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<< Diagnosis And Management Of North American Snake And Scorpion Envenomations
Diagnostic Studies
Coral Snakes
There is no adequate evidence to support the use of any specific laboratory or imaging tests in cases of coral snake envenomations. Since there are generally few cytotoxic effects, there is probably no need for testing. However, if the patient requires endotracheal intubation and mechanical ventilation for respiratory failure, a chest x-ray to assess tube position and arterial or venous blood gases to assess ventilation status are indicated.
Non-native Venomous Snakes
Again, guidance on testing will depend on the identification of the snake. Bites from other members of the family Elapidae will likely require no testing. Patients with bites from other Viperidae snakes will probably require testing similar to that recommended previously for Crotalid envenomations, e.g. complete blood count, comprehensive metabolic panel, prothrombin time, partial thromboplastin time, fibrinogen level, blood type and antibody screening. Compartment pressure measurement is indicated if compartment syndrome is suspected.
Scorpions
A complete blood count and plasma protein concentration may help predict the presence of pulmonary edema, as will a chest x-ray. Cardiac enzymes may demonstrate cardiac damage. Liver enzymes may show liver damage which was correlated with poor prognosis in a study of 951 patients admitted to a Tunisian ICU.57 Echocardiography may be necessary to evaluate cardiogenic shock or suspected cardiac dysfunction.
There is no adequate evidence to support the use of any specific laboratory or imaging tests in cases of coral snake envenomations. Since there are generally few cytotoxic effects, there is probably no need for testing. However, if the patient requires endotracheal intubation and mechanical ventilation for respiratory failure, a chest x-ray to assess tube position and arterial or venous blood gases to assess ventilation status are indicated.
Non-native Venomous Snakes
Again, guidance on testing will depend on the identification of the snake. Bites from other members of the family Elapidae will likely require no testing. Patients with bites from other Viperidae snakes will probably require testing similar to that recommended previously for Crotalid envenomations, e.g. complete blood count, comprehensive metabolic panel, prothrombin time, partial thromboplastin time, fibrinogen level, blood type and antibody screening. Compartment pressure measurement is indicated if compartment syndrome is suspected.
Scorpions
A complete blood count and plasma protein concentration may help predict the presence of pulmonary edema, as will a chest x-ray. Cardiac enzymes may demonstrate cardiac damage. Liver enzymes may show liver damage which was correlated with poor prognosis in a study of 951 patients admitted to a Tunisian ICU.57 Echocardiography may be necessary to evaluate cardiogenic shock or suspected cardiac dysfunction.
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