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For further information, see CMDT Part 40-55: Snake Bites

KEY FEATURES

  • Venom may be neurotoxic (coral snake) or cytolytic (rattlesnakes, other pit vipers)

  • Neurotoxins cause respiratory paralysis; cytolytic venoms cause tissue destruction by digestion and hemorrhage due to hemolysis and destruction of the endothelial lining of the blood vessels

CLINICAL FINDINGS

  • Manifestations of rattlesnake envenomation

    • Local pain

    • Redness

    • Swelling

    • Extravasation of blood

  • Other manifestations

    • Perioral tingling

    • Metallic taste

    • Nausea

    • Vomiting

    • Hypotension

    • Ptosis

    • Dysphagia

    • Diplopia

    • Respiratory arrest

  • Coagulopathy common and includes prolonged PT and thrombocytopenia (sometimes severe)

TREATMENT

  • Emergency measures

    • Immobilize patient and bitten area in neutral position

    • Avoid manipulation of area

    • Do not apply ice or tourniquet

    • Do not give stimulants

    • Incision and suction of bite is not justified because only a small amount of venom can be recovered

    • Transport patient to medical facility

  • For pit viper (eg, rattlesnake) envenomation, there are two commercially available antivenins for rattlesnake envenomation (CroFab and Anavip)

    • CroFab

      • Administered in increments of 4–6 vials in 250–500 mL saline by slow intravenous drip depending on the severity of symptoms

      • Higher doses and additional vials may be required for more serious envenomation with marked local effects and systemic toxicity (eg, hypotension, coagulopathy)

    • Anavip

      • Dosage: 10 vials by slow intravenous infusion over 60 minutes initially, followed by additional 10 vial increments as needed for more serious envenomations or for progression of symptoms

      • Monitor vital signs and the blood coagulation profile

      • Type and cross-match blood

    • Adequacy of venom neutralization indicated by improvement in symptoms and signs and slowed swelling rate

    • Prophylactic antibiotics not indicated

  • For elapid (coral snake) envenomation

    • 1–2 vials of specific antivenom as soon as possible

    • Antivenom no longer made in United States; supplies are dwindling

    • Call regional poison control center (1-800-222-1222) to locate antisera

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