Snake bite in SOCAL

Woman pushing baby's stroller bitten by rattler in Oceanside You don't suck out the poison like on TeeVee?

The venom can be absorbed by the mucus membranes of your mouth or through ingestion. That's what a Sawyer extractor is for. Thankfully, I've never had to put it to the test.

I've hiked in that area and found that there's a healthy population of Southern Pacific Rattlesnakes near the coast, but more of the Red Diamond Rattlesnakes as you move inland.

In all fairness, not too many years ago, "cut and suck" was the recommended treatment - it wasn't something manufactured by Hollywood. Times have changed and treatments have improved, but there is a lag in getting the word out.

Just another reason to take a course in first aid. Glad that Mom is OK.

Sucking out the poison is not recommended. Here's what the article suggests:



So, basically, don't do anything except keep the victim calm and get anti-venom as soon as possible. It's quite possible you could be watching your loved suffer a slow, painful death. Is that right?

OK, rewind. I know sucking out the poison is not recommended, but I also understand the article is saying it's NOT absolute the person sucking would become a second victim. If a loved one is dying and anti-venom is not coming soon, then it would be hard not to take a chance (especially for a daughter or son).

The article here doesn't indicate whether or not the attempt to suck out the venom actually helped the mother. Perhaps it saved her life (?). There are not enough details given.

They have an infant and having at least one parent survive should be a high priority objective. In this case the husband put his need to do something even if it's wrong ahead of his number one priority. Emotions are tough little suckers to control at times.

OK, let's change the facts a bit. The kid gets bitten, and the ambulance is taking awhile...

I have to wonder if the people that tell you that sucking the venom out with your mouth could expose you to a significant dose of venom are the same people that say that the Sawyer Extractor does not remove a significant amount of venom. The key is that it needs to be done immediately to be effective.

If it is enough to make a second victim sick, it is enough to make a positive impact on the first victim.

My wife and I share everything, so what's a little venom between us?

It probably is possible, but it is definitely not likely or probable. Snakebite deaths run to about 12 per year, out of thousands of bites (I am sorry I do not have more precise figures - perhaps someone else does).

Cut and suck went away because often the therapy was more damaging than the original bite. Evidently there are snake bites and then there are snake bites. Some bites miss completely, while some are "dry bites," in which the snake does not inject any venom. In this case, having been run over by a baby carriage, Mr Snake was apparently rather POed and delivered a good load of venom.

A big variable is the size and general health of the victim. Small folks, the elderly, and those with compromised health are more risk. Another factor is the species of snake. Some are far more toxic that others, per volume of venom, by a factor of 100 or so.

It is much easier to act and do something, anything at all, if the victim is under stress, but, yes, keep the victim calm and get anti-venom ASAP. Note that the ambulance was there within twelve minutes. In the wilderness, obviously, it would take a bit longer.

Didn't they look where they were going?? Sorry, but unless its hidden in brush, its pretty hard not to see a snake.

Concerning the Sawyer Extractor, wilderness medical programs (WMI, etc.) stopped using them a while ago.

I have stepped over a rattle snake while hiking twice, and I was looking. My vision is better than 20/20. On one occasion, the hikers in front of me stepped right over it, and I saw it as I was passing over it. Seeing all rattlesnakes requires a higher alert than is realistically possible in my experience. In this particular case, it's hindsight. During the moment, it's not like they were scanning the area perfectly 100% of the time. The mind is lazy if one hasn't seen a snake in years or ever.

Like most people, I only see a rattlesnake AFTER I am focused directly on it. (Also, rattlesnakes don't always make noise, especially if it's a little chilly out.) Even if a rattlesnake is in the middle of a sidewalk or street, the color and pattern are still NOT highlighted in my brain. Their camouflage is the real deal.

Rattlesnake Camouflage 1
Rattlesnake Camouflage 2

Those photos give me the creeps!

The incident occurred "after sunset." They are harder to spot then....

Awhile back the Aussies found that a light pressure wrap was pretty effective for treating extremity bites from snakes with neurotoxic venom. The technique was not recommended, however, for other snake venoms which are not neurotoxic and tend to do damage locally. But the latest AHA/ARC first aid guidelines now recommend a properly applied pressure wrap for any venomous snakebite. I was surprised when I saw this, since venom from vipers like rattlesnakes can do devastating damage to local tissues, and the chief mechanism of the pressure wrap is to minimize lymphatic flow.



