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Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study, such as the type of study and the number of patients in the study, will be included in bold type following the reference, where available.In addition, the most informative references cited in this paper, as determined by the authors, will be noted by an asterisk (*) next to the number of the reference.
  1. Tanen D, Ruha A, Graeme K, Curry S. Epidemiology and hospital course of rattlesnake envenomations cared for at a tertiary referral center in Central Arizona. Acad Emerg Med. Feb 2001;8(2):177-182. (Retrospective Chart Review, 236 patients
  2. Holstege CP, Miller MB, Wermuth M, Furbee B, Curry SC. Crotalid snake envenomation. Crit Care Clin. Oct 1997;13(4):889-921. (Review Article
  3. art RC, Hurlbut KM, Garcia R, Boren J. Validation of a severity score for the assessment of crotalid snakebite. Ann Emerg Med. Mar 1996;27(3):321-326. (Retrospective Chart Review, 108 patients
  4. Tokish JT, Benjamin J, Walter F. Crotalid envenomation: the southern Arizona experience. J OrthopTrauma. Jan 2001;15(1):5-9. (Retrospective Chart Review, 164 patients)
  5. Lai MW, Klein-Schwartz W, Rodgers GC, et al. 2005 Annual Report of the American Association of Poison Control Centers' national poisoning and exposure database. Clin Toxicol (Phila). 2006;44(6-7):803-932. (Epidemiology, Population Surveillance, Review Article
  6. Bond GR. Snake, spider, and scorpion envenomation in North America. Pediatr Rev. May 1999;20(5):147-150; quiz 151. (Review Article)
  7. Goldfrank LR, Flomenbaum N. Goldfrank's toxicologic emergencies. 8th ed. New York: McGraw-Hill, Medical Pub. Division; 2006. (Textbook
  8. Suchard JR, LoVecchio F. Envenomations by rattlesnakes thought to be dead. N Engl J Med. Jun 17 1999;340(24):1930. (Case Report
  9. Spaite D, Dart R, Sullivan JB. Skin testing in cases of possible crotalid envenomation. Ann Emerg Med. Jan 1988;17(1):105-106. (Letter to the Editor
  10. Whitley RE. Conservative treatment of copperhead snakebites without antivenin. J Trauma. Aug 1996;41(2):219-221. (Case Series, 55 patients)
  11. Parrish HM, Khan MS. Bites by coral snakes: report of 11 representative cases. Am J Med Sci. May 1967;253(5):561-568. (Case Series, 11 patients)
  12. Kitchens CS, Van Mierop LH. Envenomation by the Eastern coral snake (Micrurus fulvius fulvius). A study of 39 victims. Jama. Sep 25 1987;258(12):1615-1618. (Retrospective Chart Review, 39 patients
  13. * de Roodt AR, Paniagua-Solis JF, Dolab JA, et al. Effectiveness of two common antivenoms for North, Central, and South American Micrurus envenomations. J Toxicol Clin Toxicol. 2004;42(2):171-178. (Comparative Study
  14. Norris RL, Dart RC. Apparent coral snake envenomation in a patient without visible fang marks. Am J Emerg Med. Jul 1989;7(4):402-405. (Case Report)
  15. Iyaniwura TT. Snake venom constituents: biochemistry and toxicology (Part 1). Vet Hum Toxicol. Oct 1991;33(5):468-474. (Review Article)
  16. Iyaniwura TT. Snake venom constituents: biochemistry and toxicology (Part 2). Vet Hum Toxicol. Oct 1991;33(5):475-480. (Review Article)
  17. Bush SP, Jansen PW. Severe rattlesnake envenomation with anaphylaxis and rhabdomyolysis. Ann Emerg Med. Jun 1995;25(6):845-848. (Case Report)
