Biology Reference
In-Depth Information
Plate 4.94
Bleeding gingival mucosa after envenoming by the Malayan pit viper
(
Calloselasma rhodostoma
), Chantaburi, Thailand.
As is observed in victims envenomated by
some venomous species such as the crotaline viperid,
C. rhodostoma
, and the viperine viperid,
Echis
spp., patients with serious envenomation by hazard level 1 colubrids may present with (or
later develop) bleeding from numerous anatomical sites including the gingival sulcus.
Photo copyright to David A. Warrell.
mild systemic effects, but to date there are insufficient data to establish this risk (see
Table 4.1
and Sections 4.4 and 4.5). The majority of bites from these species require
only wound care and simple supportive measures as indicated (i.e., tetanus prophy-
laxis;
Table 4.3
). An overview of evidence-supported symptoms and signs reported
in documented bites of non-front-fanged colubroids is provided in
Table 4.4
. As indi-
cated above, most commonly only mild local effects are reported, but moderate local
edema, ecchymoses, and occasionally lymphadenopathy may occur after bites from a
handful of species (
Tables 4.1 and 4.4
).
4.6.2 Specific
4.6.2.1 First Aid
There is no recommended
specific
first aid other than the globally applicable WHO
recommended use of immobilization of the bitten limb and patient as universally
safe first aid for all snakebites. There is no direct evidence to support the use or
benefit of pressure-immobilization (PI)
22
or pressure pad for acute management of
hazard 1 colubrid bites. However, as many of these bites are not generally associ-
ated with significant local tissue injury, there is no clear contraindication for use of
PI either. Also, since limited Australian experience may indicate a possible benefit
for PI in delaying onset of envenoming, it is reasonable to consider PI for hazard
level 1 colubrid bites, with the understanding that this is unproven first aid in this
setting. Although rapid onset of non-front-fanged colubroid (principally, hazard level
22
The use and correct application of PI is detailed at www.toxinology.com
