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Updated 01-20-2004

Snakebite Emergency First Aid Information


WHAT TO DO IF BITTEN BY A VENOMOUS SNAKE

  • Allow bite to bleed freely for 15-30 secs.

  • Cleanse and rapidly disinfect area with Betadine, assuming not allergic to iodine, fish or shellfish. Remove clothing (pant legs, shirt sleeves, rings and jewelery on bitten side)

  • If bite on hand, finger, foot or toe, wrap leg/arm rapidly with 3" to 6" Ace or crepe bandage past the knee or elbow joint immobilizing it. Overwrap bite marks. But first, if possible, apply hard direct pressure over bite using a 4 x 4 gauze pad folded in half twice to 1 x 1. Tape in place with adhesive tape. Soak gauze pad in Betadine(tm) solution if available and victim is not allergic to iodines, fish or shellfish.

  • Strap gauze pad tightly in place with adhesive tape

  • Overwrap dressing above, over and below bite area with ACE or crepe bandage, but not too tight. Wrap ACE (elastic) bandage as tight as one would for a sprain. Not too tight. Check for pulses above and below elastic wrap; if absent it is too tight. Unpin and loosen. If pulses are strong (normal) it may be too loose.

  • Immobilize bitten extremity, use splinting if available.

  • If possible, try and keep bitten extremity at heart level or in a gravity-neutral position. Raising it above heart level can cause venom to travel into the body. Holding it down, below heart level can increase swelling.

  • Evacuate to nearest hospital or medical facility as soon as possible

  • Try and identify, kill and bring (ONLY if safe to do so) offending snake. This is the least important thing you should do. Visual identification/description usually suffices, especially in the U.S. and in regions where the local fauna is known. Local symptoms will alert doctors to whether the bite is venomous or not.

  • Bites to face, torso or buttocks are more of a problem. ACE/crepe bandaging can not be applied to such bites. A pressure dressing made of a gauze pad may help to contain venom. (see Pressure dressing procedure)

Antivenom is the only and best treatment for snakebite and you must get as much as is necessary as soon as possible. Antivenom administration should not be delayed. Up to 20 or more vials of Wyeth ACP may be needed to neutralize the effects of rattlesnake and other crotalid venoms in North America. Protheric's Cro-Fab™, a highly purified monoclonal polyclonal antivenom may require far less. It is the only antivenom containing specific antibodies to Mojave Type A and B toxins which may be present in North American rattlers other than Mojave Rattlesnakes.

http://www.rci-enr.net/neo-slither/articles/rattlesnakevenom.pdf


WHAT TO TELL THEM AT THE HOSPITAL

    1. Ask staff to contact their designated Poison Control Center Immediately

    2. Ask hospital staff, if they are not familiar with snakebite emergencies, to use physician consultants available thru the nationwide Poison Control network.

    3. Any additional questions may be directed to: sgrenard@siuh.edu or sgrenard@si.rr.com or more expediently if necessary, at 718-227-6234 or cellular at 347-452-0105.


What Not to Do if Bitten by a Venomous Snake

  • Contrary to advice given elsewhere DO NOT permit removal of pressure dressings, Sawyer or ACE bandage until you are at a facility ready and able to administer antivenom. As soon as the dressings are released the venom will spread causing the usual expected problems of venomous snakebite. The hospital at this time must be prepared to administer the antidote (antivenom)*
  • Do not eat or drink anything unless okayed by medical sources
  • Do not engage in strenuous physical activity
  • Do not apply oral (mouth) suction to bite
  • Do not cut into or incise bite marks with a blade
  • Do not drink any alcohol or use any medication
  • Do not apply either hot or cold packs
  • Do not apply a narrow, constrictive tourniquet such as a belt, necktie or cord
  • Do not use a stun gun or electric shock of any kind. For more information on electric shock treatment please click on SHOCK TREATMENT
  • Do not remove dressings/elastic wraps until arrival at hospital and antivenom available.
  • Do not waste time or take any risks trying to kill, bag or bring in offending snake

*Remember ACE or other wide bandaging must not be wrapped so tight as to cut off systemic venous or arterial circulation. Properly applied such bandages will NOT compromise the systemic circulation.


IT GOES WITHOUT SAYING BUT WE'LL SAY IT ANYWAY......

Never hike, camp, work or collect specimens in areas where there are venomous snakes unless accompanied by at least two companions. One to stay with the victim and the other to go get help. All parties should know what to do.

If you come across any snake in the field and don't know positively what it is or isn't, do not approach it, try and examine it or photograph it (unless you have a long telephoto or zoom lens). Move away from it as expediently as possible.

If you work with venomous snakes in a public (zoo/exhibit) or private collection or in a museum or university laboratory, never open their cage without a companion nearby who is familiar with snakebite first-aid

A telephone with an outside line should always be located in the room or area where venomous snakes are located in case there is a need to call for help.

Never handle or attempt to handle venomous snakes without at least one trained companion present

If you are not an experienced venomous snake handler, don't try handling or catching them without first obtaining extensive experience and training by someone who is trained

If you maintain a private or laboratory collection of live venomous species, keep all cages under lock and key; rooms where such cages are located should have a double door and vestibule, be completely visible through glass paneling from the outside and be off-limits to all but authorized personnel. If a snake appears missing from a cage you may be able to locate it before entering the room in preparation of re-securing it. Such rooms should be completely sealed. No open or screened windows and no "mouse-holes" or pipe holes through which a snake can escape. Sink drains should be also be capped and toilets, if present, always kept covered.

Finally if you deal with venomous snakes always make sure you have or know where to locate a supply of specific antivenom for the species you are involved with.


DISCUSSION:

This document suggests the use of containment or sequestration of injected venom at or near the bite site using broad (3"-6" wide) compression bandaging such as crepe or ACE(tm)-type elastic bandage. This is the standard worldwide accepted first-aid treatment for bites by elapid snakes such as cobras, mambas, coral snakes and many Australian species. This method has delayed on the onset of serious snakebite symptoms as long as 24 hours in Australia where victims of deadly bites were that far from medical assistance. The method remains controversial in the U.S. although a number of top snakebite experts have recently recommended its use in crotalid bites in printed references appearing in peer-reviewed journals. A recent study conducted at the Naval Medical Center (San Diego) and Loma Linda University Medical center in experimentally envenomated pigs indicates that the ACE wrap works to contain the venom and buy time to get to the hospital. A complementary study at Stanford, however, indicates that people are often unable to apply the wrap with sufficient pressure to work effectively. We recommend wrapping it tightly but maintaining a palpable pulse in the absence of precise means of measuring the under-wrap pressure (which should be 60 to 70 mm Hg or slightly less ... slightly below average diastolic blood pressure).

The use of containment/sequestration for certain types of North American pit viper (rattlesnake, moccasin and copperhead) bite is felt by some to increase the risk of disfiguring local tissue injury, which, while not necessarily life-threatening by itself may necessitate skin grafts and extensive repair and treatment once the acute, life -threatening phase of the event has passed. Some experts feel the spread of venom to vital organs can be life-threatening and that you have no way of knowing how life-threatening a snakebite is in the first moments of the event. Therefore, users of this method must recognize that there is a trade-off: containment as a life-saving measure at the risk of local tissue damage which while not necessarily life-threatening, could be disfiguring, painful and/or which could require prolonged and extensive follow-up treatment, plastic surgery, orthopedic surgery and rehabilitation.

We therefore urge readers who decide to use this method on ANY type of snakebite to do so as a life or death decision and to make this decision in pre-recognition of the above information. In addition some U.S. crotalid bites, particularly from large species, results in widespread damage to limbs even when bites were to digits and hands or feet. Thus the wide-area, low-pressure wraps can prevent the spread of venom and more widespread damage. Again some experts feel that this increases the intensity of more localized damage. So while snakebite mortality without these dressings may be low, we have been appraised of too many unnecessary and tragic deaths and widespread disfigurement without its use and in general advocate its use if it is properly applied. Disfiguring local injury can be limited to a much smaller area compared to crotalid (pit-viper: rattlers, copperheads, cottonmouths) snakebite where this type of containment has not been used. Compression bandages are a standard in Australia but these are mostly elapid bites although some have some SERIOUS local tissue or muscle effects as well. The venom of the King Brown Snake, a widely distributed species (Pseudechis australis) has as its main target: skeletal muscle tissue. Bites by Cobras which also have local effects also have direct acting cardiotoxins so containment can be life-saving in bites by these snakes.

In spite of drawbacks, the late Dr. Sherman Minton (pers.communication) says containment is the safest course of action when it is not known what type of venom you are dealing with or how long it will be before treatment with specific antivenom can be started.

Many strenuously oppose the out of hand dismissal of containment, used in Australia for nearly 30 years successfully, by a few experts in the United States. Denial of the value of this method by these U.S. experts has resulted in the death of professional and hobbyist handlers of cobra and other elapid snakes who erroneously were led to believe that the method should not be used because of their admonitions that local tissue destruction is its only effect and should NOT be used under any circumstances. There have been animal studies done using rattlesnake venom on pigs (Bush et al) and monkeys (Sutherland) demonstrating that it serves to prevent spread of venom and suppress widespread swelling.

There are harmless as well as venomous snakes in many regions. Consider any snakebite venomous until medically evaluated as otherwise or determined by a knowledgeable person.

The best thing you can do is not get bitten. Protective clothing, footware and gloves should be used at all times when there is risk of snakebite.

Venom is excreted in the urine. IV solutions, good hydration and voiding of dilute urine will help to eliminate venom. Do not drink any water in the field but wait for solutions to be given intravenously, in the field by paramedics or in the hospital.

Steve Grenard
Staten Island University Hospital South
375 Seguine Avenue
Staten Island NY 10309
sgrenard@siuh.edu
sgrenard@si.rr.com (always cc to second e-mail address)
718-226-2034 (M-F 9-2) 718-227-6234 (eves and weekends) 
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Burgess, JL:, Dart, RC, Egen and Meyersohn: 1992. Effects of constriction bands on rattlesnake venom Absorption: a pharmokinetic study. Ann. Emerg. Med 21:1086-93

Bush, SP et al: 2002. Abstract. Annals of Emergency Medicine: Pressure Immobilization Delays Mortality and Increases Intracompartmental Pressures after Artificial intramuscular rattlesnake (C atrox) envenomation in a porcine model.

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This document made available through the generosity of the author, Steve Grenard, to New York Search & Rescue and the public at large. All due credit belongs to him and we extend out thanks.




Updated 20 January 2004


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