  18. Moura-da-Silva AM, Laing GD, Paine MJ, et al. Processing of protumor necrosis factor-alpha by venom metalloproteinases: a hypothesis explaining local tissue damage following snake bite. Eur J Immunol. Sep 1996;26(9):2000-2005. (Comparative Study
  19. Gibly RL, Walter FG, Nowlin SW, Berg RA. Intravascular hemolysis associated with North American crotalid envenomation. J Toxicol Clin Toxicol. 1998;36(4):337-343. (Case Report)
  20. Bond RG, Burkhart KK. Thrombocytopenia following timber rattlesnake envenomation. Ann Emerg Med. Jul 1997;30(1):40-44. (Case Report)
  21. Gold BS, Barish RA. Venomous snakebites. Current concepts in diagnosis, treatment, and management. Emerg Med Clin North Am. May 1992;10(2):249-267. (Review Article)
  22. Kravitz J, Gerardo CJ. Copperhead snakebite treated with crotalidae polyvalent immune fab (ovine) antivenom in third trimester pregnancy. Clin Toxicol (Phila). 2006;44(3):353-354. (Case Report)
  23. Glenn JL, Straight RC, Wolfe MC, Hardy DL. Geographical variation in Crotalus scutulatus scutulatus (Mojave rattlesnake) venom properties. Toxicon. 1983;21(1):119-130. (Review Article)
  24. Bush SP, Siedenburg E. Neurotoxicity associated with suspected southern Pacific rattlesnake (Crotalus viridis helleri) envenomation. Wilderness Environ Med. Winter 1999;10(4):247-249. (Case Report)
  25.  Clark RF, Williams SR, Nordt SP, Boyer-Hassen LV. Successful treatment of crotalid-induced neurotoxicity with a new polyspecific crotalid Fab antivenom. Ann Emerg Med. Jul 1997;30(1):54-57. (Case Report)
  26. Richardson WH, Goto, C. S., Gutglass, D.J., Williams, S.R., Clark, R.F. Rattlesnake Envenomation with Neurotoxicity Refractory to Treatment with Crotaline Fab Antivenom. Clinical Toxicology. 2007;in press. (Case Report
  27. Wisniewski MS, Hill RE, Havey JM, Bogdan GM, Dart RC. Australian tiger snake (Notechis scutatus) and mexican coral snake (Micruris species) antivenoms prevent death from United States coral snake (Micrurus fulvius fulvius) venom in a mouse model. J Toxicol Clin Toxicol. 2003;41(1):7-10. (Comparative Study)
  28. Boyer LV, Seifert SA, Clark RF, et al. Recurrent and persistent coagulopathy following pit viper envenomation. Arch Intern Med. Apr 12 1999;159(7):706-710. (Case Report
  29. * Clark RF, Wethern-Kestner S, Vance MV, Gerkin R. Clinical presentation and treatment of black widow spider envenomation: a review of 163 cases. Ann Emerg Med. Jul 1992;21(7):782-787. (Retrospective Chart Review)
  30. Elbahlawan LM, Stidham GL, Bugnitz MC, Storgion SA, Quasney MW. Severe systemic reaction to Loxosceles reclusa spider bites in a pediatric population. Pediatr Emerg Care. Mar 2005;21(3):177-180. (Case Series, 6 patients)
  31. LoVecchio F, McBride C. Scorpion envenomations in young children in central Arizona. J Toxicol Clin Toxicol. 2003;41(7):937-940. (Case Series, 483 patients)
  32. Wendell RP. Brown recluse spiders: a review to help guide physicians in nonendemic areas. South Med J. May 2003;96(5):486-490. (Review Article
  33. Woestman R, Perkin R, Van Stralen D. The black widow: is she deadly to children? Pediatr Emerg Care. Oct 1996;12(5):360-364. (Case Series, 12 patients)
  34. Wright SW, Wrenn KD, Murray L, Seger D. Clinical presentation and outcome of brown recluse spider bite. Ann Emerg Med. Jul 1997;30(1):28-32. (Retrospective Chart Review, 111 patients
  35. * Offerman SR, Bush SP, Moynihan JA, Clark RF. Crotaline Fab antivenom for the treatment of children with rattlesnake envenomation. Pediatrics. Nov 2002;110(5):968-971. 
