Evaluation and Management of Crotalinae (rattlesnake, water moccasin [cottonmouth], or copperhead) bites in the United States
- 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
Snake bites are a significant problem in the United States. Successful treatment requires prompt definitive medical evaluation, careful clinical assessment, and timely administration of antivenom in selected patients. Consultation with a medical toxicologist or other clinician with experience in managing poisonous snake bites 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.
The clinical evaluation and management of poisonous Crotalinae (rattlesnake, water moccasin [cottonmouth] or copperhead) snake bites is reviewed here. The principles of management of coral snake bites and snake bites outside the United States are discussed separately. (See "Evaluation and management of coral snakebites" and "Snakebites worldwide: Clinical manifestations and diagnosis".)
Rattlesnakes, water moccasins (cottonmouths), and copperheads are members of the family Viperidae, subfamily Crotalinae (formerly Crotalidae). They are also commonly called pit vipers, a name that refers to the heat sensing pit located behind the nostrils.
Rattlesnakes, water moccasins (cottonmouths), and copperheads are the most numerous and cause the most snake bites in the United States. Elapids (coral snakes) and imported exotic snakes cause a smaller number .
Estimates from the 1960s suggest that there were approximately 8000 bites annually from poisonous snake species in the United States, with 10 to 12 deaths annually . Additional studies of rattlesnake bites suggest that there is an increasing number of significant bites, but mortality has remained at low levels since the 1980s [3,4].
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- GEOGRAPHICAL DISTRIBUTION
- CLINICAL MANIFESTATIONS
- FIRST AID APPROACH
- Venomous or nonvenomous?
- Techniques to avoid
- - Pressure immobilization
- INITIAL EVALUATION AND MANAGEMENT
- Clinical assessment
- Ancillary studies
- Wound management
- Supportive care
- - Coagulopathy
- - Rhabdomyolysis
- - Elevated tissue pressures and compartment syndrome
- CROTALINAE (PIT VIPER) ANTIVENOM
- Fab antivenom
- - Indications
- - Efficacy
- - Contraindications
- - Assessment of response
- - Initial regimen based upon severity
- - Treatment of acute hypersensitivity
- - Treatment of recurrent toxicity
- F(ab')2 antivenom
- Discharge instructions
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS