What other tests might be needed in the evaluation of snakebite?

Updated: Apr 09, 2021
  • Author: Spencer Greene, MD, MS, FACEP, FACMT, FAAEM; Chief Editor: Joe Alcock, MD, MS  more...
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Clinicians should examine the affected extremity for swelling, tenderness, hemorrhagic blebs, and the presence of strong distal pulses. The proximal spread of tenderness and swelling should be recorded every 15-30 minutes to document the progression of the local venom effects. This can be accomplished by palpating the proximal part of the affected extremity and moving distally until tenderness is elicited.

Serial dynamometry and negative inspiratory force assessments should be measured on patients at risk for respiratory and/or skeletal weakness/paralysis (eg, coral snake envenomations, bites from neurotoxic rattlesnakes). Capnography may also be used to identify patients with mild respiratory insufficiency.

True compartment syndrome is exceptionally uncommon following snake envenomation. However, compartmental pressures should be measured in patients with disproportionate pain and significant tissue swelling. Commercially available devices exist that are sterile, simple to assemble and read, and reliable (eg, Stryker pressure monitor).

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