Immediate In-Hospital Therapy

A complete medical history, including current tetanus immunization status and known allergies, should be obtained. A careful description of the bite and the extent of the local pathology should be documented, including measuring the diameter of the extremity and noting the extent of edema by marking the skin with a pen to help recognize progression of the envenom-ation. This evaluation should be repeated as required by the clinical condition. A comprehensive physical examination should be done. A baseline complete blood count (CBC) and platelet count, electrolytes, urinalysis, BUN, glucose, PT, PTT, and fibrinogen concentration should be obtained initially and repeated in 4-6 hours.

Pain and anxiety should be treated with analgesics and anxiolytics as clinically warranted, and tetanus prophylaxis should be addressed. The extremity should be immobilized in a well-padded splint in near-full extension and elevated to avoid dependent edema. The patient should be reassessed frequently, specifically noting any progression of swelling.

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