How to Treat a Venomous Snake Bite from a Crotalid - ITS Tactical

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How to Treat a Venomous Snake Bite from a Crotalid

By Jody Farr

SnakebitesMainTexas has its fair share of venomous snakes. Most encounters can be managed, but not totally eliminated. Growing up in west Texas I’ve seen more than my share of snakes, both venomous and non-venomous, and as a paramedic I’ve treated many snake bites.

Here in Texas the venomous snakes fall into two categories: crotalids (the most common) and elapids. We’ll discuss elapid envenomation in a future article. Crotalinae is the subfamily for all rattlesnakes, cotton mouths, and copper heads. These are the snakes that come to mind when we think of snakebites.

Most snake bites occur for typically one of two reasons. The first being that the patient did not see the snake and accidentally stepped on it. The second reason is that they were trying to pick up the snake or play with it. This sounds very stupid but it does happen. A lot.

Don’t Panic

When most people encounter a snake, the first thing that usually happens is a healthy dose of adrenaline is dumped into their system. This can cause them to react in numerous ways, most commonly in panic. That’s without even getting bit! Now imagine how most people react once bitten.

The most important thing to remember once you are bit is to stay calm. I know this seems counter-intuitive, but trust me: this is the best thing you can do for yourself. Make sure that you have either killed the snake or backed away far enough that the snake is no longer a threat.

Signs and Symptoms

With the typical Crotalinae envenomation, the patient will have sustained any number of puncture wounds from the snake’s fangs. Other signs and symptoms include:

  • Immediate burning pain
  • Tachycardia (fast heart rate)
  • Dyspnea / tachypnea (fast respiratory rate / difficulty breathing)
  • Diaphoresis (sweating)
  • Nausea and vomiting
  • Generalized weakness
  • Rubbery, minty, or metallic taste in mouth
  • Erythema and edema (swelling and redness)

Treatment

The best treatment that you can initiate is to get your cell phone out and call 911!

If it is at all possible, wash the bite with soap and water. Make sure not to get any venom that is around the bite into any open wounds. Always keep the site of the bite below the level of the heart. This will help slow the spread of the venom.

It is extremely important that you can describe the snake to medical personnel. This will help determine the course of treatment.

DO NOT try the old cowboy method of taking out your knife and cutting the wound to try to suck out the venom! This only causes more tissue damage and if you have open wounds in your mouth you have just essentially received a snake bite to your mouth.

DO NOT tie a tourniquet above the bite. This just reduces oxygenated blood flow to the site and will make the envenomation worse.

DO NOT apply ice or cold compresses to the site. This will just cause more tissue damage due to the blood vessels constricting.

Snake Bite Kits

Snake bite kits can be bought in most sporting good stores. DO NOT waste your money on these. They typically have a scalpel, suction device, constricting band and alcohol wipe. The only thing of any benefit in these kits is the alcohol wipes, which can be used to clean the bite.

Antivenom

The only way to treat a Crotalinae envenomation is with an antivenom called CroFab. CroFab is only available in hospitals. It is given intravenously and only under strict observation by a doctor. It is very important that you advise the medical personnel if you have any preexisting medical conditions such as bleeding disorders, heart, lung or kidney conditions. These conditions will play a factor in your overall treatment.

Common Sense

Most of the information that I have shared with you is just good old fashioned common sense. Just remember to stay calm, call 911 and get to the hospital for definitive treatment.

Editor’s Note: Please join us in welcoming Jody Farr RN, LP, FP-C, CCEMTP as a contributor on ITS Tactical. Jody has been a paramedic since 1992, certified flight paramedic since 2006, critical care paramedic since 1998 and a RN since 2010. He currently works as a flight medic for an EMS flight service in the D/FW metroplex.

Jody is also going to be at the 1st Annual ITS Tactical Hog Hunt, presenting some info on proper usage of our ETA Kit for those of you attending!

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Discussion

  • Sounds like good advice….

    One quick thing to add: Take a picture of the snake (if possible) with your cell phone or camera if possible. This will help the doctors determine the type of snake.

