NationMaster - Encyclopedia: Snakebite (bite)

A snakebite, or snake bite, is a bite inflicted by a snake. This article will discuss the etiology of a snakebite, along with prevention tips and, in the unfortunate event that the victim has been bitten by a venomous snake, recommended pre-hospital treatment. A bite is a wound received from the mouth (and in particular, the teeth) of an animal. ... Superfamilies and Families Henophidia Aniliidae Anomochilidae Boidae Bolyeriidae Cylindrophiidae Loxocemidae Pythonidae Tropidophiidae Uropeltidae Xenopeltidae Typhlopoidea Anomalepididae Leptotyphlopidae Typhlopidae Xenophidia Acrochordidae Atractaspididae Colubridae Elapidae Hydrophiidae Viperidae Snakes (from Old English snaca, and ultimately from PIE base *snag- or *sneg-, to crawl), also known as ophidians, are cold blooded legless reptiles closely... Etiology (alternately aetiology, aitiology) is the study of causation. ... This article needs cleanup. ...

1 Frequency and statistics
2 Prevention
3 Symptoms
4 Treatment
5 See also
6 References
7 Further reading

Frequency and statistics

Map showing global distribution of snakebite morbidity.

Since reporting is not mandatory, many snakebites go unreported. Consequently, no accurate study has ever been conducted to determine the frequency of snakebites on the international level. However, some estimates put the number at 2.5 million bites, resulting in perhaps 125,000 deaths. [1] Worldwide, snakebites occur most frequently in the summer season, especially during the months of April and September, when snakes are active and humans are outdoors (Wingert & Chan 1988). Agricultural and tropical regions report more snakebites than anywhere else. [2] Victims are typically male and between 17 and 27 years of age (Wingert & Chan 1988). Image File history File links Download high resolution version (1357x628, 70 KB) Summary Map showing global distribution of snakebite morbidity. ... Image File history File links Download high resolution version (1357x628, 70 KB) Summary Map showing global distribution of snakebite morbidity. ... The tropics are the geographic region of the Earth centered on the equator and limited in latitude by the two tropics: the Tropic of Cancer in the north and the Tropic of Capricorn in the southern hemisphere. ...

A late 1950s study estimated that 45,000 snakebites occur each year in the United States (Parrish 1966). Despite this large number, only 7,000-8,000 of those snakebites are actually caused by venomous snakes, resulting in an average of 10 deaths. [3] [4] This puts the chance of survival at roughly 499 out of 500. The majority of bites in the United States occur in the southwestern part of the country, in part because rattlesnake populations in the eastern states are much lower (Russell 1983). Species 27 species; see list of rattlesnake species and subspecies. ...

Most snakebite related deaths are attributed to eastern and western diamondback rattlesnake bites. Children and the elderly are most likely to die (Gold & Wingert 1994). The state of North Carolina has the highest frequency of reported snakebites, averaging approximately 19 bites per 100,000 persons. The national average is roughly 4 bites per 100,000 persons (Russell 1980). Official language(s) English Capital Raleigh Largest city Charlotte Area - Total - Width - Length - % water - Latitude - Longitude Ranked 28th 139,509 kmÂ² 805 km 240 km 9. ...

Most snakebite’s are caused by non-venomous snakes. Of the roughly 3,000 known species of snake found worldwide, only 15% are considered dangerous to humans (Russell 1990). Snakes are found on every continent except Antarctica. The most diverse and widely distributed snake family, the Colubrids, has only a few members which are harmful to humans. Of the 120 known indigenous snake species in North America, only 20 are venomous to human beings, all belonging to the families Viperidae and Elapidae. [5] However, every state except Maine, Alaska and Hawaii is home to at least one of 20 venomous snake species. [6] Subfamilies Boodontinae Calamariinae Colubrinae Dipsadinae Homalopsinae Natricinae Pareatinae Psammophiinae Pseudoxenodontinae Pseudoxyrhophiinae Xenodermatinae Xenodontinae See text for genera. ... Subfamilies Crotalinae (Pit Vipers) Viperinae (Vipers) The Viperidae family is made up of two subfamilies: Crotalinae (Pit Vipers) Viperinae (Vipers) Categories: Stub | Snakes ... Genera Acanthophis - death adder Aspidelaps - shieldnose cobra Aspidomorphus - collared adder Austrelaps Boulengerina - water cobra Bungarus - Indian krait Cacophis - dwarf crowned snake Calliophis - Oriental coral snake Demansia - venomous whip snake Dendroaspis - mamba Denisonia - ornamental snake Drysdalia - Australian crown snake Echiopsis - bardick snake Elapognathus - little brown snake Elapsoidea - venomous garter snake Furina... Official language(s) None Capital Augusta Largest city Portland Area - Total - Width - Length - % water - Latitude - Longitude Ranked 39th 86,542 kmÂ² 305 km 515 km 13. ... Official language(s) English Capital Juneau Largest city Anchorage Area - Total - Width - Length - % water - Latitude - Longitude Ranked 1st 1,717,854 kmÂ² 1,300 km 2,380 km 13. ... Official language(s) Hawaiian and English Capital Honolulu Largest city Honolulu Area - Total - Width - Length - % water - Latitude - Longitude Ranked 43rd 28,337 kmÂ² n/a km 2,450 km 41. ...

