What is the management of a 28-year-old male presenting with a snake bite 1 hour prior, with abdominal pain, vomiting, and normal vitals, but no local swelling or neurological deficits?

Management of Snake Bite in a 28-Year-Old Male

The patient requires immediate emergency medical services activation and transport to a healthcare facility for evaluation and potential antivenom administration, as this is the definitive treatment for snake envenomation.

Initial Assessment and First Aid Measures

• Activate emergency medical services immediately, as this is recommended for any person bitten by a venomous or possibly venomous snake 1, 2
• Rest and immobilize the bitten extremity (left forearm) to minimize venom absorption through the lymphatic system 1, 2
• Remove rings, watches, and other constricting items from the left forearm before swelling develops 1, 2
• Keep the patient calm and minimize movement to reduce systemic absorption of venom 2, 3
• Transport the patient to a medical facility as quickly as possible, as definitive treatment (antivenom) is only available in healthcare settings 1, 2

Harmful Practices to Avoid

• Do NOT apply ice to the bite wound as it has unproven benefits and may cause additional tissue injury 1, 2
• Do NOT use suction devices (with or without incision) as they are ineffective for venom removal (removes only 0.04% of venom) and may increase tissue damage 1, 2, 3
• Do NOT apply electric shock as it is ineffective and potentially harmful 1, 2
• Do NOT apply tourniquets as they can worsen local tissue injury 1, 2
• Do NOT delay transport to attempt ineffective first aid measures 2, 3

Clinical Evaluation

• The presence of two visible fang marks on the left forearm confirms a snake bite 2
• The patient's symptoms of abdominal pain and vomiting suggest systemic envenomation, which is concerning 4
• Abdominal pain is an early feature of systemic envenoming in certain venomous snake bites (appearing 5 minutes to 4 hours after the bite) and correlates with severity of envenomation 4
• The absence of local swelling, pain, burning, oozing, and redness at this early stage (1 hour post-bite) does not rule out envenomation, as these signs may develop later 1, 2
• Normal vitals and absence of ptosis are positive prognostic indicators but do not rule out progression to severe envenomation 1, 2

Hospital Management

• Establish intravenous access for fluid administration and potential antivenom administration 3
• Obtain baseline laboratory studies including complete blood count, coagulation profile, and renal function tests to assess for coagulopathy, thrombocytopenia, and acute kidney injury 5, 6
• Monitor for development of venom-induced consumption coagulopathy (VICC) which can lead to major hemorrhage 5
• Watch for signs of thrombotic microangiopathy (TMA) which presents with microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury 5
• Administer appropriate antivenom as soon as possible based on snake identification or clinical syndrome 7, 5
• Provide supportive care including antiemetics for vomiting and pain management 7
• Monitor for development of renal dysfunction, as some venomous snake bites can cause acute renal failure requiring hemodialysis 8, 6

Monitoring and Follow-up

• Continuous monitoring of vital signs, coagulation parameters, and renal function is essential 5
• Patients with evidence of systemic envenoming require admission to an intensive care unit for close observation 1, 2
• Long-term follow-up is recommended as patients are at risk of developing chronic kidney disease following snake envenomation with nephrotoxic effects 5

Special Considerations

• The combination of abdominal pain and vomiting with normal local findings suggests systemic envenomation that requires prompt medical attention 4
• Early administration of appropriate antivenom is critical to prevent progression of systemic toxicity 8, 7
• Adequate fluid therapy should be initiated early to prevent acute renal failure, especially in cases with evidence of systemic envenomation 8