Elapidae (Coral Snakes)

Background

• All coral snakes are brightly colored with black, red, and yellow rings
  • Red and yellow rings touch in coral snakes, but are separated in nonpoisonous mimics
    • "Red touch yellow, kills a fellow; red touch black, venom lack"

Coral snake.

Clinical Features

• Local injury is often minimal and easy to miss as venom is delivered via chewing rather than injection
• Venom effects may develop hours after a bite

Differential Diagnosis

Envenomations, bites and stings

• Hymenoptera stings (bees, wasps, ants)
• Mammalian bites
  • Closed fist infection (Fight bite)
  • Dog bite
• Marine toxins and envenomations
  • Toxins (ciguatera, neurotoxic shellfish poisoning, paralytic shellfish poisoning, scombroid, tetrodotoxin
  • Stingers (stingray injury)
  • Venomous fish (catfish, zebrafish, scorpion fish, stonefish, cone shells, lionfish, sea urchins)
  • Nematocysts (coral reef, fire coral, box jellyfish, sea wasp, portuguese man-of-war, sea anemones)
  • Phylum porifera (sponges)
  • Bites (alligator/crocodile, octopus, shark)
• Scorpion envenomation
• Reptile envenomation
  • Snake bites
    • Crotaline (Pit Vipers)
    • Elapidae (Coral Snakes)
  • Lizard bites
• Spider bites
  • Black widow
  • Brown recluse
  • Tarantula
  • Funnel-web spider bite
  • Armed spider bite

Treatment

Local Care

• Do:
  • Remove all jewelry
  • Mark the leading edge of erythema/edema
• Do not:
  • Attempt to suck out the venom
  • Place the affected part in cold water
  • Use a tourniquet or wrap
  • Antivenom is first line treatment for compartment syndrome; fasciotomy is last resort if elevated pressures persist.

Antivenom

• Give 3-5 vials of Antivenin (Micrurus fulvius) to ALL pts who have definitely been bitten
  • It may not be possible to prevent further effects or reverse effects once they develop
  • Additional doses of antivenom are reserved for cases in which symptoms/signs appear
• Prepare for allergic reaction from equine produced Antivenin (may dilute solution, or administer with epinephrine/benadryl)

Disposition

• Admit all pts (even if initially symptom free)

Source

Tintinalli

See Also

• Snake bites

References

• Medscape. Antivenin, Eastern & Texas Coral Snakes (Rx) - Antivenin (Micrurus fulvius). http://reference.medscape.com/drug/micrurus-fulvius-antivenin-eastern-texas-coral-snakes-343718.
• Juckett G and Hancox JG. Venomous Snakebites in the United States: Management Review and Update. Am Fam Physician. 2002 Apr 1;65(7):1367-1375.