Since the act of delivering venom is completely voluntary. all venomous snakes are capable of biting without injecting venom into their victim. Such snakes will often deliver such a “dry bite” (about 50% of the time [7]) rather than waste their venom on a creature too large for them to eat. Some dry bites may also be the result of imprecise timing on the snake’s part, as venom may be prematurely released before the fangs have penetrated the victim’s flesh.

Prevention

Snakes are most likely to bite when they feel threatened, are startled, provoked, and/or have no means of escape when cornered. If you or your party encounters a snake you should always assume it is dangerous and leave the vicinity. Unless you are an expert, there is no practical way to safely identify any snake species as appearances vary dramatically.

Snakes are likely to approach residential areas when attracted by prey, such as rodents. If it is a feasible option, practice pest control and snakes should not be an issue. If you live in an area with many snakes you may want to educate yourself on the species in your area. Likewise, if you plan to spend extended periods of time in areas of the world such as Africa, Australia, India, and southern Asia, it may be wise to research some of the more dangerous snakes inhabiting the region. If anything, you may at least be more wary of their presence and, as a result, less likely to be bitten. Families Many, see text The order Rodentia is the most numerous of all the branches on the mammal family tree. ... Pest control refers to the regulation or management of another species defined as a pest, usually because it is detrimental to a persons health, the ecology or the economy. ... A satellite composite image of Africa Africa isnt very cool, it smellscontinent, after Asia. ... This is a region of the continent of Asia that can have the following interpretations: The Indian Subcontinent and nearby islands in the Indian Ocean; see South Asia India, Pakistan, Nepal, Bhutan, Bangladesh, Maldives, Sri Lanka All of Asia that is considered to be Southwest, South and Southeast Asia. ...

Sturdy over-the-ankle boots, loose clothing and responsible behavior offer excellent protection from snakebites when in the wilderness. Give snakes plenty of warning that you are approaching by putting slight emphasis on your footsteps. The rationale behind this is that the snake will feel the vibrations and flee from the area. However, this generally only applies to North America as some larger and more aggressive snakes in other parts of the world, such as king cobras and black mambas, will actually protect their territory. In this case, if you run into a snake, stop moving and wait for several minutes. If the snake has not yet fled, slowly back away from the area. A pair of classic black leather Dr. Martens. ... Bob Marshall Wilderness, Montana, United States Wilderness is land that has not been significantly modified by direct or indirect human activity. ... World map showing North America A satellite composite image of North America. ... Binomial name Ophiophagus hannah (Cantor, 1836) The king cobra (Ophiophagus hannah) is the longest of the venomous land snakes, growing up to 18. ... The term Black Mamba can mean: The type of Mamba snake The Deadly Viper Assassination Squad codename of The Bride in the Quentin Tarantino film Kill Bill This is a disambiguation page — a navigational aid which lists other pages that might otherwise share the same title. ...

If you are camping and decide to gather firewood at night, use a flashlight and, for your sake, do not go outside barefoot. Approximately 85% of the natural snakebites occur below the victims' knees. [8] Snakes may be unusually active during especially warm nights with ambient temperatures exceeding 70˚F., and a person not wearing footwear will have no protection from a potential bite. Green flashlight Flashlight is the NATO designation for the Yakovlev Yak-25 Soviet military jet. ... This article is in need of attention from an expert on the subject. ...

