Fast Five Quiz: Snakebite Facts vs Fiction

Richard H. Sinert, DO

Disclosures

July 12, 2021

The specific treatment for crotalid envenomations is antivenom, and each patient should be assessed individually to determine whether antivenom is indicated. Some countries (eg, India, Australia) have a wider variety of venomous snake species for which multiple targeted antivenoms are available.

After administering antivenom, patients should be monitored for adverse reactions. Anaphylactic reaction may occur just moments after administration or as long as 2 hours later. Serum sickness after antivenom administration may occur as long as 2 weeks after administration, typically presenting similar to influenza, with possible microhematuria. It responds well to a short course of oral corticosteroids and antihistamines.

Some snakebites with minimal envenomation (eg, crotalid bites) do not require treatment with antivenom, but patients should undergo monitoring for at least 12 hours. Repeat coagulation panel is recommended in patients with minimal signs of envenomation to evaluate for delayed coagulopathy.

Although surgeons are often involved in the management of snake envenomation in the United States, it is essential to recognize that snakebites are a medical, not surgical, condition. Excision of the bite site was once recommended, but it is now understood that this is a disfiguring procedure that does not confer any survival benefit.

Prophylactic fasciotomies are no longer widely recommended. Morbidity and mortality are typically increased following prophylactic fasciotomy when compared with antivenom therapy. Fasciotomy should only be considered in those patients with persistently elevated compartment pressures despite adequate antivenom therapy.

Most snake envenomations do not require prolonged hospitalization. Unless the patient requires a prolonged course of antivenom, develops end-organ damage, or requires parenteral narcotics, most snakebite victims can be discharged within 24-36 hours. Patients may be discharged home once the following criteria are satisfied:

  • The antivenom course has been completed

  • Pain can be controlled with oral medication

  • Vital signs have stabilized

  • The patient can tolerate a regular diet

  • Any hematologic laboratory abnormalities have normalized

  • All of the appropriate consultations have been completed

Read more about the treatment of snakebites.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases article Snakebite.

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