluation

← Revisión anterior		Revisión del 21:08 28 sep 2017
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	==Evaluation==		==Evaluation==
	*Clinical Diagnosis		*Clinical Diagnosis
	*Evaluate for compartment syndrome (see below)		*Evaluate for [[compartment syndrome]] (see below)
	*CBC, coags: [[Thrombocytopenia]] and elevated INR can occur in Crotaline envenomations.		*CBC, coags: [[Thrombocytopenia]] and elevated INR can occur in Crotaline envenomations.

Josgood: /* Disposition */

2017-09-25T07:43:39Z

Disposition

← Revisión anterior		Revisión del 07:43 25 sep 2017
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	==Disposition==		==Disposition==
	*All snake bites with evidence of envenomations should have a period of observation and possible hospitalization		*All snake bites with evidence of envenomations should have a period of observation and possible hospitalization
	*Old bites can be assessed an discharged if no evidence of envenomation.		*Old bites can be assessed and discharged if no evidence of envenomation.

	==See Also==		==See Also==

Josgood: /* Evaluation */

2017-09-25T07:43:05Z

Evaluation

← Revisión anterior		Revisión del 07:43 25 sep 2017
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	*Clinical Diagnosis		*Clinical Diagnosis
	*Evaluate for compartment syndrome (see below)		*Evaluate for compartment syndrome (see below)
	*CBC: [[Thrombocytopenia]] can occur in Crotaline envenomations.		*CBC, coags: [[Thrombocytopenia]] and elevated INR can occur in Crotaline envenomations.

	==Management==		==Management==

Josgood: /* Evaluation */

2017-09-25T07:41:56Z

Evaluation

← Revisión anterior		Revisión del 07:41 25 sep 2017
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	*Clinical Diagnosis		*Clinical Diagnosis
	*Evaluate for compartment syndrome (see below)		*Evaluate for compartment syndrome (see below)
			*CBC: [[Thrombocytopenia]] can occur in Crotaline envenomations.

	==Management==		==Management==

Josgood: /* Clinical Features */

2017-09-25T07:40:15Z

Clinical Features

← Revisión anterior		Revisión del 07:40 25 sep 2017
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	==Clinical Features==		==Clinical Features==
	*Local injury - punctures marks from fangs not always visible, erythema, and edema		*Local injury - punctures marks from fangs not always visible; erythema, and edema
	*Ooze at fang mark reliable sign of envenomation		*Ooze at fang mark reliable sign of envenomation
	*Nausea/vomiting		*Nausea/vomiting

Josgood at 06:25, 25 September 2017

2017-09-25T06:25:11Z

← Revisión anterior		Revisión del 06:25 25 sep 2017
Línea 21:		Línea 21:
	==Evaluation==		==Evaluation==
	*Clinical Diagnosis		*Clinical Diagnosis
			*Evaluate for compartment syndrome (see below)

	==Management==		==Management==
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	*Debridement and removal of devitalized tissue may be necessary for severe bites		*Debridement and removal of devitalized tissue may be necessary for severe bites
	*Evidence does not support use of empiric antibiotics to prevent secondary infection <ref>Gold B.. Bites of venomous snakes. N Engl J Med. 2002;347(5):347-56.</ref>		*Evidence does not support use of empiric antibiotics to prevent secondary infection <ref>Gold B.. Bites of venomous snakes. N Engl J Med. 2002;347(5):347-56.</ref>
			*Compartment syndrome has been documented with crotaline envenomation but current literature does not support use of fasciotomy. <ref> Cumpston KL. Is there a role for fasciotomy in Crotalinae envenomations in North America? PMID: 21740134 </ref> Treatment should focus on antivenom.

	===Antivenom===		===Antivenom===

← Revisión anterior		Revisión del 17:08 17 mar 2021
Línea 49:		Línea 49:

	==See Also==		==See Also==
			*[[Envenomations, bites and stings]]
	*[[Crotaline (Pit Vipers)]]		*[[Crotaline (Pit Vipers)]]
	*[[Elapidae (Coral Snakes)]]		*[[Elapidae (Coral Snakes)]]