201021U. S. Special Operations Command (USSOCOM)
201021U. S. Special Operations Command (USSOCOM)
201021U. S. Special Operations Command (USSOCOM)
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ENVENOMATION<br />
SPECIAL CONSIDERATIONS:<br />
1. Toxic envenomations from a variety of sources, including bees/wasps, scorpions, jellyfish, or<br />
snakes, are all capable of causing life-threatening anaphylaxis.<br />
2. Only a minority of snakebites from toxic snakes involve severe, life-threatening envenomations.<br />
3. Incision, excision, electrical shock, tourniquet, oral suction, and cryotherapy should NOT be<br />
performed to treat snakebites.<br />
4. Suction device is not effective for removing snake venom from a wound. If previously placed, it<br />
should be left in place until patient reaches higher level of care.<br />
SIGNS AND SYMPTOMS:<br />
General:<br />
1. Pain<br />
2. Swelling / edema<br />
3. Puncture site(s) from stinger or fangs<br />
Hemotoxins:<br />
1. Sudden pain<br />
2. Erythema<br />
3. Ecchymosis<br />
4. Hemorrhagic bullae<br />
5. Bleeding from site<br />
6. Metallic taste<br />
7. Hypotension/ shock<br />
Neurotoxins:<br />
1. Cranial Nerve dysfunction (i.e. ptosis)<br />
2. Paresthesias<br />
3. Fasciculations<br />
4. Weakness<br />
5. Altered mental status<br />
MANAGEMENT:<br />
1. If signs and symptoms of anaphylaxis present, treat per Anaphylaxis Protocol.<br />
2. Diphenhydramine (Benadryl) 25mg PO / SL / IV<br />
3. Apply cold packs topically for insect envenomations.<br />
4. Treat per Pain Management Protocol.<br />
5. If toxic snakebite suspected (significant pain, edema, evidence of coagulopathy or neurologic<br />
signs/symptoms):<br />
A. Minimize activity and place on a litter<br />
B. Remove all constricting clothing and jewelry<br />
C. Start IV in unaffected extremity<br />
D. Monitor and record vital signs and extent of edema every 15 – 30 minutes<br />
E. Immobilize affected limb in neutral position and wrap affected extremity in an elastic bandage<br />
beginning proximally and progressing distally, or in an air splint.<br />
DISPOSITION:<br />
1. Urgent evacuation if treated for anaphylaxis.<br />
2. Urgent evacuation if evidence of severe envenomation (systemic signs and symptoms, edema<br />
reaching root of limb).<br />
3. Evacuation not required if signs and symptoms do not indicate anaphylaxis or severe envenomation<br />
after four hours of observation.<br />
A38<br />
Journal of <strong>Special</strong> <strong>Operations</strong> Medicine
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