f. If the decision is made to perform incision and suction, make a fine, straight
incision through each puncture wound parallel to the body part. Each incision should
not be more than 1/4" in depth or more than 1/2" in length. When making the incision,
avoid injury to nerves, tendons, and blood vessels and do not use cruciate (cross-like)
or multiple incisions.
g. After the incisions have been made, apply suction to the incised area. Always
use a mechanical suction device if an appropriate device is available and use the mouth
for suction only as a last resort. The suction probably does more to remove venom than
the incision since approximately 20% of the venom is removed in this manner. Once
suction has begun, continue it for 30 minutes, but never delay transportation to a
medical facility in order to continue suction.
h. Give the victim tetracycline HCL (tetracyn). Determine if the patient has a
current immunization of the tetanus toxoid series. If not, refer him to the battalion aid
station for an immunization. If the patient goes into shock, administer IV fluids (to
replace the edema fluids) that may be the normal saline IV of choice. Give oxygen.
i. Perform a fasciotomy ONLY if there is evidence of vascular impairment. This
can be done only by a physician.
j. Administer an antivenin IV. For this procedure, perform a skin test, not a
conjunctival testing for sensitivity prior to administering. For the amount of the antivenin
to be given, follow the manufacturer's direction for its use. Administer 3-5 units if only a
finger is swollen, 5-10 units if the entire hand is swollen, and greater than 10 units if the
entire area is swollen. Mix the antivenin in 250 cc normal saline in D5W. Administer
the antivenin immediately if the bite is that of a coral snake. Even if the antivenin is up
to 10 years out of date, it is still all right to use. Be prepared to deal with reactions from
the serum. (See appendix for additional information.)
k. Do not release the tourniquet above the bite until the antivenin IV has been
started, then release it immediately. This procedure is of questionable value after 24
hours and it is even less effective after 4 hours. It does not reverse the muscle necrosis
that has already occurred.
l. Not all bites from poisonous snakes require antivenin and normally, it is
administered only by a physician, or under the direct supervision of a physician. If the
patient will reach a physician within an hour of the bite, defer any administration of
antivenin. If you do start the antivenin, make sure that it is specific for the species
involved. There is no commercial antivenin available for the Gila monster and the
Arizona coral snake.
m. Do NOT give antivenin unless the victim's eyelids begin to droop, his speech
becomes slurred, he shows hemorrhagic tendencies, and there is severe local swelling.