[Medline]. Snake bite is a common and frequently devastating environmental and occupational disease, especially in rural areas of developing countries in tropical regions. The area around the bite may tingle, and nearby muscles may become weak.
Crotalids have hollow, mobile, relatively long fangs located in the front of the upper jaw and are capable of delivering venom quite efficiently. Gautam Phadke, MD Elinor Mannon (2020-2022) Courtesy of Sean Bush, MD.
Accessed online on March 24, 2020 [package insert]. 258 (12):1615-8. Domanski K, Kleinschmidt KC, Greene S, Ruha AM, Bebarta VS, Onisko N, et al. 2012 Jan 16. WHO emphasizes on snakebite envenoming by comprehensive snakebite control strategy and international focus on neglected tropical disease snakebite to substantially improve the outcomes of the patients and communities. Breathing difficulties can occur, particularly after Mojave rattlesnake bites. CroFab® (crotalidae polyvalent immune Fab [ovine]) [package insert] [package insert]. Antibiotic prophylaxis for pit viper envenomation: prospective, controlled trial. Marietta, Pa: Wyeth Laboratories Inc. August 31, 2001. Clin Toxicol (Phila). [Medline]. Kerrigan KR, Mertz BL, Nelson SJ, Dye JD. Ann Emerg Med. Additionally, many nonvenomous snakes can flatten their heads into a triangle shape when they feel threatened. The bitten limb should be loosely immobilized and kept positioned at about heart level.
Snake Venom. Myotoxic and edematogenic effects have also been detected in several coral snake venoms, with particularly strong activity the Eastern coral snake Mfulvius.
Snakebites can be terrifying but rarely cause deaths in the United States. When in doubt, it is prudent to assume a snake is venomous and leave it alone. 2015. Victims should call emergency services (911) rather than attempt to drive themselves to the hospital.
Madhuri Ramakrishnan, MD, Basic Science Series Trends in snakebite envenomation therapy: scientific, technological and public health considerations. [Medline]. Camilleri C, Offerman S. Anaphylaxis after Rattlesnake bite. Procedures, 2002
Diseases & Conditions, 2002
You may need more than one dose of antivenom. Prognosis depends on the person’s age and overall health and on the location and venom content of the bite. Moderate rattlesnake envenomation in a toddler after treatment with antivenom.
[Medline]. Crotalid venom is produced and stored in paired glands below the eyes. South Med J. Anaphylactic shock secondary to rattlesnake bite.
Priti Meena, MD 2004 Aug. 44 (2):99-104. Toxicon. Use of stun guns for venomous bites and stings: a review. Coral snakebites usually cause little or no immediate pain and swelling. I saw a challenging case of Russell’s viper bite during my nephrology ward rotation. [Medline]. Ann Emerg Med.
2017 Mar. There are three species of coral snakes in the United States. Tight tourniquets must be avoided so that limb loss is minimized. Copperheads and, to a lesser extent, cottonmouths account for most other poisonous snakebites. Ben Welch E, Gales BJ. In the United States, antivenom is available for all native poisonous snakes. Crotalids are characterized by large, triangular heads, comparatively small eyes, large and retractable fangs, and a thermoreceptor “pit” located between the eye and the nostril.  Mojave toxin, found in some populations of the Mojave rattlesnake (Crotalus scutulatus), inhibits the presynaptic release of acetylcholine, leading to weakness and paralysis. Prevalence of hematologic toxicity from copperhead envenomation: an observational study. … 2004 Feb. 43 (2):181-6. [Medline]. 41 (3):384-90. 2007 Feb. 100 (2):152-6.
However, death may result from intravenous deposition of venom, anaphylaxis, nonimmune anaphylactoid reactions, and following systemic toxicity (eg, cardiovascular collapse, respiratory failure.). Lavonas EJ, Ruha AM, Banner W, Bebarta V, Bernstein JN, Bush SP, et al. Pit vipers. 20 (6):659-61. [Medline].
Children age 12 and younger comprised 28.2% of snakebite patients recorded in the NASBR between 2013 and 2015. 2014 Jan. 46 (1):34-7. Courtesy of Charles Alfaro.
Ann Emerg Med. A Mariah Alexander, MD Resident Physician, Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville Coral snakes have shorter, fixed, front fangs and a smaller mouth, which make them deliver venom less efficiently. Superficial necrosis following copperhead envenomation. Redness and swelling usually follow within 30 to 60 minutes and can affect the entire leg or arm within several hours. The first three are crotalids in the family Viperidae, subfamily Crotalinae. In the United States, several thousand snakebites occur every year, resulting in fewer than 10 deaths. 2000 Fall. Sutherland SK, Coulter AR, Harris RD. Anthony Chang, MD 161 (3):474-9. Joe Alcock, MD, MS Associate Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center World J Surg.
[2, 3, 4, 5] There are four types of venomous snakes native to the United States: copperheads, cottonmouths (water moccasins), rattlesnakes, and coral snakes. Anderson VE, Gerardo CJ, Rapp-Olsson M, Bush SP, Mullins ME, Greene S, et al. A study of 39 victims. (coral snakes). Gearoid McMahon, MB, BCh, Click here for bios of RFN Editorial Board. 32 (4):445-52. 1997 May.
These changes can lead to internal bleeding and to heart, respiratory, and kidney failure. Local signs include ≥ 1 fang ... Coral snakes.
