Fast Five Quiz: Snakebite Facts vs Fiction

Richard H. Sinert, DO

Disclosures

July 12, 2021

In patients with crotalid snakebites, the progression of swelling helps determine whether antivenom is indicated. The proximal edge of the bite swelling should be marked as a baseline, noting the time. The circumference, swelling extension, and tenderness should be recorded every 15-30 minutes. After edema progression stops for four consecutive measurements, frequency of recordings can be decreased to every hour. Antivenom should be administered if swelling progresses past the bite site.

Routine imaging is not required following snake envenomation. Conventional radiographs of the affected extremity should be considered if a retained fang is suspected or if the diagnosis is uncertain. Chest radiography should be performed in patients with systemic toxicity experiencing dyspnea. Rarely, neuroimaging may be necessary to look for intracranial bleeding in patients with altered mental status. Ultrasonography of the affected extremity should be obtained in patients when the diagnosis is uncertain and deep venous thromboembolism is a clinical concern.

Patients with possible snakebite envenomation should undergo the following laboratory tests:

  • Complete blood cell count

  • Basic metabolic profile

  • Prothrombin time

  • Fibrinogen value

  • Creatine kinase value

Patients with systemic toxicity may warrant additional testing, including liver function tests, urinalysis, blood type and crossmatch, and venous blood gas analysis. Rotational thromboelastometry and thromboelastography are not readily available in many healthcare settings but may have a greater role in evaluating patients for hematotoxicity in the future. Routine measurement of D-dimer and fibrin split products is unnecessary because the results do not change management.

Rotational thromboelastometry and thromboelastography are not readily available in many healthcare settings but may have a greater role in evaluating patients for hematotoxicity in the future. They have been used to evaluate crotalid bites, but further study is needed.

Read more on the workup of snakebites.

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