It is advisable not to reach blindly into hollow logs, flip over large rocks, and enter old cabins or other potential snake hiding-places. If you are a rockclimber, do not grab ledges or crevices without first looking (this does not mean poking your finger or a stick in the crevice) as snakes are coldblooded creatures and oftentimes sunbathe atop rock ledges. Details of cabin corner joint with squared off logs A log cabin is a small house built from logs. ... Sport climbing is a style of rock climbing that relies on permanent anchors fixed to the rock, especially bolts, for protection. ... Cold-blooded organisms, more technically known as poikilothermic, are animals that have no internal metabolic mechanism for regulating their body temperatures. ...

If you own a pet snake that you know is capable of causing injury, or handle snakes as a hobby, always act with caution - approximately 65% of snakebites occur to the victims’ hands or fingers. Use your common sense and do not drink alcohol, or you may start acting foolishly once you are intoxicated. In fact, in the United States more than 40% of snakebite victims intentionally put themselves in harms way by attempting to capture wild snakes or by carelessly handling their dangerous pets. Further yet, 40% of that number had a blood alcohol level of 0.1 percent or more (Kurecki, et al 1987). Bottles of cachaÃ§a, a Brazilian alcoholic beverage. ... Blood Alcohol Content (or Blood Alcohol Concentration), often abbreviated BAC, is the concentration of alcohol in blood, measured, by volume, as a percentage. ...

Avoid snakes that appear to be dead, as some species will actually rollover on their backs and stick out their tongue to fool potential threats. Even if a snake's head is detached from its body you should not attempt to pick it up as the reflex action of a snake's jaw muscles may cause it to "bite" you. This may be just as dangerous as a bite from a live snake (Gold & Barish 1992). The mechanism of the reflex arc A reflex action is a stereotyped (involuntary) motor response elicited by a defined stimulus. ...

Symptoms

The most common symptoms of all snakebites are panic, fear and emotional instability, which may cause symptoms such as nausea and vomiting, diarrhea, vertigo, fainting, tachycardia, and cold, clammy skin (Kitchens & Mierop 1987). Television, literature and folklore are in part responsible for the hype surrounding snakebites, and a victim may have unwarranted thoughts of imminent death. Panic is a sudden fear which dominates thinking and often affects groups of people or animals. ... Fear is an unpleasant feeling of perceived risk or danger, whether it be real or imagined. ... For other uses, see Nausea (disambiguation). ... Vomiting (or emesis) is the forceful expulsion of the contents of ones stomach through the mouth. ... Diarrhea (American English) or diarrhoea (Commonwealth English) is a condition in which the sufferer has frequent and watery, chunky, or loose bowel movements (from the ancient Greek word Î´Î¹Î±ÏÏÎ¿Î® = leakage; lit. ... Vertigo, sometimes called a headrush, is the sensation of spinning while the body is stationary. ... Fainting or syncope is a sudden (and generally momentary) loss of consciousness due to a lack of sufficient blood and oxygen reaching the brain. ... Tachycardia is an abnormally rapid beating of the heart, defined as a resting heart rate of over 100 beats per minute. ... Literature is literally acquaintance with letters as in the first sense given in the Oxford English Dictionary (from the Latin littera meaning an individual written character (letter)). The term has generally come to identify a collection of texts, which in Western culture are mainly prose, both fiction and non-fiction... Folklore is the body of verbal expressive culture, including tales, legends, oral history, proverbs, jokes, popular beliefs current among a particular population, comprising the oral tradition of that culture, subculture, or group. ...

Dry snakebites, and those inflicted by a non-venomous species, are still able to cause severe injury to the victim. There are several reasons for this; a snakebite which is not treated properly may become infected (as is often reported by the victims of cobra bites whose fangs are capable of inflicting deep puncture wounds), the bite may cause anaphylaxis in certain people, and the saliva and fangs of the snake may harbor many dangerous microbial contaminants, including Clostridium tetani. An infection which is neglected may spread, and, in the worst cases, even kill the victim. An infection is the detrimental colonization of a host organism by a foreign species. ... Anaphylaxis is a severe and rapid systemic allergic reaction to a trigger substance, called an allergen. ... Saliva, often informally known as spit, is the moist, clear, and usually somewhat frothy substance produced in the mouths of some animals, including humans. ... Binomial name Clostridium tetani FlÃ¼gge, 1886 Clostridium tetani is a bacterium of the genus Clostridium. ...

