- Epidemiology: vast majority of snake bites are from nonvenomous snakes, fatalities extremely rare
- Crotalids (vipers) have hemotoxic venom, Elapids (cobras) have neurotoxic venom
- Six venomous species in North Carolina, five are vipers so treated with CroFAB
Field treatment: don’t make things worse, get to the nearest hospital
In the hospital:
1. ABCs
2. Wound assessment and pain control
3. Labs to assess for coagulopathy and rhabdomyolysis
4. Call poison control – should always talk to toxicologist
5. CroFAB vs observation only
- Mild/dry bite: no CroFAB, just observation
- Moderate/severe: one or more doses as needed based on wound progression
CroFAB is only curative treatment currently but VERY expensive; Currently evaluating anti-TNFa agents
TNFa pilot study: active now, enrolling nonpregnant healthy adults