eMedicine Specialties > Emergency Medicine > Environmental
Snake Envenomation, Coral: Follow-up
Updated: Dec 17, 2008
Follow-up
Further Inpatient Care
- Admit all persons bitten by a coral snake to a closely monitored facility, whether or not antivenom is given.
- Observe asymptomatic patients for at least 24 hours because delayed signs and symptoms may occur.
- If an appropriate antivenom was available and administered, but resulted in an anaphylactoid reaction, continue to administer systemic antihistamines and steroids as needed.
- Generally, little or no risk of tissue necrosis is present following coral snake bites.
- Inform patients who have received antivenom of the signs and symptoms of delayed serum sickness. If symptoms of serum sickness develop after discharge, promptly evaluate the patient for initiation of systemic steroids and diphenhydramine (see Medications).
Deterrence/Prevention
- Avoid handling venomous or unidentified snakes.
Complications
Complications of snake bite may include the following:
- Respiratory failure
- Cardiovascular collapse
- Prolonged neuromuscular weakness
- Antivenom-related complications
- Anaphylactoid reactions
- Delayed serum sickness
Prognosis
- With sound supportive care (eg, prevention of aspiration) and appropriate antivenom administration, when available, prognosis following coral snake envenomation is excellent; expect a full recovery. This is generally true, even in the absence of an available, appropriate antivenom, but the overall clinical course (including the need for prolonged intubation and respiratory support) will be longer.
Patient Education
- For excellent patient education resources, visit eMedicine's Bites and Stings Center. Also, see eMedicine's patient education article Snakebite.
Miscellaneous
Medicolegal Pitfalls
- Considering the potential delay in onset of signs and symptoms, it is unwise to discharge asymptomatic patients with possible coral snake bite.
- Some risk of acute or delayed allergic reaction associated with antivenom use always exists. If possible, obtain patient consent before use and be immediately available throughout the administration to intervene if necessary.
- Be aware of the lack of efficacy of inappropriate antivenom as discussed above.
- Failure to aggressively manage a patient's airway in the face of impending respiratory failure may lead to aspiration, with its attendant complications.
Special Concerns
- The biggest current special concern related to coral snake bites in the United States is the lack of a commercially available antivenom in production at the time of this writing. It is hoped that an alternative, effective antivenom from another country in Latin America will be imported for US Micrurus bites or that a manufacturer will begin supplying a new, specific antivenom for Micrurus fulvius and M tener.
- Absent an available antivenom, care must rely on support of the airway and respirations as indicated—possibly for a period of many days in cases of serious envenoming.
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References
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Kitchens CS, Van Mierop LH. Envenomation by the Eastern coral snake (Micrurus fulvius fulvius). A study of 39 victims. JAMA. Sep 25 1987;258(12):1615-8. [Medline].
Norris RL, Bush SP. North American venomous reptile bites. In: Auerbach PS, ed. Wilderness Medicine. 4th ed. St. Louis: Mosby; 2001:896-926.
Norris RL, Dart RC. Apparent coral snake envenomation in a patient without visible fang marks. Am J Emerg Med. Jul 1989;7(4):402-5. [Medline].
Norris RL, Ngo J, Nolan K, et al. Physicians and lay people are unable to apply pressure immobilization properly in a simulated snakebite scenario. Wilderness Environ Med. 2005;16(1):16-21. [Medline].
Parrish HM, Khan MS. Bites by coral snakes: report of 11 representative cases. Am J Med Sci. May 1967;253(5):561-8. [Medline].
Simpson ID, Tanwar PD, Andrade C, et al. The Ebbinghaus retention curve: training does not increase the ability to apply pressure immobilisation in simulated snake bite--implications for snake bite first aid in the developing world. Trans R Soc Trop Med Hyg. May 2008;102(5):451-9. [Medline].
Further Reading
Keywords
snake envenomation, snakebite, snake bite, coral snake, Elapidae, Micrurus fulvius, eastern coral snake, Micrurus tener, Texas coral snake, coral snake envenomations, coral snake bite, Micruroides euryxanthus, Sonoran coral snake, Arizona coral snake
