Nonpoisonous snakes sometimes leave an imprint of their two rows of teeth, but the wounds should lack fang puncture marks The dramatic signs of crotalid envenomation are derived primarily from the victim’s hypovolemic state, bleeding diathesis and neuromuscular dysfunction Table 90.23 outlines the more notable physical signs and symptoms Coral snake Coral snakes leave unimpressive local signs but can neurologically cripple their prey The bite may have one or two punctures, at most to mm apart, and other small teeth marks Extremity paresthesias and weakness are often reported initially Over several hours, generalized malaise, nausea, fasciculations, and weakness develop insidiously Other symptoms include ptosis, diplopia, dysarthria, and dysphagia Physical examination may reveal bulbar dysfunction and generalized weakness Respiratory failure may ensue Triage Pit viper The airway, breathing, and circulation of the patient must be addressed before attending to the snakebite ( Fig 90.22 ) The first priority of prehospital care of the snakebite victim is rapid transport to a medical facility All activities in the field must be tempered by the fact that time is of the essence Without delaying transport, the wound should be cleaned with soap and tap water or with an antiseptic solution It is important to approach the patient with reassurance and to place him or her at rest The affected extremity should be stripped of any constricting jewelry or clothing and immobilized in a position of function below the level of the heart to decrease systemic spread of venom The patient should be kept warm and not allowed to have anything by mouth