Wilderness Medicine: Snake Bite Treatment

I’d like to talk to you a little bit
about treatment, and immediately aftersomebody’s bitten I guess the first
thing you’d advise is for them to panicand maybe scream that’s what I’d
probably do but of course the way weteach and the best thing to do is to not
panic easy to say in a lecture easy toread in a book but people are going to
be freaking out once you gather yourselflay low don’t panic and those around you
let them do the work of going for helpthe best thing you can do is remain calm
take a deep breath as we discussedbefore it may be a dry bite and you’re
not even envenomated or poisoned that’sthe best advice I could get so what
about all the stuff that we read aboutin first-aid books cutting sucking etc
well those are all dramatic again I lovethem in movies I’ve done it myself
self-inflicted snake bites but the bestthing to do first let’s talk about
cutting and sucking again dramaticyou’ve seen it where they take out their
buck knife they’ll cut through the fangmark and then just start sucking the
gojira’s out of the person’s arm or legor name a body part
don’t do it the human mouth hasbacterial flora nastiness that’s even
worse than the snake’s mouth so you’regoing to infect the wound by sucking on
it and worse yet your knife although youmean well is going to cut through
valuable structures like tendons nervesarteries veins you need those so people
who cut then suck are actually doingmore harm than good
don’t do it people have probably heardthat cold might be helpful how do you
feel about cold we used to feel thatcold usually it’s also called
cryotherapy applying cold or ice to thewound would help and in some bites like
bee stings some spider bites a littleice isn’t such a bad thing
snake bites we discourage it and we’veeven seen people trying to immerse an
entire arm in an ice bath don’t do itit’s actually going to cause more damage
thanbest thing to do is just to elevate the
arm above the level of the heart pushsome moral fluids because that’s
probably all you’re going to have in thewilderness you’re not going to have IV
fluids remain calmsend someone else to get help the best
thing you can have are car keys and acell phone and if so the treatment is
antivenom it is and it’s getting to afacility that has it there have been
some folks saying why don’t we haveanti-venom in the wilderness with
paramedics ready to goanti-venom also has risks when you
administer it it’s taken from horsesit’s taken from sheep so when you give
that to humans you may have an allergicreaction so it’s best to give the
anti-venom in the hospital setting so inthe wilderness the best thing you can do
start up a car make a cell phone call9-1-1 to a hospital facility so what’s
the deal with cro fab and why is itbetter than the old stuff
I love Crowe fab I think they’ve done agood job they have taken the anti-venom
and refined it to a much more pure typeof anti-venom so there’s not as much of
a chance of an allergic reaction as withthe old anti-venom it is more costly
like supercouple 20 or $30 per does ahtimes that by 10 exactly so it’s about
three four hundred a vial it’s expensiveso you don’t want to give it out
willy-nilly I know that’s not much of amedical term but don’t give it out
willy-nilly but you don’t want to giveit out just for every snakebite you want
to make sure there’s actual evidence ofenvenomations swelling of the arm
blistering systemic or total bodyeffects blood toxicity lab abnormalities
that reflect a systemic or total bodyand venom ation or poisoning that’s when
you give the anti-venom less chance ofallergic reaction with the new Crowe fab
it is more expensive and we’re findingit’s safer in kids and what’s
interesting about children is the snakeis confused by the size of the human
it’s a toddler or an adult like yourselfthe snake is going to inject the same
amount of venom so kids need the sameamount of anti-venom as adults you’re
you’re essentially treating the venomnot the patient in that way exactly we
always say treat the patient not thepoison treat the patient not the numbers
here you’re treating the poison thesnake is going to inject the same amount
of venom into little Johnny as it doesin to Grandpa Rex so because of that
you’re going to treat the patientwhether a toddler or a full-sized adult
with the same amount of anti-venom whenyou’re in the emergency department and a
patient’s been bitten you’re not sureyet if they’ve been envenomated do you
wait an hour do you wait two days atwhat point can you decide that the
patient’s probably good to go home mostbites you can see something within about
6 hours 4 to 6 hours you’re going tostart seeing swelling in the arm the leg
depending on where they were bitten theglands you look for swelling most pit
vipers rattlesnakes cottonmouths watermoccasins you’re going to see that
pretty rapidly particularly if there’smaybe a vein or an artery involved in
the envenomations so if you watch themsix maybe even stretch it to 12 and you
