Snakebite Management (pre-hospital)
BY PGF
1 year, 4 months ago
Prior, on ticks and Lyme disease.
Summer is here, and with it, four-legged critters, but they aren’t the only things in the woods that can harm you. The thing about snakes is they can be just about anywhere when it’s warm.
Important factoid: Most snake bites are strikes to the hand; check the area before working or grabbing things.
Please allow me to introduce myself. I am a medical toxicologist and emergency physician at Baylor College of Medicine in Houston, Texas. I have treated 600+ snakebites and direct one of the busiest snakebite services in the U.S.
I also love snakes and consider myself a member of the herpetology community. And I want to help prevent any bad outcomes (for both humans and snakes) if a snake-human interaction goes awry.
I hate snakes, especially Cotton Mouth Moccasins which can range widely in color and markings.
These are the recommendations for pre-hospital treatment. I will have a different post dealing with hospital management.
Found at the link: Snakebite Management (in hospital) – Pit Vipers.
If you get bitten by a snake you suspect is (or may be) venomous:
1. Get away from the snake. No need to hurt the snake just because you’re angry, and you don’t want to incur additional injury.
2. If you (or someone else) can safely and quickly get a picture of the snake, great, but don’t waste time or risk a second envenomation. Ultimately, pit viper (rattlesnakes, copperheads, cottonmouths/water moccasins) envenomations are diagnosed clinically. As are coral snake bites, but most people can identify those. Just pray you have a doctor who knows what he or she is doing (see below)
If you can take a picture, you can shoot it first. Just sayin’. Pro tip: birdshot in .410 for a handgun. Outdoor Life lists several options with pros and cons for each. It may be illegal to kill snakes in your area; 3S treatments may apply.
3. Remove constrictive clothing and jewelry
4. Position the affected extremity appropriately. This is a little controversial, but some things are clear. For pit viper bites (which account for > 95% of the venomous snakebites in the U.S.), DO NOT PLACE BELOW HEART LEVEL. Almost all pit viper bites cause local tissue injury, and placing the affected extremity below heart level will cause the venom to collect in the extremity and will increase the hydrostatic pressures in the extremity. This will increase the potential damage to lymphatic vessels and increase the likelihood of some degree of permanent injury, such as post-exertional swelling. For copperhead and cottonmouth bites, in which local tissue is highly likely but the likelihood of systemic toxicity is low, I recommend placing the affected extremity ABOVE HEART LEVEL. In rattlesnake bites, it is reasonable to keep the affected extremity AT HEART LEVEL.These variations are for pre-hospital management. Once in the hospital, the affected extremity should always be elevated. This is emphasized in the unified treatment algorithm.
5. Get to an appropriate hospital. If you are having life-threatening signs and symptoms (e.g. airway issues, low blood pressure) get to the closest hospital for stabilization. They can then transfer you if needed to an expert. Otherwise, proceed directly to a hospital with a snakebite expert. If you interact with snakes a lot or are outside in snake-endemic areas, you should investigate your regional hospitals to locate one or more specialists. I can help you with this. It’s a pretty small community.
6. Avoid dangerous and/or stupid interventions:
- DO NOT cut and suck. All this does is make a wound worse and potentially introduces bacteria into the wound
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- DO NOT apply a tourniquet. There is no benefit in cutting off an extremity’s arterial blood supply unless the patient is bleeding to death.
- DO NOT apply any sort of constriction band or pressure immobilization for pit vipers. For the same reason that we do not place the affected extremity below heart level. The American College of Medical Toxicology has a position statement on this.
- Pressure immobilization IS reasonable for coral snake bites.
- DO NOT use electrical shock treatment. It does not “neutralize the venom” or whatever nonsense advocates claim. But it is a good way to cause permanent injury.
- DO NOT apply heat.
- DO NOT apply PROLONGED icepacks. A few minutes at a time is okay (say, 5 minutes on, 10 minutes off) but prolonged cryotherapy is bad for the tissue.
7. DO NOT use one of those commercially-available suctions devices. They don’t remove venom. They just suck. See the best-titled editorial ever here.Do not bring the snake to the hospital. A dead snake can still envenomate you, and I hate when people kill snakes. And as much as I like snakes, I do acknowledge it becomes a logistical difficulty when someone brings a live snake to the ED. And, as I said before, we don’t need to see the snake to provide appropriate treatment.
I love when people kill snakes.
On June 20, 2023 at 10:15 pm, MTHead said:
Out west we have a little bastard called the Mojave green. Its venom and anti-venom are different from a regular rattlesnake. And the only way to tell the difference is by the scale pattern above the eyes. So your going to need the head. (Even if it can still bite.)
And your going to need a lot of anti-venom.
That being said the jury is still out on high-voltage. As venom is a long chain hydro-carbon that breaks up just like gasoline under a high voltage spark plug.
I would not hesitate to zap myself with a tazer if bit. Hell, I would piss on a sparkplug if I thought it would help.
On June 20, 2023 at 10:59 pm, PGF said:
Purposely causing every muscle in your body to tense up seems like a very dumb thing to do if snakebit.
On June 21, 2023 at 1:54 am, TheAlaskan said:
Move to Alaska to cure snake bite.
On June 21, 2023 at 4:44 am, jrg said:
Boy, is there a sound in the world that causes an involuntary freezing in place like the dry sound of those rattles.
Unless the snake is in a dangerous location for people (i.e. adjacent to a camp), I tend to adopt the policy ‘Live and Let Live’. Snakes have a place in this world, and killing them because some people act recklessly and are struck does not make sense.
I think I’ve read a lot of people who are bitten are handling them and are bit because they became lax and weren’t paying attention.
