[at-l] Snake Bite

[gbuffmd@bigfoot.com (Gary Buffington)]

As a retired ER doctor who has treated more than a dozen snake bites, and
having earned our keep in the AMC huts talking about snake bite, I thought I
should comment here:  There are 4 poisonous snakes in the Eastern United
States-The Cotton Mouth Water Moccasin, The Rattlesnake, The Copperhead, and
the Coral Snake.  Although I practiced Emergency Medicine in Florida for 25
years, I never saw a Coral Snake bite.  The Coral Snake is essentially only
in Florida and the other three, but mainly the Rattlesnake and Copperhead,
are found along the AT.  Each year less than 10 people in the United State
die of snakebite-and most of them are very old, very young, and very drunk.
Almost no one dies of a copperhead bite.  Most have attacked the snake more
than the snake attacked them.  That is they approached the snake to play
with it in some way.  The Rattlesnake, Copperhead and Moccasin have fangs
for injecting venom.  They are like hypodermic needles.  Just because they
stick in the fangs, doesn't always mean they inject.  Only about 1/3 of all
bites actually involve injection (envenomation) that requires treatment.
About 1/3 is minimal injection and the rest is no injection.  If you are not
envenomated, you don't need treatment.  On the Eastern fanged snakes, if you
are bitten you'll see one or two fang marks and if you are envenomated
you'll know it: because of pain, swelling, tenderness, and/or a black and
blue appearance.  The only real treatment is antivenin (note the peculiar
spelling) that is available at all the hospitals (big and little) along the
AT.  The standard antivenin was derived from horse serum (not even the
medical students would volunteer to be snake bit, but the horses did).
There is now coming on the market genetic engineered antivenin that will
have fewer side effects.  However, if you need the antivenin, the side
effects aren't too bad.  I think any type of extractor is a waste of time
and not likely to extract any venom.  I don't use them.
Treatment at the scene:  Wash the would (just wipe it off, not too
important); observe a few moments for pain, swelling, tenderness, or
bruising-these are signs of significant envenomation; take the patient out
to a hospital; we can debate forever if he should walk (exercise), or "be
calm" (who could)-just get him there and he can walk if he must.  Ice is
harmful.  You'll hear about constricting bands (not tourniquets), but if you
put one on, the ER will only take it off.
The worst I ever saw was a drunken guy who came upon a drug deal.  The
dealer was a snake handler who had a giant rattlesnake to protect the drugs.
The snake bit my patient on the shoulder.  The whole shoulder and arm turned
black and blue and the patient had a cardiopulmonary arrest, resuscitation,
ventilation, and renal failure.  He received many dozens of vials of
antivenin and survived.  I also saw my golf pro's 6 year old daughter with
fang marks and no evidence of envenomation.  She needed no treatment, but I
had her stay for one hour of observation to be sure nothing was delayed.
I understand some of the Western Rattlesnakes can envenomate without
immediate local reaction.  I don't have any experience with those.
I saw one rattlesnake on the AT (in Pennsylvania) and it could have bitten
me if it wanted.  I have not heard of anyone bitten on the AT not even the
guys we heard of drinking and handling a copperhead.
Bear Bag, GA>ME 2000 with Sweet Pea
See our journal and picture site at: www.800WeSweat.com

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