I'd like to talk to you a little bit
about treatment, and immediately after
somebody's bitten I guess the first
thing you'd advise is for them to panic
and maybe scream that's what I'd
probably do but of course the way we
teach and the best thing to do is to not
panic easy to say in a lecture easy to
read in a book but people are going to
be freaking out once you gather yourself
lay low don't panic and those around you
let them do the work of going for help
the best thing you can do is remain calm
take a deep breath as we discussed
before it may be a dry bite and you're
not even envenomated or poisoned that's
the best advice I could get so what
about all the stuff that we read about
in first-aid books cutting sucking etc
well those are all dramatic again I love
them in movies I've done it myself
self-inflicted snake bites but the best
thing to do first let's talk about
cutting and sucking again dramatic
you've seen it where they take out their
buck knife they'll cut through the fang
mark and then just start sucking the
gojira's out of the person's arm or leg
or name a body part
don't do it the human mouth has
bacterial flora nastiness that's even
worse than the snake's mouth so you're
going to infect the wound by sucking on
it and worse yet your knife although you
mean well is going to cut through
valuable structures like tendons nerves
arteries veins you need those so people
who cut then suck are actually doing
more harm than good
don't do it people have probably heard
that cold might be helpful how do you
feel about cold we used to feel that
cold usually it's also called
cryotherapy applying cold or ice to the
wound would help and in some bites like
bee stings some spider bites a little
ice isn't such a bad thing
snake bites we discourage it and we've
even seen people trying to immerse an
entire arm in an ice bath don't do it
it's actually going to cause more damage
than
best thing to do is just to elevate the
arm above the level of the heart push
some moral fluids because that's
probably all you're going to have in the
wilderness you're not going to have IV
fluids remain calm
send someone else to get help the best
thing you can have are car keys and a
cell phone and if so the treatment is
antivenom it is and it's getting to a
facility that has it there have been
some folks saying why don't we have
anti-venom in the wilderness with
paramedics ready to go
anti-venom also has risks when you
administer it it's taken from horses
it's taken from sheep so when you give
that to humans you may have an allergic
reaction so it's best to give the
anti-venom in the hospital setting so in
the wilderness the best thing you can do
start up a car make a cell phone call
9-1-1 to a hospital facility so what's
the deal with cro fab and why is it
better than the old stuff
I love Crowe fab I think they've done a
good job they have taken the anti-venom
and refined it to a much more pure type
of anti-venom so there's not as much of
a chance of an allergic reaction as with
the old anti-venom it is more costly
like supercouple 20 or $30 per does ah
times that by 10 exactly so it's about
three four hundred a vial it's expensive
so you don't want to give it out
willy-nilly I know that's not much of a
medical term but don't give it out
willy-nilly but you don't want to give
it out just for every snakebite you want
to make sure there's actual evidence of
envenomations swelling of the arm
blistering systemic or total body
effects blood toxicity lab abnormalities
that reflect a systemic or total body
and venom ation or poisoning that's when
you give the anti-venom less chance of
allergic reaction with the new Crowe fab
it is more expensive and we're finding
it's safer in kids and what's
interesting about children is the snake
is confused by the size of the human
it's a toddler or an adult like yourself
the snake is going to inject the same
amount of venom so kids need the same
amount of anti-venom as adults you're
you're essentially treating the venom
not the patient in that way exactly we
always say treat the patient not the
poison treat the patient not the numbers
here you're treating the poison the
snake is going to inject the same amount
of venom into little Johnny as it does
in to Grandpa Rex so because of that
you're going to treat the patient
whether a toddler or a full-sized adult
with the same amount of anti-venom when
you're in the emergency department and a
patient's been bitten you're not sure
yet if they've been envenomated do you
wait an hour do you wait two days at
what point can you decide that the
patient's probably good to go home most
bites you can see something within about
6 hours 4 to 6 hours you're going to
start seeing swelling in the arm the leg
depending on where they were bitten the
glands you look for swelling most pit
vipers rattlesnakes cottonmouths water
moccasins you're going to see that
pretty rapidly particularly if there's
maybe a vein or an artery involved in
the envenomations so if you watch them
six maybe even stretch it to 12 and you
see no swelling lab just look good nor
