Rattle snake bites

[DFIB]

If you are an EMS provider then you know what to do. If the hospital is going to send a BLS rig out I would call for an intercept and get on the road.

Only hospitals have anticrotalics.

Old timers soak those bites in kerosene and swear by it's effectiveness. The omish have the same practice. I wonder if there is any science to soaking wounds in coal oil?

[emtdennis]

Good point Wendy, I suppose they can be taken by surprise and bite first, rattle later. Still, a defensive reaction though.

Antivenin isn't in any Paramedic scope that I am familiar with. At best they might find an ER doc willing to ride out in the ambulance, but it would likely be a waste of time unless he's actually at the base.

Artickat,

Thanks for the heads up. I wasn't sure how different areas of the country handle this situation. Haven't seen it here in New York, but I figured out west it would be a different story.

[Chief1C]

Regionally, there has been an increase in snakebites over the past two years. Used to happen all the time, when logging was a big industry, and even then, few people died. Depends on where the person is bit, and then you're more likely to suffer from the side effects that are life long; and disfigurment. But people still die from snakebites, it just depends on whether or not they seek care. If you want a swell time line, there's a video on Youtube of a lady picking berries, and she gets bit before it rattles, and the guy keeps rolling right till she gets into ICU.

I've personally treated several snakebites, but they were all from a failure to educate ones self on local snake species. For instance, I've seen some pretty damn big corn snakes. And they look EXACTLY like copperheads.. Except for the eyes and heat pits. But people only associate the snakes actions and color, before killing the poor animal. Water moccoasins are very aggressive, as are common black snakes - or water snakes. They'll bite, and it hurts, and it will become infected. But the moccoasins aren't native, and water snakes aren't venomous. But people still call, because they don't know the difference.

I took a class on snakebites last year, just b/c what *some locals do with rattlers and the influx of mexicans and gas workers. They'll toss them in machines, mail boxes, work trucks, etc. Like terrorism almost. Pre-hospital care is limited to managing symptoms, and simple first aid. MY best bet would be to fly them somewhere, b/c there aren't many hospitals that have antivenom. There is a zoo with exotic snake treatments.

[BillKaneEMT]

I grew up on Amelia Island off the coast of Jacksonville FL. We had Diamondbacks, Pygmies, Coral snakes, and Cottonmouths. I was bitten by a Pygmy when I was 9 and I was sick for a week. Didn't go necrotic, the thing bit me in the ankle after I stepped on it in the backyard. They gave antivenin at the hospital, ours stocked plenty, most of it for pygmies since they treated bites from those almost constantly. I don't remember how many doses I got, that whole week is pretty much gone for me. Fortunately my mom is an RN with plenty of experience with snakebites and she rushed me in without trying home venom extraction or a tourniquet. Do bear in mind that young snakes will nearly typically empty their venom in one bite while adult snakes will rarely do so, meaning the younger the snake the worse it will be. Typically, I'm sure there are exceptions, and that may not apply to snakes outside the US. (I've had zero experience with non US snakes.)

You guys may have seen this before but I thought I'd share it:-D

(1999, Darwin, Australia)

A bloke named Gordon from Darwin, Australia lost his arm, the use of his legs, and was revived three times on the operating table after an encounter with a king brown snake, the 21st most deadly venomous snake in the world. Gordon has said, "I still can't believe my arm's been chopped off just for one snake."

Perhaps nine snakes who each bit him once would be more easily believed than the one snake who bit him nine times. Gordon, who has admitted he was drunk at the time, had been driving with a friend from Mandorah to Darwin when they saw the snake. He picked it up with his left hand "because I was holding a beer in my right one." The snake bit the web of his hand, but Gordon managed to withstand the pain and put it in a plastic bag. He threw the bag in the back of the car.

Once again quoting Gordon, "For some stupid reason, I stuck my hand back in the bag, and it must have smelled blood, and it bit me another eight times." His friend drove him to a nearby hotel, where he was taken by ambulance to the hospital. His friend tried to keep him conscious by, as Gordon said, "whacking me in the head and pouring beer on me."

Despite his friend's quick action, doctors have said that it will take a long time and a lot of rehabilitation before Gordon regains full muscle control. When he does, we fondly anticipate another Darwin Award attempt.

[zmedic]

The most important part of treating a snake bite is to bite the snake back. Otherwise, they never learn how it feels and will keep biting people.

(To the idiots of the world, don't do this)

[DFIB]

The most important part of treating a snake bite is to bite the snake back. Otherwise, they never learn how it feels and will keep biting people.

(To the idiots of the world, don't do this)

Ancient cultures still believe this to be effective.

[the_negro_puppy]

We obviously have lots of poisonous snakes here in Aussie land. Our treatment consists of:

Restricting patient movement as much as possible.

- Obtaining info on snake/identification if possible

- Compression bandage(s) aimed at around 60mmhg "tightness"

- Splinting the limb

- Iv Access

- Cardiac Monitoring

The problem here is different snakes venom works in different ways.

For example- brown snake venom contains mainly neurotoxins and blood coagulants, where as a Red-Bellie black snake venom has neurotoxins, myotoxins, coagulants and also has haemolytic properties. Obviously different venoms = different effects. Most hospitals here carry a range of anti-venins

I've only been to a handful of snake bites, none of which were envenomated or bitten by a dangerous species.

- Pain relief

[bizar.one]

simple answer...

get them calm

mark swelling with sharpie and notate time

get in the car

dial 911

and meet up with ambulance

they will call local hospital for anti-venom

we use crofab and boy let me tell you... to mix a vial it takes about 20 minutes a pop..

so use your traveling time wisely.

Most likely the ambulance does not carry the anti-venom... its about 3,000.00 a vial.

and yes different snake venoms work differently...

neurotoxic

anticoagulants.

Edited July 15, 2012 by bizar.one

[chbare]

Let us also talk about antiventom as well. First, there are fiscal considerations. CroFab, the common agent used in the southwest costs about $4,500-$5,000 for a two vial powder kit. Next, there are several, significant adverse reactions that must be considered. At the top of the list we need to be concerned about serum sickness, anaphylaxis, and ethyl mercury exposure. Additionally, it takes a significant amount of time to mix the CroFab. If you rush the reconstitution process, you make a bunck of foam. Finally, CroFab is not a magic bullet and should not be used in every case of snake bite. The potential risks and benefits must carefully be weighed.

As stated earlier, death from snake bites in the United States (Pit Viper) is rare. Often, monitoring and supportive care is the name of the game. In over a decade of living in the southwest, I've seen many bites and have yet to see a single fatality. While it does occur, the psychological "hype" is probably one of the biggest issues that we run into with uninformed patients and friends/family members.