Page 127 - 2022 Ranger Medic Handbook

Envenomation – Snake
DEFINITION: Snake bites and actual envenomation is rare. More care should be taken to avoid snakes and potential
bites than the likelihood of an actual envenomation.
Crotalidae (Pit Vipers, Rattlesnake, Moccasin, Bush Master):
S/Sx: Sudden pain; erythema; ecchymosis; hemorrhagic bullae; bleeding from site; metallic taste; hypotension/shock;
swelling/edema.
Elapids (Coral Snake, Sea Snake, Mamba, Cobra, Taipan, Kraits):
S/Sx: Cranial nerve dysfunction (i.e., ptosis, difficulty swallowing); paresthesia; fasciculations; weakness; altered mental
status
MANAGEMENT:
1. If signs and symptoms of anaphylaxis present, treat per Anaphylaxis Protocol. SECTION 3
2. General supportive care as necessary through emergency protocols.
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. Initiate saline lock in unaffected extremity.
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 position.
g. A compression wrap (proximal to distal) may be helpful with an elapidae (neurotoxic) 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 compartment pressures have been taken.
i. Cold therapy and suction therapy is contraindicated in snakebites.
DISPOSITION: Urgent evacuation if treated for anaphylaxis. Urgent evacuation for elapidae bites or if evidence of se-
vere envenomation (systemic signs and symptoms, progressive ascending edema) exists. Evacuation not required for
crotalidae bites if signs and symptoms do not indicate anaphylaxis or development of severe envenomation after four
hours of observation.
SPECIAL CONSIDERATIONS:
1. Only a minority of snakebites from toxic snakes involve severe, life-threatening envenomations.
2. Incision, excision, electrical shock, tourniquet, oral suction, and cryotherapy should NOT be performed to treat
snakebites.
3. Suction device is not effective for removing snake venom from a wound. If previously placed, it should be left in place
until patient reaches higher level of care.

2022 RANGER MEDIC HANDBOOK 113