by Nils

First of all: Most snakes aren’t dangerous to humans! Note the classical exceptions as rattlesnake, coral snake, water moccasin and Copperhead. Being bitten by one of those might kill you. Mexico is one of the countries where most people are bitten.

If bitten one of the venomous snakes you need to go to hospital to receive anti venom. Especially if the area changes color, swell or is painful.

Do this while waiting for transport to hospital:

• Remain calm
• Move away from the snake.
• Remove rings and similar before you start to swell.

• Position the limb that is bitten below the level of your heart.
• Clean the wound roughly. Cover it with a clean, dry dressing.
• Mark the surrounding of the red swelling and write the time.

• Remember the colour and shape of the snake

Don’t do this:

• Do not use a tourniquet
• Do not apply ice.
• Don’t attempt to remove the venom
• Don’t cut the wound with a knife.
• Don’t drink anything that would increase your heart speed; caffeine or alcohol
• Don’t try to capture the snake.

Common venomous snakes

All but the coral snake have slit-like eyes and are known as pit vipers. The pit vipers heads are triangular, with a depression (pit) midway between the eye and nostril on either side of the head.

Other special characteristics:

• Rattlesnakes rattle by shaking their tails.

• Water moccasins have a white, cottony lining in their mouth.

• Coral snakes have colourful red, yellow and black rings along the length of their bodie

 

EMS guide to snakebites

To be bitten with and without venom feels different. Dry snakebites are more frequent and are painful; might be infected. Venom bites is very painful and the damage depend on venom potency, the amount injected and if the poison remains locally in the tissues or goes into the blood circulation.

Two types of venomous snakes Neurotoxic (neurosystem failure) and Hemotoxic (blood system failure). Main symptoms are: paralysis, muscle damage, clotting dysfunction, bleeding, kidney damage, and shock and tissue damage. All depend on the type of snake biting.

The most common in North America are the hemotoxic pit vipers like rattlesnakes, copperheads and cottonmouths. They got a heat sensor located in their «pits» between the eyes and nostrils. They use this sensor to locate small warm blooded animals for food. Occasionally they find body parts of humans that threatens them; accidentally or on purpose. Pit vipers normally cause local tissue damage, but might cause shock if the envenomation is severe. The actual damage is to the capillaries that allow the intravascular fluid to leak out. This might produce hypovolemic and a failure in the bloods clotting mechanism causing haemorrhage. Note that some pit vipers in the desert might be neurotoxic.

The neurotoxic Coral snakes are less common, but still present. They might cause paralysis and local tissue damage. But coral snakes are not the only neurotoxic snake in our country.

The bite

Snake bites normally occur on the extremities. The victim is classically drunk or people working around their home. Most people bitten survive, in USA dies about 5 a year; one of about 3000 bites.

EMS Treatment

This is what to do when bitten. Never forget that almost 100% survive the snake bite! Get away from the snake and keep calm. Try to avoid an increase in your heart rate; decrease the absorption of the venom. Normal EMS practise is to secure the airways and monitor the respirations. Be on alert if anything changes. Then it is time to put intra venous IV (while the veins are open) and to immobilize the bitten part (to slow absorption of venom). Since we do not know the progress of the poison we cannot directly elevate the bite site (reduce local damage) or have it down (reduce bleeding). This is why it is EMS recommended to keep the bite site on the level of the heart. Many voices also say this doesn’t matter. Remember the time of the snakebite. Every 10 minutes make some marks at the bite site and write the time. Remember to mark ALL edges of any bruising and/or swelling; take photo with your cell phone. This is information that might become very important later when the doctor is determining to use anti-venom or not, and the dosage. Remember to pay attention to the type of snake coral snake or pit viper; take a photo if needed. The classical anti-venom for pit viper bites are CROFAB. The classical anti-venom for coral snakes is more difficult. The company that produced the anti-venom have stopped to produce it, but it exist an anti-neurotoxin called ANACORAL ANTIVENOM that might work well.

Remember to not do the EMS mistake like cutting, sucking, freezing the bite site. Let the body be left alone without your extras. The ONLY that you do is to immobilization the site with a wrap below and above the bite site. This might be medium thigh; not a tourniquet.