{"id":1155,"date":"2020-12-05T21:43:55","date_gmt":"2020-12-06T02:43:55","guid":{"rendered":"https:\/\/alabamaherpsociety.com\/relocation\/?page_id=1155"},"modified":"2020-12-10T19:57:05","modified_gmt":"2020-12-11T00:57:05","slug":"snake-bite-management","status":"publish","type":"page","link":"https:\/\/alabamaherpsociety.com\/relocation\/snake-bite-management\/","title":{"rendered":"Snake Bite Management"},"content":{"rendered":"\t\t
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About Snake Bites and Snake Bite Management<\/strong><\/h2>

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It is natural to be scared following a snakebite. Take comfort in the fact that most snakebite victims will recover fully if they receive appropriate medical attention. So, what should you do if you or a loved one gets bitten by a snake? If you are 100% certain that the snake is nonvenomous, wash the area with soap and water and stay home. You\u2019ll be fine. Infection following a bite from any snake \u2013 venomous or nonvenomous \u2013 if exceptionally uncommon, and it is not appropriate to start empiric antibiotics. Similarly, the likelihood of getting tetanus from a snakebite in the Western hemisphere is essentially nil. If your last TDaP was less than 10 years ago, there\u2019s nothing you need to do. If it has been > 10 years, make an appointment for another booster shot. If you\u2019ve never been immunized, start the process. There is no need for tetanus immunoglobulin because snakebites are a low risk for tetanus. If you\u2019re bitten by a venomous snake, or if you don\u2019t know whether a snake is venomous, seek medical attention at a hospital – not urgent care, and not your primary care provider\u2019s office. Do not drive yourself. If you\u2019re not experiencing significant symptoms and someone can get you the hospital, it is reasonable to go in a car. However, if there are worrisome signs or symptoms, or for the long transport time, it makes more sense to call 911, because they can bring medical attention to you. Most of the previously recommended prehospital treatments for snakebites have been proven to be useless at best and dangerous at worst. Do not tie a tourniquet or any sort of constrictive bandage around the affected extremity. These will exacerbate the local damage and, when done incorrectly, will increase systemic toxicity simultaneously. A tourniquet is great when you want to stop life-threatening bleeding, but you don\u2019t want to cut off the arterial blood supply to a bitten extremity. Although lymphatic constriction bands and pressure immobilization don\u2019t cut off the blood supply, they do (theoretically) confine the venom to the affected extremity, which, particularly when combined with the increased swelling, causes increased local tissue injury. Because local injury is seen in > 95% of crotalid envenomations, and for most envenomations that\u2019s the only significant manifestation, we need to avoid this. All of the major toxicology organizations produced a position statement condemning the use of pressure immobilization for native crotalid envenomations. Furthermore, if pressure immobilization is performed incorrectly, it can actually enhance systemic venom absorption while simultaneously causing local injury. And, as you can see in Dr. Norris\u2019 paper, most people perform PI incorrectly:<\/strong><\/div>
Physicians and lay people are unable to apply pressure immobilization properly in a simulated snakebite scenario<\/strong><\/a><\/div>
You can read the pressure immobilization position statement here:<\/div>
Pressure Immobilization After North American Crotalinae Snake Envenomation<\/a><\/div>
Do not use a venom extraction device. They remove almost no venom following a bite (no more than 2% in one study). Certainly not a clinically significant amount. Furthermore, there is good evidence that they are harmful. They can cause a negative pressure injury and, by preferentially removing interstitial fluid, these extraction devices could theoretically concentrate the venom. These kits are good for one thing: profits for the people who manufacture and sell them. But they are certainly not beneficial to a snakebite victim. Here are some excellent studies that look at the risks and benefits of extraction devices: \u2022\u00a0<\/strong><\/div>
Suction for venomous snakebite: a study of “mock venom” extraction in a human model <\/strong><\/a>and<\/strong> Effects of a negative pressure venom extraction device (Extractor) on local tissue injury after artificial rattlesnake envenomation in a porcine model<\/strong><\/a><\/div>
