Treating Snake Bites

[Ditch Monkey]

Imagine the situation

3 days walk from civilisation. Tree cover so thick as to prevent radio / sat phone from working.

You're buddy gets bitten on the lower leg by highly poisonous snake.

In this situation would it be wise to suck the poison out?

 

[JonathanD]

Pretty much impossible to do this due to the depth of penetration, and cutting open the wound is highly dangerous and can make matters far worse. Best thing is to apply a compression bandage above the bite, calm the victim, identify the culprit safely and get help. Periodic loosening of the bandage is advised, plenty of fluids. Without sufficient medical attention within a couple of hours, it looks grim. But then many factors apply - did both fangs penetrate, did the snake inject any venom or just a small dose, is the area bitten near a main artery or fleshy, etc. etc.

 

[bogflogger]

No Sucking! No Cutting! No Tourniquets!

Apply a Compression bandage above the wound, NOT a Tourniquet.

Minimise the amount of movement that the Casualty has to do, get them splinted and on a stretcher, keep them Hydrated.

EVACUATE the casualty to competent Medical Assistance.

 

[BOD]

3 days from civilization?

Cutting, bleeding and sucking seemed to work for our forebears and peoples all over the world. Some still do it

Naturally when one is a few hours away from an antivenine and not sure if it is a venomous species or if any venom is released, it is not desirable to start cutting and jabbing so sensible advice is to wait.

But 3 days and there is no doubt it was a highly venomous snake?

A good bloodletting or a torniquet seems like a reasonable thing to do then .

If it was a king cobra and we were anything more than 5 minutes from a hospital a tourniquet would go on regardless.

 

[pteron]

I carry an Aspivenin kit, though whilst Cory loves it, other opinion is divided. It certainly works on Mossie bites if you get to it quickly enough, haven't had to test it on snake bites yet!

AFAIK the cut and suck has been thoroughly dismissed by the medics and they generally recommend throwing the little kits away.

 

[Ditch Monkey]

Thanks guys.

Divided opinion there then.

I'll be going on an expedition first aid course in a couple of months and will post what they say

 

[Stuart]

Advice on snake bite treatment from the Royal geographical societies expedition medical manual:

First, reassure the patient, who may be terrified by the thought of sudden death.

The grounds for reassurance are that only a small minority of snake species are dangerously venomous to humans and even the most notorious species, such as cobras, often bite without injecting enough venom to be harmful. The risk and rapidity of death from snake bite has been greatly exaggerated. Lethal doses of venom usually take hours (cobras, mambas, sea snakes and so on) or days (vipers, rattlesnakes another pit vipers, and so on) to kill a human, not seconds or minutes as is commonly believed. Correct treatment is very effective.

Second, cover the site of the bite with a clean dressing.
Third, immobilise the bitten limb with a splint or sling and arrange immediate
transport to a hospital, a dispensary or to the expedition medical officer. The patient must keep as still as possible and avoid exercising any part of the body, especially the bitten limb.
Do not attempt to catch or kill the snake, but if it has been killed already take it
with you; it is useful clinical evidence. However, it must not be handled with bare
hands even if it appears to be dead.
Avoid traditional remedies (incisions, suction, tourniquets, electric shock, snake
stone and so on) which do more harm than good. For example:

• Do not apply a tourniquet (ligature or tight band). However, if the snake is
one whose venom contains a dangerous neurotoxin (for example, cobra, krait,
mamba, sea snake, Australian tiger snake, taipan, etc.) use the pressure immobilisation (P-I) method. Bind the whole of the bitten limb as tightly as you would a sprained ankle, starting around the fingers or toes, using a long
stretchy crepe bandage (10cm wide, 4.5m long) and incorporating a splint.
This method should not be used after bites by snakes whose venoms cause a lot of local swelling and gangrene (for example, most vipers and some cobras).

• Do not suck at the wound with your mouth or a vacuum extractor apparatus,
cut it with a razor blade, introduce potassium permanganate crystals, apply
ice or electric shocks, or interfere in any other way.

• Do not give aspirin, which may cause bleeding.

• Do not give antivenom which can be dangerous and should be administered
only by a doctor, nurse or dispenser who has emergency drugs (adrenaline/
epinephrine, antihistamine and corticosteroid) to deal with antivenom
reactions should they occur. If you have your own supply of antivenom take it
with you to hospital where the doctor or other trained staff can administer it.

Advice for the expedition medical officer:
Absence of local swelling 4 hours after a bite by a viper, rattlesnake or other pit viper suggests that no venom was injected and that no further treatment is necessary. However, bites by some snakes with neurotoxic venoms (mambas, kraits, cobras and so on) may not cause any local swelling, but may lead to serious systemic effects.

chapters from the Royal geographical societies expedition medical manual can be downloaded for free from the RGS expedition advisory centre website here

 

[Moonraker]

Great source of reliable advice. Thanks for posting this Stuart.

