Snake Bite

bob91yj

Adventurist
Founding Member
#1
http://news.yahoo.com/man-survives-snake-bite-wash-zoos-antivenin-004609479.html

This article and the rattler under a chair at DRV are a reminder that we need to be aware of venomous snakes/insects when we are travelling.

Dave posted this on another forum a while back. With so much conflicting info and "snake bite" kits sold at stores, I thought it was good info...good enough that I printed it out, include it in my first aid kit.

Excerpt from our US Navy Corpsman Field Medicine Manual circa 2008

TERMINAL LEARNING OBJECTIVES

1. Given an envenomation casualty, in a combat environment, and standard field medical equipment and supplies, manage envenomation injuries, to prevent further injury or death. (FMST 04.05)
ENABLING LEARNING OBJECTIVES

1. Without the aid of references, given a list of symptoms, identify the type of venomous snake, per the student handout. (FMST 04.05a)
2. Without the aid of references, given a list of symptoms, identify the type of arthropods, per the student handout. (FMST 04.05b)
3. Without the aid of references, given an envenomation casualty, identify the appropriate treatment, per the student handout. (FMST 04.05c)

1. OVERVIEW

a. Envenomation - An injury or illness caused by the poisonous secretion of an animal, such as a snake, spider, or scorpion, usually transmitted by a bite or sting.

b. Mortality rates - Of all the deaths that occur annually due to envenomation injuries, the majority are caused primarily by insects followed by snakes, then spiders.

2. CLASSIFICATIONS OF POISONOUS SNAKES

a. Crotalidae Family (Pit Vipers)

(1) Characteristics:

(a)Retractable fangs
(b)Heat sensing pit located below the nostril
(c)Large triangular shaped head (in relation to their body)

(2) Examples of Pit Vipers:

(a)Rattlesnakes- Found in the New World only, from the U.S. through Central and South America
(b)Saw-Scaled Viper- Found from Pakistan, throughout the Mid East to Africa (See fig. 2)
(c)Cottonmouth (Water Moccasin, Pilot Snake)- Found throughout Southern and Eastern U. S. (See fig. 3)
(d)Copperhead (Upland Moccasin)- Found in the eastern U. S.
(e)Habu- Found throughout Southeast Asia, including Okinawa

b. Elapidae Family

(1) Characteristics:

(a)Fixed Fangs
(b)Round pupils
(c)Head width is proportionate to body size
(2)Examples
(a)Coral Snakes- Found throughout Southern U.S. to South America, and parts of Asia (See fig. 4)
(b)Cobra –Found from South Asia through Mid East and North Africa (See fig. 5)
(c)Krait- Found throughout South Asia including Pakistan (See fig. 6)

c. Hydrophidae (Sea Snakes)(See fig. 7)

(1)Characteristics:

(a)Fixed fangs
(b)Flat tail
(c)Most are brightly colored (except the Olive Sea Snake)

(2) Example - For medical purposes, size, location and species are irrelevant. Determination of species is too difficult and dangerous to matter. Sea snakes are found throughout the world but mostly in the southern Pacific and Indian ocean. Some are found in estuaries.

d. Colubridae (Most Colubridae are not poisonous)

(1) Characteristics:

(a)Fixed fangs in rear of mouth
(b)Large eyes and small pointed head

(2) Example of venomous Colubridae:
(a) Boomslang- Found throughout the African Savannah

3. ACTIONS OF SNAKE VENOM

a. Snake venoms are chemically complex mixtures of proteins, which have mostly enzymatic properties. The quantity, lethality, and composition vary with the species and the age of the snake, the geographic location, and the time of the year. Venom is highly stable and is resistant to temperature changes, drying, and drugs.

(1) Hemotoxin - Destruction of the capillary cells with resultant leakage
(2) Neurotoxin - Has a paralytic effect

b. Snake venom may include elements that produce both of these effects

4. DIAGNOSING A SNAKE BITE

a. Fang Marks - Fang marks may be present as one or more well defined punctures, or as a series of small lacerations or scratches, or there may not be any noticeable or obvious markings where the bite occurred. The absence of fang marks does not exclude the possibility of envenomation (especially if a juvenile snake is involved). However with rattlesnake envenomation, fang marks are invariably present and are generally seen on close examination. Bleeding may persist from the fang wounds. The presence of fang marks does not always indicate envenomation; rattlesnakes when striking in defense will frequently elect not to inject venom with the bite, resulting in a “dry bite.” Manifestations of signs and sypmtoms of envenomation are necessary to confirm diagnosis of a snake venom poisoning.

b. Signs and Symptoms:

(1) Crotalidae Bite: Symptoms vary depending on the type of snake, and the amount of venom deposited, i.e. younger rattlesnakes tend to dispense all of their venom in relation to a larger, older rattlesnake dispensing either none or a larger amount. Death may occur within 24-48 hours if left untreated. Even with treatment, there is the possibility of loss of effected extremity or a portion of it.

(a)Excruciating pain at the site of the bite.
(b)Presence of fang marks.
(c)Tissue swelling at the site of the bite. Swelling begins within 3 minutes and may continue for up to an hour with enough severity to break the skin.
(d)Severe headache and thirst.
(e)Bleeding from major organs that may appear as hematuria.
(f)Destruction of blood cells and other tissue cells. Discoloration of surrounding tissue.
(g)Tingling or numbness of face and scalp
(h)Muscle fasciculation

c. Elapidae and Colubridae Bite:

(1) Impairment of circulation

(a)Irregular heartbeat
(b)Hypotension
(c)Weakness and exhaustion
(d)Circulatory system collapse
(e)Lowered blood pressure

(2) Severe headache, dizziness, blurred vision, hearing difficulty, confusion and unconsciousness
(3)Nausea, vomiting and diarrhea
(4)Chills and rapid onset of fever
(5)Muscular incoordination and twitching
(6)Excessive perspiration
(7)Respiratory difficulty leading to respiratory arrest

d. Hydrophidae Bite:

(1)Stiffness, muscle aches and spasms of the jaw.
(2)Moderate to severe pain to the effected limb.
(3)Blurred vision and drowsiness.
(4)Respiratory paralysis.

e. Persistent myths about sea snakes include the mistaken idea that they cannot bite effectively. The truth is that though their teeth are small; about 2.5 mm, they are adequate to penetrate skin and they can open their mouths wide enough to bite a person’s thigh. Envenomation from sea snakes is rare, due in most part to their temperament, but does occur. Without treatment, death from sea snake envenomation can occur within 12-24 hours.

5.TREATMENT OF A SNAKE BITE

a.Most definitive care for snake envenomation is anti-venom.
b.Keep the victim calm and reassured. If possible, allow the limb to rest at a neutral level in relation to the victim’s heart.
c.Locate the bite site
d.If the bite is on the hands or feet, immediately remove any rings, bracelets, watches or any constricting items from the extremity.
e.Wrap leg or arm rapidly with 3” to 6” ACE bandage past the knee or elbow joint to immobilize it. Leave the fang marks open.
f.Apply a splint
g.Check distal pulses
h.Monitor and evacuate ASAP

i. COMMON DON’TS

(1)DO NOT cut or incise the bite site
(2)DO NOT apply ice or heat to the bite site.
(3)DO NOT apply oral (mouth) suction.
(4)DO NOT remove dressings/elastic wraps.
(5)DO NOT try to kill the snake for identification as this may lead to other people being bitten.
(6)DO NOT have the victim eat or drink anything.

6. PREVENTION OF SNAKE BITES

a. LEAVE THE SNAKE ALONE!! - This is the best way to avoid snakebite. Most snakes will only bite if threatened. Most snake bites occur when the victim is attempting to catch, kill or play with a snake. Keep hands out of areas that you cannot see (i.e. holes, under rocks and under logs).

7. ARTHROPOD ENVENOMATION

a. Bees, Wasps and Ant Stings- Most of this group sting their victims. Their primary effect is from the strong histamine reaction they cause.

(1) Signs and Symptoms:

(a)Bee/Wasp stings – Honey bees only sting once and leave the stingers and venom sac embedded in the skin. Wasps, hornets, and bumble bees can sting multiple times.

