Exotic Snakes

Emergency physicians face an increased likelihood of treating exotic enven-omation due to private collections. The clinical presentation of a victim envenomated by a cobra or other elapid that causes neurotoxicity is the development of cranial nerve palsies manifested by ptosis, ophthalmople-gia with blurred vision or diplopia, dysphagia with increased secretions, dysarthria, and facial muscle weakness. This can be followed by drowsiness and confusion, flaccid paralysis, coma, and respiratory paralysis. Cholinesterase inhibitors such as neostigmine are effective in temporarily reversing neurotoxicity in some Asiatic species of Naja (63).

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