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Agkistrodon contortrix
General Details, Taxonomy and Biology, Venom, Clinical Effects, Treatment, First Aid , Antivenoms
Agkistrodon contortrix  ( Northern Copperhead  ) subsp.  mokasen   [ Original photo copyright © Dr Julian White ]
Family: Viperidae
Subfamily: Crotalinae
Genus: Agkistrodon
Species: contortrix
Subspecies: mokasen
Common Names
( subsp. mokasen ) Northern Copperhead
Region
North America
Countries
United States of America
 
Taxonomy and Biology
Adult Length: 0.85 m
General Shape
Medium in length, moderately stout bodied snake with a moderately short to short, rapidly tapering tail that terminates with a moderately long caudal spine. Can grow to a maximum of about 1.35 metres. Head is broad, flattened, triangular and distinct from neck. Canthus rostralis is prominent. Eyes are medium in size with vertically elliptical pupils. Dorsal scales are keeled. Caudal spine is curved downwards.
Habitat
Timbered foothills with rocky outcrops above waterways, near canyon springs, irrigated crops or near swamps, marshes and periodically flooded coastal plains.
Habits
Mainly a terrestrial snake, but will freely enter the water. Basks during the day in spring and autumn, mainly nocturnal during summer, returning to the den in late autumn. Den sites are often rocky outcrops on hillsides. Prefers cooler or moist retreats in summer such as stone walls, rubbish or sawdust heaps, abandoned farms, rotting logs and smooth rocks near waterways.
Prey
Feeds mainly on lizards, frogs, small rodents, large caterpillars and cicadas. Juveniles twitch their yellowish or greenish tipped tail to lure prey. Juveniles twitch their yellowish or greenish tipped tail to lure prey.
Species Map
Small (Approx 20k) version
 
Venom
Average Venom Qty
57.8 mg ( dry weight of milked venom ), Minton (1953) ( Ref : R000465 ).
General: Venom Neurotoxins
Not present
General: Venom Myotoxins
Present but possibly not clinically significant
General: Venom Procoagulants
Possibly present
General: Venom Anticoagulants
Probably not present
General: Venom Haemorrhagins
Possibly present
General: Venom Nephrotoxins
Probably not present
General: Venom Cardiotoxins
Probably not present
General: Venom Necrotoxins
Probably not present
General: Venom Other
Unknown
 
Clinical Effects
General: Dangerousness
Moderate envenoming possible but unlikely to prove lethal
General: Rate of Envenoming: Unknown but likely to be moderate
General: Untreated Lethality Rate: Unlikely to prove lethal
General: Local Effects
Mild to no pain, mild swelling, no bruising, blistering
General: Local Necrosis
Not likely to occur
General: General Systemic Effects
General systemic symptoms usually absent
General: Neurotoxic Paralysis
Does not occur, based on current clinical evidence
General: Myotoxicity
Does not occur, based on current clinical evidence
General: Coagulopathy & Haemorrhages
May cause mild coagulopathy, but pathologic bleeding not likely
General: Renal Damage
Does not occur, based on current clinical evidence
General: Cardiotoxicity
Does not occur, based on current clinical evidence
General: Other
Insufficient clinical reports to know
 
First Aid
Description: First aid for bites by Viperid snakes likely to cause significant local injury at the bite site (see listing in Comments section).
Details
1. After ensuring the patient and onlookers have moved out of range of further strikes by the snake, the bitten person should be reassured and persuaded to lie down and remain still. Many will be terrified, fearing sudden death and, in this mood, they may behave irrationally or even hysterically. The basis for reassurance is the fact that many venomous bites do not result in envenoming, the relatively slow progression to severe envenoming (hours following elapid bites, days following viper bites) and the effectiveness of modern medical treatment.
2. The bite wound should not be tampered with in any way. Wiping it once with a damp cloth to remove surface venom is unlikely to do much harm (or good) but the wound must not be massaged.
3. All rings or other jewellery on the bitten limb, especially on fingers, should be removed, as they may act as tourniquets if oedema develops.
4. The bitten limb should be immobilised as effectively as possible using an extemporised splint or sling; if available, crepe bandaging of the splinted limb is an effective form of immobilisation.
5. If there is any impairment of vital functions, such as problems with respiration, airway, circulation, heart function, these must be supported as a priority. In particular, for bites causing flaccid paralysis, including respiratory paralysis, both airway and respiration may be impaired, requiring urgent and prolonged treatment, which may include the mouth to mask (mouth to mouth) technique of expired air transfer. Seek urgent medical attention.
6. Do not use Tourniquets, cut, suck or scarify the wound or apply chemicals or electric shock.
7. Avoid peroral intake, absolutely no alcohol. No sedatives outside hospital. If there will be considerable delay before reaching medical aid, measured in several hours to days, then give clear fluids by mouth to prevent dehydration.
8. If the offending snake has been killed it should be brought with the patient for identification (only relevant in areas where there are more than one naturally occurring venomous snake species), but be careful to avoid touching the head, as even a dead snake can envenom. No attempt should be made to pursue the snake into the undergrowth as this will risk further bites.
9. The snakebite victim should be transported as quickly and as passively as possible to the nearest place where they can be seen by a medically-trained person (health station, dispensary, clinic or hospital). The bitten limb must not be exercised as muscular contraction will promote systemic absorption of venom. If no motor vehicle or boat is available, the patient can be carried on a stretcher or hurdle, on the pillion or crossbar of a bicycle or on someone's back.
10. Most traditional, and many of the more recently fashionable, first aid measures are useless and potentially dangerous. These include local cauterization, incision, excision, amputation, suction by mouth, vacuum pump or syringe, combined incision and suction ("venom-ex" apparatus), injection or instillation of compounds such as potassium permanganate, phenol (carbolic soap) and trypsin, application of electric shocks or ice (cryotherapy), use of traditional herbal, folk and other remedies including the ingestion of emetic plant products and parts of the snake, multiple incisions, tattooing and so on.
 
Treatment
Treatment Summary
Bites by Agkistrodon species vary from only minor local effects to moderate, rarely severe local effects, the latter potentially including hypovolaemic shock. Major systemic effects are likely to be confined to coagulopathy, though systemic myolysis is a theoretical risk, but not paralysis. Cases with major local or systemic envenoming should receive antivenom IV.
Key Diagnostic Features
Local pain, swelling, ecchymosis ± coagulopathy & haemorrhage
General Approach to Management
All cases should be treated as urgent & potentially lethal. Rapid assessment & commencement of treatment including appropriate antivenom (if indicated & available) is mandatory. Admit all cases.
Antivenom Therapy
Only antivenoms available are for related species, but should be used for significant envenoming
Antivenoms
1. Antivenom Code: SAmPRO01
Antivenom Name: Polyvalent crotalid antivenom ( CroFab ), Ovine, Fab
Manufacturer: Protherics Inc. (US)
Phone: ++1-615-327-1027
Address: 5214 Maryland Way
Suite 405
Brentwood
Tennessee 37027
USA
Country: U.S.A.
2. Antivenom Code: SAmIBM06
Antivenom Name: Antivipmyn
Manufacturer: Instituto Bioclon
Phone: ++56-65-41-11
Address: Calzada de Tlalpan No. 4687
Toriello Guerra
C.P. 14050
Mexico, D.F.,
Country: Mexico
Agkistrodon contortrix ( Northern Copperhead ) subsp. mokasen [ Original photo copyright © Dr Julian White ]
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Agkistrodon contortrix ( Northern Copperhead ) subsp. mokasen [ Original photo copyright © Dr Jurg Meier ]
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