Transient Hematotoxicity After Emerald Horned Pitviper (Ophryacus smaragdinus) Envenomation: A Case Report.

Background: A minority of snake envenomations in the United States involve non-native snakes. In this report, we describe what we believe is the first documented human envenoming from an emerald horned pitviper, Ophryacus smaragdinus.

Case Report: A previously healthy 36-year-old woman was bitten on her left index finger by a captive emerald horned pitviper she was medicating at work.

Geographic variation in the clinical features of Mohave rattlesnake () envenomations reported to the North American Snakebite Registry.

The geographic variation of Mohave rattlesnake () venom is well established. We reviewed all the Mohave rattlesnake bites reported to the Toxicology Investigators Consortium's North American Snakebite Registry between January 1, 2015 and 12/31/2021. Data reviewed for this study included details regarding the snake encounter, patient demographics, signs and symptoms, treatment, and outcomes.

Captive Black Mamba (Dendroaspis Polylepis) Bite Leading to Respiratory Failure.

Background: Of the 8000-10,000 snake envenomations evaluated in U.S. emergency departments (ED) annually, approximately 1% are due to non-native snakes.

Anticonvulsant fatalities reported to the American Association of Poison Control Centers 2000 - 2019.

Background: Anticonvulsants are frequently prescribed, and exposures are commonly reported to American Association of Poison Control Centers sites. The purpose of this study was to describe the epidemiology of fatalities associated with oral anticonvulsant use, including patient demographics, specific medications, and the circumstances surrounding the deaths.

Methods: This was a retrospective analysis of cases coded with oral anticonvulsants as a single substance and associated with a fatal outcome reported to the AAPCC National Poison Data System from 2000 to 2019.

Clinical Presentations, Treatments, and Outcomes of Non-native Snake Envenomations in the United States Reported in the North American Snakebite Registry.

Background: Non-native snake envenomations in the United States are uncommon with much unknown about a patient's presenting signs and symptoms. Antivenoms for non-native snake envenomations are not typically available in hospital pharmacies which may limit their administration. What are the clinical presentations, treatments, and outcomes of non-native snake envenomation cases reported to the North American Snakebite Registry (NASBR) of the Toxicology Investigators Consortium (ToxIC)?

Methods: This is a descriptive review of all non-native envenomations reported to the NASBR from 2013 to March 2022.

Predictors of severe outcome following opioid intoxication in children.

Introduction: While the opioid crisis has claimed the lives of nearly 500,000 in the U.S. over the past two decades, and pediatric cases of opioid intoxications are increasing, only sparse data exist regarding risk factors for severe outcome in children following an opioid intoxication.

Antivenom Does Not Cause Snakebite Complications, Withholding It Does.

We read with interest the retrospective chart review "Crotalidae Polyvalent Immune Fab and Cost-Effective Management of Hospital Admission for Snakebites" by Bowden, et al. The efficacy of US snake antivenoms has been well established for decades. A randomized double-blind placebo-controlled clinical trial (RCT) has demonstrated Fab antivenom efficacy using patient-centered outcomes such as return of functionality and other patient-reported outcomes.

How Should Native Crotalid Envenomation Be Managed in the Emergency Department?

Background: Pit vipers, also known as crotalids, are a group of snakes including rattlesnakes, copperheads, and cottonmouths (water moccasins). Crotalids have a broad geographic distribution across the United States, and bites from these snakes can carry significant morbidity. Their envenomations are characterized by local tissue effects, hematologic effects, and systemic effects.

Monocled Cobra (Naja kaouthia) Envenomations Requiring Mechanical Ventilation.

Background: Bites from nonnative snakes are uncommon, accounting for 1.1% of envenomations reported to poison centers between 2015 and 2018. Here we discuss two monocled cobra (Naja kaouthia) envenomations resulting in respiratory failure.

Validity and reliability of telephone administration of the patient-specific functional scale for the assessment of recovery from snakebite envenomation.

Objectives: Although more than 1.8 million people survive snakebite envenomation each year, their recovery is understudied. Obtaining long-term follow-up is challenging in both high- and low-resource settings.

Recovery from Copperhead Snake Envenomation: Role of Age, Sex, Bite Location, Severity, and Treatment.

Introduction: Few data exist to understand the recovery phase of pit viper envenomation. A recently published placebo-controlled clinical trial affords this opportunity. The purpose of this study is to examine the time course of recovery from copperhead snake (Agkistrodon contortrix) envenomation patients managed with and without the use of antivenom, stratified by age, sex, anatomic site of envenomation, initial severity of envenomation, and geographic region.

The validity, reliability and minimal clinically important difference of the patient specific functional scale in snake envenomation.

Objective: Valid, reliable, and clinically relevant outcome measures are necessary in clinical studies of snake envenomation. The aim of this study was to evaluate the psychometric (validity and reliability) and clinimetric (minimal clinically important difference [MCID]) properties of the Patient-Specific Functional Scale (PSFS) in snakebite envenomation.

Methods: We performed a secondary analysis of two existing snakebite trials that measured clinical outcomes using the PSFS as well as other quality of life and functional assessments.

Adverse Events in the Efficacy of Crotalidae Polyvalent Immune Fab Antivenom vs Placebo in Recovery from Copperhead Snakebite Trial.

Objective: To compare the incidence of hypersensitivity reactions following copperhead envenomation treated with Fab antivenom (FabAV) or placebo.

Methods: Patients with copperhead snakebites received treatment and follow-up in a prospective, randomized, double-blind, placebo-controlled trial of FabAV or placebo. The treatment allocation ratio was 2:1 (FabAV:placebo).

Early administration of Fab antivenom resulted in faster limb recovery in copperhead snake envenomation patients.

Background: No previous research has studied whether early snake antivenom administration leads to better clinical outcomes than late antivenom administration in North American pit viper envenomation.

Methods: A secondary analysis of data from a clinical trial of Fab antivenom (FabAV) versus placebo for copperhead snake envenomation was conducted. Patients treated before the median time to FabAV administration were classified as receiving early treatment and those treated after the median time were defined as the late treatment group.

Extracorporeal Cardiopulmonary Resuscitation After Diphenhydramine Ingestion.

Introduction: Diphenhydramine is a widely used first-generation histamine (H) antagonist that can be obtained without prescription in many countries. Massive ingestions can result in severe toxicity and even death. We describe a case of diphenhydramine overdose leading to cardiac arrest, cardiopulmonary resuscitation (CPR), and extracorporeal membrane oxygenation (ECMO) cannulation for refractory ventricular fibrillation, a process we refer to as extracorporeal cardiopulmonary resuscitation (ECPR).

Theophylline toxicity: An old poisoning for a new generation of physicians.

A healthy 4-year-old female presented to the emergency department for vomiting and diarrhea. She was diagnosed with a urinary tract infection, treated with antibiotics and anti-emetics and discharged. Within four hours, her symptoms recurred, followed by decreasing responsiveness and seizures.

Puss Caterpillar Envenomation: Erucism Mimicking Appendicitis in a Young Child.

A 4-year-old female presented to the emergency department with 2 days of abdominal pain, nausea, and vomiting. She was tachycardic and had abdominal tenderness. Laboratory studies revealed a leukocytosis, hypokalemia, and metabolic acidosis.