further issues with wound care John Benitez, Vanderbilt University Medical Center 13 September 2011 The authors are to be commended for putting together a good diverse group of experts on managing snakebites (Crotalid) in the US. It puts together an organized approach to evaluating the victim of a snake bite. I would encourage, and I hope there was no disagreement in the panelists, that antibiotics not be routinely used, unless there are clear indications for doing so. Also missing from the article was any statement of need for appropriate range of motion (ROM) exercises that a patient should be encouraged to do or taught to do to avoid further complications post discharge such as contractures and loss of function of digits. We routinely encourage AROM (and where necessary PROM) exercises for the patient during hospitalization and post-hospitalization. If followed up in clinic afterwards we also monitor their symptoms, labs if appropriate, and functional capacity in the extremity involved, and use it as an opportunity to review AROM. In certain cases we find that we need to instruct some physcal therapists as to the potential long term problem following a snakebite, and what to look for and what to encourage the patient to do, if they get consulted on such cases. Competing interests NONE.