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Diagnosis And Management Of North American Snake And Scorpion Envenomations

September 2006

  Abstract

Snakes, both native and imported, and scorpions produce clinically important envenomations in the United States. While envenomations have long been considered the purview of the Southeastern US and the desert Southwest, the widespread and evergrowing population of people who maintain these animals in collections and as "pets" has made the presentation of a snakebite or scorpion sting possible in any emergency department (ED) in the country. These animals can produce devastating injuries and must be recognized promptly and treated appropriately to prevent significant morbidity and death. Not all envenomations need treatment. Indeed, there are times when the risk of treatment outweighs the benefit. However, failure to aggressively treat in the appropriate situation may result in a disastrous outcome for the patient and for the clinician who does not meet the standard of care expected of the emergency medicine specialist.

This article will divide the discussion of snakes and the management of snake and scorpion envenomations into two sections. The first section will deal exclusively with pit vipers (Crotalids), their identification, envenomation signs and symptoms, and treatment with CroFabTM. Changes and controversies in the care of patients with Crotalid envenomations will also be addressed. The second section will deal with coral snakes and the identification and treatment issues that they present, along with a brief discussion of scorpion stings and the "exotics:" The non-native captive snakes that are found more and more commonly in the US, both in zoos and as pets.
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