UAB Comprehensive Snakebite Program

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UAB Comprehensive Snakebite Program

In the United States, most snakebites are caused by the Crotalidae family of snakes, also known as pit vipers. Among pit vipers are rattlesnakes, copperheads, and water moccasins. More than half of bites by pit vipers result in envenomation, or poisoning, which happens when snakes emit venom into the bite wound, causing toxins to enter the body. Because it is often difficult to identify snakes to determine if they are non-venomous, all snakebites should be considered venomous and treated as a medical emergency. A delay in getting treatment can result in serious injury or, in rare cases, death.

Snakebite poisoning causes a variety of symptoms:

Severe pain and swelling at the wound site
Nausea and vomiting
Blurred vision
Thirst
Difficulty breathing
Sweating
Muscle cramps and weakness
Dizziness
Numbness in face and limbs
Shock, a condition caused by lack of blood flow, which damages organs by depriving them oxygen and nutrients

Toxins from snakebite poisoning can cause coagulopathy, or thinning of the blood, which decreases the blood’s ability to clot. Coagulopathy may result in uncontrolled internal or external bleeding, causing cause damage to joints, muscles, or internal organs. Long-term effects of snakebites include chronic limb swelling, wounds, and muscle damage.

Venomous snakebites are treated with antivenom, which is a medicine used to stop snake venom from binding to tissues and causing serious blood, tissue, or nervous system conditions. The use of antivenom depends on how much poison was injected and the type and size of the snake. Antivenom is the only specific treatment that can help prevent or reverse most of the effects of snakebite toxins when used early.

In addition to antivenom, additional treatment such as artificial respiration, kidney dialysis, wound care, and comprehensive rehabilitation services are needed to effectively treat snakebite.

UAB Medicine provides highly specialized care for snakebite through the UAB Comprehensive Snakebite Program, which involves many disciplines. The team includes medical toxicologists, poison center specialists, wound care physicians, pharmacists/clinical toxicologists, hospitalists, and physical therapists.

Patients who arrive at UAB Medicine are treated by Emergency Medicine physicians who have special training in snakebite treatment. Early phases of care include standardizing wound measurements, providing pain relief, assessment for systemic symptoms, and advanced testing for blood thinning. Patients are then admitted to highly trained patient care areas to receive serial measurements and overnight monitoring for coagulopathy.

A medical toxicologist trained in snake envenomation works with the patient’s healthcare team to provide a detailed antivenom plan. This stage of treatment focuses on improving mobility, range of motion, early joint usage. Inpatient wound care specialists are also available if needed.

Patients who are not treated at UAB have their care augmented by the Alabama Poison Information Center (APIC) at Children’s of Alabama. Any physician in the state can consult with experts at APIC for recommendations and care input. APIC covers all health care facilities in the state of Alabama and is available 24/7 for patient and/or physician consultation.

Treatment may continue after hospital discharge. Outpatient follow up is available at the UAB Comprehensive Wound Care Clinic, where specialists work closely with the APIC for long-term lab monitoring of potential venom injury while providing strategies for treatment of limb swelling and localized wound care. Physical therapy is available for those patients who require improved limb function recovery.

In addition to providing world-class clinical services, the Comprehensive Snakebite Program is committed to advancing research and care in the field.

Citation: NIH, WHO, CDC

Presented scientific abstracts and journal publications by UAB Snake Envenomation Faculty

Rushton WF, Rivera JV, Brown J, Kurz MC, Arnold J. Utilization of thromboelastograms in management of Crotalus adamanteus envenomation [published online ahead of print, 2020 Jul 4]. Clin Toxicol (Phila). 2020;1-4. doi:10.1080/15563650.2020.1788053
Rushton W; Brown J; Green EV; Rivera JV. Thromboelastogram use in Crotalus adamanteus envenomation. Presented at the European Association of Poisons Centres and Clinical Toxicologists. 2020, Tallinn, Estonia
Rushton W; Arnold J: Rivera J; Implementation of a protocol driven Crotalinae Envenomation Unit. Presented at International Congress of the European Association of Poisons Centres and Clinical Toxicologists. 2019, Naples Italy. CLINICAL TOXICOLOGY 57 (6), 505-505
Rushton, W., et al. “Thromboelastography in suspected Crotalus horridus horridus envenomation.” Presented at International Congress of the European Association of Poisons Centres and Clinical Toxicologists. 2017, Basel, Switzerland
Powell S, Rushton W, Arnold J. Efficacy of Crotalidae polyvalent immune Fab antivenom with delayed administration. Clin Tox 54 (4), 509-510; Presented at International Congress of the European Association of Poisons Centres and Clinical Toxicologists. 2016, Madrid, Spain
Rushton WF, Vakkalanka JP, Moak JH, Charlton NP. Negative predictive value of Excluding an Embedded Snake Foreign Body by Ultrasonography. Wilderness Environ Med. 2015 Jun 30;26(2):227-31.

Personnel:

Dag Shapshak MD, co-director
William Rushton MD, co-director

Clinical/Medical Toxicologist:

Sukhi Atti MD, medical toxicologist
Jessica Rivera Pescatore PharmD, clinical toxicologist
Ann Slattery DrPH, RN, RPh, clinical toxicologist, managing director Alabama Poison Information Center

Wound Experts: