Contributor: Gretchen Hinson, MD

Educational Pearls:

• Pit vipers include cottonmouths, rattlesnakes, and copperheads
• • All have folding long fangs, triangular face, and elliptical pupils
• About 5,000 snakebites per year reported to Poison Control
• Initially develop a local reaction (swelling, bruising, pain, bullae)
• Complications can include
• 25% of snake bites result in no envenomation (dry bites)
• 20% of bites have serious side-effects, which can include hematologic, cardiovascular, neurologic and, muscular abnormalities, or even anaphylaxis to the envenomation itself
• Minor symptoms should be observed for 12-24 hours
• Moderate to severe symptoms are typically treated with antivenom
• CroFab and other antivenoms are expensive, with costs upwards of $3200 per vial wholesale, though newer agents are cheaper
• Treat with 4-6 vials of CroFab initially with moderate symptoms and subsequent redosing with

References

Buchanan JT, Thurman J. Crotalidae Envenomation. [Updated 2021 Jan 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan.

Kanaan NC, Ray J, Stewart M, et al. Wilderness Medical Society Practice Guidelines for the Treatment of Pitviper Envenomations in the United States and Canada. Wilderness Environ Med. 2015;26(4):472-487. doi:10.1016/j.wem.2015.05.007

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

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