# poisonous snake bite



## Explorer127 (Apr 20, 2008)

I've always been told just to have the pt calm down, and do nothing else, but the logical thing to me would be to apply a tourniquet and ice...what do u guys think?


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## ffemt8978 (Apr 20, 2008)

omarsobh said:


> I've always been told just to have the pt calm down, and do nothing else, but the logical thing to me would be to apply a tourniquet and ice...what do u guys think?



It doesn't do any good.  By the time you could apply those, the poison is already circulating through their system.  A tourniquet could cause an unnecessary amputation of the limb.

Treat it like you would any other open injury.


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## BruceD (Apr 20, 2008)

Here's a nice little article from the FDA about snake bites, hope it's ok to post it

http://www.fda.gov/Fdac/features/995_snakes.html

This was written at the bottom of the page:



> How NOT to Treat a Snakebite
> 
> Though US medical professionals may not agree on every aspect of what to do for snakebite first aid, they are nearly unanimous in their views of what not to do. Among their recommendations:
> 
> ...



That site has far more info than I could give, but I too had been told not to tourniquet a bite.

Take care!
-B


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## JPINFV (Apr 20, 2008)

I believe even the constricting bandage (think tourniquet, but not nearly as tight) is now out of favor. The problem is that there is no good treatment. If you keep the poison from circulating then you've just concentrated it at the site of injection causing more local damage. Similarly, allowing it to circulate isn't too helpful either.


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## TKO (Apr 20, 2008)

Call Poison Control and they will advise you appropriately.


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## Ops Paramedic (Apr 20, 2008)

I would also not apply a tourniquet (for the same reasons already mentioned), or ice.  A lot of the treatment depends on how long ago the patient was bitten.  Definatly agree with calm and reasure and decrease movement by the patient self (To slow the heart rate as far as possible, to decrease the rate of spread).
  Another important aspect of that will impact on the treatment of the patient in hospital, is to identify the snake.  Try and take photgraph, if it still around and you're not in danger, or catch if you have the expertees available, this will allow the hospital to possibly make use of an anti-venom. 

I think if you keep the patient still and calm, and treat supportively, you should be OK!


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## Explorer127 (Apr 20, 2008)

see, what im thinking is that if the poison spreads to the rest of the body, the pt's most likely gonna get very sick and die...

but if you apply the tourniquet, then they might just end up losing their arm..


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## JPINFV (Apr 20, 2008)

But there's also the other side of it. The venom stays concentrated in the limb and they lose the limb, or the venom is diluted into the rest of the blood and the patient is discharged a few days later no worse for the wear. The possibilities and differences between snake to snake, bite to bite, and person to person are so different that it's just as dangerous to try form a one size fits all treatment plan.


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## MSDeltaFlt (Apr 20, 2008)

"Because not all snakebites, including those from the same species, are equally dangerous, doctors sometimes face a dilemma over whether or not to administer antivenin. Venomous snakes, even dangerous ones like the *Eastern diamondback, don't always release venom when they bite. Other snakes may release too small an amount to pose a hazard*."

Now the Eastern Diamondback is the most poisonous snake indiginous to the US.  Even if you got bitten, the snakes just want you to go away, so they're not going to use all of their venom.  Mainly because it takes a while to replenish it.

Now that's just in the US.  In other countries however, esp. Australia (?sp), you're screwed.:sad:


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## EMTNYC (Apr 21, 2008)

http://www.dshs.state.tx.us/idcu/health/zoonosis/Animal/Bites/Information/venom/snake/

According to the Texas DOH 1 out of 500 snake bites are fatal. -J


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## LucidResq (Apr 21, 2008)

In my area, protocol specifically prohibits in bold letters to never apply cold.

 EMT-Bs are to assess, mark the time and extent of redness/edema with a pen, remove jewelry, keep the pt. calm and immobilize the bitten part at heart level.

Paramedics are to do all of the above in addition to establishing IV access & cardiac monitoring.


