Snakebite - what's the best method?

[Kaji]

By the time I was going through scouting the BSA had long disavowed the "suck and spit" method, but cutting Xs over the bite marks and using suction cups to try to suck out the venom (if such resources are available) WAS the method they were teaching. Looking over the Webelos handbook last week, it said that that method is nothing but a wive's tale, and that now you should basically just not do anything and call 911 ASAP (as though that's any good when you're 4 miles out on a hike!). It makes some mention of a brand name snakebite kit, but says nothing on its use, just that it CAN be used.

 

What methods are people teaching these days?

[CalicoPenn]

I've been teaching this method for years, ever since I became an EMT (with A (Ambulance - now generally called Basic (B), I (Intermediate), P (Paramedic) and W (Wilderness) designations)and saw a rather nasty training film on the results of some field snakebite treatments.

 

1) Wash the bite area with soap and water

 

2) Keep the site of the bite below the heart as much as possible.

 

3) Get to professional help as soon as possible.

 

4) If help is more than 30 minutes away, tie a 2" bandage above the wound to help slow the spread of the venom - not tight like a tourniquet, it should be loose enough to force a finger underneath the bandage.

 

5) If you feel you must use a snakebite kit suction cup, use it directly over the wound rather than making any incisions. You may be able to remove some of the venom, but then again, you may not.

 

Things not to do:

 

1) Do NOT make any incisions - it doesn't help and makes things worse. This harkens back to the old days when doctors would "bleed" wounds to remove the sickness from their patients. All you accomplish when making the incisions is to hide the actual wound from the doctor when he does see the patient, and giving the patient even more wounds to worry about.

 

2) Do NOT use an ice pack on the wounds - snakebite venom freezes much faster than blood will and its crstalline structure can do great damage once frozen, especially if the victim has quite a bit of venom in him. This relates to the film I alluded to earlier - one of the segments was on a snakebite patient whose leg was iced down at the wound site - within 30 minutes, the leg began splitting - leaving a rather gaping wound.

 

3) Do not use your mouth to try to suck out venom for two reasons: a) you're introducing more germs into the victims leg, and 2) you could swallow some of the victims blood and/or some of the venom and become a victim yourself.

 

Snakebites in the US are rarely fatal, even if they haven't been treated for a few hours - best to make the patient comfortable and get him/her to a hospital.

 

CalicoPenn

(This message has been edited by CalicoPenn)

[Beavah]

Nah, constricting bands went out after morbidity studies some years back. Drop #4.

 

For an American pit viper (rattlesnake, copperhead, etc.), clean & dress the wound, remove jewelry (rings, bracelets, etc.) and constricting clothing because the area may swell (and cut off blood flow). Splint loosely. Keep limb neutral (not above, but not distinctly below level of heart). Transport to professional care rapidly.

 

No suction of any kind (recent studies show the Sawyer Extractor uneffective or in some cases problematic).

 

No constricting bands of any kind.

 

Don't bother with ID'ing the snake, the antivenin is universal for pit vipers.

 

Da rules change for bad and badder snakes in other parts of the world, where you wrap the ENTIRE limb with a wide elastic bandage to reduce toxin transport toward the core, and you may need to ID the snake.

 

Best place as a physician to keep abreast of dis stuff is the Wilderness Medical Society.

 

 

[Kaji]

Virginia and West Virginia also have coral snakes and water moccasins to deal with. Those in the same family as well, or would either require special treatment as per the end of the post?

[kenk]

Great advice!!

 

From what I saw on some TV show that followed a supposedly well-known snake-bite doctor, the only thing I can add is the doctor did often ask witnesses to give a description of the snake, so if in the area, try to get a good look, but DO NOT try to catch or kill it!

 

Also, from what that show and others, it is apparently quite common for some snakes to not release venom during a strike. Apparently venom takes a time/resources to produce and so defensive strikes are often dry. Also many are have allergic reactions to anti-veom, so for those two reasons the doctor may wait to see how bad the reaction gets before going the anti-venom route.

