VAPAGuide - Flowcharts

Bothrops sp. Crotalus durissus ssp. Lachesis 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 durissus ssp.?
Bothrops sp.?

Hours to days

Flank pain, renal bed sensitive to percussion

Urinary output <400 ml/24 h

Renal failure

?

Micrurus sp.
Crotalus durissus ssp.

Minutes to hours

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

Paralysis of the skeletal musculature including the respiratory musculature

Respiratory failure

Bothrops moojeni?
Crotalus durissus ssp.

Hours

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

Signs of paralysis

Skeletal muscle necrosis

Bothrops sp. Lachesis sp.
Minutes (to hours)

Local pain and swelling

Painful swelling of the regional lymph nodes

		Extensive swelling

		Hypovolaemia

Necrosis Loss of function of extremities Loss of extremities

Bothrops sp.?
Minutes (to hours)

Nausea, vomiting, abdominal pain, diarrhoea (urticaria, angio-oedema) (bronchospasm) arterial hypotension






Cardiovascular failure

Emergency & clinical flowcharts