Snake Bite First Aid

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KevinS
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Snake Bite First Aid

Post by KevinS » July 31st, 2012, 6:05 pm

I'll be going to camp next week as a counselor and we're headed to a new site this year that is known to have timber rattlers (and probably northern copperheads). I'm excited about the prospect of seeing some, but everyone will be looking to me for information on staying safe and avoiding bites. On the off chance that a kid would get bitten by a venomous species, I want to make sure I'm up to date on proper treatment procedures so I was hoping you guys could point me to a good source for information-there's probably even a thread on here somewhere that covers it.

There are also black bears in the area and it sounds like seeing them is much more likely. I've got no bear experience whatsoever, so any pointers on avoiding trouble with them would be appreciated as well (I know the common sense stuff like don't feed them, don't surprise them or come between a mother and cubs, etc). Thanks.

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Andy Avram
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Re: Snake Bite First Aid

Post by Andy Avram » July 31st, 2012, 6:22 pm

Snake bite - keep them calm and head to the hospital immediately.

Bears - not really too much of an issue. On the extremely extreme off chance you are attacked fight back. Black Bears don't like getting hurt and will usually retreat if you hurt them bad enough, but this doesn't work out west with Grizzlies.

Andy

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Re: Snake Bite First Aid

Post by Shane_TX » July 31st, 2012, 7:11 pm

As for bears, you don't have to worry about them.
I don't think he was asking about teddy bears;) It's best to recognize that real bears do warrant respect and it's best to know how to react.

Shane

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Re: Snake Bite First Aid

Post by Joe Bouvier » July 31st, 2012, 7:25 pm

Immobilze the bite site, if an extremity (so to slow the spread of the venom through the lymphatics). If you have help with you, try not to move the extremity and get your help to get you to an ER ASAP. The only proven effective therapy for venomous snake bite is antivenin! Do not: use a tourniquet, cut the wound area, try to suck out the venom, use electric shocks to the area, place ice on the area or other "folklore remedies." They all cause more damage on top of the venom damage. Best way to keep safe is to avoid any direct contact and watch your step and or hands/arms if you are climbing!

If very severe or central bite (not extremities), have the cell phone and call 911 for a helicopter. If no cell phone service, prepare by having another form of communication like a HAM radio and the known repeater frequencies in the area so to relay a message for emergency help. Good luck and be safe!

Dr. B

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Re: Snake Bite First Aid

Post by chris_mcmartin » July 31st, 2012, 7:50 pm

Remove all jewelry (rings, watches, bracelets, etc) from the affected area--otherwise they'll have to be cut off if the limb swells.

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Re: Snake Bite First Aid

Post by Shane_TX » July 31st, 2012, 8:06 pm

In addition, the risk from female bears with cubs is greatly overstated.
Interesting info that I'll never test.
If no cell phone service, prepare by having another form of communication like a HAM radio and the known repeater frequencies in the area so to relay a message for emergency help.
Nice. It's also good to have a widget to communicate with aircraft. Oh, the horrors of summer camp :lol:

Shane

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Re: Snake Bite First Aid

Post by herpseeker1978 » July 31st, 2012, 8:50 pm

have a black sharpie and mark the extent of the swelling writing the times on there, This helps see how fast the venom is progressing and can determine how much anti=venom is used.

Josh

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Kent VanSooy
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Re: Snake Bite First Aid

Post by Kent VanSooy » August 1st, 2012, 7:30 am

Write you name and age on a card in big letters and paste it on your chest ('cause they're going to ask you about 1000 times).

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Re: Snake Bite First Aid

Post by monklet » August 1st, 2012, 7:42 am

Kent VanSooy wrote:Write you name and age on a card in big letters and paste it on your chest ('cause they're going to ask you about 1000 times).
:lol: And you'll be sure you always pass the cognition test. ;)

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gbin
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Re: Snake Bite First Aid

Post by gbin » August 1st, 2012, 8:20 am

It's way more important to impress upon the kids how essential it is that they look before placing a hand, foot or other body part anywhere in venomous snake country so as to avoid a bite, of course, but otherwise the best preparation you can make is just to know where you're going to take someone in the event of a bite (or other medical emergency). And if (heaven forbid) a bite does occur, remove any possible restrictions from the affected area as Chris mentioned and get the person to medical attention as quickly as can calmly and safely be done as various other people mentioned. Try to give the impression with your demeanor that it's not a big deal and it'll end up being less of a big deal than it otherwise might.

I can't imagine a bear not hearing and staying well away from a bunch of kids.

