0071643192.pdf

ENVIRONMENTAL EMERGENCIES

Elapidae Family

Envenomation is characterized by minimal local reaction with marked systemic

neurotoxicity.

Coral snakes are primarily found in the southeastern and southwestern

United States.

In the United States, Elapidae are characterized by red/yellow/black bands

with red bands touching yellow bands. This does not hold true for other parts

of the world.

Elapidae family includes:

■ Corals (U.S.)

■ Cobras

■ Kraits

■ Mambas

MECHANISM OFTOXICITY

■ Coral snake venom →irreversibly binds acetylcholine receptors →systemic

toxicity.

SYMPTOMS/EXAM

■ Minimal local reaction

■ Weakness, numbness

■ Fasciculations, tremor

■ Diplopia

■ Bulbar palsies: slurred speech, dysphagia

■ Respiratory paralysis(immediate cause of death)

TREATMENT

■ Prehospital treatment similar to Viperidae envenomation, above

■ Aggressive supportive care, wound care, tetanus prophylaxis

■ Noprophylactic antibiotics

TABLE 13.5. Indications for Antivenom in Snake Envenomations

Severe localized pain or throbbing

Moderate local edema and/or erythema

Progressive spreading of erythema proximally

Any coagulapathy

Any systemic symptoms

Concern for compartment syndrome

All eastern coral snake bites

Viperidae envenomation →

local tissue toxicity >>

systemic effects.

Elapidae envenomation →

marked systemic

neurotoxicity, minimal local

reaction.

Poisonous coral snakes versus

nonpoisonous milk and king

snakes (applies to the United

States only):

“Red on yellow, kill a fellow”

“Red on black, venom lack”

Respiratory-muscle paralysis is

the immediate cause of death

in most coral snake

envenomations.