ABSTRACT
Reptile envenomations in the United States historically occurred under natural circumstances, involving native venomous species, and first aid and treatment of victims during these times were crude at best. Envenomations still occur across the country, but a large proportion result from unnatural circumstances and involve both native and non-native species. Medical treatment of victims has significantly improved as a result of advancements in both supportive care and immunotherapeutics, primarily antivenoms. Although venomous snakes cause the great majority of envenomations, Gila Monster bites are occasionally documented. The venomous snakes responsible for most envenomations in the United States are pitvipers, usually rattlesnake species and copperheads, less frequently cottonmouths, and much less frequently coral snakes. However, with the influx of exotic venomous snake species imported into the country and captive bred by amateur collectors, envenomations occur involving a variety of foreign exotic, non-native species. Timely transport to a medical facility remains the most beneficial “first aid”. Medical management, in addition to supportive care, frequently involves the use of antivenom. There are two Food and Drug Administration–approved antivenoms in the United States for treating native pitviper envenomations, or rattlesnake envenomations alone, and a single coral snake antivenom. The development of the Online Antivenom Index by the Association of Zoos 512and Aquariums (AZA) and the American Association of Poison Control Centers (AAPCC) in recent years has been a significant resource for antivenoms required in the treatment of envenomation by non-native venomous species. The availability of good medical care and efficacious antivenom therapies in the United States provides for favorable outcomes in the majority of cases.
