Elapidae (Coral Snakes): Difference between revisions
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===Serious complications=== | ===Serious complications=== | ||
*Venom-induced consumption coagulopathy (DIC-like syndrome)<ref>Isbister GK. Snakebite does not cause disseminated intravascular coagulation: coagulopathy and thrombotic microangiopathy in snake envenoming. Semin Thromb Hemost. 2010 Jun;36(4):444-51.</ref> | *Systemic signs may be delayed up to 13h after bite<ref>http://www.emdocs.net/management-of-venomous-snake-bites-in-north-america/</ref> | ||
*Neurotoxicities in particular for coral snakes | |||
**Local [[numbness]] rather than pain/swelling | |||
**[[Cranial nerve palsies]] | |||
**[[Altered mental status]] | |||
**[[Weakness]] | |||
**[[Respiratory failure]] due to paralysis | |||
*Hypovolemic [[shock]] | |||
*Venom-induced consumption coagulopathy ([[DIC]]-like syndrome)<ref>Isbister GK. Snakebite does not cause disseminated intravascular coagulation: coagulopathy and thrombotic microangiopathy in snake envenoming. Semin Thromb Hemost. 2010 Jun;36(4):444-51.</ref> (uncommon, but reported<ref>https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/elapidae</ref>) | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
*CBC with diff | *CBC with diff | ||
*PT/PTT/INR | *[[DIC]] labs: PT/PTT/INR, fibrinogen, fibrin degradation products, [[d-dimer]] | ||
*BMP | *BMP | ||
* | *[[LFTs]] | ||
*CK | *CK | ||
==Management== | ==Management== | ||
Revision as of 16:49, 26 August 2019
Background
- All coral snakes are brightly colored with black, red, and yellow rings
- Red and yellow rings touch in coral snakes, but are separated in nonpoisonous mimics
- "Red touch yellow, kills a fellow; red touch black, venom lack"
- This tool for identifying coral snakes does not apply to Mexican species
Venom
Coral snake venom is mainly neurotoxic (irreversibly binds to acetylcholine receptors) and does not cause significant local tissue injury unlike Crotaline (Pit Vipers) venom.
Clinical Features
- Local injury is often minimal and easy to miss as venom is delivered via chewing rather than injection
- Venom effects may develop hours after a bite
Serious complications
- Systemic signs may be delayed up to 13h after bite[1]
- Neurotoxicities in particular for coral snakes
- Local numbness rather than pain/swelling
- Cranial nerve palsies
- Altered mental status
- Weakness
- Respiratory failure due to paralysis
- Hypovolemic shock
- Venom-induced consumption coagulopathy (DIC-like syndrome)[2] (uncommon, but reported[3])
Differential Diagnosis
Envenomations, bites and stings
- Hymenoptera stings (bees, wasps, ants)
- Mammalian bites
- Closed fist infection (Fight bite)
- Dog bite
- Marine toxins and envenomations
- Toxins (ciguatera, neurotoxic shellfish poisoning, paralytic shellfish poisoning, scombroid, tetrodotoxin
- Stingers (stingray injury)
- Venomous fish (catfish, zebrafish, scorpion fish, stonefish, cone shells, lionfish, sea urchins)
- Nematocysts (coral reef, fire coral, box jellyfish, sea wasp, portuguese man-of-war, sea anemones)
- Phylum porifera (sponges)
- Bites (alligator/crocodile, octopus, shark)
- Scorpion envenomation
- Reptile envenomation
- Spider bites
Evaluation
Management
Local Care
- Do:
- Remove all jewelry
- Mark the leading edge of erythema/edema
- Do not:
- Attempt to suck out the venom
- Place the affected part in cold water
- Use a tourniquet or wrap
- Antivenom is first line treatment for compartment syndrome; fasciotomy is last resort if elevated pressures persist.
Antivenom
- Give 3-5 vials of Antivenin (Micrurus fulvius) to ALL patients who have definitely been bitten
- It may not be possible to prevent further effects or reverse effects once they develop
- Additional doses of antivenom are reserved for cases in which symptoms/signs appear
- Prepare for allergic reaction from equine produced Antivenin (may dilute solution, or administer with epinephrine/benadryl)
Monitor for respiratory failure
Disposition
- Admit all patients (even if initially symptom free)
See Also
References
- ↑ http://www.emdocs.net/management-of-venomous-snake-bites-in-north-america/
- ↑ Isbister GK. Snakebite does not cause disseminated intravascular coagulation: coagulopathy and thrombotic microangiopathy in snake envenoming. Semin Thromb Hemost. 2010 Jun;36(4):444-51.
- ↑ https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/elapidae
- Medscape. Antivenin, Eastern & Texas Coral Snakes (Rx) - Antivenin (Micrurus fulvius). http://reference.medscape.com/drug/micrurus-fulvius-antivenin-eastern-texas-coral-snakes-343718.
- Juckett G and Hancox JG. Venomous Snakebites in the United States: Management Review and Update. Am Fam Physician. 2002 Apr 1;65(7):1367-1375.