\u2022 This one is the best-titled editorial ever:<\/strong><\/div>
Snakebite suction devices don’t remove venom: they just suck<\/strong><\/a><\/div>
Do not pack the affected extremity and ice Do not try to use electrical therapy; this will do nothing for the envenomation. It can cause burns and, occasionally, electrocution. Do not “cut and suck”; this will not remove the venom. It will make the local injury much worse. Instead, do the following: Remove any constrictive clothing and jewelry Elevate the affected extremity for a pit viper bite (you can keep a coral snakebite in whatever position is most comfortable for the patient. Elevation will have no effect on the absorption of venom but will significantly reduce the swelling and associated discomfort of a pit viper bite There is no need to bring the snake with you to the hospital. Bringing a live snake is obviously potentially dangerous to humans as well as the snake. Bringing a dead snake is also dangerous to humans. People forget that dead snakes can envenomate, typically for about 30\u201345 minutes after the fatal injury, but the record is approximately 8.5 hours. Don\u2019t believe me? Check these out: This guy DIED after getting bitten by a dead prairie rattlesnake:<\/strong><\/div>
Death after bite from severed snake head<\/a><\/strong><\/div>This guy almost died after getting bitten by a dead rattlesnake:<\/strong><\/div>
Bodyless rattlesnake bites Texas man after it was decapitated<\/strong><\/a>
This guy got envenomated by a dead copperhead:<\/strong><\/div>
Clinically Significant Envenomation From Postmortem Copperhead (Agkistrodon contortrix)<\/a>
Most importantly, and this may blow some people\u2019s minds, we don\u2019t actually need to know what snake is responsible for the bite! All we have to do is determine whether or not it is a pit viper envenomation, and that\u2019s a clinical diagnosis. A physician who is knowledgeable about snakebites can easily distinguish a bite from a crotalid from a bite from a non-venomous snake. And, in regions where this is relevant, it\u2019s also easy to distinguish a coral snake bite from a pit viper bite and from a bite from a non-venomous snake. Once we determine whether or not it\u2019s a pit viper bite, we\u2019re good. Because<\/strong> CroFab<\/strong><\/a> is FDA-approved for all North American pit vipers: copperheads, cottonmouths, rattlesnakes. We do not need to know the species in order to treat appropriately. If you can take a picture of the snake quickly and safely, that\u2019s great. Almost everybody has a camera phone, and it\u2019s nice to know the species for epidemiological purposes. However, we definitely don\u2019t want to delay transport or treatment trying to ID the snake. You treat the patient based on the signs and symptoms. Lastly, remember that Benadryl (diphenhydramine) provides no benefit following snakebite. . Benadryl is an antihistamine. Histamine is not a major component of snake venom, so antagonizing the effects of histamine accomplishes nothing. It does not \u201cbuy time\u201d or \u201creduce inflammation\u201d or anything of the sort. All it does is give people a false sense of security and distracts them from the most important thing: getting to the hospital so that someone can determine the need for antivenom, which is the definitive treatment for snake envenomation. The only time Benadryl may be helpful is in the rare case of an allergic reaction to either the venom or the antivenom. And in serious reactions, the drug of choice would be epinephrine, not Benadryl, which helps for hives and itching but not the cardiac or respiratory complications. Please read this excellent article by Dr. Nick Brandehoff:<\/div>
BENADRYL DOES NOT FIX SNAKEBITES<\/strong><\/a><\/div>
You can also read the most recent anaphylaxis practice guidelines, which address the lack of utility of antihistamine, here:<\/strong><\/div>
Anaphylaxis\u2014a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis<\/a><\/div>
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Written by:<\/a><\/div>
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Dr.<\/strong> Spencer Greene, MD, MS, FACEP, FACMT, FAACT, FAAEM<\/strong><\/div><\/div><\/div><\/div>
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National Snakebite Support<\/h2>

Facebook group with the nations leading snake bite professionals ready to answer questions and advise you through your snake bite.<\/h3>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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