In looking over the first aid supplies in the various medical kits I don't see the Sawyer Extractor listed. It is highly recommended for snake bites, insect bites and stings. It sucks out the venom without making cuts like the old snake bite kits. Anyone have any experience with this device?

Can be seen at:

http://www.sawyerproducts.com/sawyer_products/pages/extractor/

Doug talks about the Sawyer Extractor here:

http://www.equipped.org/medical.htm#BitesStings

Regards, Vince

I have used it on insect stings and bites several times. Works better than anything else I know of. Fascinates some little kids and freaks out others. Cheap at Wally World ($11) VERY strong vacuum.

Tom

Cody Lundin recommends it too. I bought one for my first aid kit that comes along on Cub Scout Pack events and my own family trips, but luckily haven't had to use it yet.

It is quite simple to use - a good feature when chaos erupts, though I do wish the container it comes in was a bit smaller.

I keep Rattlesnakes as pets, I have the Sawyer extractor and it is awesome. I hope I never have to use it but I am confident that if the time comes it will work perfectly.

From what I have read, the Sawyer Extractor has/is falling out of favor, esp in snakebite cases. It doesn't seem to remove much if any venom and may actually concentrate it near the bite and lead to more extensive local necrosis.

I quit carrying mine a year or two ago.

Suction for venomous snakebite: a study of "mock venom" extraction in a human model.
Ann Emerg Med 2004 Feb;43(2):181-6 (ISSN: 1097-6760)
Alberts MB; Shalit M; Lo Galbo F
Department of Emergency Medicine, University Medical Center, University of California, San Francisco, Fresno 93702, USA.

STUDY OBJECTIVE: We determine the percentage of mock venom recovered by a suction device (Sawyer Extractor pump) in a simulated snakebite in human volunteers. METHODS: A mock venom (1 mL normal saline solution, 5.0 mg albumin, 2.5 mg aggregated albumin) radioactively labeled with 1 mCi of technetium was injected with a curved 16-gauge hypodermic needle 1 cm into the right lateral lower leg of 8 supine male volunteers aged 28 to 51 years. The Sawyer Extractor pump was applied after a 3-minute delay, and the blood removed by suction was collected after an additional 15 minutes. A 1991 Siemens Diacam was used to take measurements of the radioactive counts extracted and those remaining in the leg and body. RESULTS: The "envenomation load," as measured by mean radioactivity in the leg after injection, was 89,895 counts/min. The mean radioactivity found in the blood extracted in the 15 minutes of suction was 38.5 counts/min (95% confidence interval [CI] -33 to 110 counts/min), representing 0.04% of the envenomation load. The postextraction leg count was less than the envenomation load by 1,832 counts/min (95% CI -3,863 to 200 counts/min), representing a 2.0% decrease in the total body venom load. CONCLUSION: The Sawyer Extractor pump removed bloody fluid from our simulated snakebite wounds but removed virtually no mock venom, which suggests that suction is unlikely to be an effective treatment for reducing the total body venom burden after a venomous snakebite.

Duckear,

Thank you for sharing this medical review of the Sawyer Kit. I too bought one because it is listed in the book “98.6”. I have taken it on Cub Scout campouts. We have rattlesnakes here in Arizona. What is your recommended first-aid for snake bite?

Also, is ammonia a good first aid for insect bites?

Thanks!

Many people don't realize that snake venom moves through the lymph system, NOT the veins, and they immediately want to put on a tight, blood-restricting tourniquet.

DON'T DO IT!

These seem to be generally accepted instructions (from the U of MI - http://www.med.umich.edu/1libr/pa/pa_bitesnak_hhg.htm ):

"Remove any rings or bracelets. If you are more than 2 hours from the hospital, put a lymphatic tourniquet between the bite and the heart, at least 2 inches above the bite. A lymphatic tourniquet stops lymph flow through the lymph vessels. Use a wide band such as an elastic wrap or stocking. Make it snug but not tight enough to stop blood flow in the veins or arteries. If the veins stand out, the tourniquet is too tight. If the hand or foot turns white or the pulse disappears, the tourniquet is much too tight. The American Red Cross recommends that you not release the tourniquet until after antivenin has been given.

