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A 10 year boy was out hiking with his family, several feet ahead of everyone else. He heard a rattle, felt a sharp pain in his leg, and may have seen a snake slither away into the underbrush. He is brought to the ED 40 minutes after the event. On exam, his vitals are normal, and he has a bite mark with 2 punctures on his right calf. There is no surrounding swelling or discoloration, and the compartments are soft. He complains of pain, but no paresthesias.
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June 30, 2022 at 11:47 pm
D) Administer CroFab, 4-6 vials
The Crotaline, or pit viper, snakes include rattlesnakes, and are responsible for the majority of U.S. snake bites. They have a diamond-shaped head, elliptical pupils, and pits between each eye and nostril. 20-25% of bites are “dry,” with no envenomation. However, a patient may take up to 12 hours to become symptomatic, and therefore should be monitored for at least that long. Symptoms include local swelling, which can be severe enough to cause compartment syndrome, hematologic abnormalities, neurotoxicity, and rare systemic anaphylaxis-like symptoms. Due to the potential for bleeding problems, opiate analgesia is preferred over NSAIDs. CroFab antivenom is only indicated when there are progressive local or systemic symptoms.