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Diagnosis of bites of poisonous snakes
Last reviewed: 19.10.2021
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Along with the clinical manifestations of poisoning with snake venom, the final diagnosis requires the determination of the species of the snake. An anamnesis should include the following:
- bite time;
- description of the snake;
- assistance provided on the spot;
- the patient's condition;
- the presence of allergies to horse and sheep antidotes;
- data on snake bites and treatment in the past.
A complete clinical examination is required, including the measurement of the circumference of the limb, proximal and distal to the site of the bite.
Patients often can not remember the details of snake appearance. Rattlesnakes differ from non-venomous snakes by the shape of the head, elliptical pupils, heat-sensitive pits between the eyes and nose, protruding fangs and a number of tailspots starting at the anal plate on the underside of the tail.
Coral snakes in the United States have round pupils and a black muzzle, but without facial pits. Their heads are dull or cigar-shaped and alternating red, yellow (cream) and black stripes. Because of this, they are often mistaken for the usual non-venomous scarlet royal snake, which has a red, black and yellow stripes ("red on yellow kills," "red on black - little poison"). Coral snakes have short, motionless fangs, they inject poison with successive chewing movements. Traces of canine teeth allow you to make an assumption, but do not allow you to make a diagnosis; rattlesnakes can leave single or double traces of canines, other traces, while bites of non-venomous snakes usually leave multiple surface traces. However, the number of teeth marks and the place of bite may not correspond to the norms, because snakes can bite several times.
The diagnosis of a dry bite of a rattlesnake can be established if signs of poisoning do not appear more than 8 hours.
The severity of poisoning depends on the size and variety of the snake (rattlesnakes, marmots, copper snakes), the amount of poison introduced, the number of bites, the location and depth of the bite (for example, bites in the head and trunk are more dangerous than in the limb), age, body weight, health status of the victim, the time before the initiation of care and the susceptibility of the victim to the poison.
Distinguish between mild, moderate or severe poisoning. Classification is based on the severity of local manifestations, systemic symptoms, coagulation parameters and laboratory data. The degree of severity is determined by the worst symptoms and laboratory data. Poisoning can progress rapidly, from mild to severe severity, which must be constantly monitored.
[The severity of poisoning after the bites of the Yamkogo snake
|
Power |
Description |
|
Lightweight |
Changes only at the site of the bite, no systemic manifestations, negative results of laboratory tests |
|
Moderate |
Changes apply to areas outside the bite; non-life-threatening systemic manifestations (eg, nausea, vomiting, paresthesia); small changes in coagulation or laboratory changes without clinically significant bleeding |
|
Heavy |
Pathological changes capture the entire limb; severe systemic manifestations (eg, arterial hypotension, dyspnea, shock); changes in coagulation and laboratory data with clinically significant bleeding |