  36. Ford MD. Clinical toxicology. Philadelphia: W.B. Saunders; 2001. (Textbook)
  37. Arce V, Rojas E, Ownby CL, Rojas G, Gutierrez JM. Preclinical assessment of the ability of polyvalent (Crotalinae) and anticoral (Elapidae) antivenoms produced in Costa Rica to neutralize the venoms of North American snakes. Toxicon. Jun 2003;41(7):851-860. (Comparative Study
  38. Clark RF, McKinney PE, Chase PB, Walter FG. Immediate and delayed allergic reactions to Crotalidae polyvalent immune Fab (ovine) antivenom. Ann Emerg Med. Jun 2002;39(6):671-676. (Case Series, 4 patients)
  39. * Boyer LV, Seifert SA, Cain JS. Recurrence phenomena after immunoglobulin therapy for snake envenomations: Part 2. Guidelines for clinical management with crotaline Fab antivenom. Ann EmergMed. Feb 2001;37(2):196-201. (Prospective Study, 38 patients)
  40. * Seifert SA, Boyer LV. Recurrence phenomena after immunoglobulin therapy for snake envenomations: Part 1. Pharmacokinetics and pharmacodynamics of immunoglobulin antivenoms and related antibodies. Ann Emerg Med. Feb 2001;37(2):189-195. (Review Article)
  41. Brent J. Toxicologists and the assessment of risk: the problem with mercury (commentary). J Toxicol Clin Toxicol. 2001;39(7):707-710. (Letter to the Editor)
  42. Alberts MB, Shalit M, LoGalbo F. Suction for venomous snakebite: a study of "mock venom" extraction in a human model. Ann Emerg Med. Feb 2004;43(2):181-186. (Prospective Clinical Trial, 8 patients
  43. Dunnihoo DR, Rush BM, Wise RB, Brooks GG, Otterson WN. Snake bite poisoning in pregnancy. A review of the literature. J Reprod Med. Jul 1992;37(7):653-658. (Review Article)
  44. Seneviratne SL, de Silva CE, Fonseka MM, Pathmeswaran A, Gunatilake SB, de Silva HJ. Envenoming due to snake bite during pregnancy. Trans R Soc Trop Med Hyg. May-Jun 2002;96(3):272-274. (Case Report)
  45. * 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. Aug 2004;44(2):99-104. (Comparative Study)
  46. Kelly JJ, Sadeghani K, Gottlieb SF, Ownby CL, Van Meter KW, Torbati D. Reduction of rattlesnake-venom-induced myonecrosis in mice by hyperbaric oxygen therapy. J Emerg Med. Jan-Apr 1991;9(1-2):1-7. (Comparative Study)
  47. Gold BS, Barish RA, Dart RC, Silverman RP, Bochicchio GV. Resolution of compartment syndrome after rattlesnake envenomation utilizing non-invasive measures. J Emerg Med. Apr 2003;24(3):285-288. (Case Report)
  48. Bush SP, Green SM, Laack TA, Hayes WK, Cardwell MD, Tanen DA. Pressure immobilization delays mortality and increases intracompartmental pressure after artificial intramuscular rattlesnake envenomation in a porcine model. Ann Emerg Med. Dec 2004;44(6):599-604. (Comparative Study)
  49. German BT, Hack JB, Brewer K, Meggs WJ. Pressure-immobilization bandages delay toxicity in a porcine model of eastern coral snake (Micrurus fulvius fulvius) envenomation. Ann Emerg Med. Jun 2005;45(6):603-608. (Comparative Study
  50. Winkel KD, Hawdon GM, Levick N. Pressure immobilization for neurotoxic snake bites. Ann Emerg Med. Aug 1999;34(2):294-295. (Comparative Study)
  51. From the Centers for Disease Control and Prevention. Necrotic arachnidism—Pacific Northwest, 1988-1996. Jama. Jun 26 1996;275(24):1870-1871. (Review Article
  52. Ramialiharisoa A, de Haro L, Jouglard J, Goyffon M. [Latrodectism in Madagascar]. Med Trop (Mars). 1994;54(2):127-130. (Letter to the Editor
  53. Grishin E. Polypeptide neurotoxins from spider venoms. Eur J Biochem. Sep 1999;264(2):276-280. (Review Article
  54. Timms PK, Gibbons RB. Latrodectism—effects of the black widow spider bite. West J Med. Mar 1986;144(3):315-317. (Review Article)
