TL;DR: Using a modified Delphi method, an evidence-informed treatment algorithm is provided in an attempt to reduce variation in care and possibly improve clinical outcomes of crotaline envenomation.
Abstract: Envenomation by crotaline snakes (rattlesnake, cottonmouth, copperhead) is a complex, potentially lethal condition affecting thousands of people in the United States each year. Treatment of crotaline envenomation is not standardized, and significant variation in practice exists. A geographically diverse panel of experts was convened for the purpose of deriving an evidence-informed unified treatment algorithm. Research staff analyzed the extant medical literature and performed targeted analyses of existing databases to inform specific clinical decisions. A trained external facilitator used modified Delphi and structured consensus methodology to achieve consensus on the final treatment algorithm. A unified treatment algorithm was produced and endorsed by all nine expert panel members. This algorithm provides guidance about clinical and laboratory observations, indications for and dosing of antivenom, adjunctive therapies, post-stabilization care, and management of complications from envenomation and therapy. Clinical manifestations and ideal treatment of crotaline snakebite differ greatly, and can result in severe complications. Using a modified Delphi method, we provide evidence-informed treatment guidelines in an attempt to reduce variation in care and possibly improve clinical outcomes.
TL;DR: Rattlesnake and copperhead envenomations, and those in children <6 years of age, produce the most severe outcomes, but coral snakebites result in similar hospital admission rates.
Abstract: Background. Differences in victim demographics, clinical effects, managements, and outcomes among native viperid (rattlesnake, copperhead, and cottonmouth) and elapid (coral snake) species have not been systematically characterized. Methods. The database of the American Association of Poison Control Centers from 2001 through 2005 was analyzed. Results. Between 2001 and 2005, there were 23,676 human exposures (average = 4,735/year) to native venomous snakes in the United States reported to U.S. poison centers in all states except Hawaii: 98% were to viperid snakes and 2% to elapids. Overall, 77% of victims were male, 70% were adults >20 years, and 12% were aged less than 10 years. Sixty-five cases involved pregnant women, with rattlesnake bites resulting in moderate or greater effects in over 70%. The overall hospital admission rate was 53%. Outcomes were generally more severe with rattlesnake and copperhead envenomations and in children <6 years of age. The fatality rate of reported cases was 0.06%. Concl...
TL;DR: This study compares phylogeographic structure, historical demography, and approximate lineage age in two closely related and broadly co-occurring venomous snakes in eastern North America, the cottonmouth and copperhead, and suggests that unique habitat preferences may have shaped both the phyloGeographic and demographic histories of each species.
TL;DR: In this article, Weber reveals how the Copperheads came perilously close to defeating Lincoln and ending the war in the South's favor, and how the battle over these issues grew so heated, particularly in the Midwest, that Northerners feared their neighbors would destroy their livestock, burn their homes, even kill them.
Abstract: If Civil War battlefields saw vast carnage, the Northern home-front was itself far from tranquil. Fierce political debates set communities on edge, spurred secret plots against the Union, and triggered widespread violence, such as the New York City draft riots. And at the heart of all this turmoil stood Northern anti-war Democrats, nicknamed "Copperheads." Now, Jennifer L. Weber offers the first full-length portrait of this powerful faction to appear in almost half a century. Weber reveals how the Copperheads came perilously close to defeating Lincoln and ending the war in the South's favor. Indeed, by the summer of 1864, they had grown so strong that Lincoln himself thought his defeat was "exceedingly likely." Passionate defenders of civil liberties and states' rights--and often virulent racists--the Copperheads deplored Lincoln's suspension of habeas corpus, his liberal interpretation of the Constitution, and, most vehemently, his moves toward emancipation. Weber reveals how the battle over these issues grew so heated, particularly in the Midwest, that Northerners feared their neighbors would destroy their livestock, burn their homes, even kill them. Indeed, some Copperheads went so far as to conspire with Confederate forces and plan armed insurrections, including an attempt to launch an uprising during the Democratic convention in Chicago. Finally, Weber illuminates the role of Union soldiers, who, furious at Copperhead attacks on the war effort, moved firmly behind Lincoln. The soldiers' support for the embattled president kept him alive politically in his darkest times, and their victories on the battlefield secured his re-election. Disgraced after the war, the Copperheads melted into the shadows of history. Here, Jennifer L. Weber illuminates their dramatic story. Packed with sharp observation and fresh interpretations, Copperheads is a gripping account of the fierce dissent that Lincoln called "the fire in the rear."