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Snake Bites-Assessment and Treatment (102.152)

Snake Bites-Assessment and Treatment (102.152) - Policies, Clinical, UWMF Clinical, UWMF-wide, Clinical Policies and Procedures, Wound and Skin

102.152

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UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE

TITLE: SNAKE BITES - Assessment and Treatment

Effective Date: April, 2005 Approval: See Authorization
Supersedes Policy: None Contact: Clinical Staff Education
Reviewed May, 2008 May 2009 February 2012

PURPOSE: To provide guidelines for the assessment and treatment of snake bites at UWMF Clinics.

DEFINITION: Any penetration of the skin by teeth constitutes a bite exposure. A person may experience
various reactions, from irritation, itching and swelling to systemic anaphylactic reaction.

Wisconsin has two of the four major kinds of venomous snakes –
 Rattlesnakes
o Eastern Massasauga “Swap Rattler”
o Timber Rattle Snake
 Copperheads (triangular head)

POLICY: The UWMF staff will utilize the following guidelines to assess, treat, and document a snake bite
exposure involving a UWMF patient.

Snake bites should be treated as a minor wound.
Assume all snakes are venomous until proven otherwise (See assessment).
Consider a snake bite an emergency whether the snake is venomous or not.

Any person with a venomous snake bite presenting to a UWMF clinic will have the wound cleaned and dressed.

A provider caring for a person’s with a venomous snake bite should be in contact with the State of Wisconsin
Poison Control Center 1-800-222-1222. The Poison Control Center will assist the clinic with assessment (if
needed) and indicate which hospital the patient should be sent or transferred to for anti-venom treatment.

Have the following information ready for the Poison Control Center:
The age, size and general health of the patient. A small child will probably react more severely to a
smaller amount of venom than will an adult.
Patient’s current symptoms and a list of current medications, if any.
The clothing the person had on. A snake that bites through layers of clothing will not leave as much
venom as a snake that strikes bare skin.
The species of snake (if known).
The depth, location and number of bites. A single, glancing bite is much less dangerous than multiple
wounds or that deeply penetrate the flesh.
Did the bite penetrate a blood vessel? These bites are extremely dangerous.

Rarely will a fresh venomous bite will need ambulance transport. Wisconsin’s venomous snake bites generally
cause coagulopathies which most often will take hours to days to develop.

SUPPLIES: Antibiotic cream, Soap and water, Gauze, Patient’s record
Hydrogen peroxide or other mild antiseptic, Immunization record, Tetanus vaccine



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PROCEDURE:
1. Wash hands and gather equipment.

2. Introduce yourself and identify the patient, including date of birth, and verify allergies. Provide good light and
privacy.

3. Assess for anaphylaxis - ABC’s → assess airway, breathing and circulation.
Refer to and follow Anaphylaxis Protocol (if anaphylactic in nature).
Record vital signs including BP, HR, RR and pulse oximetry (if available).
Obtain brief history (onset, timing and symptoms).

4. Calm the patient. Virtually all snakebites in the U.S. are successfully treated. Anxiety increases the heart rate,
increasing the danger to the victim.

5. Assess the bite and integrity of surrounding skin to determine if bite is venomous:
Bites from venomous snakes leave one or two distinctive puncture wounds “vampire-like” fang marks
at the point of entry.
Bites from non-venomous snakes leave a horseshoe or "U" tooth pattern.

NOTE: Usually, the bite of a venomous snake will cause severe pain and rapid swelling and discoloration of the
skin at the bite area. Other conditions that may develop include body weakness, rapid pulse, nausea/vomiting,
shortness of breath, dimness of vision, or shock.

For venomous bites: DO NOT
Excite the victim. Doing so will increase blood circulation, speeding the spread of the venom beyond the
area of the bite.
Apply heat around wound (same reason as above)
Apply ice/immerse area in cold water. Doing so increases tissue damage.
Use the small rubber suction cups found in some first aid kits because they are too weak to remove any
significant amount of venom.
Cut an "X" or suck out venom with the mouth. This is ineffective and increases trauma in the area of the
wound.
Apply a tourniquet unless well-trained in its use.

For venomous bites: DO
Keep the effected area at heart level or lower (if possible).
Remove jewelry or restrictive clothing.

6. Apply a wide, ‘light’ constricting band about 2" above and below the bite, however never place the bands on
either side of a joint (such as above and below the knee or elbow). This band should be made up of wide, soft
material, such as ACE wrap, or could be a handkerchief or shredded clothing. The band should only be as tight as
the band the nurse applies when taking a blood test.
*Remember ACE or other wide bandaging must not be wrapped so tight as to cut off systemic venous or arterial
circulation, but is to restrict lymphatic flow only. Properly applied, such bandages will NOT compromise blood
flow.

7. Wash the wound thoroughly with soap and water, hydrogen peroxide or other prescribed (mild) antiseptic.

8. Apply a prescribed antibiotic cream to prevent infection and cover it with a clean and dry bandage.

9. Determine date of patient’s last Tetanus immunization. Give Tetanus (if needed)

10. Document in the patient's record:

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Type of snake or bite (pattern of teeth marks)
Symptoms exhibited by patient
Care given (including antibiotics, and pain medication)
Tetanus injection (if given) or date of last Tetanus injection
Patient's response to the procedure
Patient Education, Discharge instructions and follow-up appointment (if needed)
Call to Poison Control and instruction given to clinic or patient, if applicable
Referral or Transfer to emergency department, if applicable

11. Discharge instructions
Limit liquid intake to decrease painful swelling
Prescribed pain medication (if needed)
Avoid alcohol, which increases metabolism and impairs judgment
Keep wound clean and dry

REVIEWED BY: Carol Decker, RN, MSN, Clinical Staff Educator

WRITTEN BY: Ronnie Peterson, R.N., M.S., Manager of Clinical Support

REFERENCES:
1. Heller, J.L. (January 13, 2010). MedlinePlus. Snake Bites. Retrieved October 24, 2011 from
http://www.nlm.nih.gov/medlineplus/ency/article/000031.htm
2. Karriem-Norwood, V. (October 2, 2011). WebMD, LLC. Snakebite Treatment. Retrieved October 24, 2011 from
http://firstaid.webmd.com/snakebite-treatment
3. State of Wisconsin Poison Center 1-800-222-1222.
4. Poison Control Hotline 1-800-222-1222

AUTHORIZATION:


Medical Director Date