Pediatric emergency medicine trisk 2020 2020
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TABLE 90.22
LOCAL SIGNS OF CROTALID (PIT VIPER) ENVENOMATION
Pain
Edema
Vesicles
Hemorrhagic blebs
Erythema
Ecchymosis
Necrosis
TABLE 90.23
SYSTEMIC SIGNS AND SYMPTOMS OF CROTALID (PIT VIPER)
ENVENOMATION
General
Anxiety, diaphoresis, pallor, unresponsiveness
Cardiovascular
Tachycardia, decreased capillary perfusion, hypotension, shock
Pulmonary
Pulmonary edema, respiratory failure
Renal
Oliguria, hemoglobinuria, hematuria
Neuromuscular
Fasciculations, weakness, paralysis, convulsions
Hematologic
Bleeding diathesis
The wound should be inspected for fang punctures, and if two are present, the
distance between them should be noted. An interfang distance of less than 8 mm
suggests a small snake; 8 to 12 mm, a medium snake; and more than 12 mm, a
larger snake. Fang wounds by small snakes such as the pygmy rattler may be
extremely subtle; in larger crotalid snakebites, the fang marks may be hidden
within hemorrhagic blebs and edema. Occasionally, only one puncture or two
scratches will be present, but both wounds may be potentially venomous. Up to
20% of known rattlesnake strikes do not inject venom. Other causes of puncture
wounds such as rat bites and thorn wounds must also be kept in mind.
