Rehab Cell

Physical Medicine and Rehabilitation

Wilderness Medicine: Snake Bite Treatment

I’d like to talk to you a little bit
about treatment, and immediately after somebody’s bitten I guess the first
thing you’d advise is for them to panic and maybe scream that’s what I’d
probably do but of course the way we teach and the best thing to do is to not
panic easy to say in a lecture easy to read in a book but people are going to
be freaking out once you gather yourself lay low don’t panic and those around you
let them do the work of going for help the best thing you can do is remain calm
take a deep breath as we discussed before it may be a dry bite and you’re
not even envenomated or poisoned that’s the best advice I could get so what
about all the stuff that we read about in first-aid books cutting sucking etc
well those are all dramatic again I love them in movies I’ve done it myself
self-inflicted snake bites but the best thing to do first let’s talk about
cutting and sucking again dramatic you’ve seen it where they take out their
buck knife they’ll cut through the fang mark and then just start sucking the
gojira’s out of the person’s arm or leg or name a body part
don’t do it the human mouth has bacterial flora nastiness that’s even
worse than the snake’s mouth so you’re going to infect the wound by sucking on
it and worse yet your knife although you mean well is going to cut through
valuable structures like tendons nerves arteries veins you need those so people
who cut then suck are actually doing more harm than good
don’t do it people have probably heard that cold might be helpful how do you
feel about cold we used to feel that cold usually it’s also called
cryotherapy applying cold or ice to the wound would help and in some bites like
bee stings some spider bites a little ice isn’t such a bad thing
snake bites we discourage it and we’ve even seen people trying to immerse an
entire arm in an ice bath don’t do it it’s actually going to cause more damage
than best thing to do is just to elevate the
arm above the level of the heart push some moral fluids because that’s
probably all you’re going to have in the wilderness you’re not going to have IV
fluids remain calm send someone else to get help the best
thing you can have are car keys and a cell phone and if so the treatment is
antivenom it is and it’s getting to a facility that has it there have been
some folks saying why don’t we have anti-venom in the wilderness with
paramedics ready to go anti-venom also has risks when you
administer it it’s taken from horses it’s taken from sheep so when you give
that to humans you may have an allergic reaction so it’s best to give the
anti-venom in the hospital setting so in the wilderness the best thing you can do
start up a car make a cell phone call 9-1-1 to a hospital facility so what’s
the deal with cro fab and why is it better than the old stuff
I love Crowe fab I think they’ve done a good job they have taken the anti-venom
and refined it to a much more pure type of anti-venom so there’s not as much of
a chance of an allergic reaction as with the old anti-venom it is more costly
like supercouple 20 or $30 per does ah times that by 10 exactly so it’s about
three four hundred a vial it’s expensive so you don’t want to give it out
willy-nilly I know that’s not much of a medical term but don’t give it out
willy-nilly but you don’t want to give it out just for every snakebite you want
to make sure there’s actual evidence of envenomations swelling of the arm
blistering systemic or total body effects blood toxicity lab abnormalities
that reflect a systemic or total body and venom ation or poisoning that’s when
you give the anti-venom less chance of allergic reaction with the new Crowe fab
it is more expensive and we’re finding it’s safer in kids and what’s
interesting about children is the snake is confused by the size of the human
it’s a toddler or an adult like yourself the snake is going to inject the same
amount of venom so kids need the same amount of anti-venom as adults you’re
you’re essentially treating the venom not the patient in that way exactly we
always say treat the patient not the poison treat the patient not the numbers
here you’re treating the poison the snake is going to inject the same amount
of venom into little Johnny as it does in to Grandpa Rex so because of that
you’re going to treat the patient whether a toddler or a full-sized adult
with the same amount of anti-venom when you’re in the emergency department and a
patient’s been bitten you’re not sure yet if they’ve been envenomated do you
wait an hour do you wait two days at what point can you decide that the
patient’s probably good to go home most bites you can see something within about
6 hours 4 to 6 hours you’re going to start seeing swelling in the arm the leg
depending on where they were bitten the glands you look for swelling most pit
vipers rattlesnakes cottonmouths water moccasins you’re going to see that
pretty rapidly particularly if there’s maybe a vein or an artery involved in
the envenomations so if you watch them six maybe even stretch it to 12 and you
