Crotalid envenomation in children: selective conservative management

• Published in: Journal of pediatric surgery Vol. 24; no. 1; p. 128
• Main Authors: Wagner, C W, Golladay, E S
• Format: Journal Article
• Language: English
• Published: United States 01-01-1989
• Subjects: Adolescent; Antivenins - adverse effects; Antivenins - therapeutic use; Child; Child, Preschool; Crotalid Venoms - adverse effects; Female; Humans; Infant; Male; Snake Bites - therapy
• ISSN: 0022-3468
• DOI: 10.1016/S0022-3468(89)80317-3

Snake bites in children remain an uncommon injury. In general, there is a wide disagreement by knowledgeable authorities on a uniform approach to therapy. In the last 5 years, 29 children have been treated in our institution for snake bites, all with signs of envenomation. Treatment consisted of diagnostic laboratory studies, intravenous fluids, tetanus prophylaxis, antibiotics, bed rest, elevation, and observation. There were no deaths. A fasciotomy was required in three children. Cryotherapy initiated elsewhere resulted in tissue loss. Seven children received antivenin. All developed signs and symptoms to serum sickness. From this experience, it appears that the majority of snake bites in children, especially copperhead bites, can be treated selectively and conservatively. Care must be exercised in using antivenin as it is associated with a high rate of serum sickness. Cryotherapy adds to the morbidity of the bite and is not to be used.