Most snakebite’s, whether by a venomous snake or not, will have some type of local effect. Usually there is minor pain and redness, but this varies depending on the site. Bites by vipers and some cobras may be extremely painful, with the local tissue sometimes becoming very tender and severely swollen within 5 minutes. This area may also bleed and blister. Erythema is an abnormal redness of the skin caused by capillary congestion. ... Genera Adenorhinos Atheris Azemiops Bitis Cerastes Daboia Echis Eristicophis Macrovipera Montatheris Proatheris Pseudocerastes Vipera This page is about Viper snakes. ... Edema (BE: oedema, formerly known as dropsy) is swelling of any organ or tissue due to accumulation of excess fluid. ... A blister caused by 2nd degree burns A blister or bulla is a defense mechanism of the human body. ...

Interestingly, bites caused by the Mojave rattlesnake and the speckled rattlesnake reportedly cause little or no pain despite being serious injuries. Victims may also describe a “rubbery,” “minty,” or “metallic” taste if bitten by certain species of rattlesnake. Spitting cobras and ringhals can spit venom in their victims’ eyes. This results in immediate pain, vision problems, and sometimes blindness. The Mojave Rattlesnake (Crotalus scutulatus) is found in the desert Southwest of the United States and Central Mexico. ... For information about rattlesnakes in general, see rattlesnake. ... The term spitting cobra refers to any one of eleven species of cobras that have the ability to spit or eject venom from their mouth when defending themselves against predators. ... Ringhals is a swedish nuclear power plant with 4 reactors. ... Blindness can be defined physiologically as the condition of lacking visual perception. ...

Some Australian elapids and most viper envenomations will cause bleeding, sometimes so severe that a person may bleed spontaneously from the mouth, nose, and even old, seemingly-healed wounds. Internal organs may bleed, including the brain and intestines and will cause ecchymosis (purple discoloration) of the victim's skin. If the bleeding is left unchecked the victim may die of blood loss. This page is a candidate to be moved to Wiktionary. ... A bruise or contusion or ecchymoses is a kind of injury, usually caused by blunt impact, in which the capillaries are damaged, allowing blood to seep into the surrounding tissue. ... In physiology and medicine, hypovolemia is a state of decreased blood volume; more specifically, decrease in volume of blood plasma. ...

Venom emitted from cobras, most sea snakes, mambas, and other elapids contain toxins which attack the nervous system. The victim may present with strange disturbances to their vision, including blurriness. This is commonly due to the venom paralyzing the ciliary muscle, which is responsible for focusing the lens of the eye, but can be the result of eyelid paralysis as well. Victims will also report paresthesia throughout their body, as well as difficulty speaking and breathing. Nervous system problems will cause a huge array of symptoms, and those provided here are not exhaustive. In any case, if the victim is not treated immediately they may die from respiratory failure. Sea snakes of several different species belong to a group related to the cobras but aquatic rather than land dwelling. ... The nervous system of an animal coordinates the activity of the muscles, monitors the organs, constructs and also stops input from the senses, and initiates actions. ... Paralysis is the complete loss of muscle function for one or more muscle groups. ... The ciliary muscle is a muscle that affects zonules in the eye (fibers that suspend the lens in position during accommodation), enabling changes in lens shape for light focusing. ... Light from a single point of a distant object and light from a single point of a near object being brought to a focus by changing the curvature of the lens. ... Paresthesia (paraesthesia in British English) is a sensation of tingling, pricking, or numbness of the skin with no apparent physical cause, more generally known as the feeling of pins and needles. ... Respiratory failure is a medical term for inadequate gas exchange by the respiratory system. ...

Venom emitted from some Australian elapids, the Russell’s viper, and all sea snakes causes necrosis of muscle tissue. Muscle tissue may begin to die throughout the body, a condition known as rhabdomyolysis. Dead muscle cells may even clog the kidney which filters out proteins. This, coupled with hypotension, can lead to kidney failure, and, if left untreated, eventually death. Binomial name Vipera russelli (Shaw, 1797) The Russells Viper is a common and highly venomous terrestrial snake, usually found in open country from India and Sri Lanka to Burma, Taiwan and Java. ... Necrosis (in Greek ÎÎµÎºÏÏŒÏ‚ = Dead) is the name given to unprogrammed death of cells/living tissue (compare with apoptosis - programmed cell death). ... Rhabdomyolysis is the breakdown of skeletal muscle due to injury, either mechanical, physical or chemical. ... Renal failure is when the kidneys fail to function properly. ...

