Presentation
Only 1 patient presented with subconjunctival hemorrhage. Most of the patients (55%) presented with incoagulable blood on admission, being evidenced by positive 20 WBCT. [apjmt.mums.ac.ir]
Envenomation presents predominately with edema, pain, and hematologic manifestations. [toxicology.ucsd.edu]
Patients are often agitated, excited, painful on presentation and occasionally the patient will present in shock. Diagnosis : localized swelling and bruising, usually of the head or distal limbs. [vetstream.com]
General: Venom Neurotoxins Probably not present General: Venom Myotoxins Probably not present General: Venom Procoagulants Fibrinogenases General: Venom Anticoagulants Possibly present General: Venom Haemorrhagins Possibly present General: Venom Nephrotoxins [toxinology.com]
Mild Pain, tenderness, edema at the bite; perioral paresthesias may be present. If antivenin is necessary, administer about five vials.* II. [aafp.org]
Entire Body System
- Fever
Less Common Fever, Rectal Temperature Greater than 101.5 (in Adult) Heart Rate, Pulse Rapid, Greater than 48 BPM at Rest (in Adult) Swelling of Jaw or Under Jaw Depressed, Dull, Sick or Lethargic Wound to Cheek with Drainage or Swelling & Odor Not Eating [horsesidevetguide.com]
[…] an entire extremity within hours severe localized pain, burning and warmth discoloration, such as redness and bruising enlarged lymph nodes in the area Systematic symptoms, involving the entire body, may include: nausea or vomiting excessive sweating fever [childrenshospital.org]
Within 1-3 hours pets may also become depressed, developed a fever, vomit, have difficulty breathing, a low blood pressure, a rapid heart rate, develop bruising around the bite mark and have bleeding problems. [palenciapetclinic.com]
Follow-up all patients for signs and symptoms of delayed allergic reactions or serum sickness (e.g., rash, fever, myalgia, arthralgia). [crofab.com]
Other signs include chills, fever, weakness, nausea or breathing difficulties. Also look out for blurred vision or droopy eyelid. Severe bruising can occur several hours after the bite. [adventure.howstuffworks.com]
- Soft Tissue Swelling
There is significant soft tissue swelling, but rarely elevated intra-compartmental pressures. But the most important reason not to do fasciotomies is that elevated pressures are a SIGN of significant envenomation but NOT THE CAUSE of bad outcomes. [wsed.org]
Pain and a burning sensation at the site occur immediately followed by soft tissue swelling within an hour. Lymphangitis, ecchymosis, and hemorrhagic bullae may develop over the course of hours. [emdocs.net]
- Rigor
Biol. 55 (1):57–72 David P., Vogel G., Dubois A. (2011) On the need to follow rigorously the Rules of the Code for the subsequent designation of a nucleospecies (type species) for a nominal genus which lacked one: the case of the nominal genus Trimeresurus [indiansnakes.org]
- Dog Bite
Dawn Ruben 6,536 Views Share Overview of Snakebites from Pit Vipers to Dogs Bites by poisonous snakes, also referred to as snake envenomization, affect over 150,000 dogs and cats per year in North America. [petplace.com]
Respiratoric
- Sighing
You speak to the toxicologist later who sighs, “He received over 20 vials of antivenom.” ADVERTISEMENT Pit viper envenomation are caused by rattlesnakes, cottonmouth and copperheads in the United States. [epmonthly.com]
Gastrointestinal
- Vomiting
If a moderate amount of venom was injected, you are more likely to have severe pain, swelling of the whole limb, and general ill feelings, such as nausea, vomiting, and weakness. [myhealth.alberta.ca]
For others—with swollen, blackening limbs, nausea and vomiting, and breathing problems—it is a hellish descent, with the serum and hospital care saving their lives. [realworldsurvivor.com]
- Nausea
Systemic clinical manifestations encompass a wide variety of problems including pain, weakness, dizziness, nausea, severe hypotension, and thrombocytopenia. The victim's clotting abnormalities largely depend upon the species of snake involved. [ncbi.nlm.nih.gov]
For others—with swollen, blackening limbs, nausea and vomiting, and breathing problems—it is a hellish descent, with the serum and hospital care saving their lives. [realworldsurvivor.com]
If a moderate amount of venom was injected, you are more likely to have severe pain, swelling of the whole limb, and general ill feelings, such as nausea, vomiting, and weakness. [myhealth.alberta.ca]