 

[Wayne]

I would add to Stuarts post that the first strike from most venomous snakes is unlikely to be a loaded bite.

You are not the natural prey for a snake. A snake strike will most often be defensive your about to injury it. Step on it/ handle it hence the most common areas for snake bite are above the ankle and the hands. The secon and thrid strikes are going to be far more dangerous as you have now really offended the snake.

Please be aware that wandering around at dusk without being aware of snakes is dumb. Also look before you leap. snakes can not hear but can detect ground vibrations. It is inportant to remember that as a reptile they will be more sluggish early in the morning and less likey to have the energy to slither out your way.

snakes perforn a useful function eating rodents etc please leave them alone and they will go on doing snake like things.

 

[BOD]

RGS advice is fine for most of the time but please remember that it is general. Further more they do not want untrained people to harm someone by torniquet -ing their arm and so will advise the same protocols that are 'recognised' by the society they are in.

Just like with great white sharks there is also a legitimate concern amongst scientists and interest groups not to scare the public into an unreasonable fear of snakes or into a frenzy of snake killing.

If you are going to a particular area it pays to speak to snake handlers of the species you may come across and to earn their trust. After a while ask them "what would you do if you or one of your kids were bitten by a ...... ?". Listen carefully to what they say.

I am personally not averse to snakes having played with pythons and, I am ashamed to say, killing inoffensive cobras when young, however I am scared "s...less" by the thought of meeting a king cobra even if the risk of encounter is small. This is a snake that can look you right in the eye even if you are 6' tall. See http://en.wikipedia.org/wiki/King_Cobra

Normal advice is valueless here. Unless it was a "blank" bite your survival is poor unless you. Just over the border an elephant was down and dying in 20 minutes after a hamadryad bite. Snake Handlers have collapsed by the time they reached the telephone. See http://www.venomousreptiles.org/articles/125

It is the only tropical snake in my book where the entry reads "fatal unless treated" while all others just say "potentially fatal".

Let me quote from advice by an ER physician from Stanford knowledgable about snakes:

"All persons who have been bitten by a cobra should be treated as if a severe envenomation has occurred" cf Vipers.

"A completely occlusive tourniquet is reasonable when a victim has been bitten by a highly toxic snake, such as a cobra, and is a short distance from medical care. "

"An alternative first aid procedure is the Australian pressure immobilization technique. This technique has been shown to be helpful in delaying systemic absorption of elapid venoms, but its use in cobra bites remains controversial. An elastic compress (eg, Ace wrap, clothing, crepe bandage) is wrapped rapidly around the bitten extremity, beginning distally and progressing proximally to encompass the entire limb. The compress is as tight as one used for immobilization of a severe ligamentous sprain. Then, the extremity is splinted and kept at heart level. Research shows that, in simulated snakebite scenarios, individuals tend to underestimate the degree of tension required for the wrap to be effective" http://www.emedicine.com/EMERG/topic544.htm

Personally, an immediate torniquet is what I would do in case of a king cobra bite.

So gentlemen make up you own mind and ask the locals and local doctors. There are some especially scary snakes out there that require special considerations.

 

[BOD]

Just an afterthought.

While many venomous snakes quite often fire blanks that is not the case with cobras according to the World Health Organisation. Only 30% of bites are blanks. The remaining 70% are live rounds.

See "The Clinical Management of Snake Bites in the South East Asian Region"
http://www.searo.who.int/en/Section10/Section17/Section53/Section1024_3896.htm

For those who like snakes here are photos of a little snake amongst the childrens toys. It is getting quite annoyed with the dog. Its worth knowing what this snake is if you come to his part of the world

 

[dommyracer]

I'd rather lose a leg than my life.

 

[seamonkey]

Great thread , very interesting and i've learnt a few things as well.

I'm living in Oz for a while and haven't encountered anything whilst out and about (to the best of my knowledge!) too nasty yet, ditto my gf spent a year and a bit travelling around the bush and has only spotted a couple of snakes.


still shake out my boots and bag thu

Cheers

Graham

 

[sandbender]

A short tale and some quite nasty pictures which document a young mans experience after having been bitten by a rattlesnake in Yosemite National Park, California.

The photographs detail the ten operations spread over thirty days which saved his arm.