Yeah, but what about snakebites?

No, it's not absolute that the person sucking the venom would become the second victim, but if one of you is bitten it's not going to improve the whole situation if there are TWO people who need to be treated.

Remember that if the venom is taken into the body, the site is going to start swelling almost immediately. This also applies to the mouth, a bad place to start swelling. I once knew a Beagle who got stung on the tongue by a rattler; they couldn't get him to the vet quick enough to save his life. His tongue swelled so fast that he died of suffocation, I guess.

I think that the only reason the victim would die quickly is if the venom happened to be deposited right into the blood stream, like into a vein or artery. And there is probably anaphyaxis if the person is allergic, but I am under the impression (perhaps wrongly) that you don't get an allergic reaction the first time you're bitten/stung. The first attack sets up the body to react the next time, IF you're going to be allergic.

So, if you're with someone who is bitten, don't suck the poison, just do all the other things that you need to do: call for help, capture or kill the snake (if you can) so the medical people will know what type of snake to treat for, keep the person quiet and calm, be ready to jump up and wave to the arriving emergency personnel if you're not in a place where you'll be seen easily.

Having two people lying in the brush of a vacant lot, out of sight of rescuers isn't the ideal situation.

Sue

Sue

All this information is great when medical help is close by but what do you do if you happen to be bitten while on a backpack hunting trip, out of cell phone range 30mi. back in the sticks. Having a Beacon or Spot
is no real comfort in this situation either, it could take hours or days for help to arrive.
So: if you are on your own what do you do?
If you have only one other person with you, should they leave you to get help, remember it might be a 2-3 day walk? A Beacon or Spot might take
12hrs or more, it's 5pm now, sundown at 7pm, next light is 6:30am.

Prepare for a rough night. Take comfort that the statistics of survival favor you.

It is worth noting that snakebites in the back country are pretty rare. I did SAR for a number of years in Tucson, AZ, which is near a lot of rattlesnakes. I asked one of our senior members how many of our operations had involved snakebites. Answer - none for over 500 operations over a period of 25 years.

People had been bitten by snakes. A local doctor gave a presentation to us summarizing his experience in treating bites. There were tow groups at risk - young kids playing around the house, and males in the 17-25 year category who were intentionally messing with the snake.

Remember that a snake will avoid you if at all possible. They don't like us anymore than we like them

Most snakes, including rattlesnakes, will avoid trouble if possible. I have spotted rattlesnakes near a trail, after several people have passed, and they were just trying to hide. I have seen them surrounded by a group of people (who were not aware it was there) and the rattler was just trying to get away. Water Moccasins on the other hand are territorial and aggressive. I have been chased by them, I have seen them stand their ground in the face of several people. Their poison is not as dangerous as rattler's venom. Their smaller cousin the copperhead is fairly aggressive as well, and will strike at passersby. Their poison is much the same as the water moccasin, but they tend to like to live in places where people live (woodpiles, under houses, bushes in the yard). Most of the snake bites I have personally been aware of in the Southeast are copperheads, mostly because they are more aggressive and belligerent.

@NightHiker. You. are. on. fire. with your post comments this week.

En Fuego

And don't think that carrying a dose of antivenom with you is going to solve all your prospective problems.

It needs to be kept refrigerated.

Some people are allergic to the antivenom (hospitals test you before they give you the first dose)

And you might need a lot of it to do the job.

Sue

NightHiker, please elaborate on the constriction band. Some people here might think you're talking about a regular tourniquet, like for arterial bleeding.

Sue

Yep. A young boy in our area died in the hospital after reacting to antivenom treatment, even with the full capabilities of a Level 1 trauma center at the doctors' disposal.

But wait people - this was California after all.

The Governor commissioned a panel to study this situation, cost $5 mil. The results are due in 2015. The county issued a warning pamphlet, cost $2 mil, and posted day and night guards along the path to ensure no more snakes bit anyone, at the cost of $10 mil a year. The city commissioned a panel, a symposium and had several university professors debate the problem, costing $2 mil. And they posted warning signs for snake crossings - altho I don't know if snakes read and how do they know where they are supposed to cross?