- Diarrhea
The symptoms most commonly seen in pit viper snake bites are: Visible bite marks usually on face or extremities (i.e. two puncture wounds close together) Pain Swelling Agitation and restlessness Breathing trouble (i.e. gasping, panting) Vomiting Diarrhea [wagwalking.com]
The first death in this series was a twenty eight year-old male in Anuradhapura, who developed a profuse watery diarrhea and died on the same day of the bite. He remained in the hospital only for one day and the diarrhea was not investigated. [omicsonline.org]
2 Repeated vomiting or diarrhea, hematemesis, hematochezia 3 Hematological No symptom/sign 0 Coagulation parameters slightly abnormal (PT a < 20 seconds, PTT b < 50 seconds, platelets 100,000-150,000/µL, fibrinogen 100-150 mcg/mL) 1 Coagulation parameters [medscape.com]
- Abdominal Pain
Spitting cobra bites and spray cause local inflammation at the bite site or painful red swollen eyes and corneal ulceration. Krait bites cause severe abdominal pain and respiratory paralysis. [tripprep.com]
Coma, ophthalmoplegia, shock and profuse diarrhoea with abdominal pain are all recognised systemic effects. [omicsonline.org]
Internal haemorrhage - abdominal pain - vomiting - shock 4. Cardiotoxicity 5. Renal dysfunction #coaguability last for 6-10 hours @blood product will not correct it except anti-venom 22. Sign high volume venom 23. [slideshare.net]
Apart from this, symptomatic treatment is necessary, which may include pain medication, respiratory support, and blood transfusions. [dovemed.com]
[…] krait bites cause a distinct clinical syndrome consisting of minimal or no local envenoming, abdominal pain, vomiting, ptosis, diplopia, external ophthalmoplegia, and descending paralysis that most often lead to respiratory paralysis. 2 Russell’s viper [dovepress.com]
- Loss of Appetite
[…] of Appetite, Not Hungry Rubbing or Trying to Scratch Eye Difficulty Breathing, Struggles for Breath Foal or Newborn, Fever, Rectal Temperature Greater than 102.5 Degrees Breathing Noise at Rest Rare Lump, Bump, Growth, on Mouth, Lips, or Chin Lump, Bump [horsesidevetguide.com]
Cardiovascular
- Tachycardia
(100-125 beats/min), palpitations, generalized weakness, benign dysrhythmia, or hypertension 1 Tachycardia (126-175 beats/min) or hypotension with systolic blood pressure < 100 mm Hg 2 Extreme tachycardia (>175 beats/min) or hypotension with systolic [emedicine.medscape.com]
1) Local injury (pain, swelling, ecchymosis) 2) Coagulopathy (Thrombocytopenia, elevated prothrombin time, hypofibrinogenemia) 3) Systemic Effects (Oral Swelling, Paresthesias, Hypotension, Tachycardia) Clinically how would Pit Viper (Crotaline) bite [quizlet.com]
Then over time may develop more life-threatening symptoms such as low blood pressure, rapid breathing, severe tachycardia (heart beats very fast), altered perception of what is happening around them and respiratory failure (breathing difficulty or breathing [firstaidanywhere.com]
Vital signs are normal except for sinus tachycardia at 120. You call Jane, the local pit viper treatment expert, who recommends Fab pit viper antivenom over one hour. John’s labs return showing the arrows of abnormality. [epmonthly.com]
Skin
- Angioedema
Signs & Symptoms Signs of Envenomation Swelling – local and diffuse Tenderness Erythema Ecchymosis Blebs Elevated PT/INR Decreased fibrinogen Decreased platelets Systemic signs such as hypotension, hemorrhage, respiratory failure, angioedema, neurotoxicity [epmonthly.com]
[…] the scalp and other skin areas Life-threatening anaphylactic reactions that require immediate medical treatment may include: Low blood pressure or hypotension Bronchospasm causing narrowing of the airways (bronchi) resulting in breathing difficulties Angioedema [dovemed.com]
In a study of victims of Bothrops bite in rural Argentina, it was noted that individuals bitten twice developed hives and angioedema within 15 minutes of the second bite. Specific antibodies - both IgE and IgG were detectable in their serum. [priory.com]
- Skin Discoloration
Ecchymosis (skin discoloration resulting from bruising) and bleb formation (a pressure cyst) over 6-36 hours, and later necrosis (death of body tissue) Weakness, sweating, and chills Nausea and perhaps vomiting Numbness and swollen lymph nodes Rattlesnake [blog.nols.edu]
