Why don't you put ice on a snake bite?

[WANTYNU]

Awhhhh Dust your making me work... again. (I agree with Spenac, I don't want to work today, you picking on the new guy again?) :roll:

But hook firmly placed, I take the bait... After all I come from NYC, I gotta put up to a challenge!

It was late, I did make a mistake, but I still say the answer is simple.

You must have skipped over the first page. Spenac answered it succinctly in replies 2 and 3. Dwayne elucidated on the exact physiology a few posts later.

As for the rest, I did read every post, and I made my statement based on what I read. The reason, stated here for not using ICE, (tissue damage) is incorrect, and I stick by that answer, otherwise, why is ice still prescribed and used effectively for a sprain and other skeletal / muscle injury .

When tissue damage from cold for snake bite treatment is discussed, reference is to CRYOTHERAPY, Ice therapy is different from Cryotherapy (which is aggressive wound cooling via carbon dioxide gas, dry ice or other intensive skin cooling).

The "frostbite" answer that spenac originally gave was on the money. …. As spenac also said, there was the theory of localizing the venom to prevent systemic spread that has also been disproved

Many answers to this statement.

If you reread the literature it’s all about slowing (not stopping the venom flow).

Another theory that didn't pan out under scientific scrutiny was that of enzymatic deactivation of venom by cold therapy. Neither cold nor electric shock has been shown do have any effect on the structure of any snake venoms.

Good information, but I didn’t see it as germane to the discussion about topical ice application (not deep cooling).

Getting back to point, the question was: “Why don’t you put Ice on a snake bite”.

The JEMS article you referenced (which I read when it came out) involves a series of other treatments (mostly ALS, and Definitive), I interpreted the question as BLS (since ICE is a BLS option and we all say BLS before ALS).

And I stick to what I said the answer to the question “Why don’t you put Ice on a snake bite”.

Ice promotes skin surface vasoconstriction; pushing blood and venom into the body, causing faster absorption than if left alone. Remember the name of the game for emergent (not definitive) treatment modalities is to slow the process down.

The "frostbite" answer that spenac originally gave was on the money.

So I’m disagreeing with Spenac on this one (rare I know), but hey he’s one of the one’s who “toughened” me up (refer to earlier thread on tx of noob’s) so I do believe he can take it.

The same reason we don't see the precordial thump in lay CPR anymore. People -- EMTs included -- too often think that more is better, and they go overboard, causing tissue damage from immersing hands in ice for over an hour. Yeah, I know that sounds improbably crazy, but so does training "EMS professionals" in 120 hours of night school.

I have no answer for this other then everything we are permitted to do is under physician directed control, If an emergency medical provider does as you describe, he / she is clearly operating outside the standard of care they were taught, and that my friend is horse of different color (horses – Texas, like the reference… ;-) ). But our scope of practice is not based on what it is possible for us to do wrong, if that were the case, I don’t think we’d be allowed within ten feet of a patient.

Neither ERDoc nor I would have been posting jokes if the question was still dangling.

Never implied it, I know at the heart of this we are on the same page and you take this as serious as I do.

Neither Sources? I challenge that entire theory.

Well OK then.

There is the JEMS article you quoted.

Wilderness Medical Associates: Field guide author Jim Morrissey, EMT-P WEMT

NOLS Wilderness First Aid isbn 0-8117-3084-0

Paramedic Care: Bledsoe, Porter, Cherry

FDA Snakebite Treatment Page

(PS forget the SAS survival book, it’s completely wrong…)

All of the above state no ice, but make no reference as to why (I’m working on that) I remember reading the explanation I gave above, but currently can’t find the source, but shouldn’t it go to reason, if ice is not harmful to the skin for sprains the same would go for bites? Following that reasoning there has to be a different reason for the contraindication of using ice on a snakebite.

I have emailed a physician I know at Jacobi Hospital NYC one of the top Snakebite centers in the country.

I will find the answer, and will post it.

Be safe,

WANTYNU

[spenac]

So I’m disagreeing with Spenac on this one (rare I know), but hey he’s one of the one’s who “toughened” me up (refer to earlier thread on tx of noob’s) so I do believe he can take it.

