Snake Bites and First Aid

[HibikiR]

If you've ever heard of "pressure bandage immobilization" then you should know that while may have an application with neurotoxic venom a lot of people say it doesn't apply to many of the spiders and snakes common here.

[ldsnet]

Rattle snake bites are rarely deadly . . . it isn't the movies where you are bit by a snake and dead in minutes . . . No cutting, no suction to remove venom. Treat as any puncture wound, don't elevate to the heart, don't use a tourniquet or any other super constricting bandage; the swelling will be very quick and painful, cut away tight clothing. Transport to a medical facility for anti-venom and treatment (re-assure and keep patient calm!!!! faster pulse rate increases spread of venom through the body).

http://www.wildbackpacker.com/wilderness-survival/articles/treating-a-snake-bite/

[Friesland]

idsnet, thanks for this link;

http://www.wildbackpacker.com/wilder...-a-snake-bite/

[diveRN]

Per Wilderness ACLS (from memory):

1. Prevention is the best cure, avoid them/take precautions.
2. Have an EVAC plan ahead of time. Know where hospitals are, have a means to get there.

If a venomous bite does occur,

3. Get away from the snake. If possible to ID it, do so safely.
4. Calm down. Lower heart rate, keep affected area below level of the heart if possible.
5. Execute evac plan and seek medical attention.

Tourniquets can actually cause more damage and snake bite kits that attempt to suck out venom are worthless because venom enters the bloodstream fairly quickly and can cost time in getting medical aid.

NIH Study linky.

Abstract
STUDY OBJECTIVE:
We determine the percentage of mock venom recovered by a suction device (Sawyer Extractor pump) in a simulated snakebite in human volunteers.

METHODS:
A mock venom (1 mL normal saline solution, 5.0 mg albumin, 2.5 mg aggregated albumin) radioactively labeled with 1 mCi of technetium was injected with a curved 16-gauge hypodermic needle 1 cm into the right lateral lower leg of 8 supine male volunteers aged 28 to 51 years. The Sawyer Extractor pump was applied after a 3-minute delay, and the blood removed by suction was collected after an additional 15 minutes. A 1991 Siemens Diacam was used to take measurements of the radioactive counts extracted and those remaining in the leg and body.

RESULTS:
The "envenomation load," as measured by mean radioactivity in the leg after injection, was 89,895 counts/min. The mean radioactivity found in the blood extracted in the 15 minutes of suction was 38.5 counts/min (95% confidence interval [CI] -33 to 110 counts/min), representing 0.04% of the envenomation load. The postextraction leg count was less than the envenomation load by 1,832 counts/min (95% CI -3,863 to 200 counts/min), representing a 2.0% decrease in the total body venom load.

CONCLUSION:
The Sawyer Extractor pump removed bloody fluid from our simulated snakebite wounds but removed virtually no mock venom, which suggests that suction is unlikely to be an effective treatment for reducing the total body venom burden after a venomous snakebite.

[stitch_paradox]

[sdkevin]

I do a lot of traveling where it would take me hours to get to cell reception. So then...

Sounds like a good time to have a HAM radio and a list of local contacts.

[06er]

WHAT GLOCKMAN19 said

http://www.amazon.com/Extractor-Sting-Suction-Insects-Snakes/dp/B004AQFCMQ

THIS ^ is what he was talking about
I have one. I watched my buddy use one on a spider bite. It works using one hand. It sucked his skin about 1/2" into the clear tube. So You leave it attached for a bit. You could see a clear large drop of the venom bead up on top of the skin. They say it works great for tick heads and infection. It sucks em right out. The razor included in the kit is to shave area if needed to improve suction. The idea is to remove as much venom as immediately as You can before treatment afterward (FIRST AID).

[stitch_paradox]

WHAT GLOCKMAN19 said

http://www.amazon.com/Extractor-Sting-Suction-Insects-Snakes/dp/B004AQFCMQ

THIS ^ is what he was talking about
I have one. I watched my buddy use one on a spider bite. It works using one hand. It sucked his skin about 1/2" into the clear tube. So You leave it attached for a bit. You could see a clear large drop of the venom bead up on top of the skin. They say it works great for tick heads and infection. It sucks em right out. The razor included in the kit is to shave area if needed to improve suction. The idea is to remove as much venom as immediately as You can before treatment afterward (FIRST AID).

Are you sure it's venom and not plasma? Small wounds like puncture wounds or a scratch produce plasma leakage.

[Lugiahua]

Prevention:
- avoid snakes if possible, always check before you cross over a fallen tree or boulder, where snakes could be hiding. Do not put hands into rock gaps.
- wear gaiters and gloves could reduce/prevent injury.
- Do not attempt to catch snake, snakes can lunge further than you think. Most snake bites in US happened when someone try to grab one...

Treatment:
- Remove patient from immediate area
- wash the wound thoroughly, which can reduce infection.
- ID the snake if you can do it safely, but it's not very important in US.
- calm the patient, very few people actually died from snake bites in US
- splint the limb if possible, but do not obstruct patient's ability to evacuate.
- try not to exercise the patient, again, ability to move toward rescue is more important.
(In the past people thought they would die if they began walking, not only this is false, it also delayed the definitive care)
- pressured immobilization is ineffective to most snakes in US except coral snake.
- Extractors like the one above have shown ineffective against snake bites, and no longer recommended.

