Initial hospital management of Crotalinae snakebite (rattlesnakes, water moccasins [cottonmouths], and copperheads)

Consultation with a medical toxicologist or other physician with expertise and prior experience treating Crotalinae snake bites is strongly encouraged before initiating antivenom therapy. Emergency consultation with a medical toxicologist in the United States is available at 1-800-222-1222. Antivenom administration is associated with potentially severe allergic reactions and should be restricted to continuously monitored emergency or intensive care unit setting with immediate availability of medications to treat anaphylaxis (ie, epinephrine, diphenhydramine and famotidine or similar antihistamines, IV corticosteroids, and inhaled albuterol).

IV: intravenous; IN: intraosseous; FSP: fibrin split products.

* Weakness may occur after bites by the Mojave rattlesnake (Crotalus scutulatus) or Southern Pacific rattlesnake (Crotalus helleri). Myokymia (rippling muscle movement often seen in the face) is associated with bites by several species of rattlesnakes, including the timber rattlesnake (Crotalus horridus), the Mohave rattlesnake (Crotalus scutulatus), the Grand Canyon rattlesnake (Crotalus lutosus abyssus), the Southern Pacific rattlesnake (Crotalus helleri), the midget faded rattlesnake (Crotalus concolor), and the western diamondback rattlesnake (Crotalus atrox).

¶ For recommended Crotalinae antivenom dosing and administration and how to assess response, refer to UpToDate content on Crotalinae snakebite.

Δ At 4 hours or longer after the bite, some experts also obtain fibrin degradation testing, either D-dimer or fibrin split products, to identify patients whose initial labs do not show significant abnormalities but who remain at risk for delayed hemotoxicity. Antivenom therapy does not affect the results of fibrin degradation tests.

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Initial hospital management of Crotalinae snakebite (rattlesnakes, water moccasins [cottonmouths], and copperheads)