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January 22, 1982

Treatment of Rattlesnake Bites

JAMA. 1982;247(4):461. doi:10.1001/jama.1982.03320290011009

To the Editor.—  From 1954 to 1966, I treated victims of Western diamondback rattlesnake (Crotalus atrox) bites solely with horse serum-derived polyvalent antivenin. Loss of skin and muscle and crippling resulted from moderately severe and severe envenomations, even when ten to 20 vials of antivenin were given intravenously (IV) during the first one to two hours after the bite. In 1966,I began using a method of management of these bites that consisted of large IV doses of hydrocortisone sodium succinate to alleviate or relieve the toxic symptoms and immediate surgical exploration of the bitten area, using local or general anesthesia to determine how deep and into which structures the venom had been injected and to mechanically remove the venom, release tissue pressures, and remove necrotic tissue as soon as possible after the bite.In 1969, I reported the results1 of this method of management in 15 patients in whom a