Other Tests

Treatment & Management

Cardwell MD. Recognizing dangerous snakes in the United States and Canada: a novel 3-step identification method. Wilderness Environ Med. 2011 Dec. 22 (4):304-8. [QxMD MEDLINE Link].
Kalita J, Kumar M, Misra UK. Serial single breath count is a reliable tool for monitoring respiratory functions in Guillain-Barré Syndrome. J Clin Neurosci. 2020 Feb. 72:50-56. [QxMD MEDLINE Link].
Gummin DD, Mowry JB, Beuhler MC, Spyker DA, Bronstein AC, Rivers LJ, et al. 2020 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 38th Annual Report. Clin Toxicol (Phila). 2021 Dec. 59 (12):1282-1501. [QxMD MEDLINE Link].
de Roodt AR, De Titto E, Dolab JA, Chippaux JP. Envenoming by coral snakes (Micrurus) in Argentina, during the period between 1979-2003. Rev Inst Med Trop Sao Paulo. 2013 Jan-Feb. 55(1):13-8. [QxMD MEDLINE Link].
Pardal PP, Pardal JS, Gadelha MA, Rodrigues Lda S, Feitosa DT, Prudente AL. Envenomation by Micrurus coral snakes in the Brazilian Amazon region: report of two cases. Rev Inst Med Trop Sao Paulo. 2010 Nov-Dec. 52(6):333-7. [QxMD MEDLINE Link].
Wood A, Schauben J, Thundiyil J, Kunisaki T, Sollee D, Lewis-Younger C, et al. Review of Eastern coral snake (Micrurus fulvius fulvius) exposures managed by the Florida Poison Information Center Network: 1998-2010. Clin Toxicol (Phila). 2013 Sep-Oct. 51 (8):783-8. [QxMD MEDLINE Link].
Norris RL, Pfalzgraf RR, Laing G. Death following coral snake bite in the United States--first documented case (with ELISA confirmation of envenomation) in over 40 years. Toxicon. 2009 May. 53(6):693-7. [QxMD MEDLINE Link].
German BT, Hack JB, Brewer K, et al. Pressure-immobilization bandages delay toxicity in a porcine model of eastern coral snake (Micrurus fulvius fulvius) envenomation. Ann Emerg Med. 2005 Jun. 45(6):603-8. [QxMD MEDLINE Link].
Gray S. Pressure immobilization of snakebite. Wilderness Environ Med. 2003 Spring. 14(1):70-1. [QxMD MEDLINE Link].
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. 2008 May. 102(5):451-9. [QxMD MEDLINE Link].
Notification of Shelf Life Extension for North American Coral Snake Antivenin 10 mL Vial [package insert]. Pfizer Hospital. May, 27, 2021. Available at [Full Text].
Ramos HR, Vassão RC, de Roodt AR, Santos E Silva EC, Mirtschin P, Ho PL, et al. Cross neutralization of coral snake venoms by commercial Australian snake antivenoms. Clin Toxicol (Phila). 2017 Jan. 55 (1):33-39. [QxMD MEDLINE Link].
Sánchez EE, Lopez-Johnston JC, Rodríguez-Acosta A, Pérez JC. Neutralization of two North American coral snake venoms with United States and Mexican antivenoms. Toxicon. 2008 Feb. 51 (2):297-303. [QxMD MEDLINE Link].
Vital Brazil O, Vieira RJ. Neostigmine in the treatment of snake accidents caused by Micrurus frontalis: report of two cases (1). Rev Inst Med Trop Sao Paulo. 1996 Jan-Feb. 38 (1):61-7. [QxMD MEDLINE Link].
Mowry JB, Spyker DA, Brooks DE, Zimmerman A, Schauben JL. 2015 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 33rd Annual Report. Clin Toxicol (Phila). 2016 Dec. 54 (10):924-1109. [QxMD MEDLINE Link].
U.S. Food and Drug Administration. Expiration Date Extension for North American Coral Snake Antivenin (Micrurus fulvius) (Equine Origin) Lot L67530 through January 31, 2018. Available at https://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/ucm538841.htm. February 1, 2017; Accessed: August 2, 2018.
Norris RL, Bush SP. North American venomous reptile bites. 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. 1989 Jul. 7(4):402-5. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].