see no swelling lab just look good nor abnormalities you can safely send them
home and reassure the patient the exceptions are mojave rattlesnakes they
may only have a little blood toxicity they have a neuro or brain central
nervous system toxicity there may be a delay I would observe them for 24’s same
with coral snakes we don’t get that many certainly in the East in Florida into
Texas here where we are Arizona New Mexico this type of coral snake is
really docile its shy you have to pick it up let it chew on your finger for
about an hour then you may get envenomated
if you have those envenomations you probably want to watch them for 24 hours
otherwise you can watch these patients in the ER
if you’re going to see it it’ll manifest itself pretty quickly in some books they
talk about lymphatic or venous constrictors what’s your feeling about
any kind of constriction okay the other word for constriction is using
tourniquets or taking a bandana and wrap tight knot around the arm or leg that’s
been bitten there’s really no role for that particularly in the US with pit
vipers mostly because we have hospitals ers clinics that are pretty close
good paramedic system so I would advise against it now if you’re away in the
wilderness and you’re a day or two out you may want to do the 127 hour risk the
limb to save the life but that is really uncommon you’re probably not going to
need to do a tourniquet now internationally where we have neuro
toxic snakes like cobras crates you can loosely put them on even rotate them to
stop or impede lymphatic drainage that spreads the neurotoxin
but Australians people from India Africa they’re very good at that leave it to
them in the US I’d shy away from tourniquets avoid it and if you do put
it on put it on loosely so when we say tourniquet we’re not talking about the
tourniquet that most people imagine which is in arterial tourniquet correct
correct so it’s more of a superficial tourniquet and in the wilderness it’s
probably going to be like a rag a bandanna something like that
maybe the tubing from your Camelback or water receptacle would be a good
tourniquet but you’re not going to need to use those and in theory they say if
it’s too tight when you release it you’ll get this bolus or injection of
venom not true but probably what you’re going
to do is cause more limb arm leg constriction and bad healing and that
you don’t want to do I know that in Australia people are using ace wraps
just for gentle lymphatic compression what’s the deal with with kostik
compress as in something like an ace wrap I think
that’s fine as long as it’s not again too tight to taunt there’s nothing wrong
with that particularly if you’re out in a bit of ways from your closest ER
clinic hospital that’s going to be able to see you I don’t see a problem with
that and certainly if there’s any other trauma bleeding that can kind of help
with that and it gives the patient a feeling that you’re doing something and
the people that are around the patient they may feel like they’re doing
something but again calm oral fluids call 9-1-1 calmly drive them to the
closest ER is the best thing you can do there are some commercial devices one in
particular is the Sawyer extractor right what’s your feeling about the extractor
well there are extractors the one that is most common is Sawyer it still talked
about even in Boy Scout manuals and the idea is as soon as the snake strikes
you’re going to take a little suction device kind of cause a hickey and pull
back on a syringe and pull out some of the venom and in original studies they
thought we may get out maybe a quarter to a third of the venom and it may help
but what we’re finding now particularly with good animal studies that it doesn’t
help in fact it may cause a little more damage in the local area I know the
Sawyer people they’re outstanding folks I wouldn’t recommend it however a plug
for Sawyer they do a lot with water purification internationally and I think
they’re a fabulous product with their water treatment devices so I don’t want
to diss the Sawyer family but the suction devices for the most part even
though there’s still advertised still and wilderness kits still in emergency
kits are probably not going to help is it hard to explain the Hickey when you
get home it is particularly if you were struck on the neck by the snake Tim I
know that you work at a big center where you see everything and I know part of
your practice includes treating exotic snake bite right what you’re feeling
about people having exotic snakes as pets I’m against it I think it’s a
machismo thing i underst and why people want it leave them be
particularly exotic snakes to get them in they have to be flown in or shipped
in internationally you’re taking them out of their habitat it’s the wrong
thing to do and then you’re not being very humane putting them in a confined
area you’re only going to get into trouble and when people get bit by
exotic snakes in the US no one knows really how to treat them and other than
zoos you’re not going to have the proper anti-venom it’s very dangerous it’s the
wrong thing to do don’t do it

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