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Snake and Spider Bites
Has anyone treated a patient after they were bitten by a venemous snake or spider? What are the guidelines to follow with a patient? EMS does not carry antivenin-correct? Is there anything for a first responder can do for the patient? I have heard that all EMS can do is quickly transport to the nearest medical facility, while keeping the patient calm. I have done some research, but I keep finding conflicting answers.
Thanks in advance!!
Replies to This Discussion
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Permalink Reply by Ben Waller on
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Make sure that the snake is gone. Don't mess around with it - just get everyone away from it and treat the patient in a safe location. If it's a spider bite, have the patient disrobe to ensure the spider isn't inside the clothing.
Keep the patient calm, maintain the ABCs, treat symptomatically.
For snakebite, some protocols still recommend a constricting band for extremity snakebites, some do not. Follow local protocols but don't use a constricting band so tight that it becomes a tourniquet.
If the bite is in an extremity, keep the extremity lower than the patient's heart.
An IV in an unaffected limb and heart monitoring are indicated. If the patient has a low pulse oximetry level, oxygen is indicated.
Most EMS systems don't have antivenom treatments for either snakebites or spider bites - just transport and monitor.
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Permalink Reply by Fabulous Heather Days of Summer on
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here is a little that I know
1) younger snakes are often more venomous than grown ones - so don't assume a little snake is not deadly
2) more people die in California each year from spider bites than snake bites
do some research online, look up the tv reality show "Venom ER", which is hosted out of my hospital. Dr. Bush is a venom expert.
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p.s. if you search the "forum" search menu - you will find lots of discussions on the questions you are asking and the answers you are seeking... I think...
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Permalink Reply by Jack/dt on
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I would be interested in seeing sources that confirm that younger snakes are more venomous. The sources I've found disagree with the myth of younger snakes being (or can be) more venomous.
The maximum amount of venom available to a snake is a function of previous envenomations as well as maturity. The bigger the snake, the more venom available to inject.
There is a myth about smaller snakes not being able to control their envenomation, whereas adult snakes can "meter" their envenomations, thus where adults may limit the amount of venom injected, younger snakes don't have that 'fine" control and so inject all of their venom, thus making them more dangerous. This link and this one present very good arguments against this "smaller snakes are more dangerous" myth.
Here is a very short paper on snake envenomation. This is an information sheet from the Reptile channel and quotes some relevant research:
"...both adult and juvenile timber rattlesnakes (Crotalus horridus) have venom that is “strongly hemolytic,” which means it causes the breakdown of red blood cells, in prey (Ernst 116). Yet venom studies in older adults demonstrate that the “activity level of some venom enzymes tends to increase with the size and age of the snake” (Ernst 116). So an older timber rattlesnake has venom more virulent than a younger one.
Consider the eastern diamondback rattlesnake (Crotalus adamanteus). Juveniles of the species typically deliver less than 70 milligrams of venom, whereas a healthy adult specimen may deliver 492 to 666 milligrams of venom (Ernst 90)."
One suggestion for snake bites (and it would work as well for spider bites) is to outline the area of swelling and write in ink the time. This allows doctors to note how much and how fast the swelling is occurring.
It is suggested here NOT to use a tourniquet as it restricts the flow of blood, pooling and concentrating the venom to an extremity, where it can cause greater local damage than if allowed to circulate through the bloodstream. Restrictive clothing and jewelry are recommended to be removed.
One thing EMS can do is to try and get a description of the snake (or spider).
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My brief comment reflects my brief knowledge. As others reflect there is WAY more information to know on the topic.
I can expand only a little to clarify my thought - on my specific experiences - though by no means am I a wild animal expert - and don't have a lot of time right now to provide better Crocodile Hunter level of knowledge.
- There are times younger snakes can have stronger venom than older snakes - though thankfully, little snakes are littler and therefore have much less venom, and therefore can not deliver as much venom as a old big snake - and I think toxicity and lethality is multiplied in relation exponentially in relation to the increasing amount of venom delivered.
- And it seems big snakes scare people away better while little snakes people think are more innocent and then people tend to get closer to them, even wanting to pick them up and play with them - especially children. This leads to more younger snakes in my area being attributed to striking kids, or innocent yard/garden workers - or at my university, students commonly report large snakes for professional removal, but ignore little ones until they get struck by one laying in the bushes by their homes or classrooms... or worse, they pick up the little snake with their hands to try to move it to the more wooded area away from their personal space "because it is little" and get a nice juicy dose of venom
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It's not an issue of "Crocodile Hunter level of knowledge" (which sounds kind of snarky) but rather one of presenting accurate information.
Presupposing that younger snakes are more harmful means that, given most people's lack of knowledge of snakes (and the inherent difficulty of identifying immature snakes) small but harmless snakes are more likely to be immediately killed because people have "learned" that smaller (venomous) snakes are more deadly.
I found one source that suggested that in some immature snakes the venom may be stronger, but one of the sources I listed strongly contradicted that.
From here: 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.
Sean P. Bush, MD, FACEP, associate professor of emergency medicine and envenomation specialist at Loma Linda University Medical Center.
The rest of your comments, whole not necessarily incorrect, are anecdotal and really fail to educate. From here:
The chances of dying from a venomous snakebite in the United States is nearly zero, because we have available, high-quality medical care in the U.S. Fewer than one in 37,500 people are bitten by venomous snakes in the U.S. each year (7-8,000 bites per year), and only one in 50 million people will die from snakebite (5-6 fatalities per year). Did you know that you are nine times more likely to die from being struck by lightning than to die of venomous snakebite?
From the data included in the above link -
Approximate number of deaths per year
Snake bites - 6
Spider bites - 7
Dog bite/attack - 21
Bee or wasp sting - 53
Lightening strike - 54
You claim that "younger snakes can have stronger venom than older snakes" but then go on to dismiss that claim by further stating that older snakes envenomate greater volume of venom. You also contradict yourself by further elaborating "...toxicity and lethality is multiplied in relation exponentially in relation to the increasing amount of venom delivered."
It sounds to me like you're saying older, bigger snakes are more dangerous than smaller, younger snakes.
For discussions on this see:
http://www.venomousreptiles.org/forums/experts/27426
http://www.herpsofarkansas.com/forum/topic/2267/myth-baby-snakes-ar...
This isn't about proving anyone wrong, only about providing the best possible source and accuracy of information.
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In some pit vipers, immature snake venom may be more concentratedthan venom from an adult of the same species. That does NOT equal "more dangerous",as adult snakes produce much larger amounts of venom and may strike the same person several times.
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It should also be considered that in neonates, their fangs are both shorter and the bore (opening) narrower, thus limiting the depth of the strike as well as the volume of venom injected.
This site presents a short discussion on the different types of snake venom and how they affect the body. It's thought that some neonates may start out more neurotoxic as it works more quickly. But there seems to be little dissension with regard as to which is more 'dangerous', researchers agree that mature snakes present the greater hazard.
Since snakes are commonly avoided by most people (and one researcher found that almost all snake bites occur in males between the ages of 17 and 27, most of whom had elevated BAC), unless one goes looking for them or is in an area known to harbor them, the risk of snake bit is very low.
On the other hand, what child isn't attracted to salamanders and newts?
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