Gerry

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Re: Snake Bite First Aid

Post by Joshua Jones » August 1st, 2012, 8:42 am

gbin wrote:It's way more important to impress upon the kids how essential it is that they look before placing a hand, foot or other body part anywhere in venomous snake country so as to avoid a bite, of course, but otherwise the best preparation you can make is just to know where you're going to take someone in the event of a bite (or other medical emergency). And if (heaven forbid) a bite does occur, remove any possible restrictions from the affected area as Chris mentioned and get the person to medical attention as quickly as can calmly and safely be done as various other people mentioned. Try to give the impression with your demeanor that it's not a big deal and it'll end up being less of a big deal than it otherwise might.

I can't imagine a bear not hearing and staying well away from a bunch of kids.

Gerry

Dammit, I agree. :cry: :lol:

What's up, Gerry? :D

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Kent VanSooy
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Re: Snake Bite First Aid

Post by Kent VanSooy » August 1st, 2012, 8:49 am

I actually had a nurse get pretty pi$$ed off at me when I wasn't able to say my name and age (because my tongue was so swollen) - I guess she thought I wasn't trying hard enough.

I would impress upon the kids that if they see a rattlesnake, its mate might be close by, yet unseen. The rattler in front of you has a tendency to draw all of your attention.

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Re: Snake Bite First Aid

Post by gbin » August 1st, 2012, 8:56 am

Joshua Jones wrote:Dammit, I agree. :cry: :lol:

What's up, Gerry? :D
:lol:

Kevin didn't ask what he should do if he himself is bitten, or I might have suggested immediately, briefly applying suction via a Sawyer Extractor just in case it helps remove some venom. I figure if it's one of the kids he's in charge of who is bitten, such a device almost certainly couldn't be used in time to do any good and might instead just increase the kid's anxiety about the bite. ;)

That's a great additional point about mentioning to the kids that it's not the snake you see but the one you don't see that bites you, Kent.

Gerry

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Re: Snake Bite First Aid

Post by justinm » August 1st, 2012, 10:44 am

gbin wrote:
Joshua Jones wrote:Dammit, I agree. :cry: :lol:

What's up, Gerry? :D
:lol:

Kevin didn't ask what he should do if he himself is bitten, or I might have suggested immediately, briefly applying suction via a Sawyer Extractor just in case it helps remove some venom. I figure if it's one of the kids he's in charge of who is bitten, such a device almost certainly couldn't be used in time to do any good and might instead just increase the kid's anxiety about the bite. ;)

That's a great additional point about mentioning to the kids that it's not the snake you see but the one you don't see that bites you, Kent.

Gerry

I don't understand how anyone who has the most basic knowledge of the human circulatory system would think that "extracting" venom is going to work? As smart of a guy as you say are Jerry, that thought has never crossed your mind that the venom that was injected through the skin into muscle, and veins is just sitting there...

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gbin
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Re: Snake Bite First Aid

Post by gbin » August 1st, 2012, 11:20 am

justinm wrote:I don't understand how anyone who has the most basic knowledge of the human circulatory system would think that "extracting" venom is going to work? As smart of a guy as you say are Jerry, that thought has never crossed your mind that the venom that was injected through the skin into muscle, and veins is just sitting there...
Eh? When did I say I was such a smart guy, Justin? I'm fairly well educated about some things and fairly ignorant about some others, and so far as my ability to learn goes I'd say I do well enough but not nearly as well as I'd like. My memory is downright awful for most things, and always has been.

Venom ends up being deposited in a variety of places. It's a fairly unlucky circumstance to have it injected directly into the circulatory system where it is dispersed essentially immediately. I've never studied venom effects and will happily take correction from someone who has, but it's my understanding that if it ends up in muscle it's distributed much slower, and in fat much slower still (relatively speaking); certainly that's the way it's worked with things I've injected into animals, of which I've done a fair bit over the years for one purpose or another. Sometimes (especially with smaller species and/or glancing blows) at least a portion of it ends up still in the skin, from which it is also distributed more slowly. If applied right away, I see no reason why gentle suction can't be used to remove at least some of it. I also believe at least some studies have found that it does indeed do so.

Also, I've never suggested that anyone bet their life on it. I wouldn't delay seeking medical treatment in order to sit there and work a syringe suction device on a bite, and I definitely wouldn't use any of those old cut-and-suck devices at all. The most I think and say is that if it is applied immediately and briefly, a Sawyer Extractor might do at least some good by removing at least some venom, and if nothing else it won't cause any harm.

I understand that different folks have different opinions on this, but I don't understand at all why some folks get so aggressive about theirs being right and others' being wrong. :?

