Snake bites

Just recently we treated a victim of a rattlesnake bite. Pretty anti-climatic. The little guy (the snake) could not have been more than a few days old. The victim was picking up his bag of sports equipment when the little guy (about 6"-8" long) latched onto him.

All we did for him was watch him for a while, there were two tiny puncture wounds. There was no redness or swelling. All I could figure out was the little guy had not developed any venom yet, or very little.

I was amazed at the markings on the snake. It loked just like a tiny, tiny version of what it was, a western diamondback. The victim brought it in to the ER in a cooler. I tried my best to talk him out of it, but he would not give it up.

The pt came back a few weeks later and said he never had any effects from the bite. He also took the snake out into the woods and released it.

Snake bites are fairly uncommon in the US. Most snakes just want to be left alone, and will go the other way if given half a chance.

bob

No personal experience, but here's a recent story that was in the local news:

Snakebite tragedy called unusual

NORCO: Ross Cooke's family grapples with his death after an encounter with a rattler.

05/23/2003

By GEORGE WATSON and PAIGE AUSTIN

THE PRESS-ENTERPRISE

As a child, Ross Cooke raised 17 snakes as pets and grew to love stretching his legs while on a hike. Sometimes he carried a camera to snap photographs or rode a horse in the nature he adored.

You might even have called him a bit of a cowboy, his mother said.

The 50-year-old Norco man certainly seemed like an unlikely candidate to be bitten by a poisonous snake. In the current era of medical technology, it's even more surprising that he would die from the bite.

But now his family is grappling with the realities that still seem so unreal. Cooke died Monday, three days after a rattlesnake bit him while he was hiking in Lytle Creek near Rialto.

"We're all trying so hard to understand how it happened," said his mother, Kathryn Cooke, in a phone interview Thursday. "It's so unfair to lose him like this."

The San Bernardino County coroner's office still has not determined the cause of Ross Cooke's death. Officials are waiting on toxicology and tissue studies, which could take four to six weeks, said Randy Emon, a department spokesman, in a telephone interview.

In all likelihood, though, Emon said, Cooke died from the venom of a rattlesnake, the only type of poisonous snake found in the wild of Southern California.

Snake experts say it's uncommon for any of the six breeds of rattlesnakes indigenous to California to bite humans. It's even rarer that someone dies, they say.

But Cooke's death should serve as a stern warning to people to stay away from the snakes, experts say.

Details from interviews with Cooke's mother and county officials are emerging that might help explain the man's demise.

It was around 11:30 a.m. on May 16 when Cooke parked the truck supplied by his employer, Tyler Refrigeration Corp. of Brea. He climbed out of the vehicle and headed for a short walk near a dry riverbed just north of Interstate 15 and Sierra Avenue. He enjoyed the diversion between jobs and took the opportunity as often as he could.

Cooke ambled over the rock-strewn ground when, 500 yards from the truck, he stepped on what appeared to be a log. A thick-bodied rattlesnake suddenly jerked into action, surprising him as it twice sank its fangs into his left shin.

Once he comprehended his situation, Cooke ran back to his truck. He grabbed his mobile phone and called his wife, a hospital nurse. He phoned his boss and asked for help finding the nearest hospital. He then drove the 16 miles to get help at Kaiser Permanente Medical Center in Fontana.

"I don't know why he didn't call 911. He must have panicked," said Kathryn Cooke, 80. "If only he'd had a snakebite kit with him. Every hiker should have one."

Over the next few hours, doctors attended to Ross Cooke, who appeared to be doing fine before developing neurological problems, Emon said.

Kaiser transferred Cooke to Loma Linda University Medical Center because of its expertise in snakebites, he said. The venom likely caused a disorder called disseminated intravascular coagulation, leading to a series of small strokes and one large stroke, Emon said.

Cooke's family decided to take him off life support Monday, his mother said. He would have watched his oldest of two sons graduate from high school this month, she added.

"I'll always remember him as a good, kind and caring man, just like his father, who he looked up to so much," Kathryn Cooke said. "That's the only good thing to come out of this: He's finally with his father again."

Sean Bush, an emergency room doctor at Loma Linda University Medical Center, said in a telephone interview that he has treated 11 snakebite victims this spring, an amount he said was typical. He treats as many as four dozen cases a year, he said.

Each snakebite is different, he said. Some lead to respiratory failure, allergic reactions or organ failure.

Though serious, rattlesnake bites are rarely fatal, officials say.

"In Southern California, I hear of maybe one or two fatalities out of several hundred bites per year," Dr. Richard Clark, medical director of the San Diego division of the California Poison Control System, said in a phone interview.

Rattlesnake venom contains enzymes that enable the snake to digest its food. The enzymes cause skin to break down and prevent blood from clotting, causing hemorrhaging.

A rattlesnake bite victim should remain as still as possible until help arrives, said Lee Cantrell, assistant director of the San Diego poison control division.

"The more you move, the more you're going to circulate the venom," Cantrell said in a telephone interview.

Most snakes might want to be left alone. But in the South some people don't like to leave them alone. We see probably 15-20 snakebites each summer in our ER. Most are uneventful. Observe the patient for a little while, clean the puncture sites, etc. But one patient I will never forget.

