Annals of Emergency Medicine
Volume 37, Issue 2 , Pages 168-174 , February 2001

Out-of-hospital and interhospital management of crotaline snakebite

Presented at the North American Congress of Clinical Toxicology’s “Advances in the Management of Snakebite” Symposium, October 1999, La Jolla, CA.

Received 1 November 1999 ,Revised 21 June 2000 ,Accepted 28 August 2000.

References 

  1. Russell FE. Snake venom poisoning. Vet Hum Toxicol. 1991;33:584–586
  2. Wingert WA, Chan L. Rattlesnake bites in Southern California and rationale for recommended treatment. West J Med. 1988;148:37–44
  3. Stewart ME, Greenland S, Hoffman J. First aid treatment of poisonous snakebite: are currently recommended procedures justified?. Ann Emerg Med. 1981;10:331–335
  4. Gold BS, Wingert WA. Snake venom poisoning in the United States: a review of therapeutic practices. South Med J. 1994;87:579–589
  5. Dart RC, Russell FIE. Animal poisoning. In:  Hall I,  Schmidt G,  Woods L editor. Principles of Critical Care. New York, NY: : McGraw-Hill; 1992;p. 2163–2171
  6. Dart RC, Stark Y, Fulton B, et al.  Insufficient stocking of poisoning antidotes in hospital pharmacies. JAMA. 1996;276:1508–1510
  7. Guderian RH, MacKenzie CD, Williams JF. High voltage electric shock treatment for snakebite [letter]. Lancet. 1986;2:229
  8. Gill KA. The evaluation of cryotherapy in the treatment of snake envenomization. South Med J. 1970;63:552–556
  9. McCollough NC, Gennaro JF. Evaluation of venomous snake bite in the southern United States from parallel clinical and laboratory investigations. J Fla Med Assoc. 1960;49:959–967
  10. Bucknall NC. Electrical treatment of venomous bites and stings. Toxicon. 1991;29:397–398
  11. Dart RC, Gustafson RA. Failure of electric shock treatment for rattlesnake envenomation. Ann Emerg Med. 1991;20:659–661
  12. Hardy DL. A review of first aid measures for pitviper bite in North America with an appraisal of Extractor suction and stun gun electroshock. In:  Brodie ED editors. Biology of Pit Vipers. Tyler, TX: : Selva Publishing; 1992;p. 395–404
  13. Murdock RT, White GL, Pedersen DM, et al.  Prevention and emergency field management of venomous snakebites during military exercises. Mil Med. 1990;155:587–590
  14. Merriam TW, Leopold RS. Evaluation of incision and suction in venom removal [abstract]. Clin Res. 1960;7:258
  15. Reitz CJ, Goosen DJ, Odendaal MW, et al.  Evaluation of the Venom Ex apparatus in the treatment of Egyptian cobra envenomation. S Afr Med J. 1984;66:135–138
  16. Ya PM, Perry JF. Experimental evaluation of methods for the early treatment of snake bite. Surgery. 1960;47:975–981
  17. Leopold RS, Huber GS, Kathan RH. An evaluation of the mechanical treatment of snakebite. Mil Med. 1957;120:414–416
  18. Bush SP, Hegewald KG, Cardwell MD, et al.  Effects of a negative pressure venom extraction device (Extractor) in local tissue injury after artificial rattlesnake envenomation in a porcine model [abstract]. Acad Emerg Med. 2000;7:495–496
  19. Alberts MB, Shalit M, Lo Galbo F. Suction as initial treatment of venomous snakebite [abstract]. Acad Emerg Med. 2000;7:496
  20. Bronstein AC, Russell FE, Sullivan JB. Negative pressure suction in the field treatment of rattlesnake bite victims [abstract]. Vet Hum Toxicol. 1986;28:485
  21. Zamudio KR, Hardy DL, Martins M, et al.  Fang tip spread, puncture distance, and suction for snake bite. Toxicon. 2000;38:723–728
  22. Burgess JL, Dart RC, Egen NB, et al.  Effects of constriction bands on rattlesnake venom absorption: a pharmacokinetic study. Ann Emerg Med. 1992;21:1086–1093
  23. Sutherland SK, Coulter AR, Harris RD. Rationalisation of first-aid measures for elapid snakebite. Lancet. 1979;1:183–186
  24. Howarth DM, Southee AE, Whyte IM. Lymphatic flow rates and first-aid in simulated peripheral snake or spider envenomation. Med J Aust. 1994;161:695–700
  25. Sutherland SK, Coulter AR. Early management of bites by the eastern diamondback rattlesnake (Crotalus adamanteus): studies in monkeys (Macaca fascicularis). Am J Trop Med Hyg. 1981;30:497–500
  26. Straight RC, Glenn JL. Effects of pressure/immobilization on the systemic and local action of venoms in a mouse tail model [abstract]. Toxicon. 1985;23:40
  27. Pearn J, Morrison J, Charles N, et al.  First aid for snake bite: efficacy of a constrictive bandage with limb immobilization in the management of human envenomation. Med J Aust. 1981;2:293–295
  28. Watt G, Padre L, Tuazon ML, et al.  Tourniquet application after cobra bite: delay in the onset of neurotoxicity and the dangers of sudden release. Am J Trop Med Hyg. 1988;38:618–622
  29. Snyder CC, Pickens JE, Knowles RP, et al.  A definitive study of snakebite. J Fla Med Assn. 1968;55:330–337
  30. Anker RL, Straffon WG, Loiselle DS, et al.  Retarding the uptake of “mock venom” in humans: comparison of three first-aid methods. Med J Aust. 1982;1:212–214
  31. Anker RL, Straffon WG, Loiselle DS, et al.  Snakebite: comparison of three methods designed to delay uptake of “mock venom.”. Aust Fam Phys. 1983;12:365–368
  32. Dart RC, Seifert SA, Carroll L, et al.  Affinity-purified, mixed monospecific crotalid antivenom ovine FAb for the treatment of crotalid venom poisoning. Ann Emerg Med. 1997;30:33–39
  33. Win-Aung , Tin-Tun , Khin-Maung-Maung , et al.  Clinical trial of intramuscular anti-snake venom administration as a first aid measure in the field in the management of Russell’s viper bite patients. Southeast Asian J Trop Med Public Health. 1996;27:493–497
  34. Little M, Hudson DW, Pereira PL. Antivenoms and helicopter rescue services. Med J Aust. 1998;169:229–230

☆ Supported by a grant from Savage Laboratories, Melville, NY.

☆☆ Address for reprints: Patrick McKinney, MD, Department of Emergency Medicine, 4th Floor, Ambulatory Care Center, University of New Mexico Health Sciences Center, Albuquerque NM 87131; 505-272-5062, fax 505-272-6503;,E-mail patmckin@unm.edu .

PII: S0196-0644(01)88118-X

doi: 10.1067/mem.2001.111574

Annals of Emergency Medicine
Volume 37, Issue 2 , Pages 168-174 , February 2001

Article Tools