But then PETA sued on behalf of the snake, saying it was a territorial incursion by people. They won $15 million in a civil trial. They also got all the snakes in that area relocated to a nicer area, at the cost of another $6 mil.

Here in NC the same thing happened to me. Except I have self reliance and carry a walking stick and have been known to look at my surroundings from time to time. I saw the snake. I whacked the snake with a stick and made it into a hatband. Total cost - about $2 for salt to cure the hide.

Who was it said the US is tilted and all the loose nuts roll west?

That no longer applies. The whole country is now a giant pinball machine with nuts roaming all over the place. After all, Washington D.C. isn't in the west, is it?

Sue

Does anyone know if the small fire in a metal water bottle trick will work at sucking out the venom?

sarcasm/

Racist!

/sarcasm

I'm confident I'll be corrected.... and I cannot find a printed source. I asked a friend here who is a Hemotologist considered the regional expert on venom (snake and spiders, here. For what it is worth, here goes:

Aside from the above issue of whether or not to use suction to extract venom (mouth, Sawyer, or heated bottle) the actual issue is that none of these methods actually DO anything. Venom transports so rapidly that any remnant still extractable by suction at the bite site is irrelevant in seconds. One of the mysteries being investigated is that the venom seems to transit faster than one can explain by venous activity per se. So you can't "remove" it.

You can counter the effects with antivenom, and/or you can stabilize and medically support the patient. But if anyone can cite a good reference showing that any significant amount of venom can be removed by ANY form of suction, I'd like to read it.

Hey,wasn't Gomer Pyle from Mt.Pilot?"You gotta'right purdy mouth"(dueling banjos in the background)=NC,?

Here's a well done overview on snakebite management that addresses the Sawyer Extractor as well as the Australian pressure wrap technique. It has many informative links.

There is so little positive evidence of the Sawywer's efficacy, I am surprised at how many are willing to pack one "just in case it helps a little bit".

Trust me, NC has just as many ridiculous nanny state rules as CA. Try running a business there and you'll find out. The only pluses are a lower state sales/income tax, and saner firearms laws. But its not the bastion of self sufficiency and personal liberty that you make it out to be, thats for sure.

Purdy mouth, Georgia. Deliverance. Chatahootchee (sp) River wasn't it? Burt Reynolds, Jon Voight, Ned Beaty (he of the purdy mouth )

Gomer, Mount Airy was the model for Mayberry. And they sent that poor boy to California for his permanent duty post.

NC as a state doesn't have near as many nanny laws as one city - San Fran - in CA does. And most of the ones affecting businesses are federal, not state, at least here. I dunno about the state income taxes/sales taxes as they are the highest in the SE. The firearms laws are pretty cool tho. You do need to get a permit to buy a pistol in this county tho.

And Sue, DC doesn't count. The states send all their elected officials there. Sort of a "send the village idiots on a road trip" thing.

Funny how people didn't comment on the millions "spent" by California in my scenario. Too close to the truth maybe?

OK, ETS'ers, this thread is going off the rails. This is about snakebites - let's keep it that way.

Don't make me get out my moderator stick...

It is correct that there is little positive evidence of the Extractor's effaciacy. However, in the three of the studies I've read that that claim to disprove effaciacy, all of them waited 3 minutes and then applied the device for 30 minutes. They drew the conclusion that the device was simply not effective and also caused additional tissue damage.

As an engineer, if I were performing the same study, I would have made more narrow conclusions:
The device was not effective after a three minute wait; do not use it if three minutes has elapsed.
A 30 minute application causes tissue damage. It is not known if a shorter application time would reduce damage.
There is no point in keeping the device applied once three minutes since the bite has elapsed.

This would also compell further study. Repeat the study but with immediate application of the device. If any significant effeciveness is found, repeat the study to determine the effectivness over the range zero to 3 minutes delay. Finally, you could study the effects of varying application duration, but in any case it ought not exceed 3 minutes total.

