Page 228 - ATP-P 11th Ed

Management of Snake Bites
1. If signs and symptoms of anaphylaxis present, treat per Anaphylaxis Protocol.
2. Supportive care as necessary
3. Treat per Pain Management Protocol using narcotics. Avoid NSAID use.
4. Treat per Nausea and Vomiting Protocol.
5. If toxic snakebite suspected (significant pain, edema, evidence of coagulopathy or neuro-
logic signs/symptoms):
a. Minimize activity and place on a litter.
SECTION 2 c. Start IV in unaffected extremity.
b. Remove all constricting clothing and jewelry.
d. Monitor and record vital signs and extent of edema every 15–30min.
e. Give IV crystalloid for hypotension as necessary.
f. Immobilize affected limb in neutral position.
g. A compression wrap (proximal to distal) may be helpful with an elapidae (neuro-
toxic) snake (cobra, mamba, coral snake), but is not indicated with crotalidae (pit
viper) bites.
h. The need for a fasciotomy is difficult to determine in a snake bite unless com-
partment pressures have been taken.
i. Cold therapy and suction therapy is contraindicated in snakebites.

Disposition
1. Urgent evacuation if treated for anaphylaxis.
2. Urgent evacuation for elapidae bites or if evidence of severe envenoma tion (sys-
temic signs and symptoms, progressive ascending edema) exists.
3. Evacuation not required for crotalinae bites if signs and symptoms do not in-
dicate anaphylaxis or development of severe envenomation after four hours of
observation.

218 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 219