[CalicoPenn]

Water Mocassins (aka Cottonmouths) are pit vipers, as are rattlesnakes and copperheads. Coral snakes are in a different family - related to cobras. The treatments for both are essentially the same, though pressure immobilization in a coral snake bite if help is hours away, should be considered. This is done by wrapping an elastic (Ace) bandage starting a couple inches above the bite and wrapping towards the heart for a few inches, then continuing the wrap by wrapping down over and beyond the bite for a few inches. It should be wrapped about as tight as wrapping a sprained ankle. The idea behind this is to slow the spread of the venom through the lymphatic system (that's how venom travels through the body).

 

The same principle works with compression bands - Beavah mentioned that constriction bands are out, but while thats correct in most instances, especially when help is near at hand, if you're deep in the wilderness, constriction bands are still considered a viable option to slow the spread of venom. The main concern with constriction bands is that they may promote increased tissue necrosis (deterioration of tissue) at the bite site as snake venom, particularly in pit vipers, helps with digestion by breaking down tissue. The "but" here is that if you're deep in the wilderness, tissue necrosis is likely the least of your worries - keeping the venom from vital organs for as long as possible is the goal. Tissue necrosis can be treated.

 

CalicoPenn

 

[Beavah]

While it's important to understand that the field management of various snakebites is still an active area of research, a few comments/corrections to Calico's last are in order.

 

1) Pressure immobilization is generally advised for Elapidae (coral snake, cobra, and other snakes with high levels of neural toxins). That should be done with an Ace bandage, starting at the bite site and wrapping toward the heart as Calico suggests, but wrapping the ENTIRE LENGTH OF THE LIMB, not just a few inches. The pressure should be eqivalent to 40-70mmHg for an arm or 55-70mmHG for a leg... call it just a bit looser than what you'd do for a sprained ankle.

 

There's no good reason to use a compression band instead of this form of pressure immobilization, and several reasons not to.

 

2) Any form of pressure immobilization is no longer considered viable treatment for pit viper envenomation, mostly because of the tradeoff between local tissue necrosis and systemic effects as Calico suggests. Simply put, since pit viper bites are unlikely to be fatal, it is not worth sacrificing a limb. First, do no harm. Even trained physicians and emergency workers generally do a poor job of properly applying and managing pressure immobilization and constricting bands. In the "deep woods" the (relatively small) delay in envenomation progress is not sufficient to prevent systemic effects in any event.

 

For rattlesnake bites, teach your kids and adults to remove jewelry, clean, dress, splint loosely, and transport. Especially as a civilian responder on a scout outing in the U.S., don't use any type of constriction or pressure for a pit viper bite, and don't worry about above/below the heart.

 

[anarchist]

high all,

 

First- Kaji...good to see and old OCCOQUAN scout on the forum (Woodbridge Va ca 1963-66)

 

both Beavah and Calico have great info...(CDC approved stuff) most recent studies are at best dubious- that any usefull amount of toxin can be evacuated with the current civilian suction devices...are doubtfull...washing/letting it bleed a bit are safe and at least neutral if not somewhat beneficial.

 

mild imobiization (splinting), shock management, (trying to keep victim calm is the real trick) and heart level 'elevation' are appropriate. light clean bandage is appropriate from a wound management perspective

 

...a swig of wiskey, cutting a "X's"nd sucking out poison, tying off the old blood flow - all the old cowboy garbage are not helpful or safe...even coffee or tea are not to be given- water to drink is ok ...easy does it though..

 

Depending on your situation, You may even let a victom self-evacuate... if you can keep the heart rate down..(slow and easy)..but transport by others is recommended.

 

"In hospital"-Each bite is actually treated (in many circumstances) differently -once the victim is at the hospital... the snake discription is taken and the wound assessed- sometimes antivenin (real name of 'antivenom')is not used...at least right away ...due to being developed in equine serum many folks have a bad reaction to the antivenin...so a pause make occur while they try to determine how much of a problem they have or don't have.