:knob: :crybaby: :occasion5:

OK I'm over it. I never said the reason given was correct. I said it was the reason given. In many first aid courses and documents online it is the reason given for not using ice.

Your answer could be more scientifically correct. brushteeth Sorry had to wash that taste out of my mouth after agreeing. :wink:

My personal opinion is that unless they get you SQ, the toxin is circulating almost immediately. Much like IM. Very quick action.

Anybody here still do rolling tourniquet for snake bite?

[Scaramedic]

As much as this pains me to say, sigh, I agree with Dwayne.

I was a Football player, when I was in pee-wee football I broke my ankle, bad. So when I played in high school I spent a lot of time after games and practice with ice on my ankle. Lots of time with both real ice and ice packs, and never did I suffer any form of frostbite. Also we are talking about around the ankle, a very thin area of skin.

So I wonder if the issue with frostbite is less with the cold then the necrotic factors of snake bites. Here come the stats...

99% of snake bites in the U.S. are caused by the Crotalidae (pit viper) family of snakes [sup:596694db22](1)[/sup:596694db22]. These include rattlesnakes, cottonmouths and copperheads. Most pit vipers have a hemotoxic venom, i.e it attacks the blood and tissue.

The venom consists of proteins, polypeptides, and enzymes that cause necrosis and hemolysis. Most crotalid venoms damage capillary endothelial cells, resulting in third spacing of plasma and extravasation of erythrocytes.

[sub:596694db22] (1) Venomous Snakebites in the United States: Management Review and Update

GREGORY JUCKETT, M.D., M.P.H., and JOHN G. HANCOX, M.D.

West Virginia University School of Medicine, Morgantown, West Virginia[/sub:596694db22]

In other words the tissue itself is being damaged at the cellular level, especially the capillaries which one of their functions is to circulate warm blood the through the tissues. This of course happens through vasodilation which causes the flushing effect (redness) when say your hands get cold. Now if one considers that a basic heating pad can cause burns on a patient with decreased blood flow, corpses as well. Then it is not a big jump to see that decreased blood flow could lead to the opposite condition with snake bites and ice packs.

So in my opinion is not entirely true to say the ice is responsible for tissue damage. Rather it is the effects of the venom that leads to tissue damage, that makes the tissues more susceptible to frostbite. My argument doesn't nullify the fact that you should not use ice. I am merely trying to understand and explain why ice can cause frostbite in snake bites.

[WANTYNU]

Then it is not a big jump to see that decreased blood flow could lead to the opposite condition with snake bites and ice packs.

So in my opinion is not entirely true to say the ice is responsible for tissue damage. Rather it is the effects of the venom that leads to tissue damage, that makes the tissues more susceptible to frostbite. My argument doesn't nullify the fact that you should not use ice. I am merely trying to understand and explain why ice can cause frostbite in snake bites.

Also a sound theory, the only wrench I’ll l throw in these money works is: Isn’t it already a physiological response to surface cooling to shunt the blood flow away from the outer skin to preserve core temperature, that being so, if it’s a natural response, wouldn’t the body have a defense mechanism in place to prevent damage to outer layers?

As well to the antidotal evidence we see in the field every day with geriatrics using ice & ice packs for therapeutic needs.

W-

[Scaramedic]

It has some defense mechanisms but much these mechanism fail pretty quickly after the body starts shunting blood to the core. After the body reaches a certain temp it vasoconstricts peripheral vessels to protect the brain and internal organs. Actually you do things like shivering to stimulate heat in the muscles and increase cardiac output and respiratory rate. After that the body starts it final defense, shunting blood to the core. Once the blood flow is decrease and eventually stopped is when you get frostbite.

My little theory is that the damage from the venom to the tissues causes it to be more susceptible to cold injury.

[craig]

Just some thoughts from a 20yr veteran that lives in the country that has the most number of venemous snakes

dont put ice on the bite site.

reson one for doing this is that it does constrict the periferal blood supply and then cause constriction of the underlying tissue. this is not what you want in a LOCALISED area.

the idea that you want the poison to be slowed in the circulatory folw is incorrect as it is the LYMPHATIC system that is the transport agent for the toxins. That is whay you use the compression imobolisation banadge here in Aus. this compresses the lymph system in the whole limb thus slowing the flow throught the lymph system and reducing the envenomation.

