Table of contents
Pit viper envenomation
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of pit viper envenomation are prepared by our editorial team based on guidelines from the Wilderness Medical Society (WMS 2015).
1
Classification and risk stratification
Diagnostic investigations
Physical examination in the field
As per WMS 2015 guidelines:
Observe local tissue effects which are the most common physical manifestations of pitviper envenomations and occur in > 90% of patients with medically significant envenomations.
B
Consider patients without local or systemic symptoms 8 hours after the bite as having a dry bite, if evacuation is difficult or prolonged.
B
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Assessment in the emergency department
Laboratory studies
Abdominal imaging
Medical management
Setting of care: as per WMS 2015 guidelines, hospitalize patients with moderate-to-severe envenomations.
B
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Antibiotic prophylaxis
Pain management
Tetanus prophylaxis
Antivenom
Management of secondary infection
Nonpharmacologic interventions
First aid: as per WMS 2015 guidelines, remove or cut jewelry or constrictive clothing near the bite to avoid constriction with subsequent swelling.
B
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Evacuation
Therapeutic procedures
Surgical interventions
Fasciotomy: as per WMS 2015 guidelines, consider fasciotomy in rare patients who fail to respond. Perform fasciotomy according to the decision made by a surgeon within 6 hours of signs of neurovascular compromise and elevated intracompartmental pressure despite appropriate administration of antivenom.
B
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Digital dermotomy
Wound care
Specific circumstances
Pregnant patients: as per WMS 2015 guidelines, administer antivenom in pregnant patients with snakebite, as indicated, and provide fetal assessment or monitoring as the fetus is at higher risk to coagulopathy-related complications, such as placental abruption.
B
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Pediatric patients
Critically ill patients
Allergic reactions
Follow-up and surveillance
Clinical deterioration: as per WMS 2015 guidelines, administer repeat doses of antivenom and arrange timely toxinologist or poison control center consultation if the clinical condition deteriorates.
B
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Monitoring before discharge
Discharge from hospital
Follow-up after discharge