Mr. B - Mr. B came into triage with a tourniquet around his thumb. It was soooooooo tight his thumb was black. His first words to me - "that d@#$ snake bit me" He had been bit by a rattlesnake that he was trying to get out of the middle of the road (I say leave the snake in the road and let your tires take care of it) Anyway - Mr B's vitals are stable, but he is a little hysterical. So I take him back to a room and go report to the MD. The MD (who isn't from the South nor the country) tells me that there aren't any rattlesnakes in GA and to remove the tourniquet. Well - I just say "yes there are rattlesnakes in GA" and "NO, I don't think you should just jerk that tourniquet off" So he gets a new grad to go remove it. Within 2 minutes of removing the tourniquet guess what happens. Mr. B crashes!!!!!!!!!!! Mr. B's blood pressure bottoms out, heart rate increases to 200, pale, diaphoretic, vomiting, arm all the way up to the elbow is edematous and red, and he keeps saying "please don't let me die. I'm not ready to die" So now the MD has egg on his face and is at a loss of what to do. He calls poison control and talks to the toxicologist who tells him "Yes there are rattlesnakes in GA" and "You really shouldn't have removed that tourniquet that fast" Meanwhile, I get the Crofab (antivenom) out. Mr. B did fine. We stabilized him and gave the Crofab. And giving the antivenom is as scary as the snakebite itself. But that would be a whole different story.

So the moral of my snakebite story is "Yes there are rattlesnakes in GA" (and any true GA boy can tell you if that snake is a rattlesnake or not)

Sean Bush, an emergency room doctor at Loma Linda University Medical Center, said in a telephone interview that he has treated 11 snakebite victims this spring, an amount he said was typical. He treats as many as four dozen cases a year, he said.

Each snakebite is different, he said. Some lead to respiratory failure, allergic reactions or organ failure.

Though serious, rattlesnake bites are rarely fatal, officials say.

This doctor has his own TV show, Venom ER. I have seen every episode. I used to TIVO it, I think they might show reruns on Discovery Health or The Learning Channel.

Rattlesnake are a dime a dozen in my area so I think the medical tx is fascinating. I once found a baby rattler in my pool swimming! What worried me was where was it's mother?

We see several pit viper bites every year.

We will often treat with Crofab, which by the way costs thousands upon thousands of dollars. We only have enough for one dose because of the expense and because it expires quickly. We have to fly subsequent doses in by helicopter.

I've never had anyone die of their bite, but I've seen one older man who had some permanent nerve and vascular damage. He was old and frail and was bitten in his garden when he was weeding. He had some preexisting conditions including PVD and DM, and wasn't able to regain full function of his arm.

I hope that your husband is very very careful and doesn't plan on collecting/handling venomous snakes. Accidents happen, even with very experienced handlers.

About 6 years ago here in Dayton, a Dayton firefighter (Michael Peterman) was bitten by one of his pets while he was feeding it. The snake involved, an African rhino viper, is said to be very aggressive with a VERY nasty venom.

See:

http://www.enquirer.com/editions/2003/08/05/loc_wwwloc4snake5.html

http://cms.firehouse.com/web/online/News/Ohio-Firefighter-Dies-After-Bite-From-Pet-Snake/46$16375

http://www.igorilla.com/gorilla/animal/2003/snake_kills_firefighter_ohio.html

In talking with medics on the same department, Peterson was nailed in the thumb (injecting venom directly into a vein), and knew that he'd been nailed badly. In the few minutes it took for his wife to drive him to the nearest fire station (with paramedics at the station), he was in arrest. In a TV interview given by the local level 1 trauma center doctor who treated Peterson, I remember the doc (who himself has traveled many times to Africa & knows about this type of snake) saying that if Peterson had been bitten while in one of his hospital's trauma rooms, Peterson would have almost certainly met the same outcome.

One website I saw listed these effects of Rhino viper envenomation:

When a rhinocerous viper bites you the following happens to you in sequence:

Local Affects: Pain and swelling: onset almost immediately after bite Blistering, bleb formation Hemorrhagic edema Tissue necrosis: onset usually days after bite Ecchymosis

Cardiovascular: Severe Hypotension: onset immediately Cardiac arrythmias: Tachycardia Prolonged QT intervals Supraventricular tachycardia Inverted T waves Cardiac arrest

Hematological: Coagulation defects Spontaneous bleeding: Mucosal bleeding Hematemesis Epistasis Ecchymoses/petechiae Gastrointestinal bleeding Internal hemorrhage Hemolysis

Pulmonary Pulmonary edema Tachypnea Dyspnea

Renal/Urinary Hematuria Hemoglobinuria Myoglobinuria Renal failure

General: Nausea/Emesis Fever Abdominal pain Regional Lymphadenopathy

Then you die!

Not fun at all.

Thank goodness, my only snake bite experience was with my Mom's dog, who survived. It was, however, pretty gross. Spot was a snake killing dog. Until one bit him several times on his tongue and cheeks. He was taken to the vet, where they started an IV and gave him anti venom. Poor fellow, he was there for a week. Mom and Dad were out of town, so I visited him every other day. For two days. The first time that I saw him, I burst into tears. There was bloody drainage from his mouth and his face was swollen with wounds from the snake's fangs.

When he saw me and heard my voice, he wagged his tail. We made eye contact, and I patted him once and left him alone. The reason that he survived is because he had been bitten before and had a partial immunity to the venom. A critical factor: He had a wonderful veterinarian who was prepared for rattlesnake bites. The veterinarian technicians knew Spot and delivered excellent bedside care.

So I guess the good news is that if a mammal survives the first bite, with immediate medical intervention the second might not be fatal. Have you asked your nearest ER if they have the right stuff?