Snakebite!!!

[LucidResq]

Since it's been discussed elsewhere and there was obviously a huge level confusion and uncertainty as to how to treat a snakebite, let's do a scenario. BLS and/or ALS can play.

It's a warm March Oklahoman day, midafternoon, when you are called to a popular campground for a snakebite. While driving down the dirt road you spot your pt. and his 2 friends on the side of the road waving frantically at you. As you're parking the rig you can see that the pt's right hand is extremely red and swollen. He appears to be in his mid-twenties and is clearly distressed and in pain.

Whatcha gonna do?

Ask for information and you shall receive it, including information about the scene, patient, friends, snake, transport options, area hospitals, etc.

 

[Ridryder911]

Since I live in that area, I can assure you they are in trouble. There is only a few hospitals that have enough of one brand anti-venom for treatment regime. I have to travel emergency status to transport the anti-venom (my hospital is one of the few that stocks it).

R/r 911

 

[Arkymedic]

Since it's been discussed elsewhere and there was obviously a huge level confusion and uncertainty as to how to treat a snakebite, let's do a scenario. BLS and/or ALS can play.

It's a warm March Oklahoman day, midafternoon, when you are called to a popular campground for a snakebite. While driving down the dirt road you spot your pt. and his 2 friends on the side of the road waving frantically at you. As you're parking the rig you can see that the pt's right hand is extremely red and swollen. He appears to be in his mid-twenties and is clearly distressed and in pain.

Whatcha gonna do?

Ask for information and you shall receive it, including information about the scene, patient, friends, snake, transport options, area hospitals, etc.

In my area they probably will be flying Eagle Med or Air Evac to LR, Tulsa or OKC

 

[certguy]

Calm the pt. down , get him lying down with the hand lower than the heart . Mark the wound and where the swelling is at this time , and mark as it progresses . Note time of bite and the time of your arrival . Are there pronounced fang marks ? If so , call for ALS intercept if transport time is long . Notify hospital ASAP to line up antivenom . High flow o2 . What did the snake look like ? Did they kill it ? If so , bag it and bring it along , passing this info to the hospital so they can get a herpatologist for positive ID . Though there aren't many fatalities from snakebite , tissue damage will be a concern , so rapid transport while being prepared to give supportive care . As you describe it , it does sound like he may have recieved some venom .

 

[mikie]

I'm curious to know if there any ALS interventions or what an ALS provider would do (start IV, anything above a basic level I guess...)

Would the snake bite have any affect on the BGL? Cause I'm wondering for a vital to take a sugar...

 

[Kimmy Schaub]

Calm the pt. down , get him lying down with the hand lower than the heart . Mark the wound and where the swelling is at this time , and mark as it progresses . Note time of bite and the time of your arrival . Are there pronounced fang marks ? If so , call for ALS intercept if transport time is long . Notify hospital ASAP to line up antivenom . High flow o2 . What did the snake look like ? Did they kill it ? If so , bag it and bring it along , passing this info to the hospital so they can get a herpatologist for positive ID . Though there aren't many fatalities from snakebite , tissue damage will be a concern , so rapid transport while being prepared to give supportive care . As you describe it , it does sound like he may have recieved some venom .

Yes, good answer. Definately sounds right because I have learned of this in my training. Paramedic Intercept is very important in this situation. Plus, thanks for the info, because there are no poisonous animals in my area si I am very inexperienced with field work involving poisinous animals

 

[karaya]

This is a great article from JEMS as to why the bitten extremity should be fully immobliizied in an extended position and elevated ABOVE the heart.

Snakebites: Prehospital Assessment & Treatment of Envenomations

Ray

 

[LIFEGUARDAVIDAS]

In addition to what certguy wrote (and in case the snake was not killed / captured), ask about the snake's head shape. Was it in a shape of a diamond / wider than the rest of the body?

((Every season I work in Alabama we see some snakes near and in the river. Most are just "water snakes" but every summer there a couple of rattlesnakes. The only time there was a snake bite it happened before I started working there and for what I was told it wasn't a serious case. Many reptile experts told me the easiest way to tell if a snake is really dangerous or not is by looking at its head shape. If it similar to a diamond shape / it's wider than the rest of the body, then it's dangerous.))

Back to the scenario: could the patient and/or his friends get a look at the snake's head?

Also, since at the BLS level there's not much to do in cases like this except "scoop and run" it is not a bad idea to use a marker/pen to mark the progress of the swelling. (Writing the time near each line). It will provide useful information to ALS and ER.


Guri

 

[letsrun100]

In June 2006, I had an up close and personal encounter with a rattlesnake. The 36" rattler bit me on the left ankle. When I finally got to medical aid, the ALS crew started an IV and NS drip and transported me to the Sheridan Wyoming Hospital ED. You can read about my experience (complete with pictures) and the treatment I received on scene and at the hospital here: runtrails.net/2006/june6.htm

You can also read about the reaction I had to the serum ten days later, in the middle of a 100 mile foot race in Wyoming: runtrails.net/2006/june17.htm

I learned a lot, I think you will too.

 

[AZFF/EMT]

do not delay transport for on scene treatment. Most likely gonna be flying so there will be time to get baseline vitals/history and look for trends over the time waiting for helo. Start an IV, O2 and monitor. Locate and circle the bite mark and swollen area and write the time on the area as well. Check occasional and re-circle the area as it grows. The patients age, physical condition and medical issues will be important factors for thier survial.

We have diamondback rattlers out my way and I hate them. I could go the rest of my career without another snake removal or bite call.

 

[alex71]

a pressure band and rapid trabnsport?

 

[NomexMedic]

Yes, good answer. Definately sounds right because I have learned of this in my training. Paramedic Intercept is very important in this situation. Plus, thanks for the info, because there are no poisonous animals in my area si I am very inexperienced with field work involving poisinous animals

Looks like I'm moving to New Hampshire. I can deal with a Nor'Easter and a blizzard or seven. I don't do snakes.

 

[ChargerGirl]

when transporting the snake if you put it in a freezer/refrigerator/cooler for like 10 minutes it will make it sluggish so it wont attack you. my lil bro has a pet snake (ball python) that he likes to put in the pool when i am swimming to scare me. freakest thing ever when they swim at you but since they are cold blooded they will get tired fast with no exposure to heat.:excl:

 

[mycrofft]

crtguy, LIFEGURADDAVIDAS have it sewn up

chargergirl, how about putting the dead snake into an ice chest? I've killed more cottonmouths (in Arkansas) than you could fit into a small ice chest, but was never tempted to risk catching one.

This is another one of those ages old issues they keep rearranging the deck chairs around, probaly we can rule out cutting the wound to "suck it out". What I do know that isn't directly mentioned here (except maybe letsrun100...ten days later!!?) is that anaphylactoid reaction is a risk for either venom or antivenin.

 

[reaper]

a pressure band and rapid transport?

There is only one snake in North America that you would apply a constriction band for. That is the Coral snake and it is found only in FL and some in South GA area.

Rattlers,Cottonmouths, and Copperheads should not receive a constrictor band.

Most bites are "Dry bites", which means the snake did not inject venom. But, you must treat all as true bites.

Transport to a ED that carries anti venom(or can get it). As stated, mark the bite, IV and Airway management are the most important. Splint the extremity and keep the pt calm.

Most ED's do not like snakes being brought in. Take a pic, if you can. If you must bring it, make sure it is dead and leave it outside in the truck. They will come out there to look at it.

Also, be very careful with the dead snake. Their fangs can still inject venom for a long time after death.