Pediatric emergency medicine trisk 2021 2021
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Nonpoisonous snakes sometimes leave an imprint of their two rows of teeth, but
the wounds should lack fang puncture marks.
The dramatic signs of crotalid envenomation are derived primarily from the
victim’s hypovolemic state, bleeding diathesis and neuromuscular dysfunction.
Table 90.23 outlines the more notable physical signs and symptoms.
Coral snake. Coral snakes leave unimpressive local signs but can
neurologically cripple their prey. The bite may have one or two punctures, at most
7 to 8 mm apart, and other small teeth marks. Extremity paresthesias and
weakness are often reported initially. Over several hours, generalized malaise,
nausea, fasciculations, and weakness develop insidiously. Other symptoms
include ptosis, diplopia, dysarthria, and dysphagia. Physical examination may
reveal bulbar dysfunction and generalized weakness. Respiratory failure may
ensue.
Triage
Pit viper. The airway, breathing, and circulation of the patient must be addressed
before attending to the snakebite ( Fig. 90.22 ). The first priority of prehospital
care of the snakebite victim is rapid transport to a medical facility. All activities
in the field must be tempered by the fact that time is of the essence. Without
delaying transport, the wound should be cleaned with soap and tap water or with
an antiseptic solution.
It is important to approach the patient with reassurance and to place him or her
at rest. The affected extremity should be stripped of any constricting jewelry or
clothing and immobilized in a position of function below the level of the heart to
decrease systemic spread of venom. The patient should be kept warm and not
allowed to have anything by mouth.
