Inside Pediatrics Spring 2023

The most common complications from envenomation are local wound damage, swelling of extremities and severely painful blood blisters. When a snake envenomates a person, often on the foot, the tissues fill up with blood. “For someone with little experience of snakebite, that swollen leg can look like dead, necrotic tissue that needs to be removed to avoid wider damage,” Rushton said. “That’s a hallmark of our program, to keep people away from unnecessary or harmful procedures. These large blood blisters are cared for by a wound care specialist who has specific training of the mechanisms of envenomation. What we don’t want is someone trying to cut away that tissue, at least early on during active envenomation.” The program’s multidisciplinary approach is what truly sets it apart, Rushton says. While patients are in the hospital, physical therapists emphasize early range of-motion exercises and getting patients out of bed. Rushton says UAB pharmacy expertise has been crucial with the timing of the antivenom. Patients then get follow-up care in the snakebite clinic and the benefit of the program’s research efforts. The Comprehensive Snakebite Program is an innovator in the use of thromboelastography (TEG), a method of precisely studying blood coagulation, clot strength and clot stability. TEG can provide a more rapid answer than traditional tests, such as prothrombin time and partial thromboplastin time tests. Because the UAB Department of Emergency Medicine is a national leader in research, access to TEG is widespread enough that every snakebite patient admitted to UAB can receive the benefit of this technology and have their antivenom titrated appropriately, Rushton notes. Although the evidence is still out on whether TEGs are better than traditional labs, Rushton says the team can predict rattlesnake bites on the thromboelastogram earlier than from traditional coagulation markers. “Snakebites can be intimidating to treat given all of the various scenarios in which patients can present,” Atti said. “Many community hospitals in the state of Alabama don’t have enough antivenom for more than one loading dose nor the means to care for a critically ill patient from a snake envenomation. This can create a lot of uncertainty for a community physician in trying to decide whether a patient needs to be transferred to another hospital for further care. We’re able to guide physicians in such scenarios, allowing them to make sound decisions.”

The team can predict rattlesnake bites on the thromboelastogram (TEG) earlier than from traditional coagulation markers.

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