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## BossyCow (Apr 21, 2008)

It's my understanding that the fear associated with snake bites is more legend than fact. It takes so long for a snake to refill its venom sacs that they are actually pretty stingy with the stuff. Also, many bites, while nasty and painful, are not fatal. 

I've heard elevate but not ice the affected area. Another reason not to ice the site is that some venoms are very destructive to the surrounding tissue, applying ice can intensify the damage. 

Tourniquets are just bad. It amazes me how many of these old wives' tales are still circulating in first aid.


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## seanm028 (Apr 21, 2008)

omarsobh said:


> see, what im thinking is that if the poison spreads to the rest of the body, the pt's most likely gonna get very sick and die...
> 
> but if you apply the tourniquet, then they might just end up losing their arm..



I can see how you would draw that logic if you had a tourniquet in your hand and ready to go when the Pt was bitten.  However, if I recall correctly (and if someone knows better, please correct me) the heart circulates the body's entire volume of blood in a rather short time.  That means that in most cases, the venom will be pumped out of the bite site and through the body before EMS even arrives on scene.


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## firecoins (Apr 21, 2008)

EMTNYC said:


> http://www.dshs.state.tx.us/idcu/health/zoonosis/Animal/Bites/Information/venom/snake/
> 
> According to the Texas DOH 1 out of 500 snake bites are fatal. -J



So how does he end up in Williamsburg on your ambulance?  :unsure:


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## Explorer127 (Apr 21, 2008)

BossyCow said:


> .
> I've heard elevate but not ice the affected area..




that would increase the venom's flow to the body..

i was always taught that u should keep the area below the heart..


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## MSDeltaFlt (Apr 21, 2008)

EMTNYC said:


> http://www.dshs.state.tx.us/idcu/health/zoonosis/Animal/Bites/Information/venom/snake/
> 
> According to the Texas DOH 1 out of 500 snake bites are fatal. -J



And how many people actually get bitten per capita?


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## mikie (Apr 21, 2008)

I was always taught to suck the venom out...

is that wrong?



(This is a good topic, because I was always a little hazy on what to do)


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## BruceD (Apr 22, 2008)

EMTNYC said:


> http://www.dshs.state.tx.us/idcu/health/zoonosis/Animal/Bites/Information/venom/snake/
> 
> According to the Texas DOH 1 out of 500 snake bites are fatal. -J



Either the DOH site is listing state-only mortality stats or either the fda or DOH is wrong.

0.2% of 7000 = 14 (doh say die each year) (0.2% = 0.002 * 7000 if I'm thinking right)
5 of 7000 (FDA say die)

Just a curious little discrepancy


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## ffemt8978 (Apr 22, 2008)

My guess is the DOH is listing state only fatalities...after all, why would Texas care about what happens in Nevada or other such place?


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## Explorer127 (Apr 22, 2008)

mikie333 said:


> I was always taught to suck the venom out...
> 
> is that wrong?
> 
> ...



i actually was also told that, but idk


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## mikie (Apr 22, 2008)

omarsobh said:


> i actually was also told that, but idk



I've heard that as well, but I think that's more for the rugged outdoorsman/MacGyver-style

You won't see me sucking the venom out of any patients arm!


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## Jon (Apr 22, 2008)

mikie333 said:


> I've heard that as well, but I think that's more for the rugged outdoorsman/MacGyver-style
> 
> You won't see me sucking the venom out of any patients arm!


You are right - that would suck!


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## mikie (Apr 23, 2008)

Jon said:


> ...that would suck!



Was the pun intended?


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## paramedix (Apr 23, 2008)

Part of treatment would be possible hospitalization. So make sure the hospital you transport your patient to can accept and handle the patient and that they have the necessary RX or they can get it fast.

We have only a few hospitals that can really help with RX in our area.


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## Free-B-EMT (Apr 23, 2008)

omarsobh said:


> I've always been told just to have the pt calm down, and do nothing else, but the logical thing to me would be to apply a tourniquet and ice...what do u guys think?



