Venom ER

When snakes strike!

By Sean Bush, MD

Imagine that a rattlesnake has just bitten you. At first you can't believe it, but you look at your leg and there are two fang puncture wounds oozing blood. You have a strange metallic taste in your mouth. Your leg starts to swell and you develop severe pain. Your whole body goes numb. The muscles in your face, neck, and chest start to twitch and writhe. Breathing becomes difficult. You feel as if you are going to faint--as if you are going to die?

What should you do? Here is what you need to know.

First, call 911. Go to the closest emergency department where antivenom can be given to you. Antivenom is the antidote for snakebite. It binds venom and inactivates it so that further damage is stopped.

The case above describes what could happen in the worst case scenario. Sometimes snakebites result in only minor injury. However, it is not possible to predict which bites will result in mild symptoms and which can potentially kill you. Therefore, you should always seek immediate medical care after any venomous snakebite. All patients with rattlesnake bites should be admitted to the hospital.

Let's return to our scenario of what could happen to you after a rattlesnake bite. You should try not to panic and minimize activity if possible. However, if you are alone in the wilderness or far from access to medical care, you may have to hike out to the nearest phone.

Remove jewelry and tight-fitting clothes in anticipation of severe swelling. Do not cut across fang marks and do not try to suck out the venom with your mouth or a suction device. This could lead to complications and infections.

A tourniquet is not recommended because it could cut off circulation. However, an ace wrap and splint may delay the time to death in the rare event of a fatal bite, but could risk further injury to an arm or leg.

Do not take aspirin or ibuprofen after snakebite. Many snake venoms can thin the blood and these medicines may compound this effect, leading to bleeding.

Other first aid that does not help or that is potentially more harmful than the snakebite includes applying electric shock, drinking alcohol, and placing ice directly on the wound. Avoid further injury by staying away from the snake.

Paramedics should arrive shortly and start you on intravenous fluids. They should transport you to the hospital. Shortly after you arrive at the hospital, antivenom may be started. You may start to feel better. However, depending on the extent of injury, you may require pain medication and a surgeon may be called to evaluate your bite wounds.

If you are treated for snakebite, there are a few things you should watch for after being discharged from the hospital. You should watch for unusual bleeding, such as bleeding gums or bruising easily. If you develop any unusual bleeding, you should return to the emergency department immediately. Watch for signs of infection (for example, redness, pain, swelling, or pus) around the bite wound. Also, watch for signs of allergy to antivenom, such as an itchy rash, fever, swollen lymph nodes, or painful joints. This reaction can be easily treated.

Although snakes are widely feared, fewer than half a dozen deaths occur per year in the United States after snakebite. Lightning kills more people in the United States than snakes do. However, serious injury and disability can result from a snakebite, such as the loss of a finger or the loss of function at a joint. While recovering from these types of injuries, you may need to be referred to a physical therapist.

In southern California, we live among some of the most feared creatures in the world: rattlesnakes. Six species of rattlesnakes are found in or around the Inland Empire: red diamond, western diamondback, southern Pacific, Mojave, speckled, and sidewinder. There are no copperheads, cottonmouths, or coral snakes native to the Inland Empire.

The Mojave rattlesnake is the most deadly rattlesnake in the United States. The sidewinder, which can be identified by horns over its eyes, is the smallest and least toxic rattlesnake in southern California.

Many people believe that a baby rattlesnake is more dangerous than an adult rattlesnake. However, a large rattlesnake is more likely to deliver much more venom than a baby rattlesnake. In the clinical experience at Loma Linda University Medical Center, large rattlesnakes cause more serious injuries than baby rattlesnakes.

Snakebite prevention

Because of the antivenom shortage, it is extremely important to prevent snakebites when possible. To avoid snakebites, leave snakes alone. Don't handle or try to kill a rattlesnake. That's how many people get bitten. A snake can strike faster and farther than you might think--about half its body length. Fangs can still inject venom even after a snake is believed to be dead. Snakes that were presumed to be dead have killed people. The majority of snakebites are "intentionally interactive" meaning that the bite occurred when the snake was being handled, molested, or killed.

Don't reach or step into places outdoors that you can't see. Wearing boots and long pants when hiking may also help prevent snakebites.

If a rattlesnake is found near your home, it's best to contact professionals such as Animal Control to remove it. If you must move a rattlesnake from your home yourself, scoop the snake with a long-handled shovel into a large trash can, cover it, and relocate the snake away from your property.

If you see a snake in the wild, maintain a distance of at least 6 feet. Snakes are fascinating creatures that deserve our respect. Snakes are beneficial to the environment and most snakes (such as king snakes and gopher snakes) are harmless. I am a physician and a snake enthusiast. I hate to see people hurt by snakes, but I also hate to see snakes needlessly destroyed.

Sean P. Bush, MD, FACEP, is associate professor of emergency medicine and envenomation specialist at Loma Linda University Medical Center. To suggest topics for future columns, please call (909) 558-4419.

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