Gerry

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Re: Snake Bite First Aid

Post by Joshua Jones » August 1st, 2012, 11:45 am

I was bitten by an Arizona Brown Spider this year. I was able to squeeze a small drop of venom from the bite site, immediately afterwards. What venom was left put me in a hospital. I don't want to think about what would have happened if I'd had that one extra drop of venom in my bloodstream. Probably would have doubled the dose I received.

From what I've seen, small amounts of venom can be extracted from tissue, provided one makes the attempt to do so before it has the chance to be absorbed. You may only have seconds, but I've seen it happen. In fairness, though, I think Gerry was correct in assuming that this treatment would only be a viable option for a person who was properly trained and quick to react, rather than the kids such a man might be responsible for.

With that said, I don't carry a snakebite kit. I feel it's a waste of time and, even if it could get some of the venom out, I wouldn't be able to reach it fast enough to be effective. Squeeze out what you can right away. Otherwise, follow the protocol.

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Re: Snake Bite First Aid

Post by CCarille » August 1st, 2012, 12:41 pm

All the snakebite advice seems sound. On the bear issue...

I've had black bear come into town with cubs looking for food. If they're hungry, looking big and being loud won't necessarily scare them off. In this case you must fight back... use a stick or anything else heavy.

Don't cook near where you'll be sleeping and keep all food tied up and away (100 yards) from your tent/sleeping area. Paracord or climbing rope works well. Bear canisters are good for food storage as well. I'd also keep any clothes smelling worn while cooking away from camp - they'll pick up the scent of food.

This all may seem like overkill as black bear attacks aren't common, but having a bear in camp is not a fun time. I've had a grizzly wonder near (50-75 yards away) camp before.

Last piece of advice... carry an air horn. They work great... and you don't need to be really close like bear spray or have to worry about bear spray blowing in the air at yourself. Not to say bear spray doesn't work, but the bear needs to be really close. Air horns are loud, piercing, and scare off wildlife.

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Re: Snake Bite First Aid

Post by jonathan » August 1st, 2012, 9:00 pm

When I was a boy scout, we had a black bear tear open the tent of another scout, eat the hot dog buns he had left in his tent, and then leave. The kid didn't wake up till morning, just finding a torn-open tent, a lot of slobber, and an empty bag of hot dog buns.

So yeah, the best advice is to keep the food FAR away from people at night. And probably best to avoid leaving strong scents in any of the tents.

I've seen the "yell and run them off" technique work several times for black bears.

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Re: Snake Bite First Aid

Post by Don » August 1st, 2012, 9:28 pm

It's been 40 long years since my LAST venomous bite. The first (1966) was initially bungled by an antique pediatrician who had never seen a snakebite, and after I begged my mother to call Bill Haast (in the middle of the night) and she learned I knew a little bit about it, she consulted her doctor who had treated lots of atrox bites in the army. Those were the Wyeth days. The treatment was bizarre by today's standards, but effective. This dr took over about twelve hours into the envenomation. Cryotherapy was part of it, and local IM & ID injections of AV proximal to the bite site, as well as IV AV. It wasn't a bad bite (small sidewinder, one fang, tip of thumb), and all was good in several days. For #2 the doc picked me up at home almost immediately and although it was a worse envenomation the recovery was quicker. Same treatment (ice, local injections and of course IV AV. After that I had a doozy of a case of serum sickness. #3 was 5-6 years later, and was a big whack from a mocassin. No AV, but lots of ice. I don't think I want to do it again. Demerol is great, but prudence is better.

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Re: Snake Bite First Aid

Post by simpleyork » August 2nd, 2012, 12:08 am

jonathan that kid was lucky. just a few years ago we had a kid get killed and eaten by a black bear just ten miles from my parents home, Sad story it is. The kid had food in the tent, the parents were in another tent . The bear ripped threw grabbed the kid and hauled him off. They are wild animals and are hungry. Please keep all food away from the tents and secured.

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Re: Snake Bite First Aid

Post by Scott Waters » August 2nd, 2012, 9:55 am


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Re: Snake Bite First Aid

Post by will lattea » August 2nd, 2012, 12:25 pm

I spend most waking minutes trying to mentally prepare for bear fights.

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Re: Snake Bite First Aid

Post by DaveR » August 2nd, 2012, 3:04 pm

I spend most waking minutes trying to mentally prepare for bear fights.
:lol:

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Re: Snake Bite First Aid

Post by Andy Avram » August 2nd, 2012, 4:38 pm

will lattea wrote:I spend most waking minutes trying to mentally prepare for bear fights.
Yeah, it is that one-track type of thinking that is going to make you a cougar attack statistic.

