Snake Envenomations, Rattle
Last Updated: November 2, 2004
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Synonyms and related keywords: Crotalus species, Sistrurus species
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Author: Sean P Bush, MD, FACEP, Associate Professor, Department of Emergency Medicine, Loma Linda University School of Medicine
Sean P Bush, MD, FACEP, is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society
Editor(s): Robert Norris, MD, Chief, Associate Professor, Department of Surgery, Division of Emergency Medicine, Stanford University Medical Center; John T VanDeVoort, PharmD, Clinical Assistant Professor, College of Pharmacy, University of Minnesota; James S Walker, DO, Program Coordinator, Associate Professor, Department of Emergency Medicine, University of Oklahoma Health Sciences Center; John Halamka, MD, Chief Information Officer, CareGroup Healthcare System, Assistant Professor of Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Assistant Professor of Medicine, Harvard Medical School; and Raymond J Roberge, MD, MPH, FAAEM, FACMT, Clinical Associate Professor of Emergency Medicine, University of Pittsburgh School of Medicine; Consulting Staff, Department of Emergency Medicine, Magee-Women's Hospital of the University of Pittsburgh Medical Center
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Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Pictures Bibliography
Background: Rattlesnakes are pit vipers and include the genera Crotalus and Sistrurus. Pit vipers may be identified by a heat-sensing pit anteroinferior to the eye, elliptical pupils, a triangular head and undivided subcaudal scales. Rattlesnakes may be identified in all but one species by a rattle at the tip of the tail. Rattlesnakes are found from North to South America.
Pathophysiology: Venom is usually injected into subcutaneous tissue via hollow movable fangs located in the anterior mouth. Occasionally, intramuscular or intravenous injection occurs. Rattlesnake venom is generally composed of several digestive enzymes and spreading factors, which result in local and systemic injury. Clinically, local effects most commonly predominate, progressing from pain and edema to ecchymosis and bullae. Hematologic abnormalities, including benign defibrination with or without thrombocytopenia, may result, but severe generalized bleeding is uncommon. Local or diffuse myotoxicity may result in complications such as compartment syndrome or rhabdomyolysis. Other general effects include shock, fasciculations, taste changes, and vomiting. Rarely, direct cardiotoxicity or allergy to venom may occur. Some rattlesnakes may exhibit neurotoxicity with minimal local tissue effects (see Snake Envenomations, Mojave Rattle).
Frequency:
* In the US: Approximately 7500 reptile bites were reported to the American Association of Poison Control Centers (AAPCC) in 2001. However, this figure is probably conservative because of underreporting. Rattlesnakes cause the majority of all bites by identified venomous snakes in the United States. Dry bite (ie, no envenomation) occurs in as many as 50% of strikes.
* Internationally: An estimated 300,000-400,000 venomous snakebites occur per year. While rattlesnakes are not found naturally outside of North, Central, and South America, they are imported into zoos, museums, and private collections in other regions of the world.
Mortality/Morbidity: Fewer than half a dozen deaths occur per year as a result of snakebite in the United States; most are caused by rattlesnake bites. Estimates of deaths each year from snakebite range from 30,000-110,000 worldwide. Up to 5 times as many individuals experience permanent morbidity.
Sex: Males are bitten more commonly than females.
Age: Young adults are bitten most commonly.
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