Current management of copperhead snakebite.

Several thousand snakebites occur annually in the US, but fewer than 10 deaths occur. Most deaths are from envenomations by rattlesnakes (Crotalus species), but deaths from copperhead and water moccasin (Agkistrodon species) are rare. All snakebites presented to East Texas Medical Center, Crockett, a level III trauma center, from 1995 to 2010 were reviewed. A total of 142 snakebites were treated. Ninety-four were of the Agkistrodon species-contortrix contortrix (copperhead) or piscivorus leukostoma (water moccasin). Three were rattlesnakes, and 3 were from the Texas coral snake (Micrurus fulvius tener). Forty-two were unidentified pit vipers. The following results are of the 88 copperhead bites. The most common presenting symptoms were pain and swelling. Eighty-five percent were of grade 1 envenomations. Ten patients had laboratory abnormalities secondary to the snakebite. Forty-four were admitted for observation. The average length of stay for patients admitted was 2 days. No patients received antivenom, and no patients required surgical intervention. There were no deaths. One patient had edema and ecchymosis that persisted for more than 1 month. Accurate identification of the pit viper species involved in snakebites is essential. Although envenomation by a rattlesnake (Crotalus species) may require antivenom and uncommonly surgery, a bite by a copperhead (Agkistrodon contortrix) rarely requires any intervention other than observation. The unnecessary use of antivenom should be discouraged.

Walker JP ，Morrison RL 《-》

Management of Tissue Loss After Agkistrodon Snakebite: Appropriate Use of Crotalidae-Fab Antivenin.

Larson KW ，Schaefer KR ，Austin C ，Norton R ，Finley PJ ... -  《Journal of Trauma Nursing》

Snakebite treatment at a southeastern regional referral center.

Rudolph R ，Neal GE ，Williams JS ，McMahan AP ... -  《-》

Clinically Significant Envenomation From Postmortem Copperhead (Agkistrodon contortrix).

Over 14,000 copperhead (Agkistrodon contortrix) bites were reported to United States poison centers between 1983 and 2008, and 1809 cases were reported to poison centers in 2014. The copperhead is primarily found in the southeastern United States and belongs to the pit viper subfamily Crotalinae, which also includes the water moccasin (Agkistrodon piscivorus) and rattlesnakes (Crotalus and Sistrurus genera). Postmortem rattlesnakes have been reported to cause clinically significant envenomation; we report a case of a postmortem copperhead causing clinically significant envenomation after inadvertent puncture with the deceased copperhead fang. The copperhead was transected twice, leaving the snake in 3 separate pieces. While handling the snake head, an inadvertent puncture occurred on the right index finger followed by pain and swelling in the affected extremity necessitating antivenom administration. Care should be taken when handling deceased pit vipers due to the continued risk of envenomation.

Emswiler MP ，Griffith FP Th ，Cumpston KL 《-》

Prospective evaluation of pain, swelling, and disability from copperhead envenomation.

Roth B ，Sharma K ，Onisko N ，Chen T ... -  《-》