    • steve vandiver

      My wife was bitten by a rattlesnake at our ranch. The ranch is located 25 miles from the nearest small hospital and 25 miles from our veternarian – in the other direction. I asked her if she wanted to go to the hospital or to the vet who has successfully treated rattlesnake bits on our horses and cattle. “I’m no animal” she said so off to the hospital we went. I called ahead to be sure they had antivenom and then callet the sheriff to adivse we were coming in fast. The sheriff met us about seven miles from town and escorted us on to the hospital. An English doctor was on call who had never treated a rattlesnake bite. She had the nerve to ask if I was sure it was a rattleskake. Well I said, it had a triangular head, cat like eyes, pits, and rattles. She responded, why didn’t you bring in the snake? The fool. She messed around with my wife until her airway began to close and then rushed the antivenon. Too much too late. My wife was transported 100 miles to the nearest big hospital and en route was diverted to another hospital for entubation. My wife languished five days in intensive care at the large hospital before finally rallying. She later told me I was right to suggest the vet who unlike the English doctor knew what he was doing. Anyone thinking a rattlesnake bit is trivial should view URLREMOVEDFORSPAM. Best avoid the crawling critters, Steve.

    • Marty Black

      That link leads to spam!

  • Aubrey

    Jody,
    Thanks for this. Any comment on treatment with a Sawyer Extractor Kit or similar in a wilderness setting where 911 or quick evac is not an option?

  • TFA303

    Great article!

    Any additional suggestions for when the victim is in an isolated situation, where medical care may be days away?

    • Yokhannan

      Yeah, it’s call the “Spot” — http://www.findmespot.com/

      One button and you’ve got USCG on their way to pick your ass up for being stupid or lazy and not watching where you were walking.

  • Great article and welcome!

  • In the scenario posted,how much time approximately do you have to get Medical attention from the time you got bit?

    • Jody Farr

      It typically depends on the severity and anatomical location of the biet. In the 3rd part of this article 3 part article, I will explain in more detail on the grading of bites. But typically you have about 1 1-2 hours before it becomes detrimental to life and limb.

  • Great post, Jody. These are definitely tips worth noting.

    Brian, good idea about taking a photo!

  • JB Gilpin

    Outstanding. You are spot on. I saw the title of this article and got scared that I was about to read some inaccurate/dangerous advice. Quite the opposite. I instructed on this subject for the U.S. Border Patrol and our joke was that people died from snakebites for three reasons: 1. They (or their buddy) accidentally shot them(selves) while trying to kill the snake. 2. They panicked and blindly ran off a cliff. 3. They jumped in their car, drove 110 mph to the hospital and hit a bridge abutment. As you point out, calm and seeking professional medical care is the only real treatment.

    • Jose Soto

      Aren’t you the same Gilpin that worked in DGL?

    • JB Gilpin

      That’s me.

  • Doug

    The information listed above is great if one is a civilian and has quick & easy access to a telephone and medical personal.

    I am not a doctor, just a red neck who lives out in the woods. My family has been farming down here in Texas for 150+ years. Where access to doctors has been extremely limited until recent times.

    The old school way of taking care of snake bites from Copper Heads & Cotton Mouth bites has been passed down for over a century and a half.

    Stay calm, wash the area with soap & water, and the most important part is to clean the wound with some type of disinfectent. (alcohol & kerosene are the two used over time). Get to bed.

    When ones body is subjected to potent venom it needs rest. One can expect to enter an almost coma like sleep, where one sleeps for several hours, wakes up starving, goes back to sleep and repeats. This process may last one to three days pending on how much venom was injected.

    While I have myself have never been snake bit, I have over the years received heavy doses of venom from black widow spiders, bee swarms, and large pissed off wasps.

    So I can attest to the knowledge handed down from father to son, over the years. This is in fact the way it plays out on the human body.

    Get to a doctor if you can, but if not have no worries. It all works itself out.

    Consult a doctor about this, but you may want to pop a couple of benedril anti-histimines after venom injection. This may help with staving off negative body reactions to the toxins.

    Good luck & stay safe

  • waykno

    Keep the bite area (if possible) “below” the heart or “above?”

  • rockik

    Great article, I’m looking forward to hearing more at the hog hunt.

