things that go bump in the night...
 

You are in north carolina training and your teammate is heard swearing and comes to you with the following saying he has just been bit by something...

most likely culprit?
plan of action?
dangerous?

doc t.

Re: things that go bump in the night...
 

My extensive medical training tells me it was a snake. :D

did not realize the photo name would show...changed it but too late obviously.... :)

DX---Snakebite, mostlikely from the viper family due to the distance between the bite marks.


Had to do some research for the following.

NC is home to the following species:

Agkistrodon contortrix-- Copperhead
Agkistrodon piscivorus piscivorus----Eastern Cottonmouth
Crotalus adamanteus----Eastern Diamond-backed Rattlesnake
Crotalus horridus----Timber Rattlesnake
Sistrurus miliarius miliarius----Carolina Pygmy Rattlesnake


If the bite was in fact a rattlesnake, the PT will have the following symptoms:

If a rattlesnake injects venom into the wound, a variety of symptoms develop: swelling, pain, bleeding at the site, nausea, vomiting, sweating, chills, dizziness, weakness, numbness or tingling of the mouth or tongue, and changes in the heart rate and blood pressure. Other symptoms can include excessive salivation, thirst, swollen eyelids, blurred vision, muscle spasms and unconsciousness. Rattlesnake venom also interferes with the ability of the blood to clot properly.

TX ---Rattlesnake bite:


1. Wash area.
2. Cover with pressure bandage.
2.5. Identify snake if possible.
3. Evac for treatment ASAP.
4. Antivenom WILL have to be used to treat the PT, if the bite is found to be from a venomous snake.

Controversy exists in regards to the initial care of a snake bite victim. However, immediate evacuation of the bite victim to the nearest medical facility is the most important method of first aid. Snake classification, if possible, is also helpful. Generally, when care can be administered, it is agreed that splint immobilization and elevation of the bitten part above the level of the heart is indicated. Systemic signs of toxicity should be immediately identified.

Severe symptoms can be life-threatening and must be treated with antivenin, a prescription medication. Antivenin is given intravenously with fluids. Other therapy may include numerous laboratory tests, antibiotics and an update on the tetanus shot, if needed.

good research on rattlesnakes so of course I will make it a different type...

lets say he trapped it after it bit him...

After looking at the picture. It looks to be a Copperhead.

Agkistrodon contortrix-- Copperhead

TX--
Venow is hemotoxic.
Same as for a Rattler but from what I have read there have been no documented deaths from a copperhead bite. The bite will be very painful and cause severe swelling.
The PT will have to be EVAC'd as soon as possible to an appropriate medical facility.

Tissue necrosis and infection seems to be the big factor with a copperhead envenomation.

1. Keep patient calm.
2. Ice pack to bite area. (Cold reduces blood flow by making capillaries constrict)
3. Ace bandage above bite site to further reduce blood flow.
4. Start IV
5.Evac ASAP!

Why elevate? Makes no sense...only increases blood flow from the infected area to the heart...GRAVITY.

You are right. I was kinda wondering myself about that, even though I was trusting of the source of the information. I reckon I should go with my first instinct.

Memories...
I used to hunt copperheads with my crossman pellet gun by walking the drainage canals in shorts as a kid. They are not that tough. It usually just swelled up and hurt for about a week from what I remember. :p

Great thread Doc T.

My take on the issue after refreshing myself:
-make possible ID of snake by noting pattern/color/shape of head,etc not by trapping it and risking further bite.

-Immobilize bitten extremity, use splinting if available.

-wrap tightly (make sure pulses present distal to your wrap. It is not an arterial tournaquet. It is only to slow lymphatic flow and drainage.

-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/towards the body. Holding it down, below heart level can cause an increase swelling.

-Go to nearest hospital/evac to medical facility ASAP

you are correct... it is a copperhead...sorry it brings back memories for some.

as said before, it is very rarely a fatal injury...just painful. About 8000 snake bites a year of varying types of snakes with about 0.2% being fatal. (Not copperheads but other variety)

as for treatment...most have been mentioned.

Immobilize to lessen the spreading of the venom. After about 20-30 minutes the venom will localize within the wound. So if you can avoid having someone walk who has just been bitten it is advised to wait the 30 minutes....obviously depends on the situation.

remove all bracelets, rings, watches, etc that can become constricting as the extremity swells because it will swell...that includes boots.

as mentioned wrap tightly but not too tightly. You don't want to cut off arterial flow. The wrap needs to be reassessed frequently because it can start off loose enough but quickly become tight with the increased swelling on will expect.

Pain control would be nice...

no cutting or sucking of venom...doesn't work and cutting may actually increase the spread of the venom.

Icing is questionable as recent studies show it may make the wounds worse and not help to decrease the spread.

just a side note...when do you consider antivenom? I know you would not carry it in the field...just asking.

doc t.

Guy, is the IV to possibly dilute the venom in the bloodstream?

No...It's for the introduction/administration of drugs if need be.

Doc T:



As much as I love my wife...the wedding band comes off when I'm working. The only thing I wear is a G-Shock watch.

If the individual is ambulatory...his boots stay on! He may just have to walk some until we can get him evacuated.

Great thread.

One more question. In the case of the patient having asthma, is anything going to change regarding treatment? I would obviously have an inhaler handy wherever we go, but the nebulizer stays in the house near an electric socket.

Not unless he begins having respiratory difficulty.

At that point your treatment would be aimed at the cause. You can try the inhaler, but the cause of respiratory difficulty would be the toxin itself. The patient would require other medications (Epi and Brethine here in the civilian world) and possibly an advanced airway.

That is what concerns me. I have this fear he will have a severe attack if he gets hurt badly. Asking for the epi seems to be an even better idea now. Thanks.