Envenomations: Initial Management of Common U.S. Snakebites

Nothing says “emergency” like a bite from a venomous reptile. If you work in an area populated by snakes, which covers most of the United States and the world, then chances are good that you will see a patient with a snake bite in the Emergency Department (ED). The severity of the symptoms and the treatment vary greatly with different snakes. In this post, we will outline the ED approach to and management of common U.S. snake envenomation. Patient Case A 3 year-old presents to an ED in the Southeastern U.S. with a diffusely swollen arm. She was in their yard playing when her mother heard her cry. Her mother noticed a few drops of blood trickling down her hand and put a bandaid on it. During the next few hours the child’s hand became diffusely swollen, with ecchymosis of her hand and digit, with possible puncture wounds on her right hand at the base of the metacarpal joints of the third and fourth digits. Her mother immediately brought the child to the ED with concerns for a copperhead bite, since copperheads are endemic to the area. By the time she arrived, the swelling and pain had spread to her elbow. Figure 1: Swelling and ecchymosis from a copperhead bite Epidemiology Summer is snake bite season! Almost all bites (save those from exotic pet reptiles) occur between April and October. So as the weather warms up, U.S. EDs will begin to see more of the nearly 8,000 venomous snakebites that occur annually.1 Fortunately, very few bites are fatal.2 99% of all venomous snakebites are from the Crotalinae family (formerly known as Crotalidae), which are pit vipers and include rattlesnakes, copperheads, and cottonmouths.2 Most fatalities from … Continue reading Envenomations: Initial Management of Common U.S. Snakebites