see no swelling lab just look good norabnormalities you can safely send them
home and reassure the patient theexceptions are mojave rattlesnakes they
may only have a little blood toxicitythey have a neuro or brain central
nervous system toxicity there may be adelay I would observe them for 24’s same
with coral snakes we don’t get that manycertainly in the East in Florida into
Texas here where we are Arizona NewMexico this type of coral snake is
really docile its shy you have to pickit up let it chew on your finger for
about an hour then you may getenvenomated
if you have those envenomations youprobably want to watch them for 24 hours
otherwise you can watch these patientsin the ER
if you’re going to see it it’ll manifestitself pretty quickly in some books they
talk about lymphatic or venousconstrictors what’s your feeling about
any kind of constriction okay the otherword for constriction is using
tourniquets or taking a bandana and wraptight knot around the arm or leg that’s
been bitten there’s really no role forthat particularly in the US with pit
vipers mostly because we have hospitalsers clinics that are pretty close
good paramedic system so I would adviseagainst it now if you’re away in the
wilderness and you’re a day or two outyou may want to do the 127 hour risk the
limb to save the life but that is reallyuncommon you’re probably not going to
need to do a tourniquet nowinternationally where we have neuro
toxic snakes like cobras crates you canloosely put them on even rotate them to
stop or impede lymphatic drainage thatspreads the neurotoxin
but Australians people from India Africathey’re very good at that leave it to
them in the US I’d shy away fromtourniquets avoid it and if you do put
it on put it on loosely so when we saytourniquet we’re not talking about the
tourniquet that most people imaginewhich is in arterial tourniquet correct
correct so it’s more of a superficialtourniquet and in the wilderness it’s
probably going to be like a rag abandanna something like that
maybe the tubing from your Camelback orwater receptacle would be a good
tourniquet but you’re not going to needto use those and in theory they say if
it’s too tight when you release ityou’ll get this bolus or injection of
venomnot true but probably what you’re going
to do is cause more limb arm legconstriction and bad healing and that
you don’t want to do I know that inAustralia people are using ace wraps
just for gentle lymphatic compressionwhat’s the deal with with kostik
compressas in something like an ace wrap I think
that’s fine as long as it’s not againtoo tight to taunt there’s nothing wrong
with that particularly if you’re out ina bit of ways from your closest ER
clinic hospital that’s going to be ableto see you I don’t see a problem with
that and certainly if there’s any othertrauma bleeding that can kind of help
with that and it gives the patient afeeling that you’re doing something and
the people that are around the patientthey may feel like they’re doing
something but again calm oral fluidscall 9-1-1 calmly drive them to the
closest ER is the best thing you can dothere are some commercial devices one in
particular is the Sawyer extractor rightwhat’s your feeling about the extractor
well there are extractors the one thatis most common is Sawyer it still talked
about even in Boy Scout manuals and theidea is as soon as the snake strikes
you’re going to take a little suctiondevice kind of cause a hickey and pull
back on a syringe and pull out some ofthe venom and in original studies they
thought we may get out maybe a quarterto a third of the venom and it may help
but what we’re finding now particularlywith good animal studies that it doesn’t
help in fact it may cause a little moredamage in the local area I know the
Sawyer people they’re outstanding folksI wouldn’t recommend it however a plug
for Sawyer they do a lot with waterpurification internationally and I think
they’re a fabulous product with theirwater treatment devices so I don’t want
to diss the Sawyer family but thesuction devices for the most part even
though there’s still advertised stilland wilderness kits still in emergency
kits are probably not going to help isit hard to explain the Hickey when you
get home it is particularly if you werestruck on the neck by the snake Tim I
know that you work at a big center whereyou see everything and I know part of
your practice includes treating exoticsnake bite right what you’re feeling
about people having exotic snakes aspets I’m against it I think it’s a
machismo thing i understand why people want it leave them be
particularly exotic snakes to get themin they have to be flown in or shipped
in internationally you’re taking themout of their habitat it’s the wrong
thing to do and then you’re not beingvery humane putting them in a confined
area you’re only going to get intotrouble and when people get bit by
exotic snakes in the US no one knowsreally how to treat them and other than
zoos you’re not going to have the properanti-venom it’s very dangerous it’s the
wrong thing to do don’t do it