Subjective
Date of visit
Time of Envenomation (if known)
Reason for visit (envenomation by pit viper)
History of Present Illness:
Location of bite
Signs and symptoms at the bite site (pain, swelling, bruising, discoloration)
Systemic symptoms (nausea, vomiting, diaphoresis [sweating], dizziness, weakness)
Allergic reactions (rash, itching, wheezing)
Neurologic symptoms (ptosis [drooping eyelid], facial droop, difficulty speaking)
Past Medical History (relevant medical conditions, allergies)
Medications (current medications)
Objective
Vital Signs (temperature, heart rate, blood pressure, respiratory rate)
Physical Exam:
General (signs of systemic toxicity)
Local wound examination:
Location and size of fang marks
Swelling, ecchymosis (bruising), erythema (redness)
Evidence of bleeding or necrosis (tissue death)
Neurologic exam (assess for ptosis, facial droop, weakness)
Assessment
Pit viper envenomation (confirmed based on history and clinical presentation)
Severity of envenomation (consider local findings, systemic symptoms, and ongoing bleeding)
Plan
Immediate Management:
Secure the scene and minimize movement of the affected limb.
Apply a pressure immobilization bandage (similar to a sprain) above the bite site, excluding the fingers or toes.
Intravenous access for fluid resuscitation and medication administration.
Antivenom administration (specific for the type of pit viper) – cornerstone of treatment.
Tetanus prophylaxis (if not up to date).
Ongoing Management:
Monitor vital signs and clinical status closely.
Wound care (clean and dress the bite site).
Pain management with medications.
Compartment syndrome monitoring (may require fasciotomy – surgical decompression)
Laboratory monitoring (coagulation studies, electrolytes, CBC)
Consultation with a toxicologist or specialist in snakebite management may be necessary depending on the severity of envenomation.
Education
Explain the diagnosis and treatment plan.
Discuss the importance of avoiding further movement of the affected limb.
Provide wound care instructions.
Advise on recognizing signs of worsening and seeking immediate medical attention.
Follow-up
Schedule for close follow-up to monitor for complications (compartment syndrome, bleeding, infection)
Wound care management as needed
Consider referral to a plastic surgeon for complex wound management (if tissue necrosis is present)
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. In the case of a suspected pit viper envenomation, immediate medical attention is crucial. Please consult with a qualified healthcare professional for diagnosis and treatment.