1.Pain
2.Itching/burning sensation
3.Wheal – Raised, inflame skin
4.If patient is allergic, monitor for anaphylactic reaction

(b) Ant sting - Some species of ants, especially the fire ant, can bite and sting repeatedly.

1.Pain
2.Itching/burning sensation
3.Vesicles
4.If patient is allergic, monitor for anaphylactic reaction
5.Multiple bites – can produce the following symptoms:

a.Vomitting
b.Diarrhea
c.Generalized edema
d.Hypotension – due to vasodilation
e.Dysuria

(2) Treatment:

(a) Stingers should be removed immediately to prevent more venom from entering the victim.

1.Remove the stinger by scraping across the skin with a knife blade, ID card or similar object. Grasping the stinger with tweezers only injects the remaining venom into the victim.

(b)Apply ice to the affected area
(c)Apply Hydrocortisone Cream 1% to affected area BID (twice a day)
(d)For anaphylaxis:

1.Benadryl injectable 50mg SQ
2.Epinephrine 0.3-0.5mg 1:1000 SQ

(3) Prevention:

(a)Leave them alone
(b)Avoid nesting sites
(c)Personnel with known allergies should carry an Epi-Pen or Ana-kit

b. Centipedes, Millipedes, and Caterpillars

(1) Signs and symptoms:

(a) Millipedes - Millipedes secrete a toxin on their skin

(1)Itching
(2)Burning

(b) Centipedes - Caused by a bite:

(1)Immediate severe pain
(2)Redness
(3)Swelling
(4)Necrosis and ulceration may sometimes occur

(c) Caterpillars - Some caterpillars have venom in hollow hairs all over their bodies.

(1)Severe burning
(2)Pain
(3)Redness
(4)Swelling
(5)Necrosis

(2) Treatment:

(a)Similar to that of a bee sting. Focus mainly on anaphylactic reaction.
(b)For millipedes, wash skin with soap and water to remove secretions.
(c)For caterpillars, use scotch tape to remove hairs from skin. Do not rub area.

(3) Prevention:

(a)Leave them alone
(b)Avoid known nesting sites and hives
(c)Shake out sleeping bags and clothing and check boots before putting them on.

c. Spider Envenomation:

(1)Black Widow Spider - Only the female bites and has a neurotoxic venom

(a)Description – Glossy black with a red hourglass on the underside of the abdomen. Other species of widow spiders include Brown and Red Widows. All are poisonous and all have a red hourglass pattern on abdomen.

(b) Signs and Symptoms:

1.Initial pain is not severe, but severe local pain rapidly develops
2.The pain gradually spreads over the entire body and settles in the abdomen and legs
3.Weakness
4.Sweating
5.Excessive salivation
6.Rash may occur
7.Tremors
8.Nausea
9.Vomiting
10. Respiratory muscle weakness combined with pain may lead to respiratory arrest
11. Anaphylactic reactions can occur, but are rare
12. Symptoms usually regress after several hours and are usually gone in a few days

(c) Treatment:

1.Clean site with soap and water
2.Intermittent ice for 30 minutes each hour
3.Supportive care
4.Antibiotics if infection occurs

(2) Brown Recluse Spider - Venom is cytotoxic. (Necrotic in nature)

(a) Description- They are small, light brown, and have a dark brown violindesign on the top of their thorax.

(b) Signs and symptoms

1.Painless bite. Most often, the victim does not know they have been bitten.
2.A painful red area with a cyanotic center appears after a few hours.
3.A macular rash (a discolored area of skin that is not raised above the surface) may occur.
4.After 2 or 3 days, there is an area of discoloration that does not blanch with pressure.
5.After a week or two, the area turns dark and the scab falls off leaving an ulcer.
6.After this happens, secondary infection and regional lymphadenopathy occur.
7.The ulcer will persist for weeks or months.
8.In many cases a systemic reaction may occur that is serious and may lead to death.
9.The systemic reactions occur mainly in children and include fever, chills, joint pain, splenomegaly, vomiting, and a generalized rash. These reactions may occur at any time that the ulcer is present.