Media Gallery

Snake envenomations, coral. Comparison of the harmless Lampropeltis triangulum annulata(Mexican milksnake) (top) with Micrurus tener(Texas coral snake) (bottom). Photo by Charles Alfaro.
Coral snake skull.
The Australian pressure immobilization technique: Step 1. This technique has been shown to be helpful in delaying systemic absorption of elapid venoms. A broad pressure bandage is immediately wrapped, beginning distally, around as much of the extremity as possible. No effort should be spent removing clothing prior to bandage application. The bandage is wrapped snugly, as for a severely sprained ligament. A splint (or sling when applied to the upper extremity) is then placed, and the victim is carried from the scene. The victim should expend no effort in getting to definitive care. Pressure immobilization should remain in place until the victim has reached medical care. The doctor will decide when to remove the bandages. If venom has been injected, it will move into the bloodstream quickly once the bandages are removed. The doctor should leave the bandages and splint in position until appropriate antivenom is available whenever possible. Used with permission from Commonwealth Serum Laboratories.
The Australian pressure immobilization technique: Step 2. This technique has been shown to be helpful in delaying systemic absorption of elapid venoms. A broad pressure bandage is immediately wrapped, beginning distally, around as much of the extremity as possible. No effort should be spent removing clothing prior to bandage application. The bandage is wrapped snugly, as for a severely sprained ligament. A splint (or sling when applied to the upper extremity) is then placed, and the victim is carried from the scene. The victim should expend no effort in getting to definitive care. Pressure immobilization should remain in place until the victim has reached medical care. The doctor will decide when to remove the bandages. If venom has been injected, it will move into the bloodstream quickly once the bandages are removed. The doctor should leave the bandages and splint in position until appropriate antivenom is available whenever possible. Used with permission from Commonwealth Serum Laboratories.
The Australian pressure immobilization technique: Step 3. This technique has been shown to be helpful in delaying systemic absorption of elapid venoms. A broad pressure bandage is immediately wrapped, beginning distally, around as much of the extremity as possible. No effort should be spent removing clothing prior to bandage application. The bandage is wrapped snugly, as for a severely sprained ligament. A splint (or sling when applied to the upper extremity) is then placed, and the victim is carried from the scene. The victim should expend no effort in getting to definitive care. Pressure immobilization should remain in place until the victim has reached medical care. The doctor will decide when to remove the bandages. If venom has been injected, it will move into the bloodstream quickly once the bandages are removed. The doctor should leave the bandages and splint in position until appropriate antivenom is available whenever possible. Used with permission from Commonwealth Serum Laboratories.
The Australian pressure immobilization technique: Step 4. This technique has been shown to be helpful in delaying systemic absorption of elapid venoms. A broad pressure bandage is immediately wrapped, beginning distally, around as much of the extremity as possible. No effort should be spent removing clothing prior to bandage application. The bandage is wrapped snugly, as for a severely sprained ligament. A splint (or sling when applied to the upper extremity) is then placed, and the victim is carried from the scene. The victim should expend no effort in getting to definitive care. Pressure immobilization should remain in place until the victim has reached medical care. The doctor will decide when to remove the bandages. If venom has been injected, it will move into the bloodstream quickly once the bandages are removed. The doctor should leave the bandages and splint in position until appropriate antivenom is available whenever possible. Used with permission from Commonwealth Serum Laboratories.
The Australian pressure immobilization technique: Step 5. This technique has been shown to be helpful in delaying systemic absorption of elapid venoms. A broad pressure bandage is immediately wrapped, beginning distally, around as much of the extremity as possible. No effort should be spent removing clothing prior to bandage application. The bandage is wrapped snugly, as for a severely sprained ligament. A splint (or sling when applied to the upper extremity) is then placed, and the victim is carried from the scene. The victim should expend no effort in getting to definitive care. Pressure immobilization should remain in place until the victim has reached medical care. The doctor will decide when to remove the bandages. If venom has been injected, it will move into the bloodstream quickly once the bandages are removed. The doctor should leave the bandages and splint in position until appropriate antivenom is available whenever possible. Used with permission from Commonwealth Serum Laboratories.

of 7

Author

Stephen L Thornton, MD Associate Clinical Professor, Department of Emergency Medicine (Medical Toxicology), University of Kansas Hospital; Medical Director, University of Kansas Hospital Poison Control Center; Staff Medical Toxicologist, Children’s Mercy Hospital

Stephen L Thornton, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

David Eitel, MD, MBA Associate Professor, Department of Emergency Medicine, York Hospital; Physician Advisor for Case Management, Wellspan Health System, York

David Eitel, MD, MBA is a member of the following medical societies: American College of Emergency Physicians, American Society of Pediatric Nephrology, Society for Academic Emergency Medicine, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Chief Editor

Joe Alcock, MD, MS Associate Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center

Joe Alcock, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Robert L Norris, MD Professor Emeritus, Department of Emergency Medicine, Stanford University Medical Center

Robert L Norris, MD is a member of the following medical societies: American College of Emergency Physicians, Wilderness Medical Society

Disclosure: Nothing to disclose.

Edmond A Hooker, II, MD, DrPH, FAAEM Associate Professor, Department of Health Services Administration, Xavier University, Cincinnati, Ohio; Assistant Professor, Department of Emergency Medicine, University of Cincinnati College of Medicine

Edmond A Hooker, II, MD, DrPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Public Health Association, Society for Academic Emergency Medicine, Southern Medical Association

Disclosure: Nothing to disclose.

Coral Snake Envenomation Workup

Other Tests

References

Tables

Contributor Information and Disclosures

What would you like to print?