Treatment

It is not an easy task determining whether or not a bite by any species of snake is life-threatening. A bite by a copperhead on the ankle is usually a moderate injury to a healthy adult, but a bite to a child’s abdomen or face by the same snake may well be fatal. The outcome of all snakebites depends on a multitude of factors; the size, physical condition, and temperature of the snake, the age and physical condition of the victim, the area and tissue bitten (e.g., foot, torso, vein or muscle, etc.), the amount of venom injected, and finally the time is takes for the patient to be treated and the quality of treatment. Binomial name Agkistrodon contortrix Linnaeus, 1766 The American copperhead (Agkistrodon contortrix) is a species of venomous viper native to eastern North America. ...

First Aid

Snakebite first aid recommendations vary, in part because different snakes have different types of venom. Some have little local effect, but life-threatening systemic effects, in which case containing the venom in the region of the bite (e.g., by pressure immobilization) is highly desirable. Other venoms instigate localized tissue damage around the bitten area, and immobilization may increase the severity of the damage in this area, but also reduce the total area affected; whether this trade-off is desirable remains a point of controversy. First aid is a series of simple, life-saving medical techniques that a non-doctor or layman can be trained to perform. ...

Because snakes vary from one country to another, first aid methods also vary; treatment methods suited for rattlesnake bite in the United States might well be fatal if applied to a tiger snake bite in Australia. As always, this article is not a legitimate substitute for professional medical advice. Readers are strongly advised to obtain guidelines from a reputable first aid organization in their own region, and to beware of homegrown or anecdotal remedies. Species Notechis scutatus Notechis ater The tiger snakes are two species of highly venomous snake found in Australia. ...

However, most first aid guidelines agree on the following:

Protect the patient (and others, including yourself) from further bites. While identifying the species is desirable, do not risk further bites or delay proper medical treatment by attempting to capture or kill the snake. If the snake has not already fled, carefully remove the patient from the immediate area.
Keep the patient calm and call for help to arrange for transport to the nearest hospital emergency room, where antivenom for snakes common to the area will often be available.
Make sure to keep the bitten limb in a functional position and below the victim's heart level so as to minimize blood returning to the heart and other organs of the body.
Do not give the patient anything to eat or drink. This is especially important with consumable alcohol, a known vasodilator which will speedup the absorption of venom. Do not administer stimulants or pain medications to the victim, unless specifically directed to do so by a physician.
Remove any items or clothing which may constrict the bitten limb if it swells (rings, bracelets, watches, footwear, etc.)
Keep the patient as still as possible.

Many organizations, including the American Medical Association and American Red Cross, recommend washing the bite with soap and water. However, do not attempt to clean the area with any type of alcohol or other chemical. It has been suggested that this article or section be merged with Distress call. ... The emergency room is the American English term for a room, or group of rooms, within a hospital that is designed for the treatment of urgent and medical emergencies. ... Antivenom (or antivenin, or antivenene) is a biological product used in the treatment of venomous bites. ... A vasodilator is a substance that causes blood vessels in the body to become wider by relaxing the smooth muscle in the vessel wall, or vasodilation. ... A stimulant is a drug that increases the activity of the sympathetic nervous system and produces a sense of euphoria or the feeling of being more awake. ... For other uses of painkiller, see painkiller (disambiguation) An analgesic (colloquially known as painkiller) is any member of the diverse group of drugs used to relieve pain. ... Physician examining a child A physician is a person who practices medicine. ...

Pressure immobilization

Pressure immobilization may not be appropriate for all bites. The object of pressure immobilization is to contain venom within a bitten limb by preventing it from moving through the lymphatic system. This is preferably done by use of an elastic bandage. Bandaging begins two to four inches above the bite (i. e. between the bite and the heart), winding around in overlapping turns and moving up towards the heart, then back down over the bite and past it towards the hand or foot. The bandage should be about as tight as when strapping a sprained ankle; it should not cut off blood flow. If possible, the limb should be further immobilized by splinting and the location of the bite should be clearly marked on the bandages. Lymph originates as blood plasma lost from the circulatory system, which leaks out into the surrounding tissues. ...

Once a pressure bandage has been applied, it should not be removed until the patient has reached a medical professional. A pressure bandage can contain venom so effectively that no symptoms are visible for more than twenty-four hours, giving the impression of a dry bite. By the time symptoms become noticeable you will have missed the best time for treatment. To reiterate; removing the bandage releases that venom into the patient's system with possibly fatal consequences.

For more information on this technique visit http://www.snakebite-firstaid.com/. Besides an easy-to-use First Aid, much info on snakes and their venom.

Outmoded treatments

The following treatments have all been recommended at one time or another, but are now considered to be ineffective or outright dangerous, and should not be used under any circumstances. Many cases in which such treatments appear to work are in fact the result of dry bites.

