VAPAGuide - Flowcharts

Crotalus sp. (Sistrurus sp.) (Agkistrodon sp.)
Minutes (to hours)

Nausea, vomiting, abdominal pain, diarrhoea (urticaria, angio-oedema) (bronchospasm) arterial hypotension	Crotalus sp.
	Hours

	Non-cardiogenic pulmonary oedema Cerebral oedema	Generalised oedema

		Hypovolaemia/hypovolaemic shock

Cardiovascular failure

?

(Crotalus horridus)

Hours

Myalgia (at rest, with active/passive movement, upon pressure), dark urine, ECG changes

Signs of paralysis

Skeletal muscle necrosis

Micrurus sp.

Crotalus scutulatus

Minutes to hours

Cranial nerve deficits (ptosis, ophthalmoplegia, dysphagia, dysarthria)

Paralysis of the skeletal musculature including the respiratory musculature

Respiratory failure

Crotalus sp. (Sistrurus sp.) (Agkistrodon sp.)
Hours

Clotting time¹ abnormal ^{1 or more complex clotting tests}

Gingival bleeding

Bleeding from wounds remote from the site of the bite

Haematemesis, bleeding per rectum, haematuria

Systemic bleeding		Focal neurological deficits, meningismus, coma

Hypovolaemia/haemorrhagic shock

Cardiovascular failure	Renal failure	CNS failure

Crotalus sp. Sistrurus sp. Agkistrodon sp.
Minutes (to hours)

Local pain and swelling

Painful swelling of the regional lymph nodes

		Crotalus sp.
		Hours

		Extensive swelling

		Hypovolaemia

(Necrosis)

Emergency & clinical flowcharts