abnormalities you can safely send them
home and reassure the patient the
exceptions are mojave rattlesnakes they
may only have a little blood toxicity
they have a neuro or brain central
nervous system toxicity there may be a
delay I would observe them for 24's same
with coral snakes we don't get that many
certainly in the East in Florida into
Texas here where we are Arizona New
Mexico this type of coral snake is
really docile its shy you have to pick
it up let it chew on your finger for
about an hour then you may get
envenomated
if you have those envenomations you
probably want to watch them for 24 hours
otherwise you can watch these patients
in the ER
if you're going to see it it'll manifest
itself pretty quickly in some books they
talk about lymphatic or venous
constrictors what's your feeling about
any kind of constriction okay the other
word for constriction is using
tourniquets or taking a bandana and wrap
tight knot around the arm or leg that's
been bitten there's really no role for
that particularly in the US with pit
vipers mostly because we have hospitals
ers clinics that are pretty close
good paramedic system so I would advise
against it now if you're away in the
wilderness and you're a day or two out
you may want to do the 127 hour risk the
limb to save the life but that is really
uncommon you're probably not going to
need to do a tourniquet now
internationally where we have neuro
toxic snakes like cobras crates you can
loosely put them on even rotate them to
stop or impede lymphatic drainage that
spreads the neurotoxin
but Australians people from India Africa
they're very good at that leave it to
them in the US I'd shy away from
tourniquets avoid it and if you do put
it on put it on loosely so when we say
tourniquet we're not talking about the
tourniquet that most people imagine
which is in arterial tourniquet correct
correct so it's more of a superficial
tourniquet and in the wilderness it's
probably going to be like a rag a
bandanna something like that
maybe the tubing from your Camelback or
water receptacle would be a good
tourniquet but you're not going to need
to use those and in theory they say if
it's too tight when you release it
you'll get this bolus or injection of
venom
not true but probably what you're going
to do is cause more limb arm leg
constriction and bad healing and that
you don't want to do I know that in
Australia people are using ace wraps
just for gentle lymphatic compression
what's the deal with with kostik
compress
as in something like an ace wrap I think
that's fine as long as it's not again
too tight to taunt there's nothing wrong
with that particularly if you're out in
a bit of ways from your closest ER
clinic hospital that's going to be able
to see you I don't see a problem with
that and certainly if there's any other
trauma bleeding that can kind of help
with that and it gives the patient a
feeling that you're doing something and
the people that are around the patient
they may feel like they're doing
something but again calm oral fluids
call 9-1-1 calmly drive them to the
closest ER is the best thing you can do
there are some commercial devices one in
particular is the Sawyer extractor right
what's your feeling about the extractor
well there are extractors the one that
is most common is Sawyer it still talked
about even in Boy Scout manuals and the
idea is as soon as the snake strikes
you're going to take a little suction
device kind of cause a hickey and pull
back on a syringe and pull out some of
the venom and in original studies they
thought we may get out maybe a quarter
to a third of the venom and it may help
but what we're finding now particularly
with good animal studies that it doesn't
help in fact it may cause a little more
damage in the local area I know the
Sawyer people they're outstanding folks
I wouldn't recommend it however a plug
for Sawyer they do a lot with water
purification internationally and I think
they're a fabulous product with their
water treatment devices so I don't want
to diss the Sawyer family but the
suction devices for the most part even
though there's still advertised still
and wilderness kits still in emergency
kits are probably not going to help is
it hard to explain the Hickey when you
get home it is particularly if you were
struck on the neck by the snake Tim I
know that you work at a big center where
you see everything and I know part of
your practice includes treating exotic
snake bite right what you're feeling
about people having exotic snakes as
pets I'm against it I think it's a
machismo thing i underst
and why people want it leave them be
particularly exotic snakes to get them
in they have to be flown in or shipped
in internationally you're taking them
out of their habitat it's the wrong
thing to do and then you're not being
very humane putting them in a confined
area you're only going to get into
trouble and when people get bit by
exotic snakes in the US no one knows
really how to treat them and other than
zoos you're not going to have the proper
anti-venom it's very dangerous it's the
wrong thing to do don't do it
