Snake Envenomations Podcast

This podcast, our first, focuses on the care of patients who have been bitten by snakes, primarily North American Crotalids.  The discussion revolves around a case of envenomation we ran recently during a Grand Rounds simulation.  In the podcast, we focus on clinical assessment of the bites including determining the severity of local and systemic symptoms, the initial care and management of envenomations, and some of the complications associated with administration of antivenin.

Check out after the break for a rundown of the highlights or listen on iTunes by clicking here or by listening below.

Local Symptoms

  • Ecchymoses
  • Severe pain
  • Erythema
  • Edema
  • Lymphadenitis
  • Necrosis
  • Bullae
  • Myonecrosis

Systemic Symptoms

  • Nausea   
  • Vomiting
  • Headache
  • Weakness                                                    
  • Diaphoresis
  • Epistaxis / Gingival Bleeding
  • Coagulopathy
  • Respiratory failure / pulmonary edema
  • Shock
  • Renal failure
  • Liver failure

Grading of Envenomations

  • Minimal = No laboratory abnormalities or systemic symptoms 12 hours after bite
  • Moderate = May have mild systemic symptoms and will likely have moderately severe local symptoms to include edema spreading to the trunk, ecchymoses in the area of edema, and severe pain
  • Severe = May have rapidly progressive local and systemic symptoms and may develop significant coagulopathy, hypotension, tachycardia, and eventually renal and hepatic disturbances

For more information about the clinical pathway we use, check out


  1. Otten, M. (2006) Chapter 59 Venomous Animal Injuries. Rosen’s Emergency Medicine: Concepts and Clinical Practice, 6th edition
  2. Snake Envenomations Guidelines. Accessed 10/31/13.