Pediatric emergency medicine trisk 2026 2026
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TABLE 90.24
GRADING OF CROTALID (PIT VIPER) SNAKEBITES
Local
Mild
Moderate
Severe
Fang mark
All local signs extend
beyond wound site
Entire extremity
involvement
Intense pain
Edema
Erythema
Systemic
Laboratory
Ecchymosis
± Vesicles
Within 10–15
cm of bite
None
Nausea/vomiting
Anxiety related Weakness/fainting
Perioral, scalp
paresthesias
Metallic taste
Pallor
No
abnormalities
Tachycardia
Mild hypotension
Fasciculations
Hemoconcentration
Thrombocytopenia
Hypofibrinogenemia
As in moderate
Hypotension
Shock
Bleeding diathesis
Respiratory distress
Significant anemia
Prolonged clotting
time
Metabolic acidosis
Patients with dry bites and only a simple wound need to be monitored for a
minimum of 8 hours, with laboratory studies repeated prior to discharge to rule
out a delayed onset of signs of envenomation. Patients who present to the hospital
more than 8 hours from their initial bite can be observed for only 2 to 4 hours,
and those with normal vital signs and physical exam and no concerning
