In a series of 59 cases of rattlesnake bites at two major northern California hospitals, no deaths occurred, no amputations or fasciotomies were required and only one patient had tissue necrosis requiring a graft.Because patients are being seen in major medical facilities earlier, envenomation is encountered in earlier stages. Less specific national standards of treatment, therefore, should receive less emphasis than treatment based on the virulence of the snakes in the particular geographic region. Initial doses of antivenin given intravenously should be based on the degree of envenomation, with additional titration done for worsening symptoms.
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