Old style snake bite kit that should not be used.

Application of a tourniquet to the bitten limb.
Cutting open the bitten area.
Application of potassium permanganate.
Use of electroshock therapy. Although still advocated by some, animal testing has shown this treatment to be useless and potentially dangerous (cf Postgrad Med, 1987a, Postgrad Med, 1987b, Ann Emerg Med, 1988, Toxicon, 1987, Ann Emerg Med, 1991).
Suctioning out venom, either by mouth or with a pump. Suctioning by pump removes a clinically insignificant quantity of venom (Annals of Emergency Medicine, February 2004), and the resultant bruising speeds the venom's absorption. Suctioning by mouth presents a risk of further poisoning through the mouth's mucous tissues (Riggs, et al 1987). The well-meaning family member or friend may also release bacteria into the victim’s wound, leading to infection.
Application of ice. The process of chilling the wound area or the affected limb should certainly be avoided. This procedure would have the effect of slowing the blood flow to the area, thus preventing the natural dissipation of the venom and likely increasing its damaging effects.

In extreme cases, where the victims were in remote areas, all of these misguided attempts at treatment have resulted in injuries far worse than an otherwise mild to moderate snakebite. In worst case scenarios, thoroughly constricting tourniquets have been applied to bitten limbs, thus completely shutting off blood flow to the area. By the time the victims finally reached appropriate medical facilities their limbs had to be amputated. Image File history File links Snakebite_kit. ... Image File history File links Snakebite_kit. ... A tourniquet is a tightly tied band applied around a body part (an arm or a leg) in an attempt to stop severe traumatic bleeding. ... Potassium permanganate (KMnO4) is an inorganic chemical compound composed of potassium (K+) and permanganate (MnO4-) ions. ... Electroconvulsive therapy, also known as electroshock or ECT, is a controversial type of psychiatric shock therapy involving the induction of an artificial seizure in a patient by passing electricity through the brain. ... Amputation is the removal of a body extremity by trauma or surgery. ...

References

Gold, Barry S., Willis A. Wingert, et al. "Snake venom poisoning in the United States: A review of therapeutic practice", Southern Medical Journal, June 1994, 87(6):579-89.
Gold, Barry S., Barish RA. “Venomous snakebites: current concepts in diagnosis, treatment, treatment, and management.” Emerg Med, Clin North Am 1992;10:249-67.
Kitchens CS, Van Mierop LHS. “Envenomation by the eastern coral snake (Micrurus fulvius fulvius): a study of 39 victims.” JAMA 1987;258:1615-8.
Kurecki, Brownlee, et al. The Journal of Family Practice, 1987, 25(4):386-392
Palm Beach Herpetological Society "Venomous Snake Bite". Retrieved December 30, 2005.
Parrish HM. “Incidence of treated snakebites in the United States.” Public Health Rep 1966;81:269-76.
cf Postgrad Med, 1987, Oct;82(5):32; Postgrad Med, 1987, Aug;82(2):42; Ann Emerg Med, 1988, Mar;17(3):254-256; Toxicon, 1987;25(12):1347-1349; Ann Emerg Med, 1991, Jun;20(6):659-661.
Riggs et al. Rattlesnake evenomation with massive oropharyngeal edema following incision and suction (Abstract) AACT/AAPCC/ABMT/CAPCC Annual Scientific Meeting, 1987.
Russell, Findlay E. Ann Rev Med, 1980, 31:247-59.
Russell, Findlay E. “Snake venom poisoning.” Great Neck, N.Y.: Scholium, 1983:163.
Russell, Findlay E. “When a snake strikes.” Emerg Med, 1990;22(12):20-5, 33-4, 37-40, 43.
"Suction for Venomous Snakebite: A Study of 'Mock Venom' Extraction in a Human Model", February 2004, Annals of Emergency Medicine, p. 181.
Sullivan JB, Wingert WA, Norris Jr RL. North American Venomous Reptile Bites. Wilderness Medicine: Management of Wilderness and Environmental Emergencies, 1995; 3: 680-709.
U.S. Food and Drug Administration (November 2002) "For Goodness Snakes! Treating and Preventing Venomous Bites". Retrieved December 30, 2005.
Wingert, Willis A., Chan L. “Rattlesnake bites in southern California and rationale for recommended treatment.” West J Med, 1988;148:37-44.
World Health Organization. "Animal sera". Retrieved December 30, 2005.

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