They also say that if the snake has been killed, make SURE it's dead, and take it to the hospital with you for ID (most people don't seem to know a rattler from a coral snake from a refrigerator & the antivenin can be different).

Here in W WA, if you do get bitten by a poisonous snake, you're pretty much SOOL, as the hospitals don't carry much (if any) antivenin. Why? Because "there aren't any poisonous snake here". I'll bet the delivery fee from E WA or CA is horrendous. Slow, too, considering the circumstances....

Sue

Duckear, I sent a copy of the California findings to the Sawyer factory and ask for their response/comments. If they reply, I will post the reply here. One unanswered question was why they waited three minutes before beginning the procedure. Venom can move a lot in three minutes. Also, they just tested it on mock snake venom but made no mention of tests on various insect bites/stings.
I am not totally convinced that it is worthless at this point but I appreciate your input.

Sue, interesting post. Seems we are back to "cut & suck" which I thought was obsolete. Interesting that you say there are no poisonous snakes in W. Va. I would have thought you would have copperheads and rattlesnakes at least.

In West Kentucky we have copperheads and cottonmouths here in the Mississippi River bottoms. As you go further East, add rattlesnakes. I have seen maps that include West Kentucky as the home range of the coral snake but I have never seen one nor have I ever heard of anyone else seeing one. As to identifying poison snakes around here, all I mentioned except the coral snake have elliptical or "cat eye" pupils and nonvenomous snakes have round pupils. I have read that the coral snake has round pupils.

My copy of Wilderness Medicine is at home, not the office so I don't have a good, "official" recommendation right now. IIRC, the best first aid is keeping the victim quiet, +/- on a snug, not tight band above the bite site (controversial), keeping the bite area cool(controversial) and transporting to the nearest hospital. Unfortunately, snake bites are a lot like appendicitis....there really isn't any first aid, only definitive care. <img src="/images/graemlins/frown.gif" alt="" />

A lot of bites are dry, and some only have minimal amounts of venom. Treatment with antivenom and supportive care is an ongoing clinical decision based on how a patient is doing.

Probably to simulate the time between "Oh crap, I just got bit by a snake!!" and actually finding the kit in your pack, opening it, reading the instructions you have forgotten and applying suction.

The Sawyer Extractor is regarded to be the best tool/ method... Keeping rattlesnakes is not, however, reccomended

Good advice, however here in Aus we use a constriction bandage from the bite site up the entire limb to the trunk of the body. Check circulation of blood in the digits.

As Susan points out, lymph is transported in a separate system by the action of the large muscle groups, so the leg/arm is immobilised (even splinted) and the patient is sat or laid down for transport to medical help.

The injection site / wound is not washed or cut. The bite site is marked on the bandage. This is so the medics at the hospital can save that portion of the bandage and "type and match" any venom on the limb or the bandage, to give the correct antivenom/antivenin. This means you don't have to touch or even see the snake.

Remember also that you will rarely get two perfect puncture wounds, and a small scratch may be the only evidence of potential envenomation.

For ant bites I have always found a baking soda paste to be effective.

I understand the pet thing. I raised a Burmese Python from infancy. Finally got so big (9 feet) that I had to get rid of him. He trashed the house making his rounds. When he finally discovered the warm electric blanket, there was no shooing him off the bed so I had to sell him back to the pet shop. I do miss him...............sorta.

I don't think I would want rattlesnakes having the run of the house. Besides, they BITE! Monty didn't. <img src="/images/graemlins/wink.gif" alt="" />

The latest philosophy according to the Docs that I work with:
Treat the symptoms.
The current treatment is to only give antivenom if you are suffering cardiac problems.
Anyone that works in an ED that is using a different protocol, please post.
BTW, Copperhead bites are the most common here, a few rattler bites, but not common.

What is recommended course of action if you're a) hiking solo, b) a couple of miles from vehicle, and c) bitten by a rattlesnake. Hike straight out, with no stops, and then seek medical help? Or should there be intermittent stops during return to vehicle? Does one vs. the other make any difference in rate of venom travel?

