Bites of Venomous Reptiles

Accuracy of internet recommendations for prehospital care of venomous snake bites

OBJECTIVE

To evaluate the accuracy of Internet information regarding the prehospital care of venomous snake bites.

METHODS

Two major search engines were used to identify 48 Web sites regarding 6 prehospital treatment options for snake bite (removal of constrictive devices, ice, heat, electric shock, incision, and suction). Web sites were evaluated for their quality using the Health on the Net (HON) seal and Journal of the American Medical Association (JAMA) benchmarks.

RESULTS

Of the 48 Web sites reviewed, 26 (54.1%) contained inappropriate recommendations. The remaining 22 Web sites were appropriate regarding all modalities addressed. Among the Web sites reviewed, inappropriate treatment recommendations included: suction (14); ice (6); incision (4); electric shock (1). Five Web sites that met all 4 JAMA benchmarks and the HON seal included 3 inappropriate treatment recommendations. Conversely, the 5 Web sites that met none of the JAMA benchmarks nor included the HON seal included only 2 inappropriate treatment measures.

CONCLUSION

This study highlights the variety of misinformation available on the Internet regarding prehospital care of snake bites, and the unreliability of the HON seal and JAMA benchmarks as markers of accuracy. As the Internet becomes an increasing source of medical information for both the public and clinicians, the importance of accurate Web sites becomes imperative. Clinicians and lay people should be aware of the high variability of Internet information regarding snake bite prehospital care.

Crotalid snake envenomation

Over 5000 Americans suffer from snake bites annually, and of these, nearly one quarter are from poisonous species. Although these cases are undeniably reported, death appears to occur in only a few cases each year, and often reflects delay in obtaining medical care. Two families of venomous snake indigenous to the United States account for most envenomations: Crotalidae (pit vipers or new world vipers) and Elapidae. This article focuses on the snakes of the Crotalidae family.

Emergency Management of Poisonous Snakebites

In brief Though 42 snake species in the United States can inflict a poisonous bite, management is the same for 99% of bites because 99% of bites are inflicted by pit vipers. First aid instructions stressing rapid transit to a hospital apply to all bites. Surgical intervention has no place in acute snakebite treatment. Antivenin therapy is appropriate except in cases of mild pit viper envenomation. Pit viper antivenin is the right choice for any pit viper envenomation, and the patient history will guide the choice of coral snake antivenin. For any antivenin administration, care must be taken to prevent allergic reactions. Basic supportive care involves pain control, correcting metabolic and hematologic complications, keeping the patient comfortable, and preventing serum sickness.