Such a course of study would either conclusively prove that the device wasn't effective on snakebites at all in any situation or lead to a much better set of guidelines for its use that might reduce tissue damage.

Your points are well taken, but I suspect the reason for the three minute delay would be to account for the real world delay between the bite and even a fairly immediate first aid response.

I don't go walking down a trail, with my FAK in my hand. Three minutes sounds about right for the time it would take to size up the situation, dig out material, and get to work.

This tells me that the Sawyer may work if applied immediately, but more testing is required to learn its true limitations. If a Sawyer was kept ready for immediate access and applied within 30 sec after the bite, would it be effective? If the Sawyer works with that time constraint, then it may be worth having available for immediate use in snake country. In the Sawyer Bite and Sting Manual it states: ... "2) Use the Extractor pump immediately, you can leave the pump on for up to 15 minutes. The first few minutes are the most important for venom removal."...

If in the study they began use of the Sawyer at 3 minutes, they were intentionally ignoring Sawyer's recommended application instructions. The study may have been interested in the application at that point, but it was far from complete if they didn't at least test the manufacturer's recommended application protocol to determine if it worked at all. If the first few minutes are the most important for venom removal and the study waited until after the first few minutes had passed to begin, it's no wonder the pump failed.

I don't know. 3 minutes is a pretty long time. You get bit, freak out, run down the trail. Drop your bag, dig out the kit, drop your pants (or whatever) and start working that kit. Believe me, you'd be pretty motivated to move quick.

In EMS we have to have an AED shocking an arrest patinet in 90 seconds. that means arriving, assessing, pulling out the machine, turning it on, applying pads, charging and zap. it takes about 1 minute typically. I bet that most people would easily hit 90-120 seconds.

So I agree, 3 minutes should be the upper limits of the device. lets see a study with 30 sec, 1 min, 2 min and 3 min. Heck, I might do that in a few years!

I hope you will be working when I need an AED. But you guys are pros, following an established routine in a familiar environment. Some hiker, having never encountered a snakebite before, is bitten out of the blue. i think it will take a while to even realize exactly what is going on. Then....Dp you have that snakebite thingy? I think so... Well get it! Uhhh...OK, how does it work? Where are you bitten? All accompanied by various alarms and excursions.... And you are probably wondering where Mr Snake is, and trying to avoid him......

It is an interesting question. How long does it actually take before the victim, out in the real world, gets any kind of treatment?

Well there's two questions; first the question of whether the extractor works for average "Joe knucklehead" who doesn't prepare AT ALL and then there is the question of whether the extractor works for someone who's willing to crack the instructions ahead of time and has a bit of first aid training.

Kind of like discussing the success rates of armed self defense for someone that buys a firearm and one box of 20 cartridges (because that's all they're EVER going to need) and throws it in their sock drawer versus the success rates for people who prepare mentally, get competent instruction & practice regularly. The value of the conclusions drawn could vary dramatically based upon which group you plan to be part of.

Thanks, but I'd rather we just skip the whole "you're dead" thing

Good point ... they ARE rehearsed actions. Since I'm medical I might have a bit more interest in playing with gear beforehand and knowing where I pack it. Mr. Joe Weekender might have it in the bottom of a jansport book bag, thinking "gee, is this really needed?"

that would be an interesting study. I'll keep an eye out and maybe copy that some of the one's referenced here in shorter time frames someday. (man, I hate research ... )

I agree, and I do hate to be a downer. The first time someone gets bit, they'd probably spend the first two minutes wondering if they actually got bit and where the snake is. I think the only way the Sawyer device works is if someone has a habit of practicing pulling it out every time they feel a prick somewhere on their body. While that's possible, I don't imagine me ever being like that.



I had the same analogy in mind. If I were going into snake country, I may be motivated to practice with the Sawyer device. However, after a year or so of not getting bit, I'd probably forget all about it. I admit the weak link in the Sawyer device has got to be the operator.

Just to continue on in this line of thought. This morning I had a few spare minutes and rummaging through my car, I encountered a Sawyer that I had purchased some years ago. I took it out and examined the contents and played with them a bit.

