View source for Elapidae (Coral Snakes)

==Background==
*Coral snakes are the only ''Elapidae'' family members found in the United States
**Internationally, species include sea snakes, cobras, mambas, and kraits
*All coral snakes are brightly colored with black, red, and yellow rings
*Red and yellow rings touch in coral snakes, but are separated in nonpoisonous mimics
**"Red touch yellow, kills a fellow; red touch black, venom lack"
**This tool for identifying coral snakes '''does not apply to Mexican species'''
[[File:Coral 009.jpg|thumb|Coral snake.]]
*Venom: mainly neurotoxic (irreversibly binds to acetylcholine receptors)
**Does ''not'' cause significant local tissue injury unlike [[Crotaline (Pit Vipers)]] venom.

==Clinical Features==
*Local injury is often minimal and easy to miss as venom is delivered via chewing rather than injection
*Venom effects may develop hours after a bite

===Serious complications===
*Systemic signs may be delayed up to 13h after bite<ref>http://www.emdocs.net/management-of-venomous-snake-bites-in-north-america/</ref>
*Neurotoxicities in particular for coral snakes
**Local [[numbness]] rather than pain/swelling
**[[Cranial nerve palsies]]
**[[Altered mental status]]
**[[Weakness]]
**[[Respiratory failure]] due to paralysis
*Hypovolemic [[shock]]
*Venom-induced consumption coagulopathy ([[DIC]]-like syndrome)<ref>Isbister GK. Snakebite does not cause disseminated intravascular coagulation: coagulopathy and thrombotic microangiopathy in snake envenoming. Semin Thromb Hemost. 2010 Jun;36(4):444-51.</ref> (uncommon, but reported<ref>https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/elapidae</ref>)

==Differential Diagnosis==
{{Bites and stings DDX}}

==Evaluation==
*CBC with diff
*[[DIC]] labs: PT/PTT/INR, fibrinogen, fibrin degradation products, [[d-dimer]]
*BMP
*[[LFTs]]
*CK

==Management==
{{Snake bite local treatment}}
*[[Pressure Immobilization Dressing]]<ref>Robert L. Norris, Sean P. Bush, Michael D. Cardwell. Bites by Venomous Reptiles in the United States, Canada, and Mexico. Paul S. Auerbach. In: Auerbach’s Wilderness Medicine. 7th Ed. 2017: 742.</ref>
**Wrap the length of the bitten extremity with an elastic bandage
**Splint the extremity in neutral position to immobilize
**Immobilize victim and transport to medical care
**''If a patient presents with a tourniquet or pressure immobilization dressing, obtain IV access for potential resuscitation before removing.''

===Antivenom===
*Give 3-5 vials of Antivenin (Micrurus fulvius) to ALL patients who have definitely been bitten
**It may not be possible to prevent further effects or reverse effects once they develop
**Additional doses of antivenom are reserved for cases in which symptoms/signs appear
*Prepare for allergic reaction from equine produced Antivenin (may dilute solution, or administer with epinephrine/benadryl)

===Monitor for [[respiratory failure]]===
*Respiratory failure results from neurotoxicity rather than edema as in crotalids
*Frequently reevaluate respiratory function and ability to handle secretions
**Consider bedside spirometry testing
*Aggressive airway management with any sign of respiratory decline including mechanical ventillation as needed

==Disposition==
*Admit all patients (even if initially symptom free)

==See Also==
*[[Snake bites]]

==References==
<references/>
*Medscape. Antivenin, Eastern & Texas Coral Snakes (Rx) - Antivenin (Micrurus fulvius). http://reference.medscape.com/drug/micrurus-fulvius-antivenin-eastern-texas-coral-snakes-343718.
*Juckett G and Hancox JG. Venomous Snakebites in the United States: Management Review and Update. Am Fam Physician. 2002 Apr 1;65(7):1367-1375.

[[Category:Environmental]]
[[Category:Toxicology]]