Last reviewed: November 2017
Last updated: August  2017

Summary

Definition

History and exam

Key diagnostic factors

  • identification of the snake
  • local redness, swelling, tenderness, and pain at wound site
  • blurred or double vision
  • shortness of breath
  • difficulty swallowing
  • hypotension
  • tachypnea
  • tachycardia
  • puncture marks, fang marks
  • bulbar weakness/paralysis
  • stridor
  • hemorrhage
  • quadriplegia/locked-in syndrome

Other diagnostic factors

  • nausea and vomiting
  • malaise, generalized weakness or dizziness
  • perioral tingling or numbness
  • urticaria
  • tremors

Risk factors

  • male sex
  • alcohol consumption
  • intentional snake encounter

Diagnostic investigations

1st investigations to order

  • PT, PTT, fibrinogen, and D-dimer
  • CBC
  • electrolytes, BUN, and creatinine
  • arterial blood gas
  • CK
  • lactate
  • urinalysis
  • ECG
  • chest x-ray
  • wound x-ray
  • negative inspiratory force (NIF) test
Full details

Investigations to consider

  • CT/MRI
  • compartment pressure
  • central venous line with central venous pressure (CVP) transduction
  • arterial line with pressure transduction
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

David Vearrier

Assistant Professor

Program Director

Medical Toxicology Fellowship

Department of Emergency Medicine

Drexel College of Medicine

Philadelphia

PA

Disclosures

DV declares that he has no competing interests.

Michael Greenberg

Professor of Emergency Medicine

Professor of Public Health

Chief of Division of Medical Toxicology

Drexel University College of Medicine

Philadelphia

PA

Disclosures

MG declares that he has no competing interests.

Peer reviewers VIEW ALL

Associate Clinical Professor of Medicine

Department of Clinical Pharmacology and Toxicology

University of Colorado

Health Science Center

Denver

CO

Disclosures

SP has a professional relationship with Michael Greenberg, one of the authors of this monograph. They are partners in a private consulting company. SP does not receive money from him, nor does he receive money from SP.

Medical Director TN Poison Center

Associate Professor of Medicine and Emergency Medicine

Vanderbilt University Medical Center

Nashville

TN

Disclosures

DS declares that she has no competing interests.

Professor

Department of Medicine

Peredeniya University

Sri Lanka

Disclosures

SK declares that he has no competing interests.

Use of this content is subject to our disclaimer