Biology Reference
In-Depth Information
1 colubrid) envenomation has not been described, this consideration may assume
greater weight when the bite occurs in a remote location and/or there is anticipation
of an extensive delay for transport to a medical facility. Further cases of neurotoxic
envenomation from species such as
M. monspessulanus
would be required in order
to support the use of PI in bites from these species. As in any snakebite, harmful and/
or useless practices must be avoided [e.g., tourniquets, cut/suction, venom extractors,
electric current, ligature/cryotherapy, application of permanganate or other oxidiz-
ing agents or proteases (e.g., meat tenderizers such as papain), etc.], and the patient
should be counseled, with efforts to keep the patient as calm and still as possible.
The patient should avoid any unnecessary movements and be carried on a litter if
possible (transport by ambulance is obviously strongly recommended). Expeditious
transport to a Level 1 (if possible) trauma facility is mandatory. Although many haz-
ard level 1 colubrid bites are serious, most cases may produce significant bleeding
and complications but are not fatal.
4.6.2.2 Evaluation of the Patient
Patient assessment should follow standard protocol as in any presentation with careful
attention to medication regimens [especially NSAIDS, warfarin, some antidepressants
(particularly mixed reuptake inhibitors such as venlafaxine that predispose to ecchy-
moses), platelet inhibitors, etc.]; medical history [e.g., comorbidities such as diabetes
may predispose to more serious local wounds and delayed healing with increased risk
of infection; psychiatric illnesses may increase anxiety and somatosensory amplifica-
tion as well as potential exacerbation of cardiovascular comorbidities (see previous
section), neurological history (i.e., seizures), etc.]; drug and alcohol use and previous
history of snakebites (including nonvenomous); maintenance/husbandry of captive rep-
tiles and exposure to lyophilized venoms (potential risk for sensitization/anaphylaxis;
see later). Also, recent surgical wounds, dental work, tattoos or piercings, and even
trauma-induced bruises should be carefully examined, as in some cases these may be
subject to persistent bleeding (especially after envenoming from hazard level 1 species;
Table 4.2
). Patients presenting after being bitten by hazard level 1 colubrids must be
observed and monitored for as long as necessary in order to rule out coagulopathy, that
may have a delayed onset (e.g., several days).
4.6.2.3 Confirmation of Snake Identification
The identity of the snake must be verified and taxonomically documented. If the
snake is a captive specimen, its identity will often be known to the victim. However,
this requires evaluation on a case-by-case basis. For instance, consider issues regard-
ing confusion between potentially life-threatening species and those without
medical importance (e.g.,
Amphiesma stolata
and
R. tigrinus
; see Section 4.3 and
Plates 4.45A and B, 4.46A and B, and 4.84A-E
), as well as specimens incorrectly
identified by vendors or incorrect information obtained via the Internet. Identification
often requires professional verification (see Section 4.5.1.1).
Although exotic snakebite victims/owners usually know the identity of the
snake responsible for biting them, they may use misleading common names for
