Snakebite

Originated-1-26-2010

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Designation of condition
Patient has sustained bite from Rattlesnake (bites from other snakes including exotics require different treatment methods; Contact MCEP), usually recognized by two small puncture wounds. Even though snake may be venomous, venom may not have been injected.
FIRST RESPONDER AND BASIC PRE-HOSPITAL MANAGEMENT

  1. Attempt to calm the patient verbally.
  2. Keep patient as still as possible.
  3. Obtain history including, if possible, the type of snake.
  4. Identify the puncture site or sites and cover with sterile gauze with no circumferential taping.
  5. Oxygen.
  6. Cardiac monitoring.

REMOVE JEWELRY
DO NOT

  1. Make any incisions.
  2. Apply a tourniquet
  3. Apply ice.
  4. Elevate above level of heart.

INTERMEDIATE PRE-HOSPITAL MANAGEMENT

  1. Start IV of NS TKO in unaffected limb.
  2. Expect swelling and discoloration of the area.
  3. Treat Hypotension with aggressive IV fluid boluses.

Adults: Enroute establish two IV's of LR or NS with blood set or regular drip tubing and bolus 20 ml/kg, reassess and adjust to desired effect.

Pediatric: Enroute establish an IV or IO line with LR or NS, and bolus 20 ml/kg, reassess and titrate to effect.

PARAMEDIC PRE-HOSPITAL MANAGEMENT
If no response: Dopamine drip @ 4-12 mcg/kg/min.

  1. See Pain Management Protocols. Use Morphine cautiously with hypotensive patients.
  2. Transport.