SNAKE BITES

Snake Bites

At presentation of casualty A,B,C  of resuscitation ,some of the venomous snakes can complicate with hemorrhagic shock,cardiotoxicity

Secondary survey

1-History of the snake bites and if possible establishes whether it was venomous or not.

2-Examination of the wound inflicted can give indication whether the snake was venomous or not. Nonvenomous snakes do not produce fang marks, but rather rows of tiny puncture wounds or scratches.

3-Removal of any tight clothing on the limb or tourniquet that had been applied.

4- Obtain IV access in the non-affected limb and keep on IV fluids

5-Take vital signs continuously monitor

6-Clean the bitten part and irrigate with copious amounts of water.

7-Elevate the limb as much as possible.

8-Provide analgesia

9-Administer tetanus toxoids

10-Give prophylactic antibiotics

11-Measure circumference of the bitten part at several levels, comparing these with similar measurements carried out once on the unaffected side.

-Monitor for any continued swelling.

12-If anti venom available this can be given in the IV fluid infusion and run slowly looking out for any allergic reactions.

13-If there is continued swelling of the limb even with elevation, then fasciotomy may be necessary to prevent occurrence of compartment syndrome.

Initial investigations

1.Full blood count-Hb ,can draw blood for GXM

2.LFT-Liver transaminases ,serum bilirubin

3.Urea,electrolyte and creatinine

Urinalysis-protenuria and hematuria

4.Creatine kinase

5.Coagulation profile-  platelet count, clotting time, prothrombin time, partial thromboplastin time, fibrinogen level

6. ECG studies.

Manage any complications as appropriate:

Abnormal coagulation profile-Fresh frozen plasma transfusion.

Hemolytic anemia-Whole blood transfusion

Shock-IV fluid –crystalloids and Colloids