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*Local injury is often minimal and easy to miss as venom is delivered via chewing rather than injection | *Local injury is often minimal and easy to miss as venom is delivered via chewing rather than injection | ||
*Venom effects may develop hours after a bite | *Venom effects may develop hours after a bite | ||
===Serious complications=== | |||
*Venom-induced consumption coagulopathy (DIC-like syndrome)<ref>Isbister GK. Snakebite doesn't cause disseminated intravascular coagulation: coagulopathy and thrombotic microangiopathy in snake envenoming. Semin Thromb Hemost. 2010 Jun;36(4):444-51.</ref> | |||
*Renal failure | |||
*Hypovolemic shock | |||
*Neurotoxicities in particular for coral snaktes | |||
**Local numbness rather than pain/swelling | |||
**CN palsies | |||
**Respiratory paralysis | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revisión del 08:15 30 dic 2015
Background
- All coral snakes are brightly colored with black, red, and yellow rings
- Red and yellow rings touch in coral snakes, but are separated in nonpoisonous mimics
- "Red touch yellow, kills a fellow; red touch black, venom lack"
- Red and yellow rings touch in coral snakes, but are separated in nonpoisonous mimics
Clinical Features
- Local injury is often minimal and easy to miss as venom is delivered via chewing rather than injection
- Venom effects may develop hours after a bite
Serious complications
- Venom-induced consumption coagulopathy (DIC-like syndrome)[1]
- Renal failure
- Hypovolemic shock
- Neurotoxicities in particular for coral snaktes
- Local numbness rather than pain/swelling
- CN palsies
- Respiratory paralysis
Differential Diagnosis
Envenomations, bites and stings
- Hymenoptera stings (bees, wasps, ants)
- Mammalian bites
- Closed fist infection (Fight bite)
- Dog bite
- Marine toxins and envenomations
- Toxins (ciguatera, neurotoxic shellfish poisoning, paralytic shellfish poisoning, scombroid, tetrodotoxin
- Stingers (stingray injury)
- Venomous fish (catfish, zebrafish, scorpion fish, stonefish, cone shells, lionfish, sea urchins)
- Nematocysts (coral reef, fire coral, box jellyfish, sea wasp, portuguese man-of-war, sea anemones)
- Phylum porifera (sponges)
- Bites (alligator/crocodile, octopus, shark)
- Scorpion envenomation
- Reptile envenomation
- Spider bites
Diagnosis
- CBC with diff
- PT/PTT/INR
- Fibrinogen
- Fibrin degradation products
- BMP
- LFT
- CK
- ABG if resp compromise
Treatment
Local Care
- Do:
- Remove all jewelry
- Mark the leading edge of erythema/edema
- Do not:
- Attempt to suck out the venom
- Place the affected part in cold water
- Use a tourniquet or wrap
- Antivenom is first line treatment for compartment syndrome; fasciotomy is last resort if elevated pressures persist.
Antivenom
- Give 3-5 vials of Antivenin (Micrurus fulvius) to ALL pts who have definitely been bitten
- It may not be possible to prevent further effects or reverse effects once they develop
- Additional doses of antivenom are reserved for cases in which symptoms/signs appear
- Prepare for allergic reaction from equine produced Antivenin (may dilute solution, or administer with epinephrine/benadryl)
Monitor for respiratory failure
Disposition
- Admit all pts (even if initially symptom free)
See Also
References
- ↑ Isbister GK. Snakebite doesn't cause disseminated intravascular coagulation: coagulopathy and thrombotic microangiopathy in snake envenoming. Semin Thromb Hemost. 2010 Jun;36(4):444-51.
- Medscape. Antivenin, Eastern & Texas Coral Snakes (Rx) - Antivenin (Micrurus fulvius). http://reference.medscape.com/drug/micrurus-fulvius-antivenin-eastern-texas-coral-snakes-343718.
- Juckett G and Hancox JG. Venomous Snakebites in the United States: Management Review and Update. Am Fam Physician. 2002 Apr 1;65(7):1367-1375.