Prognosis
Snakebite without envenomation
Patients generally do well following snakebite. Wound infections are rare but may occur.
Domestic Crotalinae envenomation
Mortality following Crotalinae envenomation is rare. From 1991 to 2001, there were on average 5 deaths a year in the US from Crotalinae envenomation.[57]
Crotalinae envenomation may cause significant morbidity. In one prospective study that followed 81 patients for the duration of their symptoms, 51 (63%) were admitted to the hospital, 9 (11%) received antivenom, and 11 (14%) required crutches for ambulation.[44] On average, each patient lost 14 days of work. Edema persisted for a mean 11 days, and pain (at an average score of 5 out of 10) for 8 days. Patients bitten on the hand had reduced function for 14 days, and reduced strength for 22 days. Five patients (6%) had a prolonged wound healing course of 14 to 77 days (mean 45 days).[44]
Domestic Elapidae envenomation
Death following a coral snake bite in the US is exceptionally rare. The first documented death in many years was reported in 2009.[58]
Protracted morbidity is rare if antivenom is administered in a timely fashion. In patients not treated with antivenom, paralysis of the muscles of respiration may require weeks of mechanical ventilation, with the corresponding risks of prolonged intubation and ventilator support. The Texas coral snake may produce more local effects than the Eastern coral snake, requiring outpatient pain medications.
Exotic snake envenomation
The morbidity and mortality is not well described. The variability in snake venoms and availability of antivenom make it difficult to predict morbidity and mortality in this patient population.
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