Brave lad.

http://www.rattlesnakebite.org/index.htm

 

[Draven]

Wikipedia says that a King Cobra will generally scarper first, or feign attack (mouth shut) after flaring the hood, before actually biting - can anyone confirm that? I for one know that it wouldn't have to feign once, never mind twice for me to be replaced by a cloud of dust

 

[Sniper]

As a first aid person I have to say that the RGS advice is good and the official line to follow, but I feel this is aimed at an expedition most likely with a medical officer on hand who could take the treatment of this wound to a much deeper degree than most of us. The guidlines and suggested course of action is good and solid for the first aid treatment. Only a doctor could or should take treatment to the next level.
If however you are out in a small group with no advanced medical cover for that group then I tend to lean towards what Bod suggests but replacing the tourniquet with the pressure bandage and splint, Bod I would reckon to be the most likely person with first hand and everyday knowledge of this type of thing. Many other folks may well live and work in areas where dangerous venomous snakes are natural to the area and may well be better placed to have a more intimate understanding of first aid actions in this event than many of us here in the UK. I think a sensible course of action would be, prior to going into such an area, seeking advice from the locals who treat these wounds on a regular basis would be extremely benificial, local doctors, hospital staff and the like would provide a much better idea of how to deal with it should it happen, however without wishing to be fatalistic the scenario suggesting 3 days from help would I fear have a not so happy ending. When you choose to go on these types of expedition these are the risks that go with that decision and you must weigh up the pros and cons and risks before accepting a place on the trip.
I believe it is true that most venomous snakes do not inject on the first strike unless angered as they try to keep their venom, cos it's costly to the body to produce, for their prey and not for things they do not eat, however this is not always the case and we must assume the worst when and if it does happen.

 

[open_life]

kill the snake save dome for identification and eat the rest should the worst happen at least you had the last laugh.........sorry was no help lol

 

[Chinkapin]

Since I live where there are rattlesnakes, cottonmouths, and copperheads, I have read a lot of the literature on treating snakebite. I can tell you only one thing for a fact, and that is; there is not a real consensus on how to treat snakebite. Everything I'm about to say, I read in the literature. I'm NOT an authority. I'm merely passing on what I've read and my opinions on that are stated as such.

As far as I can determine, the two main reason to tell people not to cut is that they are panicky and tend to slash themselves. Also, the poison is generally coursing its way through the lymphatic system and not the blood system. So cutting will not do much good. As far as the sucking of the wound, this is discouraged primarily because if the person doing the sucking has any open sores, cuts, bad teeth, etc. they are open to poisoning themselves. As for tourniquets, what I have read is that if you tourniquet a limb for any length of time you stand a good possibility of loosing that limb. Another thing to consider is that a tourniquet is going to hold the venom in that area more or less concentrated. Venom is either hemotoxic or neurotoxic or in some cases both. Either way you are going to get massive tissue damage in that limb. Based on that, it may be best to let it just course throughout the entire body and dilute itself down.

I have personally known several people who were bit with one of the above mentioned pit vipers (all hemotoxic). They all said the same thing: That the bite felt like they had been stabbed with a red hot ice pick. They all were alright for about 20 to 30 minutes before they got violently ill. This time frame would let most people get to a hospital or at least to their car. People who are miles out into the woods, face a whole different scenario.

Some authorities say to do nothing but seek medical help. Others, say to use suction kits and do nothing else except get to the hospital asap. Still others recommend suction, and a light tourniquet that you can slip your finger under. No tighter than that, and to make small cuts about 1/8 inch deep in the area of swelling to let the lymphatic fluid out. Some people who have been bit in recent years have hit the bite area with an electric stun gun. The theory being that the energy of the jolt of electricity alters the toxin into a different, and harmless form. Of course bites that were not accompanied by injection may account for this cure. This is probably pure quackery but If I had a stun gun and someone to give me a blast I would probably do it. (Hey, "hope springs eternal...") If you got any heart problems, don't even think about it. Honest to God, If I was bit tomorrow, I would not know what to do.

A man who lived not too far from my cabin in Arkansas was out hunting and was bit by a copperhead. He left it untreated and started immediately for home, probably about two miles away. He made it to within about 100 yards of his house and collapsed. He laid there three days before he recovered enough to make it to the house and call an ambulance.

One more thing, If you get bit and can, in any way, kill that snake without endangering yourself or others, do it. Take it with you because the doctor has to know exactly what bit you. For instance, here in the U.S. there are several species of rattlesnake. I believe that they have antivenin for each species. The doctor will question you extensively about the snake if you don't have it with you. As was pointed out in a previous post, antivenin can be quite dangerous in itself. It is made from horse serum and you may have an allergic reaction to it and go into shock. Doctors do not like to give it unless they think that they are going to lose you if they do not.

