Clinical| Volume 40, ISSUE 6, P537-545, November 2014

Download started.

Ok

Bedside Management Considerations in the Treatment of Pit Viper Envenomation

Published:April 02, 2014DOI:https://doi.org/10.1016/j.jen.2014.01.002
      Death and disability as a result of venomous snake bite is a significant public health concern in both the United States and throughout the world. In the US, an estimated 9000 people are treated for pit viper snakebite annually,
      • Gold BS
      • Barish RA
      • Dart RC
      North American snake envenomation: diagnosis, treatment, and management.
      • O'Neil ME
      • Mack KA
      • Gilchrist J
      • Wozniak EJ
      Snakebite injuries treated in United States emergency departments, 2001-2004.
      • Langley RL
      Animal-related fatalities in the United States—an update.
      and a death rate of 1 in 756 envenomations occurs.
      • Walter FG
      • Stolz U
      • Shirazi F
      • McNally J
      Epidemiology of severe and fatal rattlesnake bites published in the American Association of Poison Control Centers' Annual Reports.
      Worldwide, an estimated 421,000 bites and 20,000 deaths occur annually from venomous snake bites, the majority of which occur in sub-Saharan Africa and Asia.
      • Kasturiratne A
      • Wickremasinghe AR
      • de Silva N
      • et al.
      The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Emergency Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Gold BS
        • Barish RA
        • Dart RC
        North American snake envenomation: diagnosis, treatment, and management.
        Emerg Med Clin North Am. 2004; 22: 423-443
        • O'Neil ME
        • Mack KA
        • Gilchrist J
        • Wozniak EJ
        Snakebite injuries treated in United States emergency departments, 2001-2004.
        Wilderness Environ Med. 2007; 18: 281-287
        • Langley RL
        Animal-related fatalities in the United States—an update.
        Wilderness Environ Med. 2005; 16: 67-74
        • Walter FG
        • Stolz U
        • Shirazi F
        • McNally J
        Epidemiology of severe and fatal rattlesnake bites published in the American Association of Poison Control Centers' Annual Reports.
        Clin Toxicol. 2009; 47: 663-669
        • Kasturiratne A
        • Wickremasinghe AR
        • de Silva N
        • et al.
        The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths.
        PLoS Med. 2008; 5: e218
        • Watson WA
        • Litovitz TL
        • Rodgers Jr., CG
        • et al.
        2004 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System.
        Am J Emerg Med. 2005; 23: 589-666
        • Warrell DA
        Snake bite.
        Lancet. 2010; 375: 77-88
        • Vohra R
        • Cantrell FL
        • Williams S
        Fasciculations after rattlesnake envenomations: a retrospective statewide poison control system study.
        Clin Toxicol. 2008; 46: 117-121
        • Lavonas E
        • Ruha AM
        • Banner W
        • et al.
        Unified treatment algorithm for the management of crotaline snakebite in the United States: results of an evidence-informed consensus workshop.
        BMC Emerg Med. 2011; 11: 2
        • Spiller HA
        • Bosse GM
        • Ryan ML
        Use of antivenom for snakebites reported to United States poison centers.
        Am J Emerg Med. 2010; 28: 780-785
        • Lavonas EJ
        • Gerardo CJ
        • O'Malley G
        • et al.
        Initial experience with Crotalidae polyvalent immune Fab (ovine) antivenom in the treatment of copperhead snakebite.
        Ann Emerg Med. 2004; 43: 200-206
        • Scharman EJ
        • Noffsinger VD
        Copperhead snakebites: clinical severity of local effects.
        Ann Emerg Med. 2001; 38: 55-61
        • Corneille MG
        • Larson S
        • Stewart RM
        • et al.
        A large single-center experience with treatment of patients with crotalid envenomations: outcomes with and evolution of antivenin therapy.
        Am J Surg. 2006; 192: 848-852
        • Tanen DA
        • Ruha AM
        • Graeme KA
        • Curry SC
        • Fischione MA
        Rattlesnake envenomations: unusual case presentations.
        Arch Intern Med. 2001; 161: 474
        • Bush S
        Rattlesnake Envenomation Treatment and Management.
        (Updated November 14, 2012, Accessed October 25 2013)
        • Cheng AC
        • Seifert SA
        Management of crotaline (rattlesnake, water moccasin [cottonmouth] or copperhead) bites in the United States.
        (Updated July 25, 2012. Accessed January 30, 2014)
      1. CroFab [approved package insert]. West Conshohocken, PA: BTG International Inc.; March 2012.

