Biology Reference
In-Depth Information
Species
Hazard Index
a
Management Recommendations
b
Red-necked keel-back,
Rhabdophis subminiatus
1
In cases featuring life-threatening DIC (especially with altered
sensorium), consider CT without contrast of the head in order to exclude
brain hemorrhage.
Patients envenomed by these species often require extended admissions,
careful monitoring, and renal/hematologic support. Extended admissions
will require attentive nursing care. Until hemostasis is fully restored,
protracted recumbent dependency may lead to serious ecchymoses.
Renal function may slowly recover days-weeks after hemostasis is
re-established. See Section 4.6 for further discussion of management.
Group II: Potential for significant effects/morbidity
Brown tree snake,
Boiga irregularis
2/3
ABC, i.v. access
Any indication of respiratory distress in a pediatric patient should be
indication for PICU or NICU admission.
CMP, CBC, PT/INR, CK.
Tetanus prophylaxis as indicated.
Neurological assessment and re-evaluation as indicated.
If neurological signs/cranial nerve palsies are present, consider the
tensilon test and/or treatment with neostigmine bromide (0.5-2.0 mg
i.v.; pediatric dosage: 0.025-0.08 (infants) or 0.025-0.10 (children) mg/
kg/dose). Pretreatment with atropine 0.6-1.2 mg i.v. (pediatric dosage
0.02 mg/kg/dose
1) given several minutes prior to the provision of the
neostigmine bromide is strongly recommended.