(c) Treatment:

1.Cold compresses intermittently for the first four (4) days
2.Apply bacitracin
3.It is necessary to excise all the indurated (hardened) skin and fascia before healing will begin.
4.If the ulcer is not excised, it will continue to grow until it is several inches in diameter.
5.Provide supportive care as necessary.
6.Tetanus prophylaxis and antibiotics are necessary to control secondary infection.
7.Anaphylactic reactions may occur.

d. Scorpion Envenomation:

(1) Description - These arthropods inhabit temperate climates around the world and number greater than 650 species. Fifty species can cause serious injury.

(a) The most dangerous scorpions in the U.S. inhabit Arizona and portions of California, Texas, and New Mexico. Although the size and shape of these arthropods can be both intimidating and frightening, envenomation, although potentially painful, very rarely produces mortality in humans.

(2) Signs and Symptoms:

(a)Erythema
(b)Edema
(c)Local pain and or paresthesia (an abnormal touch sensation such as burning or prickling often in the absence of external stimulas) at site of sting.
(d)Pain or paresthesia remote from the site of sting in addition to local
findings.
(e)Cranial nerve dysfunction - Blurred vision, wandering eye movements,
hypersalivation, trouble swallowing, tongue twitching/spasms,
problems with upper airway, slurred speech.
(f)Somatic skeletal neuromuscular dysfunction - Jerking of extremity(ies), restlesness, severe involuntary shaking and jerking that may be mistaken for a siezure.

(3) Diagnosis:

(a) Positive “Tap Test”: excruciating pain when tapping on the affected area. This is the only true way to diagnose a scorpion sting.

(4) Treatment:

(a)Based on the level of envenomation
(b)ABC’s
(c)Ice applied to the site for 30 minutes each hour until symptoms subside
(d)Oral analgesics

(5) Prevention:

(a)Wear shoes
(b)When in the field, bedclothes, sleeping bags, and shoes should be shaken out prior to use
(c)Many scorpions inhabit brush and debris piles in search of its prey. If one is coming in contact with this type of material, it is wise to wear gloves.
(d)Remove wood and rubbish piles around camp
(e)Cracks and recesses in rural desert dwellings should be filled

REFERENCES
Tropical Medicine (7th ed.), Pgs 877-888
Wilderness Medicine (3rd ed.), Ch 28, pgs 680-884, 704-705; Ch 31, pgs 743-768
Hospital Corpsman NAVEDTRA 14295, Pgs 5-12
Poisonous Snakes of the World, NAVMED P-5099 Pgs 83, 107, and 117
 

Mitch

Adventurist
Founding Member
#2
I was told at DRV that the fancy snake bite kit with the plunger extractor is worthless??

I notice that the kits aren't mentioned here, and some popular "do" items are on the "DO NOT" list!
5.TREATMENT OF A SNAKE BITE

a.Most definitive care for snake envenomation is anti-venom.
b.Keep the victim calm and reassured. If possible, allow the limb to rest at a neutral level in relation to the victim’s heart.
c.Locate the bite site
d.If the bite is on the hands or feet, immediately remove any rings, bracelets, watches or any constricting items from the extremity.
e.Wrap leg or arm rapidly with 3” to 6” ACE bandage past the knee or elbow joint to immobilize it. Leave the fang marks open.
f.Apply a splint
g.Check distal pulses
h.Monitor and evacuate ASAP

i. COMMON DON’TS

(1)DO NOT cut or incise the bite site
(2)DO NOT apply ice or heat to the bite site.
(3)DO NOT apply oral (mouth) suction.
(4)DO NOT remove dressings/elastic wraps.
(5)DO NOT try to kill the snake for identification as this may lead to other people being bitten.
(6)DO NOT have the victim eat or drink anything.
Confusing when many places like REI and Sport Chalet sell the damn kits.
 

bob91yj

Adventurist
Founding Member
#3
^^^^ With all of the conflicting methods of dealing with snake bites I was happy to see Dave post the military version of treatment. I figure the military is trying to save lives rather than make a couple $$$'s. The printed copy in my first aid kit should settle any arguments that may arise between "faith and mysticism" and documented treatment methods should the situation ever arise.
 

Trump

Adventurist
Senior Staff
Founding Member
#5
Yes, many "snake oil" kits are out there and will do nothing more than make you feel prepared and make bites worse.