I agree that the general population would not think and keep ice on the skin for greater than 20 minutes and could cause tissue damage.

The other main reason for not using ice on a bite (in Australia at leasty) is that the skin can be scraped at 99% of our hospitals to get a sample of the venom for identification.

By using ice then DILUTES this dried venom on the skin making it difficult to carry out this procedure and then delaying the use of the correct anti veniene.

These are standard envenomation treatment guidlines for any envenomation here in the great south land, being snake, spider, octopus, wasp etc.

hope this helps

stay safe

craig.

PS Chuck Norris put all the poisonous stuff in Australia so he could use it as a playground for his kids with out hurting anyone else.

[ERDoc]

Part of the problem is there have been no good studies. It is hard to get IRB approval or volunteers for studies that start, "You will be bitten by a very large, deadly snake and we will try different things to see if you will live or die (we made no promises)." So much of what we do is based on anecdotal evidence and case studies. That being said, it seems like the best treatment in the field is to get the pt to the hospital as quick as you can and provide supportive treatment. That being said, here are a few articles from emedicine with references. My favorite part is in the coral snake envenomations under prehospital care. "If possible, take a digital photo of the snake from a safe distance." Hold on while I get my cell phone out to snap a picture of an already pissed off snake who is probably looking for someone else to take it out on. If you are lucky you will have Dr. Norris in your 5 spot.

http://www.emedicine.com/emerg/index.shtml Scan down to the environmental section.

[Scaramedic]

9 Chuck Norris references in one post, is that a record?

[Dustdevil]

So in my opinion is not entirely true to say the ice is responsible for tissue damage. Rather it is the effects of the venom that leads to tissue damage, that makes the tissues more susceptible to frostbite. My argument doesn't nullify the fact that you should not use ice. I am merely trying to understand and explain why ice can cause frostbite in snake bites.

Agreed. But some of y'all are missing all of the key points:

• 1. Snakebites are not everyday occurrences like headaches and ankle sprains. Consequently, people do not react with the same prudence. People tend to panic, just like they do in CPR. In both snakebites and CPR, this results in overreactions and dangerous results.

2. We're not talking about the average Kwik Kold pack being applied with an insulator, by a medical professional, for a ten minute ride to the hospital. We're talking about first aid, at the scene of the bite, during extended scenarios, rendered by idiots who have no Kwik Kold packs, but they do have a Coleman full of iced down beer. It is this lowest common denominator that has to be addressed by first aid standards.

3. Study after study shows that -- even without the tissue damage from overcooling -- cryotherapy significantly intensifies the necrotic effect of the venom.

4. Study after study shows absolutely no benefit whatsoever to cryotherapy, regardless of the theories. Sticking with disproved theories just because they are intuitive is neither scientific nor professional. Remember, theory says the Bumble Bee lacks the aerodynamics to fly.

• So, bottom line is, ice not good. Ice bad. Even if ice weren't bad, it is still not good. What else is there to say about it? The simple fact that IT DOES NOT HELP should be wholly sufficient discussion, for even the seriously scientific minded. Geeze... now I'm starting to think they should have left out the whole part of harmful effects when they yanked cryotherapy and just stuck with the "it doesn't work" part to simplify the whole matter for everybody. My God, the way some people whine about it, you'd think you just took an ALS skill from them.

And no, we don't all say "BLS before ALS." In fact, most of us are so sick of that retarded nonsense that we have to resist the urge to throttle the next person who says it. "BLS before ALS" is not a universal principle of EMS. And it is not to be taken literally. It is a very specific principle which has one very specific application. What "BLS before ALS" means is that you take care of the ABCs before all else. Period. That's it. Do you complete your bandaging and splinting before you intubate, defibrillate, or start your IVs? Well, congratulations. You win the "BLS before ALS" idiot of the decade award. Unfortunately, you can’t explain that adequately in 120 hours of night school, especially to idiots with low IQs and poor communications skills. Any instructor that perpetuates this crap should be sacked.

EDIT: Dayum! A lot of people posted while I was writing that! :shock:

[JPINFV]

I think it should also be noted here that apoptosis (which can be helped by cooling, see stuff about cooling in cardiac arrest) is completely different than necrosis.