I actually had a call involving a bite from an Eastern Timber Rattlesnake. The patient found the snake lying in the road and wanted to save it from being hit by traffic. He grabbed it by the tail and it swung around and bit him on the hand. After throwing the snake off the side of the road, the patient went home. He did  not call for help until four hours later when the pain became so intense he could no longer stand it. We found him lying in bed, in intense pain, with his arm swollen to approx. twice its normal size and badly discolored. We called for ALS but they were unavailable so we transported to the local ED without treatment. I happened to get this same patient on an unrelated call about four months after the snake bite incident. He showed no signs of having any problems related to the snake bite at all. 
I don't know if this incident is typical or not but from my experience it does not seem that we need to be too concerned about treating in the field. There is time to get them to the hospital for proper treatment.


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## mikie (Apr 23, 2008)

*What would you do?*

So here's a question...

How would you transport the pt?  What treatment would you provide (BLS, ILS, ALS)?  Lights and sirens?

For me...Try to find out what kind of snake it was.  I would consult MedControl first, probably tx patient in position of comfort, maybe some O2 via nasal cannula (never hurts!).  Unless MedControl states otherwise, probably immobilize location of bite (remove jewelry, etc), keep it level, place over the bite a 4x4 or some sterile dressing (prevent any more infection).  If pt is in a decent amount of distress, lights & sirens (I don't know the extent of the bite and how fast it can spread, so err on the side of caution).  

Consult poison control (depending on tx time)?

Anyway, just my 2c.  Let's hear some others!


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## Jon (Apr 23, 2008)

I think first order of buisness, after ensuring scene safety, would be consulting medical command and discussing the situation.

If the bite is possibly poisionious, Medical Command may want the Pt. going downtown to the City (30-60 minutes by ground 10-15 by air) if Medical Command feels the patient needs more care than they can get at the local hospital... Additionally... if anyone would have antivenin, I'd guess it is the city.

As for treatment... treat symptoms as needed.. place Pt. on oxygen, monitor vitals, and be prepared for the patient to crash.


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## LucidResq (Apr 23, 2008)

I would be calling med control and poison control very early so if needed they could get started on collecting antivenin. I've heard that often no one hospital has enough antivenin to fully treat a snakebite, and that they have to call around to gather enough. The hospital may not even have the antivenin and you may need to transport to a specific hospital. 

If the snake was dead and on scene, I'd pick it up with a stick and put it into a secure container to bring along. Gather as much information as possible about the snake and the bite. 

Immobilize the bitten part and the joints above and below it. Trace around any marked area of erythema/edema with a pen, with the time written next to it (hospitals like to track the progression of the swelling). Keep the bitten part level with the heart and transport. Maybe place them on a nasal cannula. Full set of vitals taken often, and the regular physical assessments and history. 

I think they key thing would be keeping the pt. calm and still. A snake bite would freak anyone out but an increase in HR is only going to make the situation worse.


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## Jeremy89 (Apr 24, 2008)

LucidResq said:


> ...If the snake was dead and on scene, I'd pick it up with a stick and put it into a secure container to bring along. Gather as much information as possible about the snake and the bite....



I hear a snake has the capability to bite hours after it is 'dead'...something to do with muscle spasms or something.  If it were me, I wouldn't go near the thing.  I can look at a bloody trauma scene with no problem but the site of a snake sends chills down my spine... :wacko:


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## mikie (Apr 24, 2008)

LucidResq said:


> If the snake was dead and on scene, I'd pick it up with a stick and put it into a secure container to bring along. Gather as much information as possible about the snake and the bite.



That's good thinking as well as marking the area with the pen/marker!  I would probably (I guess depending on your location) have dispatch call animal control and THEY can transport it.  

I don't need a snake in the back of the ambulance and suddenly it wakes up...I'm not going to check its pulse on scene to confirm its death (assuming I don't see any blunt trauma...but still, I must have missed snake A&P in my basic class  )


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## LucidResq (Apr 24, 2008)

If I had a camera I'd probably take a few pictures of it instead of bringing it along. I wonder how/if you can check a pulse on a snake, not that I would want to try.


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## JPINFV (Apr 24, 2008)

^
You do it very carefully.


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