        • Caravati EM
        Copperhead bites and Crotalidae polyvalent immune Fab (ovine): routine use requires evidence of improved outcomes.
        Ann Emerg Med. 2004; 43: 207-208
        • Cumpston KL
        Is there a role for fasciotomy in Crotalinae envenomations in North America?.
        Clin Toxicol. 2011; 49: 351-365
        • Hall EL
        Role of surgical intervention in the management of crotaline snake envenomation.
        Ann Emerg Med. 2001; 37: 175-180
        • Tanen DA
        • Danish DC
        • Grice GA
        • Riffenburgh RH
        • Clark RF
        Fasciotomy worsens the amount of myonecrosis in a porcine model of crotaline envenomation.
        Ann Emerg Med. 2004; 44: 99-104
        • Gerring D
        • King TR
        • Branton R
        Validating a faster method for reconstitution of Crotalidae Polyvalent Immune Fab (ovine).
        Toxicon. 2013; 69: 42-49
        • Schaeffer TH
        • Khatri V
        • Reifler LM
        • Lavonas EJ
        Incidence of immediate hypersensitivity reaction and serum sickness following administration of Crotalidae polyvalent immune Fab antivenom: a meta-analysis.
        Acad Emerg Med. 2012; 19: 121-131
        • Cannon R
        • Ruha AM
        • Kashani J
        Acute hypersensitivity reactions associated with administration of Crotalidae polyvalent immune Fab antivenom.
        Ann Emerg Med. 2008; 51: 407-411
        • Lavonas EJ
        • Schaeffer TH
        • Kokko J
        • Mlynarchek SL
        • Bogdan GM
        Crotaline Fab antivenom appears to be effective in cases of severe North American pit viper envenomation: an integrative review.
        BMC Emerg Med. 2009; 9: 13
        • Lavonas EJ
        • Khatri V
        • Daugherty C
        • Bucher-Bartelson B
        • King T
        • Dart RC
        Medically significant late bleeding after treated crotaline envenomation: a systematic review.
        Ann Emerg Med. 2014; 63: 71-78
        • Emergency Nurses Association
        Care of the critically ill or injured patient during intrafacility transfer.
        (Published July 2010. Accessed January 30, 2014)
        • Bronstein AC
        • Spyker DA
        • Cantilena Jr., LR
        • Green JL
        • Rumack BH
        • Dart RC
        2010 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 28th Annual Report.
        Clin Toxicol. 2011; 49: 910-941
        • Sánchez EE
        • Lopez-Johnston JC
        • Rodríguez-Acosta A
        • Pérez JC
        Neutralization of two North American coral snake venoms with United States and Mexican antivenoms.
        Toxicon. 2008; 51: 297-303
        • Juckett G
        • Hancox JG
        Venomous Snakebites in the United States: Management Review and Update.
        Am Fam Physician. 2002; 65: 1367-1375

      Biography

      Susan Smith, Member, ENA Chapter #362 (Inland Empire), is Staff Nurse, Loma Linda University Medical Center, Loma Linda, CA, and Member, California State Council.

      Biography

      Susan S. Sammons, Member and Past President, ENA Coastal Empire Chapter, is Assistant Professor, School of Nursing Georgia Southern University Statesboro, GA.

      Biography

      Jennifer Carr, Member, ENA Coastal Bend Chapter, is Trauma Program Manager, HCA Corpus Christi Medical Center, Corpus Christi, TX.

      Biography

      Thomas R. King is Senior Manager, Medical Communications, BTG International Inc., West Conshohocken, PA.

      Biography

      Heather S. Ambrose is Scientific Director, BTG International Inc., West Conshohocken, PA.

      Biography

      Lance Zimmet is Registered Nurse, Trauma Intensive Care Unit, Texas Health Resources, Fort Worth, TX.

      Biography

      Terri M. Repasky, Member, ENA Florida Big Bend Chapter, is Emergency/Trauma Clinical Nurse Specialist, Tallahassee Memorial HealthCare, Tallahassee, FL, and President, ENA Florida State Council.