Snake Bites

[tcripp]

Odd one here...not a paitent I had but one I may have.

Has anyone had a snake bite patient who can give me some hands-on insight on what to expect?

I'll be working a medical stand-by with snakes involved. I know what the books read and what my guidelines suggest I do, so I'm not looking for someone to quote me what's already written online or in a text book. I'm looking for an actual case.

Thanks in advance.

[FireMedic65]

It depends on the snake and where you were bitten. I was taught at a class (taught by an MD that was an expert in the field of venom) that you are to bandage and keep the wound heart level. Applying any sort of constricting band can make things worse (or better).

Your best course of action is having dispatch get you in contact with someone that is an expert on the subject. Most hospitals are not capable of handling many of the venomous snakes out there. They sometimes carry a limited supply for snakes local to the area, but not much because it expires. Get in contact with local hospitals to see what their capabilities are for handling snake bites and what anti-venom they have. If you are rural, you might be looking at flying a patient. The closest hospital to me that can handle such things, is down in Philly. They carry a lot on hand because of the zoo being so close. Way too far to drive

What kind of standby? Their will probably even be experts on site.

Edited February 24, 2011 by FireMedic65

[brentoli]

This isn't covered in our protocols locally. Interesting though the last I knew was to use a loose constricting band. The thought being to allow blood flow but constrict the lymph, since that's how most venom travels.

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[FireMedic65]

This isn't covered in our protocols locally. Interesting though the last I knew was to use a loose constricting band. The thought being to allow blood flow but constrict the lymph, since that's how most venom travels.

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Like I said brent... it depends on the snake. Best to contact an expert. Some venom will cause the tissue necrosis if it is constricted.

[Just Plain Ruff]

Like I said brent... it depends on the snake. Best to contact an expert. Some venom will cause the tissue necrosis if it is constricted.

I believe the venom registry out in Arizona has the Dr. Sean guy who is the snake expert. I think the registry is run by the Phoenix fire department and a major hospital in Phoenix.

I also believe that if you have a major snakebite that they will fly the venom directly to you if there is time to do so.

IF you are anywhere within like 600 miles of the location where the registry is you can get enough antivenin flown to you. I think the doctor will even come along to help your local docs deal with the situation.

It's similar to the Diver Alert Network.

I did a websearch for this and couldn't find it but I am not in a good place to do a indepth search.

ok, I did a exhaustive search since my plane isn't gonna be here for another 2 hours.

http://lomalindahealth.org/medical-center/our-services/emergency/programs-and-divisions/venom-er/index.page

The venom registry is out of Loma Linda.

Here are links to specific venom residencies. I had no idea there were specific venom residencies. Cool.

Great resources on the first link.

[Richard B the EMT]

Due to location, probabley of no help, but for the entire 8,000,000 people in New York City, the hospital for snake bite is Jacobi Hospital in the Bronx, probably because they're close, geographically, to the Bronx Zoo (the one with the 4 legged, winged, or crawling animals, not the NY Yankees ball field).

[Bieber]

To be honest, I'd have to reread my paramedic school book to tell you, I do know that it does depend on the type of snake. Our protocols don't cover envenomations, so what I would do (and suggest you do) in the situation is have the poison control number on speed dial. I think they cover envenomations, don't they?

Well, in any case, have the number to whatever department handles snakebites and defer to their suggestion is what I would do.

Oh. I just noticed you were looking for actual cases. Can't say I've run any snake bites in the field, the closest thing I've come to is I know we did have a "patient" with a snake bite at our Field Ops. (I know, you're curious, a post covering it is forthcoming.)

[tcripp]

Beiber. Thank you. I was getting a little frustrated that I coulndn't get what I wanted out of this post. Actually, it's happened a couple of times. Last one was the question about etomidate. Talk about a hijacked thread. Ha ha

Seriously. I have the education. I know what to do, what not to do...who to call and when.

I was just looking to see if anyone had experienced this type of call.

As a side note, in my area, no ice and no tourniquets are part of the treatment.

[medicgirl05]

Well working in south Texas I surely have a little experience with this issue.

First, for us anyway, is the snake venemous? If so, we need to find which of our area hospitals carries antivenom. Not all do and sometimes it is out of stock, in which case we may consider a flight to a better facility.

According to our protocols, we wash the bitten extremity with saline in hopes of washing off any venom that is not already in the wound. There is not much else we can do for the actual bite but we treat the patient accordingly. We mark the affected area periodically to determine how fast the venom is moving.

As for the patient response, 2 snake bites come to mind.

First scenario- 13 year old girl with bite to ankle. Rattlesnake.

Patient found seated at home with significant pain but appears calm. BP is elevated, Pulse is elevated. All other findings appear normal. During the approximate 30 minute transport time the patient remained calm, no crying, but complained of pain on touch or movement of the extremity with the redness and swelling continuing up to reach the top of her calf.

Second-40ish male with copperhead bite to hand

Patient found outside crying in pain. BP, Pulse elevated. Patient complains of nausea/vomiting. Approximate 45 minute transport patient has no change in symptoms and receives phenergan for Nausea which removes that from the equation. Patient complains of significant pain throughout transport and due to his allergies I was unable to medicate him. Swelling and redness did not continue up the arm during transport and symptoms remained unchanged at time of transfer of care.

I think snake bite severity has many factors; location of bite, tolerance for pain, previous exposure, other medical history, and the amount of venom injected. Some things you should probably know before going, nearest facility with antivenom, and if snakes are venomous.

Good luck!

Edited February 25, 2011 by medicgirl05

[DwayneEMTP]

Yeah, except for MG no one really gave you what you were asking for...but, one thing that did come to mind..Is there a chance that you can get a list and description of the snakes that will be present at the standby?

That might at least allow a Google search for current thinking on species specific envenomation management?

Just a thought..

And Beiber I swear to God if your 'forthcoming' story involves a gazillion people crying and going out of their minds trying to save a snake bitten cat or some such shit I will kick your nuts right up next to your tonsils! Of course I mean that with love...

Dwayne