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Re: Snake Bite First Aid

Post by stlouisdude » August 5th, 2012, 5:56 am

I don't worry much about timber rattlesnakes, if I were bitten I'd get out of the woods and have an ambulance on the way, hopefully effective treatment would be closer rather than further away. As I understand it, the odds of suffering are high but death is extremely unlikely. Being careful on the drive there and back and using care on mountain sides are probably the best ways to protect the kids. I try to clean cabins of rodent poo without creating a big dust storm. Personally, I always bring water and soap into the woods to wash my hands before eating. I've seen people eating lunch after examining mammal scat,no thanks!

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Re: Snake Bite First Aid

Post by jonathan » August 5th, 2012, 9:56 am

simpleyork wrote:jonathan that kid was lucky. just a few years ago we had a kid get killed and eaten by a black bear just ten miles from my parents home, Sad story it is. The kid had food in the tent, the parents were in another tent . The bear ripped threw grabbed the kid and hauled him off. They are wild animals and are hungry. Please keep all food away from the tents and secured.

I should add - I had seen a bear in that same camping area 3 times in the week before the other scouts came. It appeared to be a 1.5-year-old and was likely the same one that entered the tent. Also saw a baby in a tree just outside of camp and a mature adult just a few hundred meters away. Later that fall the problem bear was shot by fish and game because it had become too much of a nuisance.

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Re: Snake Bite First Aid

Post by muskiemagnet » August 5th, 2012, 10:36 am

i'd also suggest showing the campers photos of any venomous snakes in the area. "leave all snakes alone" would be what i'd tell them, but hey, it is fun to scare the girls. it's summer camp for crying out loud. kids will be kids. use the opportunity for some education. throw a little conservation in as well.

i noticed at the beginning, it was mentioned no ice. i would think that would be a good thing to slow down circulation at the bite site.

i've mentioned my hobby to my doctors. i questioned whether taking epenepherine(bee sting kit) could cause any complications if used. i have yet to get an answer. i'm not too concerned about getting bit, but it does happen. my concern if bitten would be an allergic reaction to the venom. anaphalaxis can kill quickly. any body have thoughts on this?

-ben

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Re: Snake Bite First Aid

Post by jason folt » August 7th, 2012, 11:58 pm

Epipens have been discussed on here in other threads. They should not be used as "routine snake bite treatment" and do have the potential for harm.

Jason

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Re: Snake Bite First Aid

Post by chrish » August 8th, 2012, 4:29 am

I think the most important thing to convey to the kids (and other camp counselors/administrators) is the relative risk of some of these things. What you don't want to do is convey a sense of "these are wild places and they are dangerous". They get enough of that at home. As an experienced field person, that is one of the primary things you can teach - a respect for the outdoors and the fact that information trumps fear.

Being attacked by a black bear at summer camp in the NE is seems so unlikely that you should also consider the probability of being hit by falling space debris. I'm kidding, but and I think teaching bear awareness and safety is important, but I think everyone should be aware of the real risks to their well being, not just the scary ones. Save the scary stories for the campfire.

Lightning, drowning, ants, bees and wasps, campfires, etc. are much more serious threats to a bunch of summer camp kids than either snakes or bears. If people were as conscientious (paranoid) about drowning and water safety as they are about the "threat" of snakebite, no one would be allowed near the water during camps. And less people would drown.

It might be worth asking the people that run the camp what injuries have occured in the previous 10 years or so. See if snakebite or bear attack falls on that list. Hmmm...

As for what to do on the chance that a kid is bitten by a snake, seek medical attention. Don't cut and suck or do anything like that because you aren't qualified to render medical aid (nor am I). Let medical professionals take care of medical situations, particular in our overly litigious society.

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Re: Snake Bite First Aid

Post by Kent VanSooy » August 8th, 2012, 7:16 am

particular in our overly litigious society
Liability and insurance coverage is (sadly) really important too - the costs of a crotalid envenomation can easily exceed a quarter million dollars.

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Re: Snake Bite First Aid

Post by muskiemagnet » August 8th, 2012, 1:24 pm

jason folt wrote:Epipens have been discussed on here in other threads. They should not be used as "routine snake bite treatment" and do have the potential for harm.

Jason

i would never recommend using one after being bitten. i'm just saying, if your throat starts closing after a bite, use it. i know i would. i'd at least like to make it to the hospital.

-ben

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Re: Snake Bite First Aid

Post by Chris Smith » August 8th, 2012, 3:44 pm

Black Bears are not a great concern... even with cubs. They are more scared of you than you are of them! I had to chase this one for about 1/4 mile before she (with cub) stood still for a photo!

To echo others regarding snake bite, the best thing to do is to get to the hospital as soon as possible.