discoloration and swelling that slowly involves a wider region Blistering of skin (like formation of bubbles) Bleeding from the wound Swollen lymph nodes Breathing difficulties Nausea and vomiting Vomiting or coughing-up blood Blood in urine Abdominal [dovemed.com]
- Cold, Clammy Skin
clammy skin. [2] [14] Television, literature, and folklore are in part responsible for the hype surrounding snakebites, and people may have unwarranted thoughts of imminent death. [en.wikipedia.org]
Musculoskeletal
- Muscle Weakness
The symptoms may take several hours to develop and include tingling, muscle weakness, swallowing difficulties, excess saliva and potentially fatal breathing problems. [adventure.howstuffworks.com]
Symptoms Symptoms specific to rattlesnake bites are immediate and include: severe pain drooping eyelids low blood pressure thirst tiredness or muscle weakness Share on Pinterest The water moccasin is another type of pit viper. [healthline.com]
Muscle weakness, difficulty to breathe, blindness, and loss of speech are all signs of serious complications. [wildlife-removal.com]
Other signs and symptoms include nausea, vomiting, respiratory failure secondary to muscle weakness, hypersalivation, ptosis, dysarthria, dysphagia, altered mental status (lethargy or euphoria), fasciculations, and seizures. * Of note, the Mojave rattlesnake [clinicaladvisor.com]
- Muscular Atrophy
atrophy or weakness) and major muscle fasciculations. [emedicine.medscape.com]
Face, Head & Neck
- Epistaxis
General symptoms - haemopthysis - haemorrahge under the skin and mucous membrane (discoid ecchymosis) - epistaxis - bleeding gums - haematuria - maleana - oozing from bite - +ve torniquet test 21. 3. [slideshare.net]
[…] necrosis 2% Systemic envenomation Spontaneous systemic bleeding 46% Hypotension 35% Conjunctival edema 24% Bleeding from gums 20% Bleeding from venipuncture sites 15% Hematemesis 11% Melena 7% Bleeding from incisions 6% Subconjunctival hemorrhage 6% Epistaxis [toxicology.ucsd.edu]
Patients with coagulopathy typically hemorrhage from the bite site or from venipuncture sites or mucous membranes, with epistaxis, gingival bleeding, hematemesis, hematochezia, hematuria, or a combination. [msdmanuals.com]
[…] hemoccult Glucose Electrocardiography‡ Blood urea nitrogen Arterial blood gas§ The patient should be given strict instructions to return to the hospital immediately if any of the following occurs: increase in pain or onset of redness or swelling; fever; epistaxis [aafp.org]
- Facial Swelling
Usually, massive swelling at the bite site results. In some cases, the facial swelling is severe enough that it interferes with breathing through the nose. [horsesidevetguide.com]
- Facial Edema
From Dog Acute facial edema associated with pit viper snake bite [2] Snake-bite poisoning by Pit Vipers is relatively uncommon in dogs, but has been reported in dogs [3]. [vetbook.org]
Workup
The doctor treats breathing problems, shock, and/or immediately life-threatening injuries even before a full workup is complete. The wound needs to be examined and cleaned. [webmd.com]
Serum
- Fibrinogen Decreased
WARNINGS AND PRECAUTIONS Coagulopathy: In clinical trials, recurrent coagulopathy (the return of a coagulation abnormality after it has been successfully treated with antivenin), characterized by decreased fibrinogen, decreased platelets, and elevated [crofab.com]
Signs & Symptoms Signs of Envenomation Swelling – local and diffuse Tenderness Erythema Ecchymosis Blebs Elevated PT/INR Decreased fibrinogen Decreased platelets Systemic signs such as hypotension, hemorrhage, respiratory failure, angioedema, neurotoxicity [epmonthly.com]
Treatment
Symptomatic treatment with antihistamines and steroids may be needed and rarely require hospitalization. [epmonthly.com]
Treatment of Snakebites from Pit Vipers in Dogs With rapid treatment, most dogs with Crotalidae snakebites recover. [petplace.com]
Treatments May Include These treatments might be used to help resolve or improve this condition. PROGNOSIS AND RELEVANT FACTORS The prognosis for most pit viper bites is usually fair to good. [horsesidevetguide.com]
In many cases, the prognosis is good with immediate treatment and administration of antivenom Without treatment or access to proper healthcare, deaths from severe complications, such as internal bleeding, organ failure, and shock, have been reported. [dovemed.com]
