Jones,

You are quite right that the goal is to slow lymphatic circulation of the
venom;
recognition and management of envenomation. The question seems to be how best to
accomplish this. Being that I have spent years in pre-hospital and hospital
settings, I know that everyone has their own view of treatment modalities.

Chris took his question froma JEMS (pre-hospital) magazine article and I went
with that thread, The other treatments you mentioned, of course are standard
care for the complications you mentioned.

I am sorry for the length of the following, up the readers might find it
interesting. It came from another forum site.

As a former combat medic, current Physician's Assistant board certified in
remote and emergency medicine and 1 time TWS finisher I have some experience if
not expertise in dealing with envenomations (aka snake bites).

Mr. Goynes is quite right that more people have sustained unnecessary blood loss
and tissue damage from the old style snake bite kits, which contained little
more than a rudimentary capsule suction device (which also served as the
container), an exacto knife blade and a 2 foot long length of thin nylon cord to
use as a tourniquet. The predominant school of thought at the time, was that you
make a series of shallow "x shaped" incisions over each puncture site, express
venom by milking the area, apply the tourniquet and suction out what you can.
While doing this, keep the bite site below the heart, apply a cold compress and
haul a** to the nearest center of medical excellence. Please purchase one of
these kits in order to comply with TWS regulations. After check in, seal it in 9
fathoms of Gorilla Tape and drop them into the very bottom of your dry bag.
Under no circumstances should you ever expose this device to direct sunlight or
someone might actually try and use it on
you.

The good news is that we have learned a great deal since 1855.

First off, as a previously noted above, most bites are dry. That is not to say
that the snake’s fangs are constantly void of venom. Even a “dry bite” will
inject trace amounts into the bite site. This will generally produce localized
pain. On a scale of 1 – 10, dry bites usually score a solid 8. I have routinely
prescribed demerol injections for pain management. As with most dirty puncture
wounds, swelling of the appendage to +3 is common along with some paralysis. All
of this is transient and usually subsides with 2 to 10 days. A precautionary or
prophylaxis course of a broad spectrum anti-biotic is given. Cirpo 500mg twice a
day for 10 days is popular. This is what you can expect when exposed to trace
amounts.

Full envenomation is where the fun starts. I do not believe that in the history
of man, anyone has ever sustained full envenomation and wondered if they got
bit. My wife stepped on a copper-head in our bathroom and got the full dose. I
actually thought she had received a massive electric shock. The noise alone was
quite the source of amazement. Needless to say, that house had to go…on the
market.

Rarely does a snake find the good timing, luck and opportunity to inject
directly into the blood stream. As most of our bodies are covered in a layer of
subcutaneous fat (me more than most) this is where the venom goes. It is then
transported on its journey around the body via the lymphatic system. I will
spare you any more boring anatomy lessons, save this. If you have ever known a
girl to go to sleep with a pony tail holder around her wrist and wake up with
her hand resembling Mickey Mouse’s glove, then you have seen a very effective
lymphatic tourniquet. In this case, lymphatic fluids flowed down to the hand via
the lymphatic system, but could not return because of the constricted flow.
Blood however was able to flow quite easily, as the vessels and arteries are
much deeper into the structure of the body.

OK, I’m about to make a point. At least let’s hope so. If you ever have the
great misfortune to be bitten by a pit viper (rattlesnake, cotton mouth,
copperhead), modern emergency medicine suggests that you should keep that area
of the bite below the heat, apply a lymphatic tourniquet (loose enough to fit 2
fingers, feel snug pressure and still maintain a pulse) and seek medical
attention immediately. The frequency of anaphylactic (or deadly allergic)
reactions to antivenin (not really pronounced anti-venom) in over 500 times
greater than the likelihood of dying from the bite itself. You actually stand a
greater chance of dying from the cure that the condition. Because of this, you
probably won’t receive antivenin unless you are hemodynamicly decompensating.
That’s a really cool way to say you are bleeding to death, because the venom
changed how your body deals with blood.

For those snake bite groupies out there, you probably have a home shrine of Dr.
Sean Bush of Loma Linda University Medical Center in Southern California. He’s
about the smartest guy on the planet when it comes to snake bites. This is what
he says and I have actually heard it one-on-one.

“The lymphatic tourniquet will block the flow of venom to the rest of the body,
thereby limiting any neurotoxin effects on body function. But it will also allow
pool venom at the bite site, maximizing the necrotizing effect on local tissue.”

Translation: If you use the tourniquet to stop the spread of poison, then you
won’t have trouble breathing, bleeding out or watching your kidneys shut down.
What you will have is the poison act like a slow acid as you contain it within a
small area of tissue and watch that tissue rot and fall away.

So what does Dr. Bush recommend?

1) Don’t get bitten by snakes,

2) if you are bitten go to the ER and get treated for the pain and the staff
will wait, and wait and wait some more to see just how bad it gets before doing
anything else.

The best outcomes so far have been from people who actually did nothing in the
way of first aid, other than activate 911 or otherwise seek immediate medical
assistance. Everything else was a trade off.

With regard to the Extractor, several popular tests including one by the Myth
Buster guys gave no positive indication that venom injected into subcutaneous
layers can be extracted. Even the manufacturer Sawyer concedes to the
controversy: http://www.sawyerproducts.com/controversy.htm

I personally have never seen a healthy person die from a snake bite that did not
have a secondary or underlying allergic reaction to either the venom or the
antivenin.

Given my knowledge, experience and desire to keep all my body parts; if bitten I
would drop from the race and seek immediate medical attention with little more
than basic first aid practices in place.

My apologies to the entire community for the length of this post.

Yes, I am in the military, currently a reservist. My last job in the US was in
the positon as a Clinic Instructor for a EMT/Paramedic program at a major
university.

At this time I live and work in Baghdad.

David RN BSN, Lic. Paramedic/Instructor
LCDR USNR

(Fear the Goat!)






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