Background: Snake bites in the US are relatively uncommon and mortality even less with 5-15 deaths reported annually. Recognizing these bites as either true envenomations or “dry bites” is important.

Crotalines:
      -Rattlesnakes, copperheads and water moccasins have complex venom and has effects on local tissue necrosis, the                       coagulation cascade, and platelet function
      -The Mojave rattlesnake has a potent neurotoxin that can lead to skeletal muscle weakness, respiratory depression and             respiratory failure
      -The ONLY treatment that has been shown to help includes expediting transport to the nearest emergency department,               constriction bands (not tourniquets!), immobilization and elevation of the affected limb
      -If the local swelling is progressing beyond serial demarcations, fibrinogen is <100mg/dL or platelets are                                  <100,000/mm3, Crotaline polyvalent immune Fab (CroFab) should be administered (start with 4-6 vials) 
      -Transfusion is normally not indicated as this is a consumptive process
      -Follow the dosing recommendations from the manufacturer or discuss with your local toxicologist or poison control                 center for further administration instructions

Elapids:
      -Coral snake envenomations have purely neurotoxic effects and true envenomations are difficult to detect
      -There is no antivenom any longer in the US and these patients need critical care observation for possible respiratory                 failure and need for intubation

Exotic snakebites:
      -Account for only 3% of all US snakebites
      -Antivenom for these snakes can usually be found at your local zoo, a neighboring zoo, or by contacting the Miami-Dade           Fire Rescue Venom Response Team (786) 331-4443

**In all cases of snake bites, contact your local poison control center for guidance to treatment: 1 (800) 222-1222