Bottom line - if you are ever going to use one of these things, take it out, read the extensive instruction sheet and try it out. The operation of the syringe-like extractor is counter intuitive; i.e., it extracts venom when you depress the plunger, not when you draw the plunger back. You also have to assemble the blame thing.

I am pretty sure that you will lose precious minutes in applying the unit unless you are at least moderately well versed in its operation. The instruction sheet is very comprehensive and thorough.

I have had good luck with it on insects but even with our discussion a while back had indicated it wasn't useful on snakes. I still would probably try it, if I had nothing to lose and help wasn't coming or self rescue wasn't possible. I had remembered the story nighthiker had told with the marine who got bit on the hand/arm and he tried it and it still had swollen up, etc..
I wish something would work but it seems no matter if it's electricity, suction, voodoo doll or what have you, if you don't have antivenin you are going to be in big trouble.

http://forums.equipped.org/ubbthreads.php?ubb=showflat&Number=99868&page=3

One thing I have long wondered about as an emergency treatment for snakebite.

Sugar and salt both have absorbing effects on certain things, esp moisture.

I believe salt is used for curing meats (I've never done it, my knowledge of the how-tos are very vague).

An older method of dealing with a uterine prolapse (inside out) of dairy cattle after/during giving birth was to cover the exposed uterus with quite a large amount of sugar, to shrink the organ enough so it could be put back into the cow.

It has occurred to me that if I were snake-bitten, with no help coming anytime soon, and I had a goodly amount of either salt or sugar at hand, I would try it: pile some on, wait a bit, scrape off any salt/sugar that had absorbed any moisture, then add more salt or sugar, and repeat.

I don't know how much good it would do, but I don't think it would do much harm, either.

This is just my own idea, I have never seen such a thing advocated online or anywhere else. I've seen quite a few snakebites, and the idea of just sitting there watching my leg or arm swell and turn red and then black as the skin dies just doesn't appeal very much.

Any thought on this idea from medical personnel? Good, bad, ineffective idea?

Sue

It's an intriguing idea, but if it worked, I think people would've figured this particular question out a long time ago.

Actually, assuming that there's any similarity, brining a turkey makes it more moist and juicy as some of the salt penetrates the bird. Drawing more fluid into the affected area seems to be the opposite of what you think it is going to do. The salt in the brine also serves to help break down the turkey meat. If you've been bitten with venom that is trying to break down your tissues, helping it along also doesn't seem to be a wise idea.

Besides, even if you were able to somehow only draw out fluid from the swollen bite site and that's all, I'm still not sure that's the best thing to do. Any remaining venom and toxins that your damaged cells are releasing as they die and split open would tend to get more concentrated as the water content in the swollen area decreases. It doesn't matter after some point, but again, I don't think it helps any.

But that's just my Food Network-based opinion, so I'm all ears on alternate answers.

Its very interesting to read that different countries take different approaches to snake bite.

In Australia, for many years now, Pressure Immobilization has been the prefered treatment for all snake bites. Of course we have a lot of neurotoxic snakes here, and (I think) fairly high levels on en-venomation (ie even when a snake bites, it does not always inject venom, and the amount of venom can vary too).

I carry two (quality) compression bandages (and a couple of safety pins to secure them) to be used to apply pressure to the limb. Here's a copy of the "Crisis Card" which I carry with the kit:

Pressure-immobilisation
• REST and REASSURE the casualty
• BANDAGE FIRMLY, initially cover the bite site then cover the whole limb starting from fingers/toes
• IMMOBILISE limb.
• DO NOT wash the bite area
• DO NOT elevate the limb
• Call Ambulance on xxx or xxx from mobile
(Different numbers down here)


Here's a good Australian article on Pressure Immobilization, its well worth a read:
http://www.avru.org/compendium/biogs/A000066b.htm

Has anybody else had snake nightmares after thinking about this topic too much?

I know sugar has been used as coagulant and topical antibiotic for gunshot wounds dating back to the 18th century. Sort of an early Quikclot. I have no idea what it would do against the snake venom, but keeping the venom concentrated near the wound site doesn't sound like a good idea. I'm guessing it would damage the local tissues much more severely then if it had diluted.

On the other hand, would you rather lose your leg or your life?

