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Old 09-22-2011
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Default CCS- sanke bite

Snake bite

ER Location
25 y young guy
30min after hx of snake bite.
Havent
brought snake,

order-
vitals/hr
IV Access
NS
Pulse oxi
O2
Abg
Cont BP moniter
Cardiac moniter
cbc
bmp
ua
pt
ptt
Bleeding time
ECG
CXR
Blood type and cross match.
Foley
Urine output
NPO

PE-(complete)
shows local cellulitis, noticed 2 fang sites on his ankle Neuro xam shows drowsiness
order-
Polyvalent snake antivenom -SNAKE
Shift to ICU
interval hx+rest Ex
Bedrest
Vitalsq2h
Pulse Oximetry q2h
Neuro exam q2h
Monitor Bleeding time, PT, PTT, Platelet counts (Can develop DIC)
H&H-6h
Ranitidine
Inj TT
Ampicillin/Cloxacillin IV
ABG q8h
cbc/24
Bmp/24

If Neuroparalyis symptoms---- (Atropine + Neostigmine IV)
If devloping resp failure---- intubate and mech ventilation

D/C ASV when Bleeding time/PT/PTT parameters normal and neuro symptoms subside,
D/c IV antibiotics; make oral
When pt okÔ
€”to wd Later send home
counselling

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