A little review here commenting on those type kits:
The body of research into snakebites and envenomation in general, as well as the basic physiology of humans and the morphology of most snakes large enough to bit a human just do not support the use of a negative pressure device such as the Extractor or Aspivenin. In most cases the only effect is an increase in localized necrosis. Anecdotal stories of someone using one and having "saved their life" is almost assuredly the result of a dry bite, which several venomous snakes routinely do in a defensive behavior (versus offensive, such as killing prey). If you want to truly prepare for a venomous snake bite (or insect, spider, etc) go take a First Responder course, become familiar with the species that occur in the area you will be in, and take appropriate precautions and preparedness measures. These would include wearing protective chaps, gloves, etc when in high risk areas and having a plan to execute in the event one of your party was bitten. Carrying one of these suction devices should not give anyone the feeling that they are prepared for a venomous bite, and it's just bad to think otherwise. These are indeed "old school" in they presuppose that your finger, hand, arm, leg, whatever is a static vessel into which something bad has been deposited and it can simply be sucked out. Instead, you have a fairly high constant metabolic rate that ensures any materials that are in your circulatory system will almost instantaneously be moved along.

And though it doesn't matter, for the record in case it's perceived I'm talking from some non-informed position I hold a doctorate in Physiology, Morphology and Behavior of Reptiles and Amphibians from an Ivy League school and have worked in the desert southwest of the US interacting with venomous snakes, insects and spiders for 20 years.

Mike R

a decent review (http://www.llu.edu/llu/grad/natsci/h...snakebite.html)
 

Jonathan Hanson

Adventurist
Founding Member
#7
Here I am! Just discovered the forum thanks to Tim Bleau.

However, in this case there's little reason for me to pontificate. The "common don'ts" section of the military guide sums up proper first-aid treatment excellently. The axiom is that the best field treatment for snake bites is a set of car keys and a Google map to the nearest hospital. (However, the mention that rattlesnakes "frequently" do not inject venom is optimistic—the best estimates indicate that perhaps 25 percent of such bites are "dry.")

It's true that the Extractor has failed to show efficacy in controlled tests. The only anecdotal support I've heard for its use was mentioned by a herpetologist friend, who said he thought the distraction provided for the victim by being able to actually do something while being driven to a facility might help keep him calm, which would be a huge benefit. I actually try to keep a pair of Extractors handy at our house along with a sealable container; my plan if I'm ever bit while walking to the bathroom or something equally stupid is to go ahead and apply the device and save the extracted liquid so it can be analyzed.

There is some evidence that pressure immobilization (i.e. wrapping the bitten limb snugly with an Ace bandage or something similar) can delay the onset of symptoms in elapid envenomation. However, proper tension is critical, and even subjects taught the technique in controlled conditions have frequently applied the constricting band improperly. Recently a first-aid chapter in a motorcycling book recommended the treatment for any venomous snake bite, which is incorrect.

The Extractor is far from the worst product on the market. You can still find the nasty little suction-cup kits complete with lancet for incising the bite, and a tourniquet. I'm amazed that company hasn't been litigated out of existence by some poor soul who used it and then lost an arm or leg.

There is a place for the stun guns that were claimed to "neutralize" venom some decades ago. If you're bitten and a friend is driving you to the hospital, you can occasionally nail him with it and yell, "Drive faster!"
 
Last edited:

Trump

Adventurist
Senior Staff
Founding Member
#8
There is a place for the stun guns that were claimed to "neutralize" venom some decades ago. If you're bitten and a friend is driving you to the hospital, you can occasionally nail him with it and yell, "Drive faster!"
:rofl

Welcome aboard, Jonathan.
 

Mitch

Adventurist
Founding Member
#12
Rattlesnake under a chair at DRV? What happened? Was the snake harmed?
The long story??? Ok...

So we're sitting around the group campfire, which is in the middle of a huge clearing, some of us talking, some of us dozing, it was getting late... It wasn't really hot or cold out, but we had a decent fire going. I'm sitting next to Mark (SWR) who is dozing off here and there, and Mark is sitting across from Mark (Trump)... Trump and I hear a noise in SWR's direction. As I hear it, I also look and noticed movement as well. Trump thought he farted. I didn't think it was a fart, but I had to know what the movement/noise was. I don't think we've met, Quartermain, but I'm the guy with the flashlight that reacts to most sounds, Just ask Barlow! haha!

