1. Treatment of snakebites at a regional burn center: report of a case series
Gie N. Yu, M.D., Stephen D. Helmer, Ph.D., Anjay K. Khandelwal, M.D.
Via Christi Regional Burn Center
University of Kansas School of Medicine- Wichita

3. Background
venomous snakebites each year in the United States
5-6 deaths
Although a rare occurrence, they can be life threatening
Crotaline (rattlesnake, cottonmouth, copperhead)

4. Background Envenomation syndromes Local tissue damage
Non-specific systemic effects
Coagulopathy
Rhabdomyolysis
Increased vascular permeability, tachycardia, tachypnea, hypotension
neurotoxicity
Symptoms can be delayed so it is recommended that patients with crotaline snake bites be observed in the ER for at least 8 hours

5. Objective
Review the characteristics, treatment, and outcome of patients with snakebites treated at a regional burn center

6. Methods Retrospective chart review
American Burn Association verified regional burn center
All patients admitted for treatment of a snakebite
January 2000 – May 2009
All snake bit patients are to be admitted to the burn center

7. Results 12 patients 1 patient was excluded
Admitted for wound debridement and skin graft 3 weeks after treatment at another facility

8. Results
10/11 snakebites occurred between April and September

9. Results Male Caucasian Age Rattlesnakes N=10 (90.9%) N= 8 (72.2%)
33.5 years average age
Rattlesnakes
Cause in 7 of 11 envenomations
Type of snake unknown in other three

10. Results Transport by air Received antivenom
One patient’s family refused
One patient had a local reaction to a test dose
No anaphylactoid reactions to the antivenom were recorded

11. Results Surgical intervention Average hospital stay N=3 3.5 days
Fasciotomy for clinically diagnosed compartment syndrome (9.1%)
Debridement and full thickness skin graft
Incision and drainage of abscess
Average hospital stay
3.5 days

12. Results One patient No mortalities All discharged home
Readmitted secondary to upper GI bleed
coagulopathy 11 days after snakebite injury
No mortalities
All discharged home

13. Discussion Characteristics of patients similar to other studies
Majority male patients
Occurred during the warmer months
Majority of patients treated with Antivenom
No mortality

14. Conclusions
Patients who sustain snakebites can be effectively monitored and managed at a burn center
In this case series, no anaphylactic reactions resulted from antivenin use.

15. Thank you

16. References
Parrish HM. Incidence of treated snakebites in the United States. Public Health Rep 1966; 81:269-76
ONeil ME, et al. Snakebite Injuries Treated in United States Emergency Departments, Wilderness and Environmental Medicine. 2007; vol 18,
Langley RL, Morrow WE. Deaths resulting from animal attacks in the United States. Wild Env Med 1997;8:8-16
Gold BS et al. North American snake envenomation: diagnosis, treatment, and management. Emerg Med Clin N Am 2004; 22:
Tokish JT et al. Crotalid envenomation: the southern Arizona experience. J of Orthopaedic Trauma ; vol 15; no 1: 5-9.
Bradley J, Lichtenhan JB. Venomous Snake Bites in Kansas. Kans Med May: 90(5):

17. Snakebite treatments FabAV therapy Give 4-6 grams (vials) initially
Crotalinae bites and moderate to severe toxicity
Confirmed rattlesnake or cottonmouth bites and minimal toxicity
Give 4-6 grams (vials) initially
Repeat if patient has not responded after one hour