Foreword

Years ago, as we struggled to decide how to treat a severe rattlesnake envenomation, our young, bright emergency physician pulled several of us into the medicine room and said, “Let’s pretend for a moment that this guy dies. What are people going to look at… where did we get our information?” He then pulled out the drug insert for the antivenom, saying that was what we were going to follow. Well, as it turned out the patient did fine, but we were much more aggressive than we might have been had we been experienced in the treatment of envenomation. As a result of that case, I determined that we had to do better, and I knew that we would need to lean on the people who know the most about this unusual subject.

Information that is depended upon to support life has to be the most informed, with absolutely no compromise. It has to have “passed muster”. To assure complete accuracy, the text was most graciously reviewed and edited by Rick Dart, M.D., immediate Past-President of the American Association of Poison Control Centers, the Director of the Rocky Mountain Poison and Drug Center since 1992, and a Deputy Editor of Annals of Emergency Medicine. Dr. Dart is trained as a medical doctor specializing in emergency medicine and toxicology, and is certified by the American Board of Emergency Medicine and the American Board of Medical Toxicology.

As the author, I am completely comfortable (a very hard task to achieve) with medical staff depending upon the information and instruments in this work. Variations on themes regarding snakebite treatment have abounded over the years, but at the age of sixty-two and without humility, after further editing to include the findings of an evidence-informed consensus workshop published in February, 2011, (attended by toxicologists from across the United States, including Dr. Dart), I can honestly say that this text pulls everything together in a fully accurate and very useful text that will serve everyone admirably both at the bedside and in the classroom.

The Book
“The ability of the venom to attack the blood coagulation cascade, coupled with the possibility of hypovolemic shock resulting from a shift of intravascular fluid into the tissues, constitutes the threat to the victim, but the attack on the blood coagulation cascade is the stealth bomber because coagulopathy cannot be felt.”