Page 113 - PJ MED OPS Handbook 8th Ed

d. Monitor and record vital signs and extent of edema every 15–30 minutes
e. IV crystalloid for hypotension as necessary
f. Immobilize affected limb in neutral use
g. Do not perform fasciotomy
h. Cold therapy and suction therapy are contraindicated in snakebites
DISPOSITION:
1. Urgent evacuation if treated for anaphylaxis.
2. Urgent evacuation for confirmed elapidae bites.
3. Urgent evacuation if evidence of severe envenomation (systemic signs and symptoms,
progressive ascending edema) exists.
4. Evacuation not required for crotalidae bites if signs and symptoms do not indicate anaphy-
laxis or development of severe envenomation after 4 hours of observation.

NOTE: If urgent evacuation is not possible, a telemedicine consult with an experienced
treatment center is recommended to guide antivenin drip dosing or other supportive care
requirements.

Marine Envenomation

SPECIAL CONSIDERATIONS:
1. Envenomation results from stings by jellyfish, fire corals, sting rays, sea urchins, bristle
worms, fish spines, sea snakes, etc.
2. Jellyfish account for the vast majority of envenomation, which occur with contact to sting-
ing cells on tentacles.
3. Stingrays are the most common cause of envenomation by marine vertebrates.
4. Sea snake venom is 2–10 times more potent than cobra venom, but only about 25% of
those bitten develop symptoms (due to an inefficient delivery system and small mouth).
5. All of these envenomations are more likely to occur in intratidal regions, reefs, and surf
zones.

Signs and Symptoms:
1. Envenomation by jellyfish:
a. Contact with jellyfish tentacles causes immediate, intense sharp and burning pain, followed
by a local, linear, erythematous eruption.
b. Severe stings can cause anaphylactic reaction, hematuria, vomiting, syncope, hypotension,
or paralysis.
2. Envenomation by fire coral is similar to jellyfish, but less severe and rarely causes complications.
Pain symptoms usually resolve within 12 hours.
3. Envenomation by stingray:
a. Spine on tail contains retro-serrated teeth, with a venom gland along the groove.
b. Envenomation causes immediate, intense pain at site of injury out of proportion to exam,
and edema.

Chapter 8. Tactical Medical Emergency Protocols (TMEPs) n 111