Snake bites

Snakebites in the US usually occur during intentional snake exposures, such as snake handling, snake hunts, and aggravating snakes in the wild.

Few physicians have experience treating snakebites, and a poison center should be consulted in all cases.

All snakebites should be copiously irrigated and inspected for foreign bodies or tendon damage. Infection is rare and prophylactic antibiotics are generally not indicated.

Crotalinae (pit viper) envenomation may cause significant local and systemic effects including rhabdomyolysis, compartment syndrome, coagulopathy, pulmonary edema, and hypotension.

Crotalinae antivenom (Crotalidae polyvalent immune Fab) should be administered in Crotalinae envenomations with worsening local toxicity or systemic symptoms.

The first sign of Elapidae (coral snake) envenomation is frequently ptosis. Paralysis of the muscles of respiration may ensue, leading to morbidity and mortality.

Elapidae antivenom (antivenin, North American coral snake) should be administered in all confirmed Eastern coral snake envenomations to arrest progression of toxicity.

There are 120 species of snakes native to the US, approximately 20 of which are considered venomous.[1]Dart RC. Reptile bites. In: Tintinalli JE, Ma OJ, Cline DM, eds. Tintinalli's emergency medicine: a comprehensive study guide. 6th ed. Chapel Hill, NC: McGraw-Hill; 2004. The vast majority of venomous snakebites in the US are from pit vipers (family Viperidae, subfamily Crotalinae) while the remainder are from coral snakes (family Elapidae).