 

Some snakes (for various reasons) do not inject, or do not inject a full "pay load". And many in the medical community will attempt to determine if there is gonna be a raging reaction or just a mild one..or even no serious outcome. (Heck, it seems that some have less potent venom -either genetically or environmentally driven).

 

Coral snakes may call for pressure bandaging by Ace bandages or crepe gauze but the number of coral snakes biting people in the U.S. is statistically insignificant...many more people suffer more life threatening injuries taking a bath than from coral snakes...seems they do not have the best 'delivery' system for envenomization...and it is true of all snake bites combined in the U.S.- bee strings kill more people...

 

good luck and watch the timber rattlers..though I think they are all in the den playing cards this time of year.

 

good chatting

anarchist

 

[johndaigler]

Great thread, guys. Thanks.

 

jd

[ManassasEagle]

Just a point of information (and I'm in the other end of Prince William as in Bull Run District) but there are no Coral snakes native to Virginia. The only venomous ones we have are the Cottonmouth (Water Moccasin), Copperhead, and Timber Rattler (some count the Canebrake Rattler as a fourth, others consider it a type of Timber Rattler).

 

I don't know about West Virginia

[anarchist]

Discussion of coral snakes seemed appropriate since they were mentioned-lots of scouts go to Seabase etc..

 

Coral snakes (two "kinds in the US-Eastern and western- red and yellow kill a fellow!)

are native to the southern United States (south East N.C. to Mississippi, Florida keys and then to the deserts or Arizona...etc., as ManassasEagle notes not native to Virginia nor seemingly to West-by-god-Virginia. And as an informational point Manassas Eagle; the cotton mouth/water moccasin is only native to the far southeastern portion of Virginia (Dismal Swamp area and somewhat south west) though lots of poor norther and southern brown watersnakes get killed "as" water moccasins by our fellow northern Virginians.

 

slithering along

anarchist

[lynncc]

Oh we are so lucky here in NE texas. We have every poisonous snake native to North America. We have your copperhead - in great abundance. The watermoccasin/cotton mouth - again in great abundance around all our creeks/ponds/lakes etc...your rarely seen but still present coral snake as well as the often killed non poisonous king snake (red on yellow - friendly fellow) most people just chop the heads off before they decide if it is red on yellow or red on black. And of course the ever popular rattle snake. Not as common as other parts of the state but still can be found. YIPPEEEE. Wanta go for a hike...

 

lynncc

[anarchist]

lynncc,

 

not to be a picker of nits...but you have made a common mistake in the recall of the "ditty" to I.D. corals

 

should be:

 

Red on yellow, dangerous fellow"

"Red on black, friend to Jack"

 

"Red on yellow, kill a fellow"

"Red on black, venom lack"

 

please review your source material...such a poem could get a boy bit....('course,... with some kids it might be...well no, I guess we need to tell them correctly)

 

for further ID...all corals start with black nose....

best of all just don't mess with them...sort of like Texas (huh?)

 

guess I'll just shed and run...

Anarchist

 

 

[lynncc]

OOPs my mistake. Good thing I tell my son if any snake is in the wild just leave it alone. Now was that red on black. geen on red what was that again. does it have vertical slits in their eyes (I think that means they are poisonous in the US) do they have little pits on their heads. Is the head triangle shaped....just leave it alone. If you are that close to a snake to figure all that out then you are to close.

 

I used to think the only good snake was a dead one. I have changed my mind about that. They eat rodents and other things eat them. Everyone needs to eat. I still do not want to see them in the wild. They scare me. I don't know why I am so afraid of being bitten. But oh well. I'll stick with my boa who is safely tucked away in his cage, lounging around wait for sunday when I wiggle that thawed out mouse in front of him.

 

Thanks for pointing out my mistake. I will be more careful next time I post. Thanks again.

 

lynncc

[le Voyageur]

I've had to deal with snakebites in the backcountry. If you're a MD, EMT, W-EMT, etc. pm me for my technique....