Image

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Re: Snake Bite First Aid

Post by hellihooks » August 8th, 2012, 4:18 pm

Get a positive ID on the snake... even if you have to dig it out. kill it, whatever. Any forum member should be able to positively ID a snake... so the 'kill it if you have to' advice applies to situations where there is no knowledgeable people around (and the ONLY time I advise killing a snake...if no one is SURE what type of snake it was... :? )


lacking a 'very certain' ID... doctors (fearing lawsuits) will be hesitant to administer antivenin until the symptoms themselves make the ID certain.... not good... :roll: jim

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Re: Snake Bite First Aid

Post by jason folt » August 8th, 2012, 9:39 pm

hellihooks wrote:Get a positive ID on the snake... even if you have to dig it out. kill it, whatever. Any forum member should be able to positively ID a snake... so the 'kill it if you have to' advice applies to situations where there is no knowledgeable people around (and the ONLY time I advise killing a snake...if no one is SURE what type of snake it was... )


lacking a 'very certain' ID... doctors (fearing lawsuits) will be hesitant to administer antivenin until the symptoms themselves make the ID certain.... not good... jim
I disagree with this strongly. Only bad can come from people trying to "obtain the snake for ID". You increase the chances of being bitten again, or having another person being bitten. You also waste valuable time that could be spent en route to the hospital. If you can snap a quick picture great, if not, oh well.

I am strictly speaking about Crotalids here, as well as in huge generalities. Obviously every case is different... but by the time you arrive to the hospital a medically significant bite would be showing some signs of envenomation that would steer us down the treatment pathway. If anything, most doctors would err on the side of caution and treat bites that showed evidence of envenomation, even if a positive ID was not available. If you aren't showing any local signs of a bite, and your labs are kosher, you probably don't need antivenom. Even if you were sure you were bit by a rattlesnake. If I treated ever person who swore they were bitten by a venomous snake...

Jason

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Re: Snake Bite First Aid

Post by hellihooks » August 9th, 2012, 7:21 am

Any ER you call will say 'get a positive id, if possible' Often, with a bite, people kill the snake as a matter of course. Get a pic, have a qualified person stay and try to locate and ID the snake, while the victim is in route... whatever.

From personal experience I can say that treatment goes much slower without a positive ID. I had to convince the doctors that I knew one snake from another, before they administered antivenin, hard to do with a numb, mushy mouth... :roll: jim

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Re: Snake Bite First Aid

Post by gbin » August 9th, 2012, 7:40 am

jason folt wrote:
hellihooks wrote:Get a positive ID on the snake... even if you have to dig it out. kill it, whatever. Any forum member should be able to positively ID a snake... so the 'kill it if you have to' advice applies to situations where there is no knowledgeable people around (and the ONLY time I advise killing a snake...if no one is SURE what type of snake it was... )

lacking a 'very certain' ID... doctors (fearing lawsuits) will be hesitant to administer antivenin until the symptoms themselves make the ID certain.... not good... jim
I disagree with this strongly. Only bad can come from people trying to "obtain the snake for ID". You increase the chances of being bitten again, or having another person being bitten. You also waste valuable time that could be spent en route to the hospital. If you can snap a quick picture great, if not, oh well.

I am strictly speaking about Crotalids here, as well as in huge generalities. Obviously every case is different... but by the time you arrive to the hospital a medically significant bite would be showing some signs of envenomation that would steer us down the treatment pathway. If anything, most doctors would err on the side of caution and treat bites that showed evidence of envenomation, even if a positive ID was not available. If you aren't showing any local signs of a bite, and your labs are kosher, you probably don't need antivenom. Even if you were sure you were bit by a rattlesnake. If I treated ever person who swore they were bitten by a venomous snake...

Jason
I'm with you, Jason, as is I'm sure every poison control center in the United States. Attempting to catch/kill the snake for ID is terrible - potentially seriously harmful, even fatal - advice, even without a bunch of kids on hand trying to "help." :shock: Treatment for envenomation is properly based on evidence of envenomation, at least some of which would be expected by the time the victim reached medical care, not eyewitness accounts of the bite or a snake in a bucket. Pretty much everyone carries some kind of a camera these days, so if one feels compelled to obtain some kind of voucher of the snake then s/he can just take its picture - so long as s/he doesn't waste any time on the matter nor put anyone at risk in the process.

Gerry

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Re: Snake Bite First Aid

Post by Tamara D. McConnell » August 9th, 2012, 8:35 am

My understanding of the subject is very limited, and thankfully, I have no first hand experience with envenomation. Someone correct me if I am mistaken in my ideas. I am thinking killing/capturing the snake would be very unnecessary in my part of the country (Gulf coast) because:
-I would not need AV unless I were showing signs of envenomation.
-All of our venomous snakes here are either pit vipers (copperheads, cottonmouths, rattlers) or one species of coral snake. Wouldn't all pit viper bites respond to the same kind of AV? Crofab?
-A coral snake looks so markedly different from any of the pit vipers, even a novice can tell the difference. Corals are easy snakes to describe. Therefore, if I am showing signs of envenomation, and what I describe is not a coral, the doctor will give me Crofab, right?
Thanks in advance to anyone who helps educate me regarding this.

