Evaluation and management of coral snakebites
- Allen C Cheng, MB, BS, FRACP
Allen C Cheng, MB, BS, FRACP
- Infectious Diseases Physician
- Menzies School of Health Research
- Steven A Seifert, MD, FAACT, FACMT
Steven A Seifert, MD, FAACT, FACMT
- Professor of Emergency Medicine
- University of New Mexico School of Medicine
- Section Editors
- Daniel F Danzl, MD
Daniel F Danzl, MD
- Section Editor — Environmental Emergencies
- Professor of Emergency Medicine
- University of Louisville School of Medicine
- Stephen J Traub, MD
Stephen J Traub, MD
- Section Editor — Toxicology
- Associate Professor of Emergency Medicine
- Mayo Medical School
- Michele M Burns, MD, MPH
Michele M Burns, MD, MPH
- Section Editor — Pediatric Toxicology
- Assistant Professor of Pediatrics
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Coral snakebites are rare. Successful treatment requires prompt transfer of the snakebite victim to definitive medical care, careful clinical assessment, and timely administration of antivenom in selected patients. Consultation with a medical toxicologist or other physician with experience in managing poisonous snakebites is recommended prior to antivenom administration. Phone consultation with a medical toxicologist is available through a United States regional poison control center by calling 1-800-222-1222. For clinicians outside of the United States, the World Health Organization (WHO) provides a listing of international poison centers on its website.
The clinical evaluation and management of coral snakebites is reviewed here. The principles of management of Crotalinae (eg, “pit vipers”, including rattlesnakes, water moccasin [cottonmouth], or copperhead) snakebites and snakebites outside the United States are discussed separately. (See "Snakebites worldwide: Clinical manifestations and diagnosis" and "Snakebites worldwide: Management" and "Evaluation and Management of Crotalinae (rattlesnake, water moccasin [cottonmouth], or copperhead) bites in the United States".)
Coral snakes are native to a large portion of the Americas from the southern United States through Mexico, Central America, and South America to southern Argentina (figure 1) . Throughout the Americas, coral snakebites are uncommon, ranging from 2 bites per year in Argentina to less than 100 bites per year in the southern United States [1,2]. In Central American, Colombia, and Brazil, <1 to 2 percent of all snakebites are attributed to coral snakes [1,3]. Most bites involve Micrurus species [1,3,4]. As an example, Micrurus fulvius fulvius (eastern coral snake) (picture 1) and Micrurus fulvius tenere (Texas coral snake) account for almost all bites reported in the United States . Envenomation is most notable for causing neurologic symptoms. Fatalities from coral snake envenomation are rare but have been described .
Coral snakes are also found outside of the Americas, including Asia and southern Africa. Neurotoxicity with bites by these snakes is possible but rarely described .
CORAL SNAKE CHARACTERISTICS
Appearance, venom apparatus, and venom actions for coral snakes are as follows:
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- CORAL SNAKE CHARACTERISTICS
- CLINICAL MANIFESTATIONS
- Physical examination
- Ancillary studies
- - Respiratory function
- DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS
- FIRST AID
- General principles
- Pressure immobilization
- Techniques to avoid
- INITIAL MANAGEMENT
- Respiratory support
- Wound management
- Acute hypersensitivity reactions
- - Expired or alternative antivenoms
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS