Question

Mr. Vaughn, a 27-year-old man, is hiking in the woods near his home in the American Midwest. He feels a sharp stinging sensation on his left ankle. As he looks down he sees a dark colored snake moving off the trail into the woods. Mr. Vaughn calls the ED at the local hospital. He tells the nurse what has happened. What should the nurse tell Mr. Vaughn? What actions should the nurse take at this time? Mr. Vaughn is brought to the ED via the paramedics along with a park ranger. The park ranger used the patient's description of the snake and determined that it was a pit viper. What is the priority of care for Mr. Vaughn? When the Mr. Vaughn's wounds are reassessed, the nurse notes heavy bleeding from the puncture site. What should the nurse's next actions be? Why?

Answer 1

The nurse should tell him to: 1) Remove any rings, watches, tight clothing and anything else from the bitten limb, because the swelling will make it a lot bigger soon.

2) Keep the area of the bite below the heart in order to slow the spread of venom through the bloodstream.

3) Remain still and calm. If possible, roll over to the side and rest in the recovery position. Moving around a lot will cause the venom to spread faster through the body.

4) Cover the bite with a clean, dry bandage. Try to use a pressure immobilization bandage if possible. This type of bandage should be tightly wrapped around the bite. Then, wrap another bandage around the entire limb, so that it’s immobilized.

5)Not to apply a tourniquet, not to suck out the venom, not to cut into the wound, not to apply ice or use water to submerge the wound and not to take any pain-relieving medication, such as ibuprofen (Advil, Acetaminophen)

THE NURSE SHOULD IMMEDIATELY MAKE ARRANGEMETS TO TRANSPORT MR. VAUGHN TO A HOSPITAL.

Pit viper venom has direct and indirect adverse effects on vital organs, including the kidneys and the lungs. Lung sounds should be closely monitored for signs of pulmonary edema. IV fluid administration rates should be carefully adjusted to prevent renal toxicity and to prevent fluid overload. The heart can be directly affected as well. Some pit viper venoms contain a direct cardiac muscle depressant.

Activation of the coagulation cascade and multiple defects in blood clotting (coagulopathy) are common following pit viper envenomation, putting the patient at risk of a serious bleeding diathesis. The nurse should give fresh frozen plasma, cryoprecipitate (fibrinogen, factor VIII), fresh whole blood, or platelet concentrates(C), this helps stop bleeding.