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Re: Snake Bite First Aid

Post by hellihooks » August 9th, 2012, 11:08 am

Just to be clear... killing a snake (if it hadn't been already dispatched) is a very LAST resort... if no one can ID it... if it can be done safely, ect.

In the ER... they don't know if its a bite from a native pit viper, or an escaped gaboon... and will wait to see what symptoms develop... so... let me amend my statement to: Get a positive ID, if possible. :roll: jim

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Re: Snake Bite First Aid

Post by jason folt » August 10th, 2012, 7:58 pm

I disagree, but what do I know. I'm just one of those stupid ER docs.

Tamara - For the most part you are right on.

Stay safe out there everyone.

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Re: Snake Bite First Aid

Post by hellihooks » August 11th, 2012, 8:21 am

No disrespect intended Jason... but with all 3 of my bites, ID was questioned again and again, and delayed treatment. a positive ID HAS to be better than 'no clue'. In this specific circumstance... I think knowing if it was a Timber bite vs a Copperhead bite would be a good thing to know. Safety first, of course... but common sense alone would suggest an ID, if possible.
Thing is... people sometimes panic and forget the 'common sense' stuff. which is why I mentioned it. jim

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Re: Snake Bite First Aid

Post by Terry Vandeventer » August 11th, 2012, 2:05 pm

With the exception of Jason :) most ER docs simply cannot identify a venomous snake, even with a wall poster or field guide. It's just a fact. They are doctors, not herpetologists. The point is, killing the snake puts the victim at greater risk. About half of the United State's pitviper bites are dry. You are risking an actual venomous bite by sticking around to kill the snake. And if he does get you after he's injured, frightened, and in pain, it's likely to be a more serious wound.

A snakebite physician friend and I used to give a seminar to emergency room staffs in the southern US. It was titled " Snakebite: Panic in the Emergency Room." Doctors, nurses, and techs are all afraid of snakes and they really don't want you dragging a snake, alive or dead, into their ER. Their words. Experienced snakebite doctors treat snakebites symptomatically. Sure, on some level it's nice to know if it was a baby Eastern Diamondback Rattlesnake as opposed to a six-footer, or a Kentucky Timber Rattlesnake instead of a north Florida Canebrake Rattlesnake, but with Crofab being more or less affective against all of our pitvipers, the snake ID is almost irrelevant.

Distance yourself from the snake. Remove jewelry. Disinfect wound. Immobilize the limb. Treat for Shock. Transport. If a friend can safely photograph the snake with a cell phone, without wasting precious moments, good, but again, unless the photo goes to an expert on snake ID, it will probably be a wasted effort anyway.

Watch where you put your hands, seats, and feets, and don't kill snakes, and the average citizen will never have a bad experience.

Cheers,

TV

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Re: Snake Bite First Aid

Post by hellihooks » August 11th, 2012, 3:20 pm

Yeah...I guess that now that the antivenins are polyvalent... my advice for the need for ID may be a bit outdated, and not as important.
And again, I stress... That is the ONLY circumstance that I think killing a snake could be argued as justifiable...If no one knows what it was. Often (usually?) in cases like that... some good samaritan/hero has killed the snake anyways... :roll:
With the exception of Dr Bush, and the Loma Linda Staff... my bites were the first ones the attending Drs, at three different ERs, had ever treated. The first one, in 75, they consulted a boy scout manual to find out what to do... then cut and applied 'jury-rigged' suction (not having a rattlesnake suction kit.. :crazyeyes: )
I will (again) ammend my advice to "If possible to do so safely... get an ID" The more information the Drs have to work with... the better the chance of a good outcome. :| jim

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Re: Snake Bite First Aid

Post by GlyptemysNE » August 11th, 2012, 7:38 pm

Agree in full with the comments from Jason the EM physician.

