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Old 03-15-2014, 07:54 PM
justintime justintime is offline
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Default Snake Bite 101



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I've been seeing these snake bite threads here and there. There's a lot of good advice, and a LOT of bad advice. I've compiled information from the threads and written a guideline from a recent lecture our medical school class had on snake bite treatments. I hope it clears some things up and helps educate people on proper treatment.

Background:
  • Most poisonous snakes in America are pit vipers, noted by triangular heads and pits in front of their eyes. Of these, rattlesnakes make up the majority of bites in the U.S.
  • The current death rate for rattlesnake bites is 4-5 per year out of about 4000 - 7000 bites per year.
  • Venom is made up of proteins, just like in our body. These proteins destroy tissue, leading to cell dysfunction, death, and necrosis.
  • Venom travels through lymphatics, NOT vessels. Thus, spread is slow and persistent.

Treatment:
  1. Immediately after bite, move away from the snake. Do not attempt to kill it. You may get bit again and get twice the dose, or get truly envenomed after an initial dry bite.
  2. Assess your ABCs to check for anaphylaxis from the venom.
  3. Remove all jewelry and items from the effected limb. It will start to swell quickly, and this is your one chance to get them off. If you need to, use a string or floss to wrap a finger and remove a ring.
  4. If possible, get a picture of the snake from a safe distance. This can help with ID, but in most cases, won't change course of treatment in a hospital.
  5. Keep limb lowered and immobilize with a sling and splint if available. If bitten on the leg or foot, immobilize the extremity and use a splint or brace. Carry the person out or use two people as support to reduce leg use.
  6. Seek medical attention as soon as possible. If you are more than 5 -6 hours out from medical attention or show signs of rapid systemic progression, consider sending a runner or calling for heli-vac. For a young child, it is advisable to seek the most rapid medical attention possible!

OK, now that we have that down, there are additional treatment techniques you can use to slow venom spread. These are used if you absolutely cannot get medical help within 10-12 hours. Note however, that venom has local effects on tissue it contacts, meaning that if you choose this method, studies indicate there is a greater chance in actually losing the limb from great tissue destruction such as compartment syndrome.

Currently, the American Heart Association recommends applying pressure immobilization as described below because of a small chance of delayed systemic effects which can kill you (renal damage, widespread edema, severe hypotension, etc). However, American Board of Toxicology does NOT recommend using this because of the increased likelihood of limb loss.
  1. Assess for radial pulse.
  2. Apply an Ace bandage starting just above (1/2 inch or so) above the bite wrapping UP the arm or leg. It should be as tight as possible WITHOUT occluding venous or arterial blood flow. This is VERY hard to do. Try your best and err on the loose side, as even mildly obstructed lymphatics if better than free flowing lymphatics.
  3. Recheck for similar radial pulse as you had prior to wrapping.
  4. If the limb turns blue or radial pulse is lost, you have occluded venous or arterial supply, respectively. Rewrap looser.
  5. You WILL have to rewrap several times regardless due to swelling in the limb, which will eventually occlude the veins.

Finally, things which have been proven to not work in slowing the venom:
  • Icing the bite
  • Using suction methods
  • Cutting the wound
  • Homemade remedies

And those bordering on idiocracy, unless I have missed a serious clinical trial:
  • Electroshock therapy (using a stun gun or taser)


Once at the hospital, you can expect something like this:
  • Supportive treatment to avoid hypotension (fluids, etc)
  • Antivenin if available. Multiple treatment are needed. Antivenin works by binding the toxin proteins in circulation until they are slowly filtered out of the body/degraded. Antivenin is cleared by the body, so symptoms can relapse as the antivenin is cleared and more toxic proteins are available in the circulation again. Multiple treatments are needed and can last 3-7 days at 3-6 vials/day. One antivenin is currently used to treatment multiple snake types (can bind multiple types of venom).
  • Rate of anaphylaxis to the newer antivenin is relatively low compared to the older equine antivenin in use 15 years ago. It currently sits at about 8% - 14%, I believe. Anaphylaxis to the old antivenin approached 30%. They used to have a prednisone drip in one hand and antivenin in the other. Yikes.
  • Antivenin has a 40-50% relapse rate because once cleared, the toxic effects of the venom can manifest again. The key is to keep enough antivenin in your system until the venom is mostly cleared by the body, which takes days. Relapses up to two weeks have been reported.
  • Because the venom uses lymphatics, raising the arm or limp will help clear the toxin faster (this is why you keep it lowered while on the trail, to avoid faster systemic effects). Once in the hospital, raising the arm and clearing toxin faster can potentially be a good thing. People can go home from the hospital after a week, reach up for a bowl, and start getting toxic effects again as sequestered venom is mobilized.


The bottom line is, the toxin is a peptide/protein, just like those in your own body. Antivenin is the only thing that will help here: something specifically designed to bind the protein. Running vs walking has not been shown to change outcome, as a fast runner moving the venom faster vs a slower walker not moving the venom seems to have similar clinical courses. Take your time, don't make mistakes, and keep in mind mortality is low. If the length of time to medical treatment is long, consider getting medically evacuated. If that is not an option, consider sacrificing a limb to POSSIBLY avoid the dangerous systemic effects of the toxin.

