• Spencer Greene, David Cheng, Gary M Vilke, and Garret Winkler.
• Department of Emergency Medicine, HCA Houston Healthcare-Kingwood, University of Houston College of Medicine, Kingwood, Texas.
• J Emerg Med. 2021 Jul 1; 61 (1): 41-48.

BackgroundPit vipers, also known as crotalids, are a group of snakes including rattlesnakes, copperheads, and cottonmouths (water moccasins). Crotalids have a broad geographic distribution across the United States, and bites from these snakes can carry significant morbidity. Their envenomations are characterized by local tissue effects, hematologic effects, and systemic effects. Envenomations are generally treated with 1 of 2 antivenoms available in the United States.ObjectiveWe developed a series of clinical questions to assist and guide the emergency physician in the acute management of a patient envenomated by a crotalid.MethodsWe conducted a PubMed literature review from January 1970 to May 2020 in English for articles with the keywords "bite" and "crotalidae."ResultsOur literature search resulted in 177 articles. A total of 33 articles met criteria for rigorous review and citation in the development of these consensus guidelines.ConclusionsPatients should be initially evaluated, stabilized, and assessed for local effects, hematologic effects, and systemic toxicity suggestive of envenomation. Antivenom should be given if toxic effects are present. Surgical intervention including debridement and fasciotomy should be avoided. Prophylactic antibiotics are not necessary.Copyright © 2021 Elsevier Inc. All rights reserved.

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