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<< Bites and Stings Snakes, Spiders, and Scorpions in the United States

Part I. Snakes: Epidemiology

We will discuss the main types of venomous snakes found in the United States, namely the crotalinae (pit viper) and elapidae (coral snake) species. Exotic snakes in the United States are usually restricted under the care of zoos and experienced handlers. Zoos are required to carry antivenoms for the exotic snakes and usually have contracts with specific hospitals to care for victims of these envenomations. Exotic snake envenomations will not be discussed in this issue.

Venomous snakes are found throughout the United States except in Maine, Alaska, and Hawaii. Most snakes hibernate in the winter and, as a result, the majority of bites in the United States occur between May and October. Most bites involve the extremities, although the occasional bite to the face and tongue may occur when the snake is held close to the body. In children, most bites occur to the lower extremities in contrast to adult patients who typically present with upper extremity injuries. Children, intoxicated individuals, snake handlers, and collectors are frequent victims.1

It is important to note that some crotaline bites do not impart venom; these are known as "dry bites." Dry bites are defined as bites that do not result in local tissue damage, hematological abnormalities, or regional lymph node pain; they have been reported in the medical literature to occur in approximately 25% of crotaline snakebites. The true incidence of dry bites may be much higher since they may not be seen in an emergency department and are not reported to the local poison center.1-4

Though rarely fatal, snakebites do occur with significant frequency in the United States. In 2005, there were over 2900 reports to U.S. poison centers of people who were bitten by crotaline snakes, with 79% of these reports involving rattlesnakes and copperheads. 116 victims were less than six years of age and 542 patients were between 6 to 10 years of age. 1875 victims were evaluated at a health care facility. Six deaths were reported with rattlesnakes and unknown crotaline bites. 171 patients were reported to have life-threatening envenomations.5, 6

Coral snake envenomations occur less frequently than crotaline bites. In 2005, 58 exposures were called to poison centers, of which, 14 victims were less than 19 years of age. Six victims had lifethreatening envenomations, and there were no deaths.5

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