  55. Sams HH, Dunnick CA, Smith ML, King LE, Jr. Necrotic arachnidism. J Am Acad Dermatol. Apr 2001;44(4):561-573; quiz 573-566. (Review Article)
  56. Sams HH, King LE, Jr. Brown recluse spider bites. Dermatol Nurs. Dec 1999;11(6):427-433. (Review Article
  57. Way S, Lachar G, Givens M. A child with fever, malaise, and a skin wound. Pediatr Emerg Care. Sep 2005;21(9):620-623. (Case Report)
  58. * Hogan CJ, Barbaro KC, Winkel K. Loxoscelism: old obstacles, new directions. Ann Emerg Med. Dec 2004;44(6):608-624. (Review Article)
  59. Cacy J, Mold JW. The clinical characteristics of brown recluse spider bites treated by family physicians: an OKPRN Study. Oklahoma Physicians Research Network. J Fam Pract. Jul 1999;48(7):536-542. (Review Article)
  60. Goto CS, Abramo TJ, Ginsburg CM. Upper airway obstruction caused by brown recluse spider envenomization of the neck. Am J Emerg Med. Nov 1996;14(7):660-662. (Case Report)
  61. Clark RF. The safety and efficacy of antivenin Latrodectus mactans. J Toxicol Clin Toxicol. 2001;39(2):125-127. (Review Article
  62. O'Malley GF, Dart RC, Kuffner EF. Successful treatment of latrodectism with antivenin after 90 hours. N Engl J Med. Feb 25 1999;340(8):657. (Case Report)
  63. Hoover NG, Fortenberry JD. Use of antivenin to treat priapism after a black widow spider bite. Pediatrics. Jul 2004;114(1):e128-129. (Case Report)
  64. Handel CC, Izquierdo LA, Curet LB. Black widow spider (Latrodectus mactans) bite during pregnancy. West J Med. Mar 1994;160(3):261-262. (Case Report
  65. Bailey B. Are there teratogenic risks associated with antidotes used in the acute management of poisoned pregnant women? Birth Defects Res A Clin Mol Teratol. Feb 2003;67(2):133-140. (Review Article
  66. Russell FE, Marcus P, Streng JA. Black widow spider envenomation during pregnancy. Report of a case. Toxicon. 1979;17(2):188-189. (Case Report)
  67. Rosenthal L, Zacchetti D, Madeddu L, Meldolesi J. Mode of action of alpha-latrotoxin: role of divalent cations in Ca2(+)-dependent and Ca2(+)-independent effects mediated by the toxin. Mol Pharmacol. Dec 1990;38(6):917-923. (In Vitro Prospective Study
  68. King LE, Jr., Rees RS. Dapsone treatment of a brown recluse bite. Jama. Aug 5 1983;250(5):648. (Case Report
  69. Rees RS, Altenbern DP, Lynch JB, King LE, Jr. Brown recluse spider bites. A comparison of early surgical excision versus dapsone and delayed surgical excision. Ann Surg. Nov 1985;202(5):659-663. (Comparative Study)
  70. Barrett SM, Romine-Jenkins M, Blick KE. Passive hemagglutination inhibition test for diagnosis of brown recluse spider bite envenomation. Clin Chem. Oct 1993;39(10):2104-2107. (In Vitro Prospective Study)
  71. Frey HM, Gershon AA, Borkowsky W, Bullock WE. Fatal reaction to dapsone during treatment of leprosy. Ann Intern Med. Jun 1981;94(6):777-779. (Case Report
  72. Phillips S, Kohn M, Baker D, et al. Therapy of brown spider envenomation: a controlled trial of hyperbaric oxygen, dapsone, and cyproheptadine. Ann Emerg Med. Mar 1995;25(3):363-368. (Comparative In Vitro Study)
  73. Wille RC, Morrow JD. Case report: dapsone hypersensitivity syndrome associated with treatment of the bite of a brown recluse spider. Am J Med Sci. Oct 1988;296(4):270-271. (Case Report
  74. DeLozier JB, Reaves L, King LE, Jr., Rees RS. Brown recluse spider bites of the upper extremity. South Med J. Feb 1988;81(2):181-184. (Case Series, 31 patients)
  75. Sams HH, Hearth SB, Long LL, Wilson DC, Sanders DH, King LE, Jr. Nineteen documented cases of Loxosceles reclusa envenomation. J Am Acad Dermatol. Apr 2001;44(4):603-608. (Case Series, 19 patients
