Current management of copperhead snakebite

Background: Several thousand snakebites occur annually in the US, but fewer than 10 deaths occur. Most deaths are from envenomations by rattlesnakes (Crotalus species), but deaths from copperhead and water moccasin (Agkistrodon species) are rare. Study Design: All snakebites presented to East Texas Medical Center, Crockett, a level III trauma center, from 1995 to 2010 were reviewed. A total of 142 snakebites were treated. Ninety-four were of the Agkistrodon species-contortrix contortrix (copperhead) or piscivorus leukostoma (water moccasin). Three were rattlesnakes, and 3 were from the Texas coral snake (Micrurus fulvius tener). Forty-two were unidentified pit vipers. The following results are of the 88 copperhead bites. Results: The most common presenting symptoms were pain and swelling. Eighty-five percent were of grade 1 envenomations. Ten patients had laboratory abnormalities secondary to the snakebite. Forty-four were admitted for observation. The average length of stay for patients admitted was 2 days. No patients received antivenom, and no patients required surgical intervention. There were no deaths. One patient had edema and ecchymosis that persisted for more than 1 month. Conclusions: Accurate identification of the pit viper species involved in snakebites is essential. Although envenomation by a rattlesnake (Crotalus species) may require antivenom and uncommonly surgery, a bite by a copperhead (Agkistrodon contortrix) rarely requires any intervention other than observation. The unnecessary use of antivenom should be discouraged.