Elapidae (Coral Snakes)
- All coral snakes are brightly colored with black, red, and yellow rings
- Red and yellow rings touch in coral snakes, but are separated in nonpoisonous mimics
- "Red touch yellow, kills a fellow; red touch black, venom lack"
- This tool for identifying coral snakes does not apply to Mexican species
Coral snake venom is mainly neurotoxic (irreversibly binds to acetylcholine receptors) and does not cause significant local tissue injury unlike Crotaline (Pit Vipers) venom.
- Local injury is often minimal and easy to miss as venom is delivered via chewing rather than injection
- Venom effects may develop hours after a bite
- Venom-induced consumption coagulopathy (DIC-like syndrome)
- Renal failure
- Hypovolemic shock
- Neurotoxicities in particular for coral snaktes
- Local numbness rather than pain/swelling
- CN palsies
- Respiratory paralysis
- Hymenoptera stings (bees, wasps, ants)
- Mammalian bites
- Closed fist infection (Fight bite)
- Marine toxins and envenomations
- Scorpion envenomation
- Snake bites
- Spider bites
- CBC with diff
- Fibrin degradation products
- ABG if respiratory compromise
- Immobilize limb in a neutral position
- Remove all jewelry
- Mark the leading edge of erythema/edema
- Do not:
- Attempt to suck out the venom
- Place the affected part in cold water
- Use a tourniquet or wrap
- Antivenom is first line treatment for compartment syndrome; fasciotomy is last resort if elevated pressures persist.
- Give 3-5 vials of Antivenin (Micrurus fulvius) to ALL patients who have definitely been bitten
- It may not be possible to prevent further effects or reverse effects once they develop
- Additional doses of antivenom are reserved for cases in which symptoms/signs appear
- Prepare for allergic reaction from equine produced Antivenin (may dilute solution, or administer with epinephrine/benadryl)
Monitor for respiratory failure
- Admit all patients (even if initially symptom free)
- Isbister GK. Snakebite does not cause disseminated intravascular coagulation: coagulopathy and thrombotic microangiopathy in snake envenoming. Semin Thromb Hemost. 2010 Jun;36(4):444-51.
- Medscape. Antivenin, Eastern & Texas Coral Snakes (Rx) - Antivenin (Micrurus fulvius). http://reference.medscape.com/drug/micrurus-fulvius-antivenin-eastern-texas-coral-snakes-343718.
- Juckett G and Hancox JG. Venomous Snakebites in the United States: Management Review and Update. Am Fam Physician. 2002 Apr 1;65(7):1367-1375.