10
A. Pitviper
Envenomations:
- deaths rarely occur in < 8 hr unless venom is injected intravascularly or near head/neck (asphyxia)
- usually occur @ 18-32 hr
- mortality most commonly due to hypovolemic shock, pulmonary edema (& respiratory failure in
Mojave rattlesnake envenomation)
- prior to antivenom, mortality was 5-35% (approx. 200/yr)
- current mortality rate:
- treated without antivenom:
2.61%
- treated with antivenom:
0.28%
- morbidity & complications: residual paresthesias, decreased range of motion, amputation, renal
failure
- in one series, there was significant functional loss in 32% of upper extremity bites and 12% of
lower extremity bites (these figures can be improved upon by appropriate use of antivenom)
B. Coral
Snake
Envenomations:
- there have been no deaths reported from coral snake envenomation since the Wyeth antivenom
became available
- the estimated case fatality rate in untreated coral snake envenomations approaches 10% (due to
respiratory failure)
XIII. A NOTE ON EXOTIC VENOMOUS SNAKEBITE IN THE U.S.:
- increasing # of amateur hobbyists maintaining exotic venomous snakes in "underground zoos"; traditional
zoos and "snake shows" maintain a wide array of venomous exotic species
- there were approx 30 such bites reported in 1984
- zoo personnel can be helpful in identifying exotic species (most zoos have a 24 hr emergency line that can be
called for assistance)
- Management assistance can be obtained from:
- regional poison control center
- University of Arizona Poison and Drug Information Center 520/626-6016 (keeps list of available
exotic antivenoms)
XIV. SUGGESTED READING:
·
Alberts MB, Shalit M, LoGalbo F: Suction for venomous snakebite: a study of "mock venom" extraction in a human model. Ann
Emerg Med 2004;43:181.
·
Burgess JL, Dart RC, Egen NB, et al: Effects of constriction bands on rattlesnake venom absorption: a pharmacokinetic study. Ann
Emerg Med 1992;21(9):1086.
·
Bush SP, Hegewald KG, Green SM, Cardwell MD, Hayes WK: Effects of a negative pressure venom extraction device
(ExtractorTM) on local tissue injury after artificial rattlesnake envenomation in a porcine model. Wild Environ Med 2000;11(3):180.
·
Consroe P, Egen NB, Russell FE, Gerrish K, Smith DC, Sidki A, Landon JT: Comparison of a new ovine antigen binding fragment
(Fab) antivenin for United States crotalidae with the commercial antivenin for protection against venom-induced lethality in mice.
Am J Trop Med Hyg 1995;53(5):507-510.
·
Dart RC, Lindsey D: Snakebites and shocks, Ann Emerg Med 1988;17(11):1262.
·
Dart RC, McNally J: Efficacy, safety, and use of snake antivenoms in the United States. Ann Emerg Med 2001;37(2):181-188.
·
Dart RC, Seifert SA, Boyer LV, et al: A randomized multicenter trial of Crotalinae polyvalent immune Fab (ovine) antivenom for
the treatment for crotaline snakebite in the United States. Arch Intern Med 2001;161(16):2030-2036.
·
Dart RC, Seifert SA, Carroll L, et al: Affinity-purified, mixed monoclonal specific crotalid antivenom ovine Fab for the treatment of
crotalid venom poisoning. Ann Emerg Med 30(1):33, 1997.
·
Garfin SR, Mubarak SJ, and Davidson TM: Rattlesnake bites: current concepts, Clin Orthop 1979;140:50.
·
Gold BS, Dart RC, Barish RA: Bites of venomous snakes. New Engl J Med 2002;347(5):347-356.
·
Goldstein EJ, et al: Bacteriology of rattlesnake venom and implications for therapy, J Infect Dis 1979;140:818.
·
Guderian RH, Mackenzie CD, Williams JF: High voltage shock treatment for snakebite. Lancet 1986;2:229.
·
Hasiba U, Rosenbach L, and Rockwell D: DIC-like syndrome after envenomation by the snake, Crotulus horridus horridus, N Engl
J Med 1975;292:505.
·
Howe NR, and Meisenheimer JL: Electric shock does not save snakebitten rats, Ann Emerg Med 1988;17(3):245.
·
Hurlbut KM, Dart RC, Spaite D, et al: Reliability of clinical presentation for predicting significant pit viper envenomation. Ann
Emerg Med 1988;17(4):438.
