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Environmental

Snakebite Envenomation
Clinical Syndromes

There are 3 major clinical syndromes of snakebite envenomation worldwide and 3 major signs and symptoms of each. All
dangerous snakes capable of injuring or killing a human will produce at least one sign or symptom from at least one of the 3 major
snakebite syndromes. Specific antivenoms required will vary regionally but the major triads are applicable globally.

Continued from:
Principles
Conduct Focused Assessment and
Snake Envenomation Management: General Examination to Identify Envenomation
Syndrome
With permanent marker:
HEMOTOXIC SYNDROME: • Write time of bite on patient YES
• Circle bite mark on patient
• Internal and external active bleeding CYTOTOXIC SYNDROME:
should cease within 30–60 minutes of
antivenom administration once the Conduct rapid examination for signs of: • Mark leading edge of pain with a
appropriate dose has been given. • Pain dash line (- - -) and annotate time
• Packed red blood cell or whole blood • Swelling (edema) • Mark leading edge of edema
with a solid line and annotate time
transfusion can be considered if the • Tissues destruction (necrosis)
patient is in hemorrhagic shock NO It is important to keep the limb
• Platelets, fresh frozen plasma, YES Rapid examination for signs of local or significantly elevated (>60º is ideal)
cryoprecipitate, TXA, and other agents systemic bleeding: whenever possible to limit dependent
are not effective in these cases due • persistent local bleeding >30 mins from the edema and swelling.
to the mechanism of the venoms. bite wound (if visible) or other lesions
• Inspect the molar gingiva and other mucosa
for signs of systemic bleeding
NO
Rapid examination for signs of NUEROTOXIC SYNDROME:
neuromuscular weakness:
• Evaluate respiratory muscle weakness by Anticipate the need for aggressive
single breath count testing airway management with intubation
• Dyspnea?. YES and prolonged ventilation in all patients Consider:
• Signs and symptoms of descending flaccid presenting with neurotoxic Atropine 0.5mg IV/IO
ENVIRONMENTAL
paralysis: Ptosis, diplopia, neck flexor muscle envenomation. • Titrated by auscultation to

weakness, bulbar weakness, etc. dry up bronchial and oral
• Signs and symptoms of parasympathetic / hypersecretions
cholinergic crisis: SLUDGE mnemonic - Cholinergic Crisis?
Salivation, Lacrimation, Urination, Defecation, Pediatric Dose:
GI distress, Emesis 0.01mg/kg up to .25mg
• Altered Mental Status?
Refer to JOINT TRAUMA SYSTEM CLINICAL PRACTICE GUIDELINE (JTS CPG) Global Snake Envenomation Management (CPG ID: 81)
for 1 st and 2 nd line ANTIVENOM based on Region and Syndrome. Follow JTS CPG for ANTIVENOM administrations.
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