{"id":1260,"date":"2021-08-16T00:00:00","date_gmt":"2021-08-16T00:00:00","guid":{"rendered":"https:\/\/protherics2.aazzxx.com\/insights\/so-you-went-out-and-got-yourself-snake-bitten-now-what\/"},"modified":"2022-11-15T11:10:07","modified_gmt":"2022-11-15T11:10:07","slug":"so-you-went-out-and-got-yourself-snake-bitten-now-what","status":"publish","type":"insights","link":"https:\/\/serb.com\/nl\/insights\/so-you-went-out-and-got-yourself-snake-bitten-now-what\/","title":{"rendered":"So, you went out and got yourself snake bitten. Now what? (part 2)"},"content":{"rendered":"\n

Part 2: In-hospital Management<\/h2>\n\n\n

So you\u2019ve been admitted to the hospital following a snakebite. If you have any signs of an envenomation, you need to be monitored for at least 12 to 24 hours.<\/p>\n

If you have a minimal envenomation, treatment with antivenom may be unnecessary. Of course, it\u2019s essential to monitor for any progression to something more significant.<\/p>\n

If you have an envenomation that is more-than-minimal, you should be treated with antivenom. Hopefully the first dose was already administered in the emergency department. If not, hopefully your treating physicians will start it as soon as possible.<\/p>\n

So what happens next?<\/p>\n

The team caring for you should continue elevating the affected extremity. As mentioned previously, elevation is really helpful.<\/a> I would argue that it\u2019s second only to antivenom in improving outcomes.<\/p>\n

You need good pain control. We initially start with intravenous opioids, but at some point, we need to transition to oral analgesics, because you won\u2019t go home with an IV. The good news is that elevation and appropriate treatment with CroFab\u00ae can reduce total opioid requirements<\/a>.<\/p>\n

Maintenance CroFab\u00ae dosing consists of two vials every six hours for three doses. In some circumstances, when there is a physician with snakebite expertise who can frequently reassess the patient at the bedside, one or more maintenance doses may not be needed<\/a>. In the absence of such an expert, maintenance dosing is recommended.<\/p>\n

I suggest consulting physical therapy and occupational therapy early in the hospitalization. For lower extremity bites, you need to learn to ambulate and transfer without bearing weight on the affected limb. Patients with upper extremity bites may need assistance performing skills one-handed, especially if the envenomation affected the dominant hand. Physical therapy and occupational therapy can also teach you how to do the important range-of-motion exercises to prevent atrophy and contractures.<\/p>\n

As I mentioned in a previous blog, prophylactic antibiotics are unnecessary. Snake envenomation is rarely associated with infection. Less than 1% of the time in one large study<\/a> out of the University of Arizona. Prophylactic antibiotics confer no benefit<\/a>, and unnecessary antibiotics can lead to side effects and contribute to antibiotic resistance. Antibiotics should be reserved for documented infection, which is fortunately rare in snakebite.<\/p>\n

Similarly, surgical intervention is rarely necessary<\/a> following snake envenomation. If a surgeon comes to see you, you can be civil to him or her. Even charming. But do not let anyone cut into you without a compelling reason. There will almost never be one.<\/p>\n

In the absence of an allergy to the antivenom (rare) or the snake envenomation itself (also rare), there\u2019s no direct benefit from corticosteroids or diphenhydramine (Benadryl)<\/a>.<\/p>\n

Most snakebite patients can be discharged within 24 hours. My criteria for discharge include:<\/p>\n