Good luck to all and stay safe!

Additional Information Contributed by Members
Quote:
Originally Posted by TMcArthur View Post
Excellent essay!

Quickie addendum here.
  • Pit vipers are primarily hemotoxic in venom. They destroy capillaries and start to digest tissue. There is only one antivenin generally available for them in the US, CroFab. The same stuff is used here for all rattlesnake, copperhead, water moccasin and even fer de lance bites.
  • Coral snake treatment consists of putting you on an artificial respirator until your body clears out the neurotoxin. Period. In this case only, modest constriction of the extremity above the bite site is useful. You have to be pretty lame to get envenomated by a coral snake. They are not aggressive and have to chew their way thru the skin for the venom to penetrate. Mexico still makes coral snake antivenin because they don't have a lot of free respirators lying around.
  • More exotic antivenins are available unofficially thru zoos and herpetology experts.
  • The northern Mojave rattler is the only one that combines a large amount of neurotoxin with its regular venom. You still get CroFab and then they stick you on a respirator if you show signs of neurotoxin envenomation.
  • Snake mouths are very dirty. Prophylactic antibiotics are used for almost all snake bites, venomous or not.
  • California medical facilities do NOT recommend any kind of constriction above the wound site.
  • Veterinarians have a vaccine that reduces the effects of rattlesnake venom on bitten animals. Does not make them immune however. Not approved for human use by FDA and not likely ever to go to trials.
Disclaimer: This guide is written as a suggestion only. The posting user and posting forum associated with the user assumes no responsibility for outcomes resulting in deciding to follow these suggestions. Always seek help from a professional in the field of medical toxicology.
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Old 03-15-2014, 08:01 PM
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Always carry a flagon of whiskey in case of snakebite and furthermore always carry a small snake.
W. C. Fields

Disclaimer: this advise freely give bt w.c.Fields while partaking in a flagon.
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Old 03-15-2014, 08:11 PM
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Yes, and I have posted this same information over, and over again. However, you still get people insisting on falling for "snake oil" (pardon the pun) treatments.

Thank you.
Old 03-15-2014, 08:12 PM
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Old 03-15-2014, 10:46 PM
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Regarding the OP:
Excellent sound advice, making this a great post worthy of a bump.
The warm hiking season is here.

A few summers back while hiking a section of the PCT, my group came upon another group of hikers with one fella who had been bit on the palm of his hand.
A rattlesnake.

They had him lying down while they sucked his palm using some snake bite kit.
A few of us advised them to abandon the "treatment", and hike it out to a ranger station about four or five miles away.
They looked at us like we were crazy, and refused.
We told them to stay put and we would let the rangers know their position.

I never understood why they would not hike it out... a bite on the hand wouldn't affect hiking.
The fella looked quite capable to hump it out, but seemed to be reacting to all the drama by the rest of his group.

Panic city on the trail.
To each their own.
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Old 03-16-2014, 02:59 AM
justintime justintime is offline
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Quote:
Originally Posted by Dragunov View Post
Yes, and I have posted this same information over, and over again. However, you still get people insisting on falling for "snake oil" (pardon the pun) treatments.

Thank you.
Seriously. There is some really bad advice out there. Granted, the medical community tends to ignore a lot of great homeopathic and alternative medical treatments (in my opinion), but then there's bush doctoring.... Might as well go back to burning people all over the body to release the bad JuJu...

Quote:
Originally Posted by LeftCoast Grower View Post
Excellent sound advice, making this a great post worthy of a bump.
The warm hiking season is here.

A few summers back while hiking a section of the PCT, my group came upon another group of hikers with one fella who had been bit on the palm of his hand.
A rattlesnake.

They had him lying down while they sucked his palm using some snake bite kit.
A few of us advised them to abandon the "treatment", and hike it out to a ranger station about four or five miles away.
They looked at us like we were crazy, and refused.
We told them to stay put and we would let the rangers know their position.

I never understood why they would not hike it out... a bite on the hand wouldn't affect hiking.
The fella looked quite capable to hump it out, but seemed to be reacting to all the drama by the rest of his group.

Panic city on the trail.
To each their own.
At 4-5 miles, they most likely had ample time. That's crazy! If the guy was fit, that's a two hour hike. I wouldn't do a thing with a rattler bite. I'd grab my gear and go for it.

Even if they stayed, what good are they doing sitting there? At least send a runner.
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Old 03-16-2014, 09:14 PM
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Excellent essay!

Quickie addendum here.

Pit vipers are primarily hemotoxic in venom. They destroy capillaries and start to digest tissue. There is only one antivenin generally available for them in the US, CroFab. The same stuff is used here for all rattlesnake, copperhead, water moccasin and even fer de lance bites.

Coarl snake treatment consists of putting you on an artificial respirator until your body clears out the neurotoxin. Period. In this case only, modest constriction of the extremity above the bite site is useful. You have to be pretty lame to get envenomated by a coral snake. They are not aggressive and have to chew their way thru the skin for the venom to penetrate. Mexico still makes coral snake antivenin because they don't have a lot of free respirators lying around.

