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Pit Viper Snake Bite

Crotalid Venoms


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]
  • The recommended dose for symptomatic pit viper bites range from 4-12 vials initially in both children and adults depending on the presenting signs and symptoms.[epmonthly.com]
  • 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]
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]
  • Ecchymosis Blebs Elevated PT/INR Decreased fibrinogen Decreased platelets Systemic signs such as hypotension, hemorrhage, respiratory failure, angioedema, neurotoxicity Signs of serum sickness, which may occur with antivenom treatment ADVERTISEMENT Fever[epmonthly.com]
  • Serum sickness causes fevers, joint aches, itching, swollen lymph nodes, and fatigue, but it is not life threatening.[webmd.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]
  • ., rash, fever, myalgia, arthralgia). ADVERSE REACTIONS The most common adverse reactions (incidence 5% of subjects) reported in the clinical studies were urticaria, rash, nausea, pruritus and back pain.[crofab.com]
Malaise
  • […] difficulties Nausea and vomiting Vomiting or coughing-up blood Blood in urine Abdominal pain and diarrhea Sweating Death of tissue (or necrosis) around the affected region or limb, observed within a few days Low blood pressure Fainting, dizziness Weakness and malaise[dovemed.com]
  • Serum sickness may develop, manifesting 7 to 21 days after treatment as fever, rash, malaise, urticaria, arthralgia, and lymphadenopathy (see Symptoms and Signs ). Treatment is H 1 blockers and a tapering course of oral corticosteroids.[msdmanuals.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
  • ., 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 Lacépède, 1804 (Reptilia: Squamata[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]
Cough
  • […] feet and ankles followed by the hands Skin 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[dovemed.com]
  • Should any signs of ALLERGY/ANAPHYLAXIS develop (e.g. coughing, dyspnea, urticaria, itching, increased oral secretions, etc.), immediately discontinue the administration of antivenom and treat symptoms with Corticosteroids, Epinephrine, Benadryl, Atarax[toxicology.ucsd.edu]
  • These reactions generally become evident within 30 minutes after antivenin administration; signs and symptoms of the reactions include apprehension; flushing; itching; urticaria; edema of the face, tongue, and throat; cough; dyspnea; cyanosis; vomiting[drugs.com]
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]
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
  • 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]
  • 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]
  • 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
  • Bites by Colubridae cause vomiting, abdominal pain, and widespread bleeding, starting hours or days after the bite, followed later by kidney failure.[tripprep.com]
  • pain and diarrhea Sweating Death of tissue (or necrosis) around the affected region or limb, observed within a few days Low blood pressure Fainting, dizziness Weakness and malaise Partial consciousness or unconsciousness Some of the systemic signs and[dovemed.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]
  • […] severe local necrosis as well as acute systemic envenoming; ptosis, diplopia, external ophthalmoplegia, and descending paralysis. 1 Common krait and Sri Lankan krait bites cause a distinct clinical syndrome consisting of minimal or no local envenoming, abdominal[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]
Drooling
  • Other signs include: Rapid swelling at the site of the bite Intense pain Oozing blood Fang marks (can be difficult to identify in some animals) Drooling Rapid breathing Dilated pupils Pale gums Weakness Collapse Tissue swelling is often worse 24 to 48[petplace.com]
  • Other symptoms to watch for: Extreme pain Dizziness Nausea Vomiting Diarrhea Weakness Shallow or labored breathing Abnormally low blood pressure Bleeding, bruising or slow blood clotting Restlessness Drooling Abnormal gait Spreading local tissue damage[wagwalking.com]
  • Exilicauda) 1) CN & Somatic Motor Dysfunction 2) RESULTING IN ABNORMAL ROVING EYE MOTION 3) Blurred vision 4) Drooling 5) Respiratory Compromise 6) Excessive Motor Activity - Restlessness - Uncontrolled jerking of the extremities What happens in severe[quizlet.com]
  • Signs and symptoms of scorpion stings include: Sharp pain at the site of the sting Swelling that gradually spreads Discoloration Nausea and vomiting Restlessness Drooling Poor coordination Incontinence Seizures Treatment: Apply ice to relieve the pain[snivalleyfire.org]
Tachycardia
  • 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]
  • (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 blood[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]
Heart Failure
  • Proteolytic, coagulant and hemorrhagic effects can be identified from the venom of this species, with a peptide found in their venom being used to develop drugs for heart failure and hypertension.[drugtargetreview.com]
  • Prairie Rattlesnakes and some other species of Pit Vipers have elements in their venom that damage heart muscle cells, potentially causing long-term heart damage and heart failure.[horsesidevetguide.com]
  • ACE inhibitors were initially approved for the treatment of high blood pressure (hypertension), though it is also prescribed for some types of congestive heart failure and cardiovascular and kidney diseases.[animalresearch.info]
  • Bites from this snake are extremely toxic, and can lead to respiratory paralysis and heart failure. It will bite readily if picked up, and has a very flexible neck that can twist, so make sure you leave this one well alone if you encounter it.[animalemergency.com.hk]
Palpitations
  • 20-25 breaths/min 1 Moderate respiratory distress (tachypnea, 26-40 breaths/min, accessory muscle use) 2 Cyanosis, air hunger, extreme tachypnea, or respiratory insufficiency/failure 3 Cardiovascular No symptom/sign 0 Tachycardia (100-125 beats/min), palpitations[medscape.com]
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[cancertherapyadvisor.com]
Muscular Atrophy
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]
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
  • In some cases, the facial swelling is severe enough that it interferes with breathing through the nose. Even horses that experience difficulty breathing can usually breathe well enough to survive, unless they become excited or are exercised.[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]
Intracranial Hemorrhage
  • It can also cause systemic bleeding from the skin, gums and nose, and could cause death due to shock, intracranial hemorrhage and renal failure.[drugtargetreview.com]

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]
Fibrinogen Decreased
  • 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]
  • 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]

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]
  • See the best-titled editorial ever here: A great reference is the unified treatment algorithm for management of crotaline envenomations . 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]
  • Outlook 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.[webmd.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.[cancertherapyadvisor.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]
  • ., who studies snakebite epidemiology. "This is because we now know these things can do harm and we don't know if they really change the outcome." Many health-care professionals embrace just a few basic first-aid techniques.[consejo.bz]
Sex distribution
Age distribution

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

  • 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]
  • Many first aid measures have been advocated for pit viper bite victims, none has been shown to prevent morbidity or mortality.[ncbi.nlm.nih.gov]
  • All snake bites should be considered as medical emergencies and evaluated by trained medical professionals, as soon as possible; the first 6-8 hours are particularly vital for preventing life-threatening symptoms.[dovemed.com]
  • 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]

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