Out-of-hospital and interhospital management of crotaline snakebite

Despite insufficient data far the development of evidence-based guidelines far the out-of-hospital treatment of crotaline snake envenomation, practica l concerns dictate a rational approach based on existing information. Out-o f-hospital care should focus on stabilization and rapid transport of the vi ctim to a health care facility with the capability of antivenom administrat ion. However, the out-of-hospital interval provides for the evaluation and management of the patients with snakebite. Out-of-hospital providers must b e familiar with common first-aid techniques and be aware of their potential complications. Proven measures to slow systemic absorption are limited but should include immobilization of the bitten extremity in a neutral positio n in every case, and the patient should maintain strict bed rest. Constrict ion bands or pressure wraps placed on the wound at the scene and without Va scular compromise should be left in place until arrival at a health care fa cility. Placement of a constriction band or pressure wrap (to delay systemi c absorption of venom) can be considered for prolonged transport times or w hen the patient's condition is deteriorating. A suction device, if applied and functioning, should be left in place. Vital signs should be closely mon itored to assess for hypotension as a sign of systemic toxicity. The extent of local swelling should be documented, and information regarding extent a nd progression of the envenomation syndrome should be relayed to the receiv ing hospital to expedite antivenom administration, if indicated. During int erhospital transport of patients who have received or continue to receive a ntivenom, the patient should be monitored for allergic reactions to treatme nt and treated appropriately. Routine stocking of the existing horse serum antivenom product on ambulances is not recommended because of the extended length of lime required to prepare the infusion and potential allergic comp lications. Antivenoms with improved side effect profiles may be better suit ed to use in the out-of-hospital setting in well-defined cases.