  • It would be more accurate to say that applying a tourniquet will increase the local concentration of venom and likely make the trauma around the bite site significantly worse. It does not contribute to the severity of systemic effects.
    However, using a pressure immobilization bandage does have merit and has shown to reduce or control systemic effects in severe envenomations. But they should, generally speaking, only be used with severe envenomations with significant systemic effects or if you have long transport times.
    Keep in mind that these PI bandages are not meant to restrict blood flow, either arterial or venous, but rather attempt to slow down lymphatic distribution of the venom. They’ve been used with a great deal of success in Australia for years.

    Crotalids are nasty and the reactions to their venom varies greatly as their venom can contain both neurotoxins and hemotoxins, depending on both species and individual snakes.
    Systemic effects can be remarkably bad and in some cases will result in coagulation disorders that persist well after the administration of antivenin.
    And I do strongly agree with Mr. Farr when it comes to suction devices like the Sawyer extractor. They’re an awesome way to really make the wound significantly worse and they offer no benefit at all. Avoid, avoid, avoid.

  • waykno

    I’ll try again–the article states: “Always keep the site of the bite below the level of the heart. This will help slow the spread of the venom.”
    My question is: above or below the heart? I thought it was above, if possible.

    • Jody Farr

      You want to keep the affected limb “below the level of the heart”. This will impede the spread of the venom as the venous blood returen will be slowed by gravity. If the limb was placed above or at the level of the heart gravity would actually help in the spread of the venom.

  • Jason Witch

    Waykno,

    The reason you keep the wound below the heart is to reduce the venous and lymph return. You do not want to stop it but slow it down. If you elevate the wound it will speed up return and it will enter systemic circulation faster.

  • nifty

    Ian is Correct about using a pressure Immobilization bandage. Here in Australia we have 20 of the worlds most poisonous snakes and the treatment is a P.I.B. to “crush” the lymphatic sysystem which is a sponge like surface under the skin which carries the venom via fluid called “Lymph” to the Lymph nodes which you could say are like “storm drains” for catching viruses and venom and filter it back into the body in a smaller dosage that the body can handle. Doug was also correct in resting after being bitten. The aborigines when bitten would find a place to lay down and they would be covered with leaves and they would rest for three days to allow the lymph nodes to do their work which they found would kill them if they kept walking around.

  • Dean Allan

    Check out a website from a company called Living with Wildlife at http://www.livingwithwildlifeusa.com. They talk about snakes, their reactions when they come into contact with humans and how to greatly reduce the chance of being bitten by one. They even have snake bite first aid instructions that you can download for free direct from their site. It is well worth having a look.

  • Homer J. Simpson

    Interestingly, the AHA’s revised guidelines for 2010 recommend a PI bandage for any venomous snakebite, not just the exotic ones. AFAIK, in the past this was not recommended for North American species:

    http://www.redcross.org/portal/site/en/menuitem.94aae335470e233f6cf911df43181aa0/?vgnextoid=2d792ea5d8fbb210VgnVCM10000089f0870aRCRD

    Combined with the acceptance of tourniquets by NREMT and PHTLS, next thing you know dogs and cats will be living together! But that’s OK, as long as they really love each other.

  • If you can, kill the snake and take it with you to the hospital.

    Shalom,

    Eliyah

  • Andrew

    Wow, very different to what is done in Australia.

    The worst thing you can do is clean the wound. We circle the bite with a thick texta (marker pen), apply the first bandage and repeat the marking on each subsequent layer. This enables the ED to take a swab and analyse the venom to ensure the appropriate anti-venom is administered.

    We also aren’t big fans of trying to kill the snake and take it with us. Chances are that will just double your patient list.

  • Gen.Anesthesia

    Im reading this a few years down the road. In North America, please do not apply a compression dressing or tourniquet to a Crotalinae bite. It will increase the tissue death in the affected limb. Keep it at or below the heart level. Wash it and transport, if possible, keeping things quiet and calm for your patient.
    For snakes with a neurotoxic venom, of which many of the worlds venomous snakes qualify including our coral snakes, the compression bandage (ACE Wrap, etc.) is the treatment of choice along with a calm but swift transport. Prepare to support respirations if transport is lengthy or delayed.

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