A couple pearls from experience out west:
- I think when people read "immobilize the bitten extremity" suddenly there is a thought of applying a splint and wrapping it with bandages. Do nothing that even slightly constricts blood flow - you don't need to wrap or tape a splint. Elevate it on in *full extension* (straightened out) - we like to elevate the bitten extremity on blankets, pillows, etc. Don't use a sling for arm bites - again, keep the bitten extremity in full extension and elevate when you can.
- I still see a lot of herpers (specifically) making comments about the Sawyer Extractor being possibly helpful and not harmful (as compared to cut-and-suck snakebite kits). The Sawyer Extractor should absolutely not be used, it will cause worsened local tissue injury and offers no benefit. There is reasonable evidence behind this.
- In 2010 the American Heart Association and American Red Cross published first aid guidelines for snakebite, and they recommended elastic (ace) bandages after enevnomations by Crotalinae species. This practice, while standard and lifesaving in the old world, has no role in managing crot bites here in North America. They can rapidly transform what is very rarely a life-threatening situation into a limb-threatening one. In our experience, rattlesnake bite victims who become critically ill in the field do so very rapidly, generally from one of three issues: anaphylaxis, anaphylactoid syndrome (basically, an anaphylaxis-like presentation but without previous sensitizing exposure), or intravascular injection of venom. In these circumstances, no matter how fast you apply an elastic bandage (or a Sawyer Extractor), there is no conceivable benefit.
- If someone applied a Sawyer Extractor, you should remove it immediately. If someone applied an elastic bandage, tourniquet, or "lympthatic constricting band" it should be left in place - typically we remove these in the emergency department after we get big IVs in the patient, give them intravenous fluids, start their antivenom, and are ready for them to crump.
- If getting to medical care is delayed, and the victim is conscious, it seems reasonable to drink a lot of fluids (not beer or your buddy's urine).
- Dry bite isn't diagnosed in 2 minutes. I know many herpers have gotten nailed and not had symptoms and counted themselves as lucky and not gone to the hospital. If you get tagged by a venomous snake, head for the hospital regardless of symptoms. In the hospital, if it looks like you have a dry bite, you should expect to be watched (including labs) for at least 8 hours. Experts in the east might send patients home sooner if they have responsible grown-ups to watch them - but that should be an expert (e.g. a toxicologist) making that decision. Our tox groups watch known or suspected Scut bites, all kids, and lower extremity bites for 24 hours. I flew a patient a couple years ago that was bitten by a rattlesnake, went to a local hospital, saw the triage nurse and ED doc and was on his way home within 30 minutes. He thought this was awesome until a few hours later when he was so weak he couldn't stand, was coagulopathic, and in shock.
- We see snakebitten patients horrifically mismanaged in certain hospitals. As a herper you should know a few things about first aid and know that if someone from the ambulance or emergency department tells you they are going to put a tourniquet around your bitten limb, they are dangerously incompetent and you should refuse that. In addition, you should insist that the emergency physician promptly consult a medical toxicologist with snakebite experience. If they want to do a fasciotomy on you, really really insist they consult a medical toxicologist and know you have a right to be fully informed about your situation, including what the consultant said. In 2012, emergency medicine physicians and toxicologists should be the providers in charge of your management after snakebite - not a general surgeon or orthopaed who likes to do fasciotomies.

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Re: Snake Bite First Aid

Post by GlyptemysNE » August 11th, 2012, 7:46 pm

Top,

There was no reason for ID to be "questioned again and again" if you were bitten by something venomous that wasn't exotic and wasn't a coral snake. We manage the patient based on presentation, not species. I'm sure Jason can tell you about how many times he's been confronted with a Water Moccasin bite and the offending animal is Nerodia. I've had "rattlesnake bites" and been presented a beheaded Pituophis. So from that perspective, a picture is nice, but otherwise, it's not important.

Personally, we love to know what the involved species is - but that's purely academic - it doesn't impact management except that in the southwest, we watch presumed dry Mojave bites longer - but if there is any question, we watch them longer anyway.

In terms of clinical management, it wouldn't matter if it was a copperhead vs a timber rattlesnake - it'd be nice to know to satisfy intellectual curiosity - but management will be driven by the patient, not the involved snake species. More of than not, presumptions about venom composition for a given species in a given geographic region leads to faulty decision making, rather than help take care of the patient.

hellihooks wrote:No disrespect intended Jason... but with all 3 of my bites, ID was questioned again and again, and delayed treatment. a positive ID HAS to be better than 'no clue'. In this specific circumstance... I think knowing if it was a Timber bite vs a Copperhead bite would be a good thing to know. Safety first, of course... but common sense alone would suggest an ID, if possible.
Thing is... people sometimes panic and forget the 'common sense' stuff. which is why I mentioned it. jim

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Re: Snake Bite First Aid

Post by gbin » August 11th, 2012, 9:19 pm

GlyptemysNE wrote:- I still see a lot of herpers (specifically) making comments about the Sawyer Extractor being possibly helpful and not harmful (as compared to cut-and-suck snakebite kits). The Sawyer Extractor should absolutely not be used, it will cause worsened local tissue injury and offers no benefit. There is reasonable evidence behind this.
I'm afraid I have to challenge your statement because the evidence behind it is decidedly not reasonable. Unless you're aware of scientific studies that I (and Web of Knowledge) haven't yet heard of:

