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Old 07-28-2006, 08:25   #1
Pigpen
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What is current Snake bite immediate treatment?

Hey all,

Title sums it up. However let me add some details. I DO NOT need noob advice. I am looking for the latest recommended procedure for immediate treatment prior to EVAC. The reason is, I have students in remote areas with potential for run ins with Western diamondbacks and other associated rattlers. Our MEDEVAC capability is severely limited due to the remoteness of the site, trained personnel and Transportation, it will take us roughly one hour to get a bite victim to Medical facility. This being said, I need advice on immediate treatment, during that hour. Thanks in advance.
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Old 07-28-2006, 08:41   #2
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No answer to your query, but I too am interested in the answer. We own a home on 8 acres outside of Santa Fe, NM. We have rattlesnakes, which I thought was pretty cool til my wife reminded me that our small grandchildren will be visiting, and trooping the grounds.

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Old 07-28-2006, 09:30   #3
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Quote:
Originally Posted by Pigpen
Hey all,

Title sums it up. However let me add some details. I DO NOT need noob advice. I am looking for the latest recommended procedure for immediate treatment prior to EVAC. The reason is, I have students in remote areas with potential for run ins with Western diamondbacks and other associated rattlers. Our MEDEVAC capability is severely limited due to the remoteness of the site, trained personnel and Transportation, it will take us roughly one hour to get a bite victim to Medical facility. This being said, I need advice on immediate treatment, during that hour. Thanks in advance.
Chief Where are you in AZ?

Also PM me your data so we can vet you.

TS
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Old 07-28-2006, 09:34   #4
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More than you wanted to know about rattlesnakes.

http://www.pestproducts.com/rattlesnakes.htm
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Old 07-29-2006, 17:00   #5
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I can't find a consensus anywhere on prehospital treatment of snake bites that actually does any good. Most of the techniques that have been taught in various first aid courses (tourniquets, incision and suction, suction extraction kits) have shown to be useless, if not dangerous. Two articles were published in 2004 in Annals of Emergency Medicine (pm me with an email address if you'd like copies of the articles) that looked at the efficacy of the Sawyer snake bit kit. They showed that the kit removed less than two percent of the total venom load injected. The study was modeled off western diamondback envemonation as it suggested that this snake was responsible for the most deaths in the US each year.

In one of the articles, Dr. Bush (snake bite expert from Loma Linda Hospital and star of the TV show Venom ER) suggests that "a cell phone and a helicopter" are the best prehospital treatments for envenomation. He bases this off the fact that when first aid treaments have been studied, they have been ineffective and that there are on average of only 5 snake bite deaths a year in the US. This is from an estimated 8,000 envenomations a year.

The only reccomendations that seem to apply universally are immobilization of the extermity effected and rapid transport to the hospital with support of the ABCs on the way. In the past, I've called poison control (888-222-1222) to help coordinate finding anti-venom and getting it enroute to the hospital that would be receiving the patient if the snake had been positively id'd. Keep in mind, when you call the universal number for poison control from a cell phone, it will be routed to the poison control center nearest to the area code your cell phone is registered in. When I first came to the DC area, my cell phone still had a Boston area code. I learned this the hard way on a run when I called poison control from DC and was routed to the one at Children's Hospital Boston. Miami Dade Fire/Rescue has also set up a phone system specifally designed to help with management of snake bites called Venom One. The phone number for them is 1-786-336-6600. The website is http://www.venomone.com

Hopefully this was of some help,
Erik
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Old 07-29-2006, 17:41   #6
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There was a conference back in 1997 or 1998 sponsered by the Wilderness Medical Society entitled Tactical Management of Wilderness Casualties in Special Operations (PM me with an email address if you want a copy of this publication). Dr. Otten from the University of Cinncinati discussed a hypothetical case of a snake bite during a twelve man patrol with the helicopter extrication point at least six miles away.

He makes three points initially:
1) 30 percent of snake bites from poisonous snakes do not involve any envenomation. He suggests doing whatever possible to keep the person calm as initial complaints from the patient could very well be from a panic attack.
2) Intravenous bites with envenomation are almost universally fatal no matter what you do.
3) Subcutaneous bites with envenomation, although still potentially fatal, give you some time before you have to intervene with antivenom

Treatment wise, he suggests:
1) elevation and compression. although he specifically states that for most types of envenomation, there is no evidence this works, for the Australian eliped snake, this has been shown to be as effective as antivenom. You can do this with a field dressing and an ace bandage.
2) he, and the physicians who discuss the case, also mention that most other suggested prehospital treatments for envenomation probably do not work.
3) supportive treatment to the best of your abilities while awaiting extrication

Erik
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Old 07-31-2006, 09:10   #7
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Thank you all for the input. I have taken the liberty to cut and paste these answers (Editted o'course) and send them around to our office. They support my gripes here. The best treatment is commo and Medevac.

Again thanks all for the input
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