More exotic antivenins are available unofficially thru zoos and herpetology experts.

The northern Mojave rattler is the only one that combines a large amount of neurotoxin with its regular venom. You still get CroFab and then they stick you on a respirator if you show signs of neurotoxin envenomation.

Snake mouths are very dirty. Prophylactic antibiotics are used for almost all snake bites, venomous or not.

California medical facilities do NOT recommend any kind of constriction above the wound site.

Veterinarians have a vaccine that reduces the effects of rattlesnake venom on bitten animals. Does not make them immune however. Not approved for human use by FDA and not likely ever to go to trials.
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Old 03-16-2014, 10:46 PM
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Quote:
Originally Posted by madcritter View Post
Always carry a flagon of whiskey in case of snakebite and furthermore always carry a small snake.
W. C. Fields

Disclaimer: this advise freely give bt w.c.Fields while partaking in a flagon.
how hard it is to find a dang snake when you need one?
Old 03-17-2014, 02:39 PM
justintime justintime is offline
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Quote:
Originally Posted by TMcArthur View Post
Excellent essay!

Quickie addendum here.

Pit vipers are primarily hemotoxic in venom. They destroy capillaries and start to digest tissue. There is only one antivenin generally available for them in the US, CroFab. The same stuff is used here for all rattlesnake, copperhead, water moccasin and even fer de lance bites.

Coarl snake treatment consists of putting you on an artificial respirator until your body clears out the neurotoxin. Period. In this case only, modest constriction of the extremity above the bite site is useful. You have to be pretty lame to get envenomated by a coral snake. They are not aggressive and have to chew their way thru the skin for the venom to penetrate. Mexico still makes coral snake antivenin because they don't have a lot of free respirators lying around.

More exotic antivenins are available unofficially thru zoos and herpetology experts.

The northern Mojave rattler is the only one that combines a large amount of neurotoxin with its regular venom. You still get CroFab and then they stick you on a respirator if you show signs of neurotoxin envenomation.

Snake mouths are very dirty. Prophylactic antibiotics are used for almost all snake bites, venomous or not.

California medical facilities do NOT recommend any kind of constriction above the wound site.

Veterinarians have a vaccine that reduces the effects of rattlesnake venom on bitten animals. Does not make them immune however. Not approved for human use by FDA and not likely ever to go to trials.
Great info, we went over much of this during our snakebite lecture, but I didn't want to type it up. If you don't mind, I'll append the first post with your name and quote so others have quick access to it?

I remember a story they told of a guy bitten by snake in one state, but it wasn't treated by CroFab, so they had to use an antivenin from a zoo in another state. Had to have sheriff's dept. drive it to state lines.

Of course, also note that as TMcArthur said, there are more antivenins, but to my knowledge few of them have been clinically tested. They may work, but they can cause bad reactions. Better than dying, which is why they tend to use them anyway if they can get them from a nearby zoo. They usually write up case reports after to help guide future bite treatment with rare antivenins.
Old 03-19-2014, 07:24 AM
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I dont have many venomous snakes around my area, but we have a crap load of venomous spiders. Does this same information apply to spider bites?
Old 03-19-2014, 04:29 PM
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No, it doesn't. For instance, Black Widows victims won't be able to walk out from the severe limb pain and abdominal cramps. Recluse bites can be very serious due to local tissue injury, but usually after a day or two.

That's just the U.S. If you live in Australia, all bets are off. :P
Old 03-19-2014, 08:15 PM
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Aussies have these really nasty funnelweb spiders. They inject a neurotoxin that can cause uncontrollable muscle spasms and frequently death. They are as big as tarantulas and the males are extremely aggressive, often grabbing the victim and delivering multiple rapid bites. Their fangs can penetrate your thumbnail. They can survive a full day underwater and some people are bitten in their swimming pools when a wandering male falls in. Bites almost always involve full envenomation.



First aid consists of a constriction bandage above the bite to prevent the venom from making it thru the rest of your body. Then antivenin. Since the introduction of antivenin, nobody has died from the bite of the funnelweb. Interestingly the venom is only lethal to primates. Dogs and cats and cattle seem comparatively immune.

Ausies also have a native version of the black widow called, IIRC, the redback. Same rules apply as for the widow.

I have read that the three deadliest spiders in the world are the Sydney funnelweb, the Brazilian wandering spider (aka banana spider) and the Six-Eyed Sand Spider which is found in sandy places in Africa, Arabia and South America.



Unlike the funnelweb and wandering spiders, six eyes has a necrotoxin like the recluse - only much much more potent. Fortunately it is very shy, live in remote areas and rarely comes in contact with people. Experimental bites on rabbits are lethal and much of the rabbit just rots away.

One of the effects of the neurotoxin from the wandering spider is such extreme priapism that it can result in gangrene or other disabling damage to the affected organ. (Currently under evaluation as an anti-impotence drug.) Even with prompt antivenin treatment, wandering spider bites have proven lethal to healthy people.



OTOH most spiders are capable of a dry bite and some people are less vulnerable to their toxins.
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