So I hear the sound, and see movement under SWR's chair.. I usually have a flashlight in hand but this time, it was my head lamp that was sitting in the cupholder of my chair.. So I grab that and get some light under SWR's chair... I spot a baby sidewinder about maybe 14-16 inches long sitting under his chair. 12-16 inches is ok to me, a snake can only strike about half of its body length. Or so I've been told, and after this, I find out a lot of what I'm told about snake bites and the myriad of kits for bites is a bunch of...well, as Trump put it...Snake Oil!

At first, I'm thinking of how to handle this, it's not moving at the moment, so what do I have SWR do? Jump up from his chair?? So I said "MARK!....dude,...lift your legs up, and hold them out straight!" as I began to alert the 6-8 people sitting around the camp that we have a venomous visitor, and he's too close for comfort to Mark. So we grab a stick attempt to nudge him away, and he moves towards where Mark's feet used to be, closer to the fire ring.

Here he is after he's scooted from under SWR's chair
sidewinder.jpg

He didn't seem to have a problem getting close to the flames, crawling between the rocks that made the fire ring, he moved his way into the ring.

So now we're faced with another problem... He's not doing his part and running away from the scary humans, and he isn't doing much in the way of rattling or coiling for attack either. I don't think I heard him rattle after that 1/4 second burst he let out when we discovered him. With him refusing to leave the campfire area, we can't walk away knowing others might walk up to the campfire unaware of the little guy enjoying the fire. And we can't just shoo him away a few feet and still sit there comfortably.

Linda (suntinez) tells us she has a fire poker, the kind with the hook, which she retrieves for us. Trump took that and began to wrangle the snake. It took awhile to get him away from the fire ring, but once we did, Trump got him aboard the poker, and we decided to relocate him to the area south east of the camp fire where the bush line begins.

After a long walk with a little snake on a short poker, we relocated him well away from people.

And once again, MY idea of using my .40 snake rounds was voted down.
 

Mitch

Adventurist
Founding Member
#13
BTW, when the snake moved, it moved in a sideways manner most times... And I made the comment at the campfire that it was a sidewinder... Some said no, but after looking on google images for Sidewinder Snake, and comparing the markings to our photos... I'm convinced it was. Not that they are uncommon in the deserts of CA, they are, but I'd never seen one before up close and alive.

The evil looking eyebrows these things have...ugh!
 

Quatermain

Adventurist
Founding Member
#14
Scary. Glad no one was hurt.

I saw a Southwestern Speckled Rattlesnake last time I camped at Joshua Tree, but nowhere near as up close and personal as you did.

I think moving the little guy was definitely the braver thing to do.
 
#15
Hey! I wasn't dozing! I was resting my eyes, and dreaming of my next beer!:clang

And! I never Fart around a group campfire! Little white doves swoop down and carry them off!:cool:

Very Accurate story Mitch! That's exactly how I remember it. I remember Trump/Mark yelling out! And I knew something was up big time! I could not hear it, I guess because it was under my chair and the sound was moving out, not up. Scary!

Yes that was very scary! Glad to finally see a pic! Thanks for posting that! I wanted to see it again. That does not look like a diamond back. But I have never seen a sidewinder in socal. We need confirmation on what that really was.

It was actually a good abb exercise! ;)
 

Jonathan Hanson

Adventurist
Founding Member
#17
Yes, a sidewinder. Beautiful, and 18 inches is adult size for them, although they can grow to 30 inches or so.

And I agree, much better to relocate it. Rattlesnakes are pitifully easy to kill once you've spotted them; no reason to do so if it's not an immediate threat.
 

suntinez

Adventurist
Founding Member
#18
After a long walk with a little snake on a short poker ...
There's a quote here somewhere ... but it won't be me saying it! Good job getting the visitor relocated Mark.

Quite a few scorpions showed up too, Brent got a little nip as we were packing up to leave. Someone had a first-aid app on their iphone. Woefully inadequate should something major happen, but at least somewhat helpful for panicky people when emergency strikes.
 
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