Correspondence

Envenomations by Rattlesnakes Thought to Be Dead

N Engl J Med 1999; 340:1930June 17, 1999

Article

To the Editor:

Even after suffering potentially fatal injuries, venomous snakes are capable of injuring humans. Klauber performed experiments showing that rattlesnake heads are dangerous for 20 to 60 minutes after decapitation.1 We prospectively collected data on patients admitted to our toxicology referral center for rattlesnake bites. Thirty-four patients were admitted for rattlesnake bites from June 1997 to April 1998; of these, five patients (14.7 percent) — all men between 20 and 48 years old — were bitten by snakes that had been fatally injured and were presumed to be dead.

Patient 1 bludgeoned a rattlesnake on the head with wood, rendering it motionless, and was bitten on the right index finger when he picked up the apparently dead snake. He received 20 vials of polyvalent Crotalidae antivenin (Wyeth Laboratories, Marietta, Pa.) for progressive local tissue reaction. Patient 2 shot a rattlesnake, striking the head several times, and observed no movement for three minutes. When the patient lifted the snake, it envenomated his right index finger. He received 40 vials of antivenin for progressive local tissue reaction and coagulopathy. Patient 3 shot and then decapitated a rattlesnake. His right index finder was envenomated when he picked up the head. He developed a self-limited coagulopathy but ultimately required finger amputation because of local tissue destruction.

Patient 4 was envenomated on his left ring finger and right index finger by a decapitated rattlesnake head that had been motionless for five minutes. He received 30 vials of antivenin for progressive local tissue reaction, coagulopathy, and thrombocytopenia. Patient 5 was envenomated on the left index finger by a rattlesnake he had presumed to be dead from multiple gunshot wounds, including one to the head. He was bitten while attempting to cut off the rattle. He developed thrombocytopenia and coagulopathy, complicated by ethanol withdrawal and by anaphylaxis in response to antivenin (21 vials total).

We found two reports of envenomation by decapitated rattlesnake heads that had been preserved,2,3 but none regarding envenomation by recently killed snakes. Young men — particularly while intoxicated — suffer a disproportionate number of “illegitimate” rattlesnake envenomations (that is, those that occur when a person voluntarily approaches the snake), often to the upper extremities.4,5 We found that a sizable proportion of patients admitted for snakebites were injured when handling snakes they presumed to be dead. Imminently fatal injuries do not prevent rattlesnakes from producing serious or even multiple envenomations. Education to prevent snakebites should include warnings against handling recently killed snakes.

Jeffrey R. Suchard, M.D.
Frank LoVecchio, D.O.
Good Samaritan Regional Medical Center, Phoenix, AZ 85006

5 References

1. 1

   Klauber LM. Rattlesnakes: their habits, life histories, and influence on mankind. 2nd ed. Berkeley: University of California Press, 1972:341-9.
   

2. 2

   Griffen D, Donovan JW. Significant envenomation from a preserved rattlesnake head (in a patient with a history of immediate hypersensitivity to antivenin). Ann Emerg Med 1986;15:955-958
   CrossRef | Web of Science | Medline

3. 3

   Keyler DE, Schwitzer K. Envenomation from the fang of a freeze-dried prairie rattlesnake head. Vet Hum Toxicol 1987;29:440-441
   Medline

4. 4

   Curry SC, Horning D, Brady P, Requa R, Kunkel DB, Vance MV. The legitimacy of rattlesnake bites in central Arizona. Ann Emerg Med 1989;18:658-663
   CrossRef | Web of Science | Medline

5. 5

   Morandi N, Williams J. Snakebite injuries: contributing factors and intentionality of exposure. Wilderness Environ Med 1997;8:152-155
   CrossRef | Web of Science | Medline

Citing Articles (2)

Citing Articles

1. 1

   Danielle Bury, Neil Langlois, Roger W. Byard. (2011) Animal-Related Fatalities-Part II: Characteristic Autopsy Findings and Variable Causes of Death Associated with Envenomation, Poisoning, Anaphylaxis, Asphyxiation, and Sepsis. Journal of Forensic Sciencesno-no
   CrossRef

2. 2

   Rais Vohra, Saralyn Williams, Lee Cantrell. (2006) Nonbite Exposures to Rattlesnakes: A Retrospective Review From a Statewide Poison Control System. Wilderness and Environmental Medicine 17:3, 206
   CrossRef