  76. Auer AI, Hershey FB. Proceedings: Surgery for necrotic bites of the brown spider. Arch Surg. Apr 1974;108(4):612-618. (Review Article
  77. Gross AS, Wilson DC, King LE, Jr. Persistent segmental cutaneous anesthesia after a brown recluse spider bite. South Med J. Nov 1990;83(11):1321-1323. (Case Report)
  78. King LE, Jr., Rees RS. Treatment of brown recluse spider bites. J Am Acad Dermatol. Apr 1986;14(4):691-692. (Letter to the Editor
  79. Rees RS, Fields JP, King LE, Jr. Do brown recluse spider bites induce pyoderma gangrenosum? South Med J. Mar 1985;78(3):283-287. (Case Report)
  80. Barrett SM, Romine-Jenkins M, Fisher DE. Dapsone or electric shock therapy of brown recluse spider envenomation? Ann Emerg Med. Jul 1994;24(1):21-25. (Prospective Experimental Trial)
  81. Dillaha CJ, Jansen GT, Honeycutt WM, Hayden CR. North American Loxoscelism. Necrotic Bite of the Brown Recluse Spider. Jama. Apr 6 1964;188:33-36. (Case Report)
  82. Mara JE, Myers BS. Brown spider bite. Treatment with hydrocortisone. Rocky Mt Med J. Sep-Oct 1977;74(5):257-258. (Case Report
  83. Bernstein B, Ehrlich F. Brown recluse spider bites. J Emerg Med. 1986;4(6):457-462. (Review Article)
  84. Gomez HF, Miller MJ, Trachy JW, Marks RM, Warren JS. Intradermal anti-loxosceles Fab fragments attenuate dermonecrotic arachnidism. Acad Emerg Med. Dec 1999;6(12):1195-1202. (Comparative Study
  85. Strain GM, Snider TG, Tedford BL, Cohn GH. Hyperbaric oxygen effects on brown recluse spider (Loxosceles reclusa) envenomation in rabbits. Toxicon. 1991;29(8):989-996. (Comparative Study)
  86. Svendsen FJ. Treatment of clinically diagnosed brown recluse spider bites with hyperbaric oxygen: a clinical observation. J Ark Med Soc. Oct 1986;83(5):199-204. (Case Report)
  87. Osborn CD. Treatment of spider bites by high voltage direct current. J Okla State Med Assoc. Jun 1991;84(6):257-260. (Case Report
  88. Gibly R, Williams M, Walter FG, McNally J, Conroy C, Berg RA. Continuous intravenous midazolam infusion for Centruroides exilicauda scorpion envenomation. Ann Emerg Med. Nov 1999;34(5):620-625. (Retrospective Chart Review, 109 patients
  89. Litovitz TL, Klein-Schwartz W, Dyer KS, Shannon M, Lee S, Powers M. 1997 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 1998;16(5):443-497. (Epidemiology, Population Surveillance, Review Article
  90. * Curry SC, Vance MV, Ryan PJ, Kunkel DB, Northey WT. Envenomation by the scorpion Centruroides sculpturatus. J Toxicol Clin Toxicol. 1983;21(4-5):417-449. (Review article, Case Reports)
  91. Rachesky IJ, Banner W, Jr., Dansky J, Tong T. Treatments for Centruroides exilicauda envenomation. Am J Dis Child. Dec 1984;138(12):1136-1139. (Case Reports)
  92. Rimsza ME, Zimmerman DR, Bergeson PS. Scorpion envenomation. Pediatrics. Aug 1980;66(2):298-302. (Review Article
  93. Likes K, Banner W, Jr., Chavez M. Centruroides exilicauda envenomation in Arizona. West J Med. Nov 1984;141(5):634-637. (Retrospective Chart Review)
  94. LoVecchio F, Welch S, Klemens J, Curry SC, Thomas R. Incidence of immediate and delayed hypersensitivity to Centruroides antivenom. Ann Emerg Med. Nov 1999;34(5):615-619. (Case Report)
  95. Suchard JR, Hilder R. Atropine use in Centruroides scorpion envenomation. J Toxicol Clin Toxicol. 2001;39(6):595-598; discussion 599. (Case Report)
  96. Sofer S, Shahak E, Gueron M. Scorpion envenomation and antivenom therapy. J Pediatr. Jun 1994;124(6):973-978. (Retrospective ChartReview, 52 patients)

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