Exotic Snake Envenomations Quiz

Viperidae account for 43% of all non-native snake envenomations within the united states. Elapids account for 39% of envenomations. Snakes in the elapid family include coral snakes, kraits, sea snakes, cobras, Australian brown snakes, tiger snakes, taipans, and the infamous black mamba.  The family of colubridae consists of mostly non-venemous snakes such as kingsnakes.  However, colubridae does have two highly venomous snakes:  the African boomslang (Dispholidus typus) and the Twig snake (Thelotornis spp). These snakes account for only a small amount of exotic envenomations in the United States. Bothrops is a genus, not a family, and contains South American pit vipers, such as the lancehead.

The correct answer is the antivenom index. This can be accessed by contacting any poison center or the American Zoo Associatin (AZA). It contains a list of all the available antivenoms for exotic snakes and their location.  Although herpetologist are specialist in knowledge regarding reptiles, this answer choice is incorrect because they do not usually have access to antivenoms. UpToDate® may be able to reference the correct antivenom but certainly will not aid in procurement of the antivenom. A hospital phramacy in the United States will not have antivenom for a black mamba.

Elapidae which include a larger variety of snakes including: Kraits, Cobras, Coral snakes, Sea snakes, Taipans, and the majority of venomous Australian snakes predominantly have neurotoxin. Some varieties have phospholipase, but this is not universal. Myotoxins, neurotoxins, and Hemotoxins can be seen in the viperidae family. Hepatotoxins are not typically associated with envenomations.

In this case, the patient is obviously neurotoxic and on the point of respiratory failure. Regardless of the species of the culprit snake, the patient should be intubated for airway support. This will at least temporize respiratory depression as a result of neurotoxicity. Less aggressive supportive care with oxygenation will not crystalloid would be inappropriate. CroFrab may help, but given the possibility of an Elapid envenomation, is not the best answer.