The methodology used in the study claiming no benefit to the device - specifically no appreciable removal of injected mock venom - entailed applying the Extractor at least 3 minutes after the mock venom was injected. I'm not aware of any study documenting how much venom might be removed if it were applied right away (say, in the 30 seconds to 1 minute range) rather than after such a delay. (The question of how realistic it is to think that people can use it that quickly is another topic, and so far as I'm aware also hasn't actually been tested by anyone.) Are you? Is anyone else here?

The methodology used in the study claiming local tissue injury from use of the device entailed applying the suction device (again) after 3 minutes post-injection and then leaving it in place for 30 minutes(!). If the device is only possibly going to be useful if applied essentially immediately, there's obviously no benefit to be derived from using it for such an outrageously long period of time. Indeed, that methodology suggests to me that the study wasn't designed to test the safety of the device, but rather specifically to try to obtain evidence that it is not safe - not cool at all, scientifically speaking. Again, are you or is anyone else here aware of any study that found local tissue damage after only a brief application (I would think somewhere less than 1 minute, maybe even half that, is going to do whatever it's going to do for a person) of the device? Not me.

Without truly reasonable evidence naysaying it, I stand by my earlier statement: If applied immediately and briefly after a venomous snakebite, a Sawyer Extractor might do at least some good by removing at least some venom, and if nothing else it won't cause any harm.

Gerry

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Re: Snake Bite First Aid

Post by kit fox » August 12th, 2012, 5:38 am

simpleyork wrote:jonathan that kid was lucky. just a few years ago we had a kid get killed and eaten by a black bear just ten miles from my parents home, Sad story it is. The kid had food in the tent, the parents were in another tent . The bear ripped threw grabbed the kid and hauled him off. They are wild animals and are hungry. Please keep all food away from the tents and secured.
Was his name Samuel Ives? "Ives was grabbed from a family tent in American Fork Canyon, and mauled."

For those that plainly discount the threat of Black Bears, read the list: http://en.wikipedia.org/wiki/List_of_fa ... th_America .

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Re: Snake Bite First Aid

Post by Terry Vandeventer » August 12th, 2012, 6:48 am

GlyptemysNE,

Two excellent posts!

Cheers,

TV

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Re: Snake Bite First Aid

Post by Kent VanSooy » August 12th, 2012, 6:50 am

For what it's worth (meaning one data point), the ER folks and my doc had no problems believing what we told them about the snake's ID. My doc was also a herper, which helped, I'm sure.

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Re: Snake Bite First Aid

Post by VICtort » August 12th, 2012, 7:31 am

Glyptemys, thank you for sharing this surprising difficult to access information. Welcome to the forum and thankyou for posting, it is valuable information indeed and going to a receptive audience. I will no longer advocate for a constiction band between the bite and the heart as many have formerly suggested. It is truly amazing to me after all these years and medical knowledge advancement how little we collecively know about venomous snake bites, and the variations in venom even within a species. I read you loud and clear about that fasciotomy option...not without overwhelming consensus would I allow it.

Gratefully, Vic

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Re: Snake Bite First Aid

Post by hellihooks » August 12th, 2012, 7:53 am

So... there's a lady I know, who last year, got tagged in the heel by a speck. After 6 hrs of observation at St Mary's (Apple Valley) they sent her home as a 'dry bite'. Later that night, she suffered onset of symptoms and taken by ambulance to Loma Linda, where she was treated with the new antivenin in clinical trials, and spent 3 days at Loma Linda.
I don't understand how onset could be delayed by 10-12 hrs. Is it possible that the venom went directly into bone... and it took that long to work it's way into her lymphatic system?

She was able to ID the snake as a Speckled Rattlesnake only because I've relocated nearly a dozen of them, over the past several years, from the barn, where she raises rabbits... :roll:

Along with Mitchelli, she also has scutes and cerastes and possibly desert-clade helleri on her property.
She's pretty sure that this speck, that I relocated this spring, is the same one that tagged her last year. It was close to 3 ft.
Image
So yeah... in this case... an ID didn't initially help, as the bite was misdiagnosed as 'dry'. :|
BTW... her name is Karen Scott, in case anyone wants to look up her case, as 'unusual'.
Glyptemys.. I too, appreciate your comprehensive reply. Could you speak to the efficacy of cool packs, applied intermittently, during transit? I've heard that recommended, as a revision of 'ice pack' application, now known to do more harm than good. thx.. jim

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