![]() ![]() Viperidae venom is a complex solution of various proteins, peptides and enzymes that allow the snake to kill its prey quickly and begin the digestive process. Tourniquets should not be applied to extremities with snake bite wounds. The affected limb should be elevated (only once the patient has arrived to the emergency department) and the area surrounding the bite should be marked to assess progression of symptoms. warfarin), immunization status, allergies, type of animal which caused the envenomations, time and location of bite, the progression of symptoms since envenomation, and the types of pre-hospital therapies performed. After airway, breathing, and circulation have been evaluated and stabilized, a detailed history should be obtained for the following information: previous comorbidities (e.g. The initial evaluation in the emergency department is no different for any other patient who presents for evaluation and management. In the pre-hospital setting, the affected extremity should be placed in a neutral position and pain control initiated. It is thought that the snake must maintain its bite for a prolonged period of time in order to administer a significant amount of venom. The snake must chew to deliver its venom. Thus, most of the bites occur while being handled, often because the victim believes they are dealing with the nonpoisonous California king snake. This has led to the saying, “Red on yellow, kill a fellow red on black, venom lack.” Coral snakes are not aggressive and live mostly underground. In the coral snake, the red and yellow rings touch, while in the king snake, the red and black rings touch. Coral snakes have black snouts and king snakes have red snouts. The king and coral snake can be distinguished by their colored rings and the color of their snouts. There are many mimickers of coral snakes, including the California king snake. The coral snakes have distinctive red, yellow and black bands. Red on Black, Venom Lack (or Friend of Jack)” applies only to North American coral snakes The mnemonic “Red on Yellow, Kill a Fellow. The remaining 10% are from water moccasins.Įlapidae Snakes A rattlesnake skull, showing the long fangs used to inject venom Rattlesnakes account for 65% of Viperidae bites copperheads are responsible for 25%. The caudal end of the snake has a single row plates or scales, as opposed to the double row of scaled found on non-venomous varieties. The fangs are connected to venom sacs that inject venom. Viperidae snakes, also known as pit vipers, are identified by their heat-sensing pit organs, fangs, triangular head, and elliptical pupils. The true incidence may be much higher since they may not be seen in the emergency department and thus are not reported to the poison control center. It is important to note that 25% of crotaline bites do not impart venom these are known as “dry” bites, defined as bites that do not result in local tissue damage, hematological abnormalities, or regional lymph node pain. This is because Elapidae venom apparatus is not as efficient for venom delivery and the species mouth is much smaller. The remaining 1% result from coral snakes and exotic species. Viperidae snakes account for 99% of venomous snakebites in the United States. Adult patients typically present with upper extremity injuries and children typically present with lower extremity injuries. Children, intoxicated persons, snake handlers and collectors are frequent victims. Most bites involve the extremities, but can occur to the face or tongue when the snake is held close to the body. The majority of bites occur between May and October as most snakes hibernate in the winter. Venomous snakes are found throughout the Unites States except in Maine, Alaska, and Hawaii. The main types of venous snakes in the United States include the Viperidae (Crotalid, pit viper) and Epalidae (coral snake species). ![]() Understand the key treatment principles of Viperidae and Elapidae snakebites.Recognize the clinical presentation of Viperidae and Elapidae snakebites in the U.S.Upon completing this module, you should be able to: SAEMF/CDEM Innovations in Undergraduate Emergency Medicine Education GrantĬareer Development and Mentorship CommitteeĬDEM Medical Education Fellow Travel ScholarshipĪuthor: Jessica Slim, MD, MPH, PGY3 in Emergency Medicine, Denver Health Medical Center Presidential Address: Where Do We Go From Here?ĮMF/SAEMF Medical Student Research Training Grant Virtual Rotation and Educational ResourcesĬommittee Update: NBME EM Advanced Clinical Examination Task Force Visit us on Twitter LinkedIn Facebook YouTubeĮffective Consultation in Emergency Medicine Video ![]()
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