Related: Pre-hospital Snakebite Treatment [wsed.org]
Prognosis
PROGNOSIS AND RELEVANT FACTORS The prognosis for most pit viper bites is usually fair to good. [horsesidevetguide.com]
The sooner treatment is initiated the better the prognosis. [palenciapetclinic.com]
Snakebite Prognosis and Outcomes Although the vast majority of victims bitten by venomous snakes in the United States do very well, predicting the prognosis in any individual case can be difficult. [emedicinehealth.com]
Etiology
(Etiology) Malayan Pit Viper Snake Bite takes place when one comes into contact with the venomous and dangerous Malayan pit viper, usually unintentionally or inadvertently. [dovemed.com]
Etiology In the United States, more than 40% of victims put themselves in danger by either handling pets or attempting to capture reptiles in the wild. [emedicine.medscape.com]
Ongoing controversies regarding etiology, diagnosis, treatment Significant debate exists concerning fasciotomy. [clinicaladvisor.com]
Epidemiology
Baseline epidemiological study on snake-bite treatment and management. Weekly Epidemiolog Rev. 1987;42:319-320. 14. Hansdak SG, Lallar KS, Pokharel P, Shyangwa P, Karki P, Koirala S. A clinico-epidemiological study of snake bite in Nepal. [priory.com]
The epidemiology, clinical course, and management of snakebites in the North American Snakebite Registry. J Med Toxicol. 2017;13(4):309-320. 7. Mackessy SP, ed. Handbook of Venoms and Toxins of Reptiles. Boca Raton, FL: CRC Press; 2010. 8. [crofab.com]
Distinctive epidemiologic and clinical features of common krait ( Bungarus caeruleus ) bites in Sri Lanka. Am J Trop Med Hyg. 2008;79(3):458–462. 3. Kularatne SA. [dovepress.com]
Epidemiology and Risk Factors The risk of snakebite depends on the density of the local snake population, activities that bring people into contact with snakes, and the aggressiveness or timidity of the species of snake. [tripprep.com]
"In the past five or 10 years, there's been a backing off in first aid from really invasive things like making incisions," says Arizona physician David Hardy, M.D., who studies snakebite epidemiology. [consejo.bz]
Pathophysiology
Once the venom has initiated the pathophysiological events, the team will need to identify the action and therapeutic effects of rutin. [drugtargetreview.com]
Pathogenesis Pathophysiology Rattlesnakes have a pair of long, hollow fangs that lie in the rostral portion of the head, folded back against the roof of the mouth. These are connected to venom glands by small tubules or ducts. [vetstream.com]
Pathophysiology Crotalid venom is produced and stored in paired glands below the eye. It is discharged from hollow fangs located in the upper jaw. Fangs can grow to 20 mm in large rattlesnakes. [emedicine.medscape.com]
Other systemic manifestations depend upon the pathophysiological changes induced by the venom of that particular species (See Fig. 1). [priory.com]
It is likely that common pathophysiological mechanisms are responsible for both these important systemic complications of hump-nosed viper bite. Hump-nosed viper venom contains procoagulant, nephrotoxic, myotoxic and cytotoxic properties. [omicsonline.org]
Prevention
Since we're sharing the outdoors with these reptiles, it's a good time to know what to watch for to prevent snakebites. As always with wilderness medicine, prevention is key. [blog.nols.edu]
READ MORE: WHO SEARO Guidelines for the Management of Snake-bites in South East-Asia Snakebite is a preventable injury. Finding ways to effectively prevent snakebites is particularly challenging in the tropics of Asia and New Guinea. [snakebiteinitiative.org]
Preventing snake bites Some bites, such as those inflicted when your child accidentally steps on a snake in the woods, are nearly impossible to prevent. However, there are precautions that can reduce your child's chances of being bitten by a snake. [stanfordchildrens.org]
If the bite comes from a nonvenomous snake, a person should still seek medical attention to receive proper wound care and prevent infection. Preventing snake bites In most cases, snake bites are preventable. [medicalnewstoday.com]
Continued Prevention The snake is almost always more scared of you than you are of the snake. Giving the snake the opportunity to escape prevents most bites. Do not attempt to handle, capture, or tease venomous snakes or snakes of unknown identity. [webmd.com]