Rattlesnake bite not cheap. Antivenin per vial $500-1000 x 5-20+ vials, depending on variables. Plus provider costs (physician, hospital etc).

That stuff has really gone up. I had to pick up a couple of doses from the local hospital pharmacy in Glendora, CA when I worked for the vet there. I signed a receipt for $34 for both.

Sue

If I'm in remote country, I usually carry a Sawyer extractor with me. My main hope is to use it for insect bites, and skin punctures due to thorns. In both cases it has the potential to be very helpful for those types of wounds. I would also use it on a needle-stick accident, if working around patients where blood is being drawn. Always the same basic idea ... get blood flowing out of the body, and hopefully carrying any infectious agents out with it.

Sawyers were invented for snakebite, but I think research has shown that they only remove maybe 5-10% of the venom. Something like that. You've got to get the Sawyer directly onto the bite as soon as possible after it happens. It's probably very worthwhile for neurotoxic venoms. Of course, if you wait too long then the venom diffuses through the veins and capillaries.

I would still use the pressure immobilization treatment for a rattlesnake bite. But the concerns here are valid. That toxin eats away flesh in nasty ways. Victims who don't die from a rattlesnake bite often lose large amounts of flesh in the bitten extremity. It's not pretty at all - quite debilitating. The moral is ... DON'T get bitten!! Stay alert.

I looked into carrying anti-venins, but they are expensive and unless you've got a lot of training it's probably a no-go. It might work if you positively know that the threat only comes from one kind of snake e.g. Pacific diamondback rattlesnake. i.e. you've working a specific area where such a snake is common. But otherwise there's an immediate issue that you don't have a positive ID on the snake, you're scared because the dumb thing just bit you, and there's no guarantee that you've got the correct anti-venin for the situation. Polyvalent anti-venons do exist, but again you need to be sure you've got the right species of snake. Might work in parts of the USA.

cheers,
Pete2

Hi everyone. I know I'm a noob here, but I need to say this. Throw your Sawyer Extractors in the trash. They do more harm than good. I'm a nurse practitioner in SoCal, and I happen to have been charge nurse in an ED where Sean Bush, MD used to work (Yes, the guy from the Venom ER show on Animal Planet). He is brilliant, knows snakes, and last I heard held a presidential commission to treat any ennvenomations the president might encounter. That being said, the guy also keeps live rattlesnakes *in his house*.

Anyway, he has done studies on the Sawyer Extractor (using pigs, whose skin is very similar to human's) and found that: 1) They don't extract any venom, and 2) they actually seem to cause necrosis (death) of the skin where they are used, making a wound in addition to the envenomation. Here is a link to the abstract of the paper he published on it.

It seems to me that the concept behind the Sawyer is based on a fallacy. There is no pocket of venom to be sucked out of the tissue. This should be obvious to anyone who has used a flavor injector on a turkey. Basically a giant syringe, you use them to add flavor and moisture to your turkey before you cook it (I recommend white wine in turkey, or OJ into duck). Other than the tiniest dribble when you pull the needle out, the fluid soaks into the tissue almost immediately. By the time you've sat down, gotten the kit out, opened up your pant leg, etc. it's too late. Get to the nearest ED.

Welcome to ETS! I would be delighted if Dr. Bush could join the forum and answer a few questions about his study. I do not know if the Extractor is or can be effective against snakebite, but I am sure that his study does not answer that question.

In the study, the Extractor was applied 3 minutes after envenomation and left in place for 30 minutes. However, the Extractor instructions clearly state:

The only valid conclusion to be made from the study is that the Extractor is not effective and can cause tissue damage if you delay treatment until it is too late and then apply it for twice the maximum recommended time.

I understand why a study might need to be limited to testing under only one set of parameters, but why did Dr. Bush choose such a gross misapplication of the instructions as his one and only data point?

I would dearly like to see the study repeated with a zero delay in order to determine if there is any possibility for the device to be effective. If significant positive results were seen, it would compel an additional study to determine the effectiveness after delays of, say, 15 seconds and longer. Oh, and the optimum application time should be determined, but based on the original study one could reasonably assume that removal three minutes post-envenomation, regardless of when it was applied, makes sense.

Thanks!

Welcome aboard, Keith!