Follow-Up Care for Rattlesnake Bite One Week After Hospital Discharge
At a one-week follow-up visit after a rattlesnake bite, patients should be thoroughly assessed for recurrent coagulopathy, wound healing complications, and renal involvement, with laboratory testing including complete blood count, coagulation studies, and renal function tests. 1
Assessment Components
Physical Examination
- Wound site evaluation:
- Check for signs of infection (redness, warmth, purulent drainage)
- Assess tissue necrosis or sloughing
- Evaluate wound healing progress
- Document any persistent swelling or edema
- Neurovascular assessment:
- Distal pulses, capillary refill
- Sensation and motor function in affected limb
- Pain levels and distribution
- Systemic assessment:
- Vital signs (fever may indicate infection)
- Cardiopulmonary status
- Neurological status
Laboratory Testing
- Coagulation studies:
- PT/INR, PTT, fibrinogen levels
- D-dimer
- Platelet count
- Complete blood count:
- To assess for anemia or infection
- Renal function:
- BUN, creatinine, eGFR
- Urinalysis (check for proteinuria, hematuria)
- Creatine kinase (CK) and LDH:
- To monitor for ongoing rhabdomyolysis 2
Complications to Monitor
Recurrent Coagulopathy
- Can occur up to two weeks after the bite despite initial antivenom treatment 3
- Signs include:
- Easy bruising
- Bleeding gums
- Epistaxis
- Hematuria
- Abnormal laboratory coagulation values
Wound Complications
- Infection
- Tissue necrosis
- Compartment syndrome (rare at this stage but possible)
- Tendon or nerve damage
- Poor healing requiring surgical intervention
Renal Involvement
- Up to 41% of patients may show persistent renal involvement 1
- Risk of progression to chronic kidney disease in 5-20% of cases 1
- Monitor for:
- Decreased urine output
- Edema
- Elevated creatinine
- Proteinuria
Management Recommendations
Wound Care
- Clean wound with sterile normal saline 4
- Remove superficial debris if present
- Avoid deep debridement unless absolutely necessary
- Leave infected wounds open (do not close) 4
- Consider referral to plastic surgery for facial wounds 4
Elevation and Immobilization
- Continue elevation of affected limb if swelling persists 4
- Passive elevation methods (sling for outpatients) 4
- Gradually increase activity as healing progresses
Medication Management
- Continue antibiotics if prescribed for infection
- Appropriate pain management
- If coagulopathy recurs, urgent referral for possible additional antivenom 3
Follow-up Schedule
- Schedule next follow-up within 1-2 weeks
- More frequent follow-up if complications present
- Monitor for recurrent coagulopathy for at least one week 1
- Long-term follow-up to monitor for chronic kidney disease 1
Red Flags Requiring Immediate Medical Attention
- New or worsening swelling, pain, or redness at bite site
- Fever
- Bleeding from any site
- Difficulty breathing
- Neurological symptoms (confusion, weakness)
- Decreased urine output
- Severe headache
- Chest pain
Patient Education
- Importance of completing full course of any prescribed antibiotics
- Wound care instructions
- Activity limitations and gradual return to normal activities
- Signs and symptoms requiring immediate medical attention
- Importance of follow-up appointments
- Long-term monitoring for kidney function if indicated
Special Considerations
- Continuous antivenom infusion may be needed for refractory coagulopathy rather than bolus dosing 3
- Patients with severe envenomation should be monitored more closely for complications
- Bites to extremities may have higher risk of severe envenomation 2
- Children may require more frequent follow-up due to potential for more severe manifestations 2
By following this structured approach to follow-up care after rattlesnake envenomation, clinicians can identify and address complications early, potentially improving patient outcomes and reducing long-term morbidity.