Elapidae (Coral Snakes)
- Coral snakes are the only Elapidae family members found in the United States
- Internationally, species include sea snakes, cobras, mambas, and kraits
- 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
- Venom: mainly neurotoxic (irreversibly binds to acetylcholine receptors)
- 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
- Systemic signs may be delayed up to 13h after bite
- Neurotoxicities in particular for coral snakes
- Hypovolemic shock
- Venom-induced consumption coagulopathy (DIC-like syndrome) (uncommon, but reported)
- Hymenoptera stings (bees, wasps, ants)
- Mammalian bites
- Marine toxins and envenomations
- Toxins (ciguatera, neurotoxic shellfish poisoning, paralytic shellfish poisoning, scombroid, tetrodotoxin
- Stingers (stingray injury)
- Venomous fish (catfish, zebrafish, scorpion fish, stonefish, cone shells, lionfish, sea urchins)
- Nematocysts (coral reef, fire coral, box jellyfish, sea wasp, portuguese man-of-war, sea anemones)
- Phylum porifera (sponges)
- Bites (alligator/crocodile, octopus, shark)
- Scorpion envenomation
- Reptile envenomation
- Spider bites
- 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.
- Pressure Immobilization Dressing
- Wrap the length of the bitten extremity with an elastic bandage
- Splint the extremity in neutral position to immobilize
- Immobilize victim and transport to medical care
- If a patient presents with a tourniquet or pressure immobilization dressing, obtain IV access for potential resuscitation before removing.
- 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
- Respiratory failure results from neurotoxicity rather than edema as in crotalids
- Frequently reevaluate respiratory function and ability to handle secretions
- Consider bedside spirometry testing
- Aggressive airway management with any sign of respiratory decline including mechanical ventillation as needed
- 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.
- Robert L. Norris, Sean P. Bush, Michael D. Cardwell. Bites by Venomous Reptiles in the United States, Canada, and Mexico. Paul S. Auerbach. In: Auerbach’s Wilderness Medicine. 7th Ed. 2017: 742.
- 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.