Crotalid envenomation: The Southern Arizona experience

Objective: To review a regional experience with the treatment of snakebites. Setting: Five major southern Arizona hospitals, including two Level I trauma centers. Design: A review of all snakebite admissions over a five-year period was performed. Results: During the period reviewed, 164 patients were admitted for snakebites. Rattlesnakes were responsible for 98 percent of identified envenomations. Thirty-six percent of the patients were transported by air to the admitting facility. Eighty percent of patients were admitted to the intensive care unit for an average of 1.6 days. Total hospital stays averaged 2.8 days. Ninety percent of patients received antivenin, usually only on the day of admission. Of those receiving antivenin, 20 percent had an anaphylactoid reaction, and 1 percent required readmission for serum sickness. Laboratory evaluation indicated abnormalities in platelet count, coagulation parameters, and fibrinogen levels, but these rarely required treatment. Thirteen percent of patients underwent surgical intervention, including a 4 percent fasciotomy rate, and a single amputation. Conclusion: The use of field treatment, including "cut and suck," tourniquets, and cryotherapy, increased the likelihood of surgery. The authors concluded that the intensive care unit and helicopter transport system were overused. They recommend that established objective envenomation severity scores be used to dictate patient treatment, specifically the use of antivenin.