 However, those who used alcohol were 27 times as likely to receive antivenom and 31 times as likely to die from the envenomation compared to those who had not consumed ethanol. Thrombocytopenia following timber rattlesnake envenomation. Pit viper antivenom is made from the serum of sheep or horses that have been immunized with snake venom. Previous studies suggest that most people get envenomated because they are intentionally interacting with the snake. 8 (2):89-93. Leonardo Riella, MD (Kidney Transplantation), Faculty Advisors Schulte J, Kleinschmidt KC, Domanski K, Smith EA, Haynes A, Roth B. Broad-banded copperhead, Agkistrodon laticinctus. 1999 Apr 12. Ruha AM, Curry SC, Albrecht C, Riley B, Pizon A. [Medline]. Available at [Full Text]. [Medline]. BMC Immunol. Venom Bradykinin-related peptides (BRPs) and its multiple biological roles. Courtesy of Chip St. John. Spencer Greene, MD, MS, FACEP, FACMT, FAAEM President, Bayou City Medical Toxicology and Emergency Medicine Consultants, PLLC Clin Toxicol (Phila). Eryn E. Dixon for: Medscape. The genus Agkistrodon has both copperheads (Agkistrodoncontortrix, Agkistrodonlaticinctus) and cottonmouths (Agkistrodonpiscivorus, Agkistrodonconanti). J Toxicol Clin Toxicol. Danwen Yang, MD, Focus on POCUN (Point of Care Ultrasound in Nephrology)
Most snakebite victims survive, even without antivenom. Gutiérrez JM, Lomonte B, León G, Rucavado A, Chaves F, Angulo Y. Even a bite from a harmless snake can lead to an allergic reaction or infection. 2004. 1994 Apr. Antivenom contains antibodies that neutralize venom’s toxic effects. Bond RG, Burkhart KK. Spiller HA, Bosse GM. Courtesy of Sean Bush, MD. Ruha AM, Kang AM, Onisko NS, Greene S, Rohra R. Antibiotic use in the management of snake envenomation [abstract]. Toschlog EA, Bauer CR, Hall EL, Dart RC, Khatri V, Lavonas EJ. Although snakebites do occur throughout the year, they are most common in the summer months, from June to September. J Toxicol Clin Toxicol. 2012 Feb. 59 (2):356-64. 2019 Jan. 57 (1):25-30. 2013 Dec. 51 (10):949-1229. Sam Kant, MD (2019-2021) 1997 May. Jansen PW, Perkin RM, Van Stralen D. Mojave rattlesnake envenomation: prolonged neurotoxicity and rhabdomyolysis. , MD, MBA, University of Illinois at Chicago; , MD, Department of Emergency Medicine, LSU Health Sciences Center Shreveport. Venomous snakes in the United States include pit vipers (rattlesnakes, copperheads, and cottonmouths) and coral snakes. The state of Texas had the most fatalities (17), followed by Florida (14), and Georgia (12). Recovery is usually complete except in cases with cortical necrosis or severe tubular necrosis with marked interstitial changes.
 Pit viper venom may also include bradykinin-related peptides that can lead to angioedema and hypotension. Copperhead envenomations in the Carolinas. [Medline]. Snakebite - Pathophysiology - Snake Venom. Toxicon. The venom may also have direct neurotoxic action leading to paralysis and respiratory arrest, cardiotoxic effect causing cardiac arrest, myotoxic and nephrotoxic effect. Immobilization of the whole patient, especially the bitten limb is needed, and transportation should be arranged to the nearing medical center. 42 (2):171-8. Management of snakebite includes first aid, local wound care, anti-venom and supportive measures. Pressure-immobilization bandages delay toxicity in a porcine model of eastern coral snake (Micrurus fulvius fulvius) envenomation. 1971 May. There are approximately 25 species of rattlesnakes in the genera Crotalus and Sistrurus. Stewart RM, Page CP, Schwesinger WH, McCarter R, Martinez J, Aust JB. Schaeffer TH, Khatri V, Reifler LM, Lavonas EJ. Venom in many snakes, such as pitvipers, affects virtually every organ system in the human body and can be a combination of many toxins, including cytotoxins, hemotoxins, neurotoxins, and myotoxins, allowing for an enormous variety of symptoms. Rings, watches, and tight clothing should be removed from the area of the bite. Most deaths occur in children, older people, and people who are untreated or treated too late or inappropriately. Matthew A. Sparks, MD, FASN, FAHA South Med J. People who are bitten by a poisonous snake are generally kept in the hospital for observation for 6 to 8 hours to see if any symptoms develop. Although there is much known about the protein compositions of venoms from Asian and American snakes, comparatively little is known of Australian snakes. Bush SP, Siedenburg E. Neurotoxicity associated with suspected southern Pacific rattlesnake (Crotalus viridis helleri) envenomation. Report of two cases: Rattlesnake venom-induced thrombocytopenia. 21 (2):120-6. Failure of electric shock treatment for rattlesnake envenomation. More severe symptoms may take several hours to develop. [Medline]. The fangs of a poisonous snake usually produce one or two large punctures, whereas the teeth of nonpoisonous snakes usually leave multiple small rows of scratches. Wilderness Environ Med. Clin Toxicol (Phila). This website also contains material copyrighted by 3rd parties. Boyer LV, Seifert SA, Clark RF, McNally JT, Williams SR, Nordt SP, et al. Lu Q, Clemetson JM, Clemetson KJ.