PHYSICAL EXAMINATION

Careful assessment of the site of the bite and signs of local envenomation and examination of the patient should be carried out and recorded.

Monitor the patient closely and repeat all above, every 1-2 hourly.

– Check for and monitor the following: Pulse rate, respiratory rate, blood pressure and 20 minutes Whole Blood clotting test (20 WBCT) every hour for first 3 hours and every 4 hours for remaining 24 hours.

– Check distal pulses and monitor if there is presence of gross swelling. The presence of a pulse does not rule out compartment syndrome.

Pain on passive movement, pallor, pulseless limb, hypoaesthesia over the sensory nerve passing through the compartment are suggestive of compartment syndrome.

Measure compartment pressure directly if there is concern that a compartment syndrome is developing. The diagnosis is established. If the compartment pressure, measured directly by inserting a 16 G IV cannula and connecting it with manometer, is raised above 40 cm water/saline.

Direct measurement is necessary before resorting to fasciotomy since compartment syndrome is rare in snakebite victims. Fasciotomy done without correction of hemostatic abnormality may cause the patient to bleed to death