QUESTIONS and CONTROVERSIAL ISSUES

1. How can you identify a venous pit viper from a nonpoisonous snake?

   A) Triangular or arrow shaped head

   (nonpoisonous: smooth tapered body, narrow head)

   B) Facial pits between the nostril, and eye

   (serves as a heat and vibration sensor)

   C) Vertical, elliptical pupils

   (nonvenomous: round pupils)

   D) Single row of subcaudal scales

   (nonpoisonous: double row)

   E) Genus Crotalus further characterized by tail rattles.

2. What is the major toxicity associated with rattle snakes?
   1. A) Hematotoxicity
   2. B) Coaguolopathy, DIC-like presentation
   3. C) Draw laboratory data for CBC, PLT, PT/PTT, FSP, myoglobin, U/A
3. What are some of the more controversial first aid treatments of snake bite?
   1. Tourniquet application
   2. Incision, suction and drainage
   3. Cryotherapy
   4. Electric shock therapy
   5. Prehospital antivenin administration
4. What are the indications for crotalid antivenin administration?
   1. Amount of antivenin administered depends on the severity of envenomation.
   2. No envenomation (dry bite): - 0 vials
   3. Minimal (significant swelling at bite site) - 5 vials
   4. Moderate (swelling up extremity, systemic symptoms) - 10 vials
   5. Severe (systemic toxicity, lab evidence of hematotoxicity) -15 vials
5. V) What are the complications of antivenin administration?
   1. Acute anaphylaxis (antivenin harvested from horses)
   2. Delayed serum sickness
      1. 1-4 weeks post antivenin treatment
      2. Normally resolves with antihistamines and corticosteroids
6. VI) What is the major toxicity of coral snake envenomations?
   1. Venom primarily neurotoxic
   2. Local edema, paraethesias, vomiting, weakness, diplopia, fasciculations, confusion, respiratory distress/failure
   3. "Red on yellow, kill a fellow; red on black, venom lack"
   4. Antivenin for Eastern coral snake
7. Snake Bite Trivia
   1. What state has more snake bites per capita than any other state in the USA? Which state has the least?
   2. What country has more snake bites per capita than any other country in the world? Which one has the least?

CLINICAL COURSE The patient develops continued swelling up his extremity and laboratory evidence of hematotoxicity. As a result, it is elected to administer 10 vails of crotalid antivenin and IV antibiotics. He recovers after a 3 day hopitalization and develops serum sickness 2 weeks later, responsive to diphenhydramine and prednisone. Four weeks after hospitalization, the patient wins the Indiana state lottery, moves out of his trailor home, but insists on keeping his pet snake.