[Squirly]

Thanks for the input. This response seems to not only direct, but also explain. Knowledge is power.

I hike where the rattle snake would be agreessor. I've seen 100s in my life so not scared... Just you never know when u cross the wrong path and what... It happens... Hiking shoes and shorts are gonna do much to block

I teach environmental hazards and first aid/CLS to Marines, and I agree to what the others have stated. I will just reiterate and expound more as to why we shouldn't do the following method of supposed treatments.

Tourniquets:
If you put a TQ on a snake bitten limb, while you are constricting the blood flow in that area, you also contaminate all of the blood in that limb with the venom. So when the patient reache the hospital and the surgeon removes the TQ, it will create a burst dam effect spreading contaminated blood rapidly all throughout the body and possibly putting the patient into shock. Plus, if the snake bite was not actually venomous you might have just destroyed the nerves on that limb and could have possibly lost it.

Cutting and Bleeding the wound:
It's a common misconception that as soon as you get bitten by a snake, if you cute the bite site and let the wound bleed out you can actually get rid of the venom. I don't know where people get that but that's actually dumb. Why would you complicate the wound and possibly expose it to more infection by slicing it when all you have is two puncture wounds? Also some poisonous snakes have anti-coagulative venoms that will prevent the blood from clotting and the wound will bleed out.

Sucking the venom out:
I always get this from the Marines. Not only does it sound absurd but it’s the most dangerous method of all. Who in the right mind would want to suck a poison into their system, right?
“But doc, I would spit out the venom right away!”
True you can spit it out faster than you can spit a dip, but are you 100% sure that you don’t have any open lesions or sores in your mouth that the venom can seep in? Even a bleeding gum because you flossed your teeth that morning can put your health at risk. So now instead of just one patient, we have two. The majority of the snakebite suction kits that you buy in the stores does not work either.


Ice/or cold compress:

Now I get conflicting instructions on this. Some providers advocate this method some don’t. The only reason why I think it’s frowned upon is because the dirty water from the ice or the compress can contaminate the bite site and further infect wound. The idea of icing and cold compress came about because it was taught that you should contain or minimize the swelling of the wound right away, and we all know cold keeps the swelling down.



Chasing or catching the snake for identification:

Why would you catch something that just bit you 5 seconds ago? If you or your friends have a cellphone with a camera or a camera, take a picture of it instead. If that’s not available try to memorize the key features or characteristics of the snake, i.e. rattling sounds, color, pattern, etc.


Now we go for the treatment. I learned this when we did training in the Australian outback from the Australian Army. Some of it where new to me specially number 5. Now keep in mind that in the Outbacks anything can kill you and if you get injured there, depending on some places the air medevac can take almost an hour, so they take this stuff seriously.

1. Avoid the snake. Preventive medicine is the best medicine. Know where the snake hangs out and if in doubt if there’s snake in the direction where you’re going keep a safe distance and try throwing rocks or sticks to see if there is indeed something lurking in that area. Take the dog with you when you hike, they can usually sense right away if there is something wrong in front of you.

2. Say the unavoidable happened and you get bitten. Stay calm and don’t panic. The more you panic the more your heart rate goes faster and the possibility the venom spreading through your body is greater.
3. Evacuate ASAP. The quicker you get to a treatment facility the quicker you can get access to the anti-venom (if you are indeed bitten by a venomous snake).
4. Immobilize the bite area or the limb of the bitten area. Most bites believe or not will be on you extremities. The more you use your muscle the more it circulates the blood and possibly the venom, and we want to avoid that. Also some snake bites will swell up really quick and it will stretch the skin, that even a slight movement will burst the skin open. Put a splint on the area or limb if you can.
5. Wrap it with an elastic bandage. This method is more so for when you cannot be medevac for more than 2 hours or so or if you are in an excursion and have a medical supply. Now this takes practice as one wrong placement or turn of the bandage can cause more damage than aid.
So say you get bitten in the lower right arm, you just don’t put a wrap on the bite site but you put several layers of wrap on the whole arm, starting from the distal fingers all the way to the almost to the armpit of you can. Mind you, that when you are wrapping a bandage it should not be too tight that it will cut off the circulation and not be too loose or it won’t do you any good. You should at least do 2 or 3 layers of wraps. Wrap one layer of elastic bandage, then another on top of the first layer. Implement the splinting method on top of the second layer of the wrap, then lastly secure it with a third wrap.
The Idea of this method is that you are knocking out 3 birds in one stone (method)
1. You immobilize the movement of the affected limb by using several layers of bandages and splint.
2. You minimize the blood flow from that limb and minimize the possibility of spreading the venom in the body. Now, noticed I said minimize and not restrict. Remember when I said we don’t want that “dam effect” by using the TQ? With this method, you are slowing down the circulation of blood in that whole arm, at the same time you are not creating a damn effect. That’s why you also wrap the most distal part of that limb.
3. With this method you compress the body tissue to avoid swelling, hence eliminating the need for cold compress.

I know it is a long read. But please do share your insights and opinions.