Rattle snake bites

[Inthecity]

I just have a question about rattle snake bites if that is ok. Have you ever transported a patient with one? Do you always have to go to the hospital for the antivenin or do ambulances ever carry it ( I am doubting they do since I hear its hard to get sometimes). I ask this because today I was at my moms house. She lives an hour from the nearest hospital out in the country. I was playing with my 2 year old and 6 year old in the yard and my dad said ok there is a rattle snake right by you. I look down and seriously it is a foot from my son and I! And I was wearing flip flops and shorts! We move out of the way and no one gets bit but I was wondering what to do in case of a snake bit. Would you recommend my parents drive us the hour to the hospital or call 911 and wait for life flight to get there or the ambulance to get there. Almost seems if it were the ambulance driving it would take longer! Also do all hospitals carry antivenin and how long would symptoms of the snake bite show? It really freaked me out because my 2 year old and 6 year old were just so close to it.

[cscboulder11]

If someone is bitten, the best thing you can do is get them calm to slow the spread of venom. There's a debate on whether or not to use a torquinet to slow the spread if the bite is located on an extremity, but I've heard this isn't effective. Symptoms generally show 20-30 minutes after a bite in an adult.

As for anti-venom at hospitals, it's generally limited to what you find in the region. If you get bitten by an exotic snake, a hospital will have to fly anti-venom in, assuming you'll live long enough.

Edited June 11, 2012 by cscboulder11

[Eydawn]

Antivenin is not a prehospital intervention anywhere in my area. No, not all hospitals carry it. You will be transferred to appropriate care if they don't have it.

As far as severity of effects and time of onset, it depends on what bites you (juvenile vs adult), where it bites, and if it gets a major blood vessel instead of muscle tissue. One of my fellow SAR members was bitten on a training exercise and had systemic symptom onset in less than 30 minutes, as a juvenile snake popped right into a main vessel. He spent a good few days in the ICU and got about $36k worth of antivenin vials. He's a lucky fellow. If it hits a muscle, could just cause local necrosis. It's highly variable.

Only an idiot would go POV if the option of EMS was available. That's my stance on ANYTHING other than a simple fracture/sprain/minor burn/uncomplicated expected labor. Especially if you're talking a transport time of more than 30 minutes. What happens if you go into respiratory arrest in your parents' car? You get to die in their car! Whee!

@_@ Seriously... do like you would for any other serious injury/illness and call for the prehospital professionals who can provide support enroute, instead of just taxi service.

Do not cut, suck, nor spit anything. Do not apply tourniquets, nor ice. Remain calm to keep heart rate down, and keep the affected bite area below the level of the heart if possible.

Wendy

CO RN-ADN Student

[Inthecity]

My mom was saying that it would be quicker to just drive to the hospital then to wait for the ambulance to come all the way to her house and then back.I know this is all hypothetical and will most likely never happen but I do like to hear what you all say about it.

[JakeEMTP]

Is the ambulance coming from the hospital? If it is going to take EMS some time to get to you due to logistics, I would begin transport in my vehicle and meet the ambulance enroute. One of the downfalls of living in the country is emergency services aren't readily available, be it police, fire or EMS. Calling 911 and explaining your injury and telling them you will begin transport in your own vehicle saves time for everybody.

The posts above state that the onset of symptoms can begin in 25-30 minutes. You stated your 60 minutes away from the hospital. Meet in the middle. As Diamond Rio sings, "You start walkin' my way, and I'll start walkin' yours".

[DwayneEMTP]

From what I've been taught very few people die from rattlesnake bites, but many have increased injury from the treatments provided.

You actually want the venom to enter the main circulation where it can be diluted. Ice, constriction bands, etc, keep the venom concentrated which can cause a lot of damage.

So as stated above, if you suspect a bite, even if you're not sure, or just see a scratch instead of a puncture, start the ambulance enroute via 911, explain to the patient that though they might feel sick that they shouldn't be thinking about death, keep them calm and go and meet the ambulance enroute.

I was bitten as a child, but other than seeing everyone freaked out getting me to the hospital, and then someone at the hospital saying, "This is going to make you sleepy" I don't remember anything. Evidently they kept me sleeping for a few days...that was nearly 45 years ago now, though, so I'm guessing things were likely done differently.

As in any emergency, panic is your enemy here....

[Arctickat]

Couple of things.

Rattle Snakes never bite as the aggressor unless it's their prey . They use it as a defensive measure only. Since snakes warn before they bite, if this snake wasn't rattling at you and your kids, you weren't in any immediate danger.

Wendy's recommendations are bang on, I can't add anything to it. I don't have an issue with your POV meeting the ambulance enroute, provided that the driver is able to keep his wits and isn't driving recklessly at a 100 miles an hour.

[Eydawn]

The fellow I know who got bitten stepped on a juvenile that was sitting quietly in long grass. Heard it rattle AFTER it bit him... whoops!

If you're meeting halfway, that's different than just going all the way POV in my opinion... which is what I read as the recommendation. The team that was out with this fellow carried him out piggyback style (we're still really proud of them) and got on the radio with dispatch as they drove towards town. They had EMS intercept at a rendezvous point.

The important thing is to make sure you have the intercept coming... in case things go south as you're closing distance...

Wendy

CO EMT-B

[emtdennis]

When you notify 911, make it very clear that there was a snakebite. I would think, dispatch would be able to make some arrangement (such as a paramedic with anti venom) to be given on scene or enroute to the hospital.

Just a thought....

[Arctickat]

The fellow I know who got bitten stepped on a juvenile that was sitting quietly in long grass. Heard it rattle AFTER it bit him... whoops!

Wendy

CO EMT-B

Good point Wendy, I suppose they can be taken by surprise and bite first, rattle later. Still, a defensive reaction though.

When you notify 911, make it very clear that there was a snakebite. I would think, dispatch would be able to make some arrangement (such as a paramedic with anti venom) to be given on scene or enroute to the hospital.

Just a thought....

Antivenin isn't in any Paramedic scope that I am familiar with. At best they might find an ER doc willing to ride out in the ambulance, but it would likely be a waste of time unless he's actually at the base.

Edited June 11, 2012 by Arctickat