On June 21, 2023 at 7:52 am, Don W Curton said:
I know of 2 cases personally where a snake-bit person was not administered anti-venom because the doctor wasn’t sure what type of snake it was. So for this guy to suggest that it can be “diagnosed clinically”, I’m going call BS. A dead snake (I don’t care who gets triggered) will allow 100% confirmation and the correct administration of anti-venom.
And for his suggestion to position the limb according to the type of snake and get to the hospital, in most cases I can imagine the hospital is anywhere for 30 minutes to several hours away. That certainly sounds like fun.
I would think the sucking device might be useful, but only if used almost immediately. After about 10 minutes whatever venom is in you is in you. But then again I’m not the expert.
Best advice if you have some property in Texas, get the state to release a blue indigo snake there. My parents did that on their ranch. The Texas Indigo (or blue indigo) will hunt, kill, and eat rattlesnakes. They haven’t seen one since.
On June 21, 2023 at 8:16 am, June J said:
I hate snakes. Dead snake is a good snake.
On June 21, 2023 at 10:44 am, George said:
Having twice stepped on a rattlesnake, I can personally testify that yes indeed humans can levitate!
I think Mojaves are neurotoxic as is the Eastern Diamondback.
Neurotoxic venom is bad juju.
On June 21, 2023 at 11:46 am, George said:
I have also heard that a snake isn’t dead until its head is removed and the body hung up until the sun goes down.
On June 21, 2023 at 12:16 pm, Grunt said:
Git the shovel!
On June 21, 2023 at 12:32 pm, MTHead said:
George, I had a headless rattler spin and strike my arm when I picked it up to show it off to some friends. After 3 hours in the back of my pick-up.
My reaction was a big laugh at the time. And still is today. But ya, they can be deadly even after being dead a long time.
If it would have had a head, I would have been in big trouble.
On June 21, 2023 at 12:50 pm, Bob in NC said:
I studied snakes in college and thought about being a herpetologist- until I realized I needed to pay my bills and eat .
So, I do not hate snakes because they have their role in the ecosystem, and work to keep the vermin population (mice, voles, moles etc.) down.
All that aside, I have not hesitated to proactively kill Copperheads when they could be a danger to people or my dog- for safety reasons and financial -I know of two former neighbors who were bitten by Copperheads and had to go to the ER- the OOP cost of anti-venom is astoundingly high -upwards of $40k per dose!
We never saw any Cottonmouths or rattlers where we lived (Raleigh area) for which I was eternally thankful- Water Moccasins are usually more aggressive and one of the native rattlers (Eastern Diamondback) has a particularly nasty venom.
I leave all other non-venomous snakes alone -and we had plenty at our old house.
On June 21, 2023 at 1:03 pm, Bob in NC said:
PS- whenever I worked in the natural areas on our property I always wore boots, and carried my revolver loaded with snake shot. I would also stomp my feet through those places where leaves were pretty deep, since snakes can sense vibrations and will always choose to avoid confrontations unless surprised.
They know from the vibrations that a person is too big to be a potential meal and venomous snakes do not want to waste their venom
On June 21, 2023 at 1:56 pm, Adino said:
We live in deep woods in Middle TN and have copperheads, water moccasins, and timber rattlers. We live on top of hill so very, very rarely see the water moccasins unless we go downhill to the creeks. Last summer on vacation I had one swim parallel to me 20 yards out. That ended the swim pretty quick.
Timber rattlers are very shy and 99% of the time scatter before you get near them. Only seen 1 that was not street pizza in 20 years. Eating a mouse behind my garbage can when I went to put it on the street.
Copperheads are responsible for more bites than the others combined. They are lazy snakes and will not scatter when they know you’re coming, they are convinced their camo will hide them. And some of them have awesome camo. Get to close and wack. My middle Jack Russell got hit (she made it). My neighbor got hit in his shed. Nasty affairs.
Best defense is good offense. Keep rodent populations down, grass cut short and leaves cleaned up. And leave all non venomous alive they keep the venomous population down and away. We have a 7′ black racer lives on top of our hill.
I never touch a woodpile or lumber pile in the snake months with my hands, I always use a garden rake to pull off what I need.
Lastly, because we coexist with all 3 venomous I have invested in snake tongs. I have 4 and keep 2 in the garage for the front and 2 in the walkout basement for the back. They are a little pricey but I consider it some of the best money I’ve ever spent. I prefer to stand well off the snake at least 6-7′. I get it in the tongs and take off it’s head with a spear. And stay away from the head they will bite for a time when off. I will admit if I ever see a 7′ timber rattler it’s shotgun time. But for all snakes 3-5′ I like the tongs and spear.
And we also have a couple of these in our trauma kits: https://tongs.com/product/snakebite-kit-venom-locc/
That’s the same company we got our tongs at.
On June 21, 2023 at 4:49 pm, George said:
MTHead: once while quail hunting I shot a pretty good sized rattler. My son was with me, about 6 at the time. He wanted the rattlers. I had shot the snakes head off with my shotgun. I went out to cut off the rattlers and stepped on the snake just in front of the rattlers. When I cut the rattlers the stump came back and struck me. Made me jump, but also made my son’s head hit the inside of the cab!
On June 22, 2023 at 12:08 pm, Latigo Morgan said:
I’ve been running across rattlesnakes that decided they don’t have to rattle anymore. Not cool. In the past, I’ve had an understanding with Jake – he leaves me alone, and I’ll leave him alone. He’d always rattle to let me know he was there. But this newer generation of rattlesnakes that won’t rattle is a borderline dealbreaker.
Then there was the time a sidewinder chased me when I stopped to take a leak on the side of the road. Bastard chased me around the car – hope I ran over him when I took off. Never had a rattler chase me before, like that.