If there are any M.D. snake bite specialist out there who have research backed facts about what to do, I would hope they would come forward and tell us. I once asked my physician about the treatment of snake bite and he said it was barely covered in the medical school that he attended.

Best advice: don't get bit. Best way to not get bit: wear tall boots, NEVER put you hands or feet somewhere that you can't see. WATCH where you step. If crossing a log, first step up onto the log, then step off the top, stepping as far as you can away from the log, in case a snake is laying on the far side. Some snakes climb trees, watch where your face is in relation to nearby limbs, bushes, etc. Learn what the poisonous snakes of the area look like. I don't mean look at a picture in a book. Look at them on the ground in their native habitat. A rattlesnake or a copperhead will almost completely disappear on the forest floor. Yet you can learn to see them. You can get very good at picking them out -- but you have to be looking! This does not require paranoia, just be alert. You cannot believe how many times I have been in the woods with people who were just completely oblivious to the surroundings. Looking at everything, and seeing nothing. I apologize for this being entirely too long.

 

[swagman]

from the Australian royal flying doctor

Of the world's 25 most deadly snakes, Australia is home to 21 of them. The perceived threat of snake bites is one of the most common fears for people planning to travel in Outback Australia, especially overseas tourists.

Contrary to popular belief, however, snake bites are not a major cause of death for people in Australia. In 1997, six people died of snake bites (Australian Bureau of Statistics)

It is important for everyone to know what action to take after a real or suspected snake bite. The action taken immediately is crucial for the patient's recovery.

What snake is it?
Being able to identify the snake will help the doctor pick the right anti-venom quickly. But if you don't know what type of snake it was, don't guess. Doctors can use a 'venom-detection kit' to determine what type of snake bit you and which anti-venom to use.

If you don't know for certain what type of snake bit you, don't guess. Don't assume because it was brown that it was a 'brown snake'. It could be disastrous if the doctor gave you anti-venom for the wrong snake bite.

Stay still and apply pressure
Most snake bites are to the lower limbs. It is most important that you stay still and apply pressure to the bitten area, preferably with firm bandages, about as tight as you would bind a sprained ankle. Do not apply a tourniquet. Splint the whole area to immobilise.

Don't take off jeans or other clothing, as the movement involved could help the venom enter and travel through the bloodstream. Do not try and force the venom out of the bitten area. This will only push the venom further into the bloodstream.

Once the area is bandaged and splinted, it will be comfortable and can be left on for several hours. Do not take off the bandage until you reach medical care, or it reaches you. The doctor will decide when to remove the bandages, usually when the anti-venom is prepared and ready to be administered.

Taking this action will help prevent venom from spreading through your body and bringing on severe symptoms. It also means you will need less anti-venom and will suffer from less anti-venom side effects.

Have you been bitten?
Australian snake bites often are not painful and you might not realise you have been bitten. Take note of the following symptoms:

Continued bleeding from bite site
Tender or painful regional lymph nodes
Headache, nausea, vomiting, abdominal pain
Sudden and perhaps transient hypotension (abnormally low blood pressure) which may cause partial loss of consciousness
Blurred or double vision
Facial paralysis
Voluntary muscle weakness and the diaphragm may be paralysed progressively.
How do you get medical help?
If you are travelling in Outback Australia and you are bitten by a snake, contact the Flying Doctors on your HF radio or satellite phone as soon as possible. They will give you advice and make arrangements to fly in to provide medical assistance.

In many parts of Australia, access to adequate health care can mean long journeys by road. The RFDS not only provides general health care and emergency services to local communities, but also to travellers.

We urge all overseas visitors to take out adequate travel insurance when visiting Australia.

 

[dogwood]

Cutting, bleeding and sucking seemed to work for our forebears and peoples all over the world. Some still do it

The whole cutting and sucking thing is mostly a 20th century fantasy perpetrated by dime novel adventure stories.

Most of our forebears didn't do it and if they did, it didn't actually have a positive effect. But you might *think* it did for this reason: most venomous snake bites are dry bites without venom.

In other words you could sprinkle sugar a bite and it would *look* like the sugar did the job when in fact there was no venom.

Cutting and sucking are NOT what you should do and WILL make matters substantially worse. We shouldn't perpetuate practices like this -- you can take a bad situation and make it massively worse cutting and sucking.

The advice others in the thread have provided is sound and proven in the field: compression, shock precautions if you have to wait it out, and evacuate when possible if it's clear the bite wasn't dry.

If rapid necrosis sets in -- which can be the case with rattlesnake bites here in the states -- and if you can spare a person to go for help and another to stay with the victim, it's best for someone to try to make it out and call for an air evac. I bite to the thumb, if it goes necrotic, can cost you your entire arm....