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. 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).
History and exam
- identification of the snake
- local redness, swelling, tenderness, and pain at wound site
- blurred or double vision
- shortness of breath
- difficulty swallowing
- puncture marks, fang marks
- bulbar weakness/paralysis
- quadriplegia/locked-in syndrome
Medical Toxicology Fellowship
Department of Emergency Medicine
Drexel College of Medicine
DV declares that he has no competing interests.
Professor of Emergency Medicine
Professor of Public Health
Chief of Division of Medical Toxicology
Drexel University College of Medicine
MG declares that he has no competing interests.
Associate Clinical Professor of Medicine
Department of Clinical Pharmacology and Toxicology
University of Colorado
Health Science Center
SP has a professional relationship with Michael Greenberg, one of the authors of this topic. They are partners in a private consulting company. SP does not receive money from him, nor does he receive money from SP.
Medical Director TN Poison Center
Associate Professor of Medicine and Emergency Medicine
Vanderbilt University Medical Center
DS declares that she has no competing interests.
Department of Medicine
SK declares that he has no competing interests.
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