Page 112 - PJ MED OPS Handbook 8th Ed

Envenomation
Snake Envenomation

SPECIAL CONSIDERATIONS – General:
1. Toxic envenomations from a variety of sources, including insects, spiders, bees/wasps,
scorpions, snakes, or marine life are all capable of causing life-threatening anaphylaxis
and should be treated according to the Anaphylaxis Protocol.
Snakes:
1. Only a minority of snakebites from toxic snakes involve severe, life-threatening
envenomations.
2. Incision, excision, electrical shock, tourniquet, oral suction, and cryotherapy are ineffec-
tive treatments and should NOT be performed to treat snakebites.
3. Suction devices are not effective for removing snake venom from a wound. If previously
placed, remove the device.
4. Elapidae envenomations, especially from the coral snake, may show minimal local signs
until sudden decompensation hours later.
Snake Signs and Symptoms:
1. Crotalidae (Pit vipers, rattlesnake, moccasin, bush master)-Vascular and bleeding
a. Sudden pain
b. Erythema
c. Ecchymosis
d. Hemorrhagic bullae
e. Bleeding from site
f. Metallic taste
g. Hypotension/shock
h. Swelling/edema
2. Elapidae (Coral snake, sea snake, mamba, cobra, taipan, kraits) – Neurologic
a. Cranial Nerve dysfunction (i.e., ptosis, difficulty swallowing)
b. Paresthesias
c. Fasciculations
d. Weakness
e. Altered mental status

Management of Snake Bites:
1. If signs and symptoms of anaphylaxis present, treat per Anaphylaxis Protocol
2. Supportive care (ABC) 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 neurologic
signs/symptoms):
a. Minimize activity and place on a litter
b. Remove all constricting clothing and jewelry
c. Start IV in unaffected extremity

110 n Pararescue Medical Operations Handbook / 8th Edition