Mojave Rattlesnake Envenomation Follow-up

Updated: Jun 25, 2015
  • Author: Sean P Bush, MD, FACEP; Chief Editor: Joe Alcock, MD, MS  more...
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Follow-up

Further Outpatient Care

Discharge instructions should include the following:

  • Return immediately if swelling worsens or pain becomes severe.
  • Return immediately if any abnormal bleeding or bruising, dark tarry stools, or severe headache occur.
  • Return for signs of wound infection, such as swelling, excessive tenderness, redness or streaks, heat, or drainage (pus).
  • Return or follow up if a fever, itchy rash, joint pain, or swollen lymph nodes occur any time during the next few weeks.
  • Do not take nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Motrin, Advil), or naproxen (Naprosyn, Aleve) for 2 weeks after the snakebite. Acetaminophen (Tylenol) or a prescribed pain medication can be taken.
  • Do not participate in contact sports, undergo elective surgery, or have dental work for 2 weeks after the snakebite.
  • Drink plenty of liquids. Return if urine decreases in amount or becomes cola colored.
  • Referral to a physical therapist or surgeon may be indicated.
  • Wound check at the physician's discretion on a case-by-case basis. Return to the ED or follow up every 3 days for 2 weeks with repeat CBC, PT/INR, and fibrinogen. Laboratory studies may need to be rechecked more or less frequently or for a longer or shorter duration on a case-by-case basis.
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Further Inpatient Care

Admit

Strongly consider admission for all Mojave rattlesnake envenomations. Because patients with severe Mojave envenomation may present with only minimal local tissue effects, underestimation of a significant injury can easily occur. Because of the relative infrequency of the injury, admitting all patients with suspected Mojave rattlesnake envenomations is probably prudent and cost effective.

Effects of Mojave rattlesnake envenomation may be prolonged and have been shown to improve with late administration of antivenom.

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Inpatient & Outpatient Medications

Administer antihistamines and steroids if serum sickness develops.

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Transfer

All hospitals should have enough antivenom to treat at least one patient. However, antidote stocking varies and shortages do occur. Therefore, if antivenom is not available at the presenting hospital, patients should be transferred to a facility where antivenom may be administered. However, if it is available, antivenom may be necessary to optimize stabilization of a patient prior to transfer.

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Deterrence/Prevention

Never handle a rattlesnake, even if it is believed to be dead. Serious, even fatal, envenomations have been documented to occur after handling the decapitated head of a rattlesnake up to 90 minutes after it was severed.

Do not reach or step into places outdoors that are not visible.

At home, remove debris in which snakes might hide (eg, log piles). Remove items, such as bird feeders, that might attract snakes—seeds that fall from bird feeders attract rodents, which attract snakes.

Heavy clothing (such as hiking boots) may retard some strikes.

Young children should be closely supervised, and older children should be educated to avoid snakes.

Keep garage doors closed to prevent rattlesnakes from seeking shelter in garages.

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Complications

Complications can include rhabdomyolysis, infection, respiratory difficulty, and death (rare)

Antivenom-associated complications

Anaphylaxis is a type I (immediate) hypersensitivity reaction that may be life threatening. It is characterized by urticaria, wheezing laryngeal edema, and shock.

Serum sickness is a type III (delayed) hypersensitivity reaction. It is characterized by fever, urticaria, lymphadenopathy, and arthritis and may occur 5 days to 3 weeks after antivenom treatment.

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Prognosis

Full recovery is usually anticipated. Before antivenom, estimates of mortality rates ranged from 5-25%. Because of the development of antivenom, rapid EMS transport, and emergency/intensive care, mortality rates have improved to 0.28% (or better) when antivenom is administered and to 2.6% when antivenom is not administered.

Mortality/Morbidity

Mojave toxin is one of the most lethal venom components found in US snakes. Venom B populations are less lethal than venom A populations. At least one death has been attributed to a Mojave rattlesnake in the Annual Report of the American Association of Poison Control Centers, although a number of deaths have been documented. [17]  Most documented deaths are associated with bites in which the bitten individual was intentionally interacting with the snake and when a delay occurred in seeking medical care.

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Patient Education

Call professionals, such as animal control, to move snakes (if it is necessary to move the snake). Never attempt to handle, possess, or kill venomous reptiles. For patient education resources, see eMedicineHealth's patient education article Snakebite.

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