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<< Diagnosis And Management Of North American Snake And Scorpion Envenomations

Emergency Department Evaluation

Coral Snakes

Coral snakebites produce little, if any, pain and local reaction. Assessment of signs of neuropathy must be aggressively sought, as progression to bulbar paralysis and respiratory failure may be rapid. The onset of neurological symptoms may be delayed one to four hours, but once neurological signs appear, progression to paralysis and respiratory failure may occur over a few minutes. Tremors, ptosis, dysphonia, dysphagia, and decreased deep tendon reflexes are the most common neurologic signs and may indicate impending respiratory paralysis.7

Non-native Venomous Snakes

Depending on the species, envenomations may produce mostly neurotoxic effects, especially from the other Elapids, e.g. cobras, kraits, and mambas. Cytotoxic and coagulopathic effects may predominate from bites of other snakes, especially the Viperidae (both pit and true vipers). Once identification is made, a poison center consultation and/or accessing one of the available web resources will help guide clinical decision making; see Table 5.



Scorpions

Children are at the greatest risk of severe effects because of low body weight to venom ratios. Elderly  people may also have lower reserves against the physiologic insult of the toxins. Evaluation of local,  systemic, and neurological effects is essential. Deaths occur from cardiopulmonary collapse or respiratory paralysis. Identification of impaired tissue perfusion, tachycardia, tachypnea, hypoxemia, hypotension, agitation, altered mental status, and/or cranial and somatic neuromuscular dysfunction are a prompt for aggressive treatment. A retrospective study of 428 patients admitted to the intensive care unit in Tunisia for scorpion envenomations found that respiratory rate > 30 breaths per minute, agitation, and sweating were predictors of pulmonary edema.56

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Last Modified: 06/27/2017
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