Pitviper Bites: Rational Management in Locales in Which Copperheads and Cottonmouths Predominate

Wt, Lawrence; Giannopoulos, Aris; Hansen, Alfred R.

doi:10.1097/00000637-199603000-00009

Cited by 24 publications

(22 citation statements)

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“…Most patients are adult males, and the large majority sustained their bite performing an activity in the vicinity of their residence. The majority of patients (87%) developed mild to moderate envenomations consistent with previous reports (4,11). Only nine patients (6%) in our database developed severe envenomation.…”

Section: Discussionsupporting

confidence: 91%

“…Only nine patients (6%) in our database developed severe envenomation. Severe envenomation was also unusual in prior reports, occurring in 4 -11% of cases (4,11). Consequently, mortality due to copperhead is exceedingly rare.…”

Section: Discussionmentioning

confidence: 69%

“…A small number of patients (8%) were treated with equine-derived antivenin. Use of antivenin in previous reports varies greatly from 0 to 32% of cases (6 -8, 11,12). There is insufficient information to comment on antivenin effectiveness in our series.…”

Section: Discussionmentioning

confidence: 99%

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Copperhead Envenomations In The Carolinas

Thorson

Lavonas

Rouse³

et al. 2003

Journal of Toxicology: Clinical Toxicology

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 69%

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Copperhead Envenomations In The Carolinas

Thorson

Lavonas

Rouse³

et al. 2003

Journal of Toxicology: Clinical Toxicology

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“…Suction does remove some venom, but the amount is very small. 134 Suction has no clinical benefit 135 and it may aggravate the injury. 136 -138 Applying a pressure immobilization bandage with a pressure between 40 and 70 mm Hg in the upper extremity and between 55 and 70 mm Hg in the lower extremity around the entire length of the bitten extremity is a reasonable way to slow the dissemination of venom by slowing lymph flow (Class IIa, LOE C 139,140 ).…”

Section: Snakebitesmentioning

confidence: 99%

Part 17: First Aid

Markenson¹,

Ferguson²,

Chameides³

et al. 2010

Circulation

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“…The author concluded that "suction may be conducive to a more rapid invasion of venom." One LOE 4 retrospective case series 247 concluded that there was little support for the application of suction in the management of snake envenomation. One LOE 5 simulated-snakebite study in human volunteers 248 determined that only 0.04% of a venom load was recovered by a suction device.…”

Section: Fa-1002amentioning

confidence: 99%

Part 13: First Aid

Markenson¹,

Ferguson²,

Chameides³

et al. 2010

Circulation

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The International First Aid Science Advisory Board identified 38 questions in first aid practice that had not been subjected to an evidence review process or that needed to be updated since the 2005 process. Two or more members of the International First Aid Science Advisory Board volunteered to independently review the scientific literature and complete an evidence-based review worksheet summarizing the literature (see Part 2 of this supplement for additional information). After the evidence was presented to the full board, a draft consensus summary of the scientific evidence and a draft consensus treatment recommendation were developed and represented at a subsequent meeting. Thus, each question, evidence-based review, draft summary of science, and draft treatment recommendation was presented and discussed on 2 separate occasions, and a Consensus on Science and Treatment Recommendation was reached by the Board. This document is a report of the group's consensus.As in 2005, the worksheets revealed the continuing paucity of scientific evidence to support specific first aid interventions. Very little research is being conducted in first aid, and most of the recommendations are extrapolations from research and experience in other medical venues, animal studies, and case series. It is hoped that this document will be a stimulus to future research in first aid. First Aid for Medical Emergencies SummaryThe medical questions addressed include poisoning, anaphylaxis, oxygen administration, and aspirin administration for a suspected coronary event.No changes were recommended for first aid management of acute poisoning.In reviewing epinephrine administration for anaphylaxis, evidence was found that laypeople and some medical and prehospital professionals are unable to recognize the signs and symptoms of anaphylaxis and therefore cannot, without training, make an independent decision to administer epinephrine with an auto-injector or to administer a second dose if the first is not effective. This issue takes on added importance in view of legislation in some jurisdictions that permits these actions.No evidence was found, except in decompression injuries, to support the routine administration of oxygen by first aid providers.The administration of aspirin to a victim experiencing chest discomfort is problematic. The literature is clear on the benefit of early administration of aspirin in an acute coronary event, except when there is a clear contraindication, such as aspirin allergy or a bleeding disorder. Less clear, however, is whether first aid providers can recognize the signs and symptoms of an acute Consensus on ScienceThere are no human studies on the effect of treating oral caustic exposure with dilution therapy. One in vitro LOE 5 chemistry study 2 demonstrated no benefit from the addition of large volumes of diluent to either a strong base or a strong acid. Five LOE 5 animal studies 3-7 demonstrated histological benefit to the esophagus when a diluent was administered following exposure to an alkali or acid. Treat...

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Pitviper Bites: Rational Management in Locales in Which Copperheads and Cottonmouths Predominate

Cited by 24 publications

References 0 publications

Copperhead Envenomations In The Carolinas

Copperhead Envenomations In The Carolinas

Part 17: First Aid

Part 13: First Aid

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