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What is current Snake bite immediate treatment?
Old 07-28-2006, 09:25   #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, 09:41   #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, 10:30   #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, 10:34   #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, 18:00   #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, 18:41   #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, 10:10   #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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Old 07-31-2006, 14:10   #8
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Quote:
Originally Posted by Pigpen
The best treatment is commo and Medevac.

Again thanks all for the input
Same answers I got today from a couple of MD's.

Good luck.

TS
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Old 08-01-2006, 11:35   #9
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Fully in agreement with the above answers, basically, treat as you would a fracture and get moving! Unlike trauma management, there's nothing you can do to 'buy time'. This is where the time spent on medevac plans and hospital reconnaissance pays off big time!
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Old 08-01-2006, 23:07   #10
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Here is a thread we did a long time ago on this site....

http://www.professionalsoldiers.com/...ght=snake+bite

Hope it helps pigpen.
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Old 08-26-2006, 16:07   #11
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Looks like I need to find my sawyer kit just in case. I killed TWO copperheads in my back yard and saw another last night but could see it in the dark and under a bush....they have near perfect camouflage! I think there must be a nest near by. My wife is having a class one fit over this! Any body had a similar experience?
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Old 08-26-2006, 16:54   #12
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Quote:
Originally Posted by haztacmedic
Looks like I need to find my sawyer kit just in case. I killed TWO copperheads in my back yard and saw another last night but could see it in the dark and under a bush....they have near perfect camouflage! I think there must be a nest near by. My wife is having a class one fit over this! Any body had a similar experience?
with the wife or the multiple copperheads? wife - yes. snakes - no.
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Old 08-27-2006, 14:28   #13
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This came up in class (SFMS) and our PA cadre told us that at this years SOMA Conference the consensus was still observation/supportive care until the the pt can recieve definitive tx at a fixed facility.

According to that same conversation, as many of 30% of the bites of North American pit-vipers are non-envenomating - so observation for s/s prior to beginning an antivenin regimen is called for as a precaution against hypersensitivity rxn.

FWIW
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Old 08-27-2006, 14:52   #14
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Quote:
Originally Posted by haztacmedic
Looks like I need to find my sawyer kit just in case. I killed TWO copperheads in my back yard and saw another last night but could see it in the dark and under a bush....they have near perfect camouflage! I think there must be a nest near by. My wife is having a class one fit over this! Any body had a similar experience?
Are you sure that they are Copperheads and not Corn/Rat Snakes?? They look a whole lot alike. Best way to tell is that the Corm Snake has pupils like ours, round whereas the Vipers eyes look like a cat, eliptical. Also the noticeable pit on the side of their snout.

Later
Martin
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Old 08-27-2006, 14:58   #15
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In the civilian world, we don't (no one should) treat prophylactically. We treat when there are specific symptoms, and/or laboratory value changes that indicate chemical changes to the bodies ability to clot. Observation is a key but lab testing is needed to verify problems. We don't treat edema (swelling) or pain with anti-venom, we do treat neulogic changes, perform compartment fasciotomies when indicated and monitor closely. It helps tremendously if we know the snake type as it allows for a better prediction for the need for cro-fab.
Below is a foot bitten by a copperhead, 3 bites, initial day and next day. Outside hospital gave cro-fab with normal labs but saw the degree of edema and spent $9000 needlessly. I have yet to treat a copperhead bite with cro-fab. but would treat the local eastern diamond back rattler...he's a bad player. Again, know the snake before presuming the need to treat.

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