[at-l] Snake Bite

[icw39@ncfreedom.net (Clark Wright)]

Good post, but there are a couple of additions needed.  First coral
snakes are endemic to North Carolina and other states north of Florida. 
Second, while rare, coral snakes are more deadly than the other three -
and, unfortunately, are the hardest to distinguish from some harmless
cousins.  Third, the fact that constriction bands are removed in the ER
is true, but does not answer the question of whether they are worthwhile
to have in place PENDING getting to the ER!  Depending on one's on-scene
evaluation of the amount of venom injected relative to the size, age and
health of the victim, distance to be traveled, etc. - and assuming that
the "helping hands" involved know how to use the thing, a constriction
band might well be a useful thing to apply until the hospital is
reached.  If it is an extremity that is bitten, I personally would
recommend elevation of the extremity and light use of a constriction
band as a general rule . . .

now, for my confession, I'm only the son of a doctor - but I did stay at
a Holiday Inn Express last night! :)

thru-thinker

Gary Buffington wrote:
> 
> 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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