Bit by a snake with fang marks in the skin, pain, erythema, ecchymosis, edema extending from the bite, plus nausea/vomiting, perioral paresthesia, and lethargy. Which management step is indicated?

Bit by a snake with fang marks in the skin, pain, erythema, ecchymosis, edema extending from the bite, plus nausea/vomiting, perioral paresthesia, and lethargy. Which management step is indicated?

• A. Antivenom therapy with FabAV
• B. Immediate constriction band proximal to the bite
• C. Prednisone for serum sickness prophylaxis
• D. Mannitol for renal protection only if oliguria occurs

Answer: (A)

Recognizing systemic envenomation from a pit viper is what drives management here. Signs such as spreading edema from the bite plus systemic symptoms like nausea/vomiting, perioral paresthesias, and lethargy indicate venom is circulating and causing effects beyond the local tissue. The best step is administering crotalidae polyvalent immune Fab antivenom (FabAV) to neutralize the circulating venom and halt progression, which will help reverse both local swelling and systemic symptoms. Constriction bands are outdated and can cause tissue injury without reliably slowing venom spread. Steroids like prednisone don’t prevent serum sickness and aren’t used as prophylaxis for antivenom reactions. Mannitol isn’t given routinely for renal protection in snakebite and is not a standard preventive measure; renal support is managed based on the clinical picture and fluid status. The priority is antivenom therapy with careful monitoring for infusion reactions.

Recognizing systemic envenomation from a pit viper is what drives management here. Signs such as spreading edema from the bite plus systemic symptoms like nausea/vomiting, perioral paresthesias, and lethargy indicate venom is circulating and causing effects beyond the local tissue. The best step is administering crotalidae polyvalent immune Fab antivenom (FabAV) to neutralize the circulating venom and halt progression, which will help reverse both local swelling and systemic symptoms.

Constriction bands are outdated and can cause tissue injury without reliably slowing venom spread. Steroids like prednisone don’t prevent serum sickness and aren’t used as prophylaxis for antivenom reactions. Mannitol isn’t given routinely for renal protection in snakebite and is not a standard preventive measure; renal support is managed based on the clinical picture and fluid status. The priority is antivenom therapy with careful monitoring for infusion reactions.