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Snake Envenomation

Snake Envenomation is a topic covered in the 5-Minute Emergency Consult.

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  • Pit viper venom:
    • Mixture of proteolytic enzymes and thrombin-like esterases:
      • Enzymes cause local muscle and subcutaneous tissue necrosis.
      • Esterases have defibrinating anticoagulant effect, leading to venom-induced consumption coagulopathy (VICC) in severe envenomations.
  • Bite location:
    • Extremity bites most common
    • Head, neck, or trunk bites more severe than bite on extremities
  • Severe envenomation:
    • Direct bite into artery or vein
    • Neurotoxic envenomations
  • Bite mark significance:
    • Pit viper bite: Classically includes 1 or 2 puncture marks
    • Nonvenomous snakes and elapids: Horseshoe-shaped row of multiple teeth marks
  • 25% of all pit viper bites are dry and do not result in envenomation.


Venomous Snakes Indigenous to US
  • Pit vipers (Crotalinae):
    • Account for 95% of all envenomations
    • Rattlesnakes, cottonmouths, and copperheads
  • Coral snakes (Elapidae):
    • Neurotoxic
    • Western coral snakes, found in Arizona and New Mexico
    • More venomous eastern coral snakes, found in Carolinas and Gulf states

International Exotic Venomous Snakes
Occur in zoos or in owners of exotic snakes
Pediatric Considerations
  • 30% of all snakebites involve patients younger than 20 yr. 12% of all snakebites are 9 yr or younger.
  • Because of their low body weight, smaller children and infants are more vulnerable to severe envenomation with systemic symptoms.

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Rosen, Peter, et al., editors. "Snake Envenomation." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307009/all/Snake_Envenomation.
Snake Envenomation. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307009/all/Snake_Envenomation. Accessed April 26, 2019.
Snake Envenomation. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307009/all/Snake_Envenomation
Snake Envenomation [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307009/all/Snake_Envenomation.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Snake Envenomation ID - 307009 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307009/all/Snake_Envenomation PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -