Educational Pearls:

• Snake bites commonly occur between April and October.

• Rattlesnake bites are the most common.

• Venom contains proteins/enzymes that cause local inflammation, coagulopathy, and systemic effects (hypotension, angioedema, renal failure, etc.) along with neurotoxins may cause fasciculations, ptosis, drooling, or hyporeflexia.

• Management:

• Mark site for swelling.

• Monitor progression.

• Elevate and immobilize injured limb and treat pain.

• Check basic labs including coagulation studies, and update tetanus.

• Antidote is CroFab and use if patient has systemic symptoms. Anaphylaxis is a known complication of CroFab

• Avoid: ice, tourniquets, and incision and drainage.

References

Hifumi T et. al.. Venomous snake bites: clinical diagnosis and treatment. J Intensive Care. 2015 Apr 1;3(1):16. doi: 10.1186/s40560-015-0081-8.

Warrell DA. Snake bite. Lancet. 2010. 375(9708):77-88. doi: 10.1016/S0140-6736(09)61754-2.

Warrell DA. Envenoming and injuries by venomous and nonvenomous reptiles worldwide. In: Wilderness Medicine, 6th Edition, Auerbach PS (Ed), Elsevier Mosby, Philadelphia 2012. p.1040.