title: Clinically Significant Envenomation From Postmortem Copperhead (Agkistrodon contortrix).
abstract: Over 14,000 copperhead (Agkistrodon contortrix) bites were reported to United States poison centers between 1983 and 2008, and 1809 cases were reported to poison centers in 2014. The copperhead is primarily found in the southeastern United States and belongs to the pit viper subfamily Crotalinae, which also includes the water moccasin (Agkistrodon piscivorus) and rattlesnakes (Crotalus and Sistrurus genera). Postmortem rattlesnakes have been reported to cause clinically significant envenomation; we report a case of a postmortem copperhead causing clinically significant envenomation after inadvertent puncture with the deceased copperhead fang. The copperhead was transected twice, leaving the snake in 3 separate pieces. While handling the snake head, an inadvertent puncture occurred on the right index finger followed by pain and swelling in the affected extremity necessitating antivenom administration. Care should be taken when handling deceased pit vipers due to the continued risk of envenomation.
authors.affiliation: Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, Richmond, VA (Drs Emswiler and Cumpston); Virginia Poison Center, Richmond, VA (Drs Emswiler and Cumpston); Department of Emergency Medicine, VCU Medical Center, Richmond, VA (Drs Emswiler and Cumpston). Electronic address: emswilermp@vcu.edu.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Emswiler
authors.affiliation: Virginia Commonwealth University School of Medicine, Richmond, VA (Dr Griffith).
authors.forename: F Phillip
authors.initials: FP
authors.lastname: Griffith
authors.affiliation: Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, Richmond, VA (Drs Emswiler and Cumpston); Virginia Poison Center, Richmond, VA (Drs Emswiler and Cumpston); Department of Emergency Medicine, VCU Medical Center, Richmond, VA (Drs Emswiler and Cumpston).
authors.forename: Kirk L
authors.initials: KL
authors.lastname: Cumpston
mesh_terms: D017836:Agkistrodon; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use; D006225:Hand / Q000473:pathology; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D008297:Male; D012909:Snake Bites / Q000209:etiology* / Q000628:therapy; D055815:Young Adult
chemical_list: D000997:Antivenins; C431183:Crotalidae Polyvalent immune Fab; D007140:Immunoglobulin Fab Fragments
keywords: Crotalid; antivenom; copperhead; envenomation