No way of knowing for sure. I would hike as fast as you can without getting your heart rate up. (good luck <img src="/images/graemlins/wink.gif" alt="" /> )

Here are a couple of more articles. I can't get the abstract online. Flipping thru 4th ed of Wilderness Medicine, the literature for or against the extractor is more anecdotal than experimental. There is one study I have read, but can't find now, that states the Extractor will concentrate venom near the suction site (instead of completely removing it) and this will lead to more local tissue damage.


Gellert GA
Snake-venom and insect-venom extractors: an unproved therapy.
N Engl J Med (United States), Oct 29 1992, 327(18) p1322



Gold BS
Snake venom extractors: a valuable first aid tool.
Vet Hum Toxicol (United States), Jun 1993, 35(3) p255

Forgey WW
More on snake-venom and insect-venom extractors.
N Engl J Med (United States), Feb 18 1993, 328(7) p516-7

Not all poisonous snake bites are deadly (at least in North America). I live in an area with a variety of poisonous snakes and grew up in an area litterally infested with several breeds. Snake bites are rare and death resulting from one is extremely rare. The best cure for a poisonous snake bite is not getting bitten. I only know of one breed of poisonous snake (water mocassin) in N America that is thought (might be urban legend) to be territorial and "may" attack a person. All the rest have to be kicked, stepped on, poked with a short stick, etc in order for them to bite. I grew up in the woods of East Texas and still spend much time in the woods. I have come across many snakes and even had a Copperhead as pet when I was a kid. I have never been bit (by a poisonous snake) and never known first-hand of anyone else being bit either. It is very rare. It is so much more rare than people think. I have also had a non-poisonous (ball python) wild snake as a pet and this snake I spent much time handling. Even in handling a snake regularly (at least this particular breed) you really have to do something to make them angry in order to get bit.

Brian, you're missing an important risk factor!!!
.. the last time I was in Texas, a rattlesnake made me run into a cactus.

Injuries resulting from high speed collisions with cacti are a whole nother story. <img src="/images/graemlins/wink.gif" alt="" />

Hey Brian, didn't the cactus learn that the more you got, the less you need to know?

Well I was dry bit twice by buzzworms surveying a future 'development' below the Reagan Library ( collective forum yawns as I've posted this a few times.) Both times my greatest fear was the idiot with a cutter kit and Rambo knife wanting to suck on my ankles. Indiana Jones isn't the only archaeologist packing heat for protection <img src="/images/graemlins/blush.gif" alt="" />. The problem is so many rattlesnakes have been wiped out by people, especially those inane roundup festivals, that surviving snakes who DON'T tend to rattle are passing on this trait. We are selectively breeding non rattling rattlesnakes.As for cacti, respect is also the keyword. remember the idiot in AZ who blasted a Suquaro with a 12 guage until a major arm wieghing a few tonnes fell on him? <img src="/images/graemlins/grin.gif" alt="" />

Sawyer extractor is great for immediate use in the event of a bite or sting-one significant draw back is damage to local tissue due to vaccume action-it can cause the toxin to pool in the tissue and cause some local necrosis-its still better than nothing but its one of those things you need to be aware of before using it. The best use for this device is as soon as your "hit" apply it lightning quick and leave it on for a min of 5-10 min. , then release it...........its design is to try to get any residual poison out of the tissue before its effects fully set it.......in most cases the toxins are gone about as fast as the bite/or sting happens due to blood flow in the surrounding areas. But compared to the old cut and suck method........its better than nothing. Lastly if you do get a bite/sting, stay calm and do your best to reach medical attention.

All excellent points. It's funny (and a little disturbing) how something so incredibly unlikely occupies such a terrifying place in people's imaginations. I was talking with someone this past weekend who was worried about being struck by lightning. Of course, it's nothing to laugh at, but he was so much more likely to be hurt simply driving to his camp site that I can't imagine spending any time worrying about something as improbable as a lightning strike.