Pediatric emergency medicine trisk 2022 2022
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FIGURE 90.22 Management of pit viper bite. a Complete blood cell count, platelet count,
prothrombin time, partial thromboplastin time, urinalysis, type and hold; in moderate or severe
cases, add fibrinogen, arterial blood gases, electrolytes, blood urea nitrogen, and creatinine. b
Seldom need antivenin; exceptions with large snakes and small children.
Tourniquets, inadvertently tightened for prolonged full vascular occlusion,
have created more problems than they have solved and therefore cannot be
recommended for prehospital care. In experienced hands, however, a constriction
band that obstructs lymph and venous flow can be valuable when a long transport
is anticipated (longer than 30 to 60 minutes). The band should be at least 2 cm
wide and placed 5 to 10 cm proximal to the wound (proximal to the nearest joint
if the wound is nearby). The constriction should be loose enough to admit a finger
and preserve good distal arterial pulses. Vigilant observation for adequate
