Re: Snake Envenomation

[Guest guest]

NO, NO, NO, NO, NO to ice. This has been proven to actually increase

morbidity of limb loss. And no tourniquets either. A constricting band and

transport to ER. Anti-venin is the treatment.

For a comprehensive article on the subject of snakebites go to:

http://www.emedicine.com/emerg

This is Emergency Medicine Online, a free emergency medicine textbook written

by acknowledged experts.

I spend lots of time in Tucson where they treat many snakebites, and ice is

an absolute NO-NO.

Gene Gandy

In a message dated 9/7/2000 12:42:23 Central Daylight Time,

anorris@... writes:

Ricky,

I haven't had much experince with snake bites What I have been told to

do is pack the area with ice and maybe a venous tournaquet(BP cuff or IV

band). Transport to the nearest ER. Maybe someone else can give better advice.

Alan Norris, NREMT-B

Oak Cliff F.D.

Logan Co., OK

[Guest guest]

The ice is a bad idea. If the tissue is cooled to a certain degree, you do

indeed cause a local vasoconstriction which may be helpful in slowing the spread

of the venom. The problem lies in the fact that if the tissue is cooled too

much, and there is no way of monitering the degree of cooling, then a condition

similiar to reactive hyperemia takes place and the vessels actually dialate to a

larger diameter than normal, thus accelerating the spread of the venom. The

Parkland Trauma Handbook advises: Immobilization and alignment of affected

extremity below the level of the heart, constriction bands 5-10 cm proximal to

bite, adjusted for edema periodically, distal pulse eval q 5 min, degree of

envenomation graded and antivenin prn. PMH says Incision and suction are

discouraged and cryotherapy is contranindicated. I couldn't find anything in

the ATLS book, although I didn't look too hard.

Hope this helps,

Blaine Rourke

[Guest guest]

Alan:

Actually, most of the 'sperts oppose the use of ice in treating snake

envenomations. It appears to make the tissue damage worse and doesn't really

slow the spread of venom enough to make it worthwhile. Pit viper venom

contains enzymes that dissolve tissue and blood cells. It does damage

sitting right where it is. Also the device used on a snake bit is not a

tourniquet, which is a device that cuts off arterial blood flow. It is a

constricting band that reduces or obstructs venous return to the central

circulation (exactly like the thing we use to start IVs which is also

erroneously called a tourniquet).

Use of constricting bands and placement of the affected extremity below

heart level so gravity can also impede blood return to the heart are the

best procedures. The patient should not be allowed to walk or otherwise move

around if at all possible. Lastly, the old slice and suck routine has been

discounted as ineffective by a lot of the experts. The use of this

potentially maiming procedure is generally ineffective because the venom

rapidly spreads through the tissues and doesn't pool long enough for a

rescuer to reach it. I have heard slice 'n suck compared to trying to suck

one cc of colored water out of a sponge.

Dave

[texasems-L] Snake Envenomation

>

> Ricky,

> I haven't had much experince with snake bites What I have been told to

do is pack the area with ice and maybe a venous tournaquet(BP cuff or IV

band). Transport to the nearest ER. Maybe someone else can give better

advice.

>

> Alan Norris, NREMT-B

> Oak Cliff F.D.

> Logan Co., OK

>

>

>

[Guest guest]

Gene,

I was reared in Nolan County, Texas, where snakes are a business. Sweetwater has

the oldest Rattlesnake Round-up in the country, and I was there when Bill

Ransberger and the Sweetwater Jaycees got it started. That round-up still

provides more venom for antivenin production than any other source.

You are dead on regarding the use of ice, but the decision to use antivenin is a

crucial and controversial one. There have been several documented cases of

anaphylaxis due to the indiscriminate administration. The antivenin is obtained

from equines hyper-immunized with snake venom, and your patient may prove to be

hypersensitive to horse serum. the antivenin also contains other horse proteins

besides the neutralizing antibodies which may cause problems of their own. Some

texts (Callaham, Current Therapy in Emergency Medicine) indicate that incidence

of serum sickness may occur in up to 75% of cases where antivenin is used.

Before antivenin is administered skin testing should be done to rule out

hypersensitivity. In a severely envenomated patient who tests positive for

antivenin hypersensitivity the ED staff must administer the antivenin, but

should be prepared to deal an anaphylactic emergency.

On another note, not all snakebites result in envenomation. Many bites are " dry "

bites and the only resulting harm is a patient needing a change of underwear.

Best regards,

---------------------------------------------------------

D.E. (Donn) , REMT-P

Safety & Training Coordinator

R & B Falcon Deepwater & International

donn@...

http://www.phudpucker.com/

http://www.rbfalcon.com/

---------------------------------------------------------

Re: [texasems-L] Snake Envenomation

NO, NO, NO, NO, NO to ice. This has been proven to actually increase

morbidity of limb loss. And no tourniquets either. A constricting band and

transport to ER. Anti-venin is the treatment.

For a comprehensive article on the subject of snakebites go to:

http://www.emedicine.com/emerg

This is Emergency Medicine Online, a free emergency medicine textbook written

by acknowledged experts.

I spend lots of time in Tucson where they treat many snakebites, and ice is

an absolute NO-NO.

Gene Gandy

In a message dated 9/7/2000 12:42:23 Central Daylight Time,

anorris@... writes:

[Guest guest]

Thanks, Donn,

You are entirely and completely correct. My post was too abbreviated and I

should have provided the information you've posted. In Tucson, they're very

cautious about using the anti-venin and recognize that it results in

reactions lots of the time. It's one of those things that actually requires

" experience " to do correctly.

One can usually tell whether there's been envenomation because of the local

reaction. The rapidity of the response usually tells the story well. A bite

that shows very little swelling, pain, and discoloration, is probably not

going to need anti-venin. OTOH, one that results in rapid swelling and

systemic signs/symptoms will need aggressive treatment.

The Tucson people at all levels are very adept at reading these signs and

anti-venin is NOT given without good cause. Of course, it is a hospital-only

treatment.

Gene Gandy

In a message dated 9/7/2000 17:53:39 Central Daylight Time,

donn@... writes:

<< Subj: Re: [texasems-L] Snake Envenomation

Date: 9/7/2000 17:53:39 Central Daylight Time

From: donn@... (D.E. (Donn) )

Reply-to: <A HREF= " mailto:egroups " >egroups</A>

To: egroups

Gene,

I was reared in Nolan County, Texas, where snakes are a business. Sweetwater

has the oldest Rattlesnake Round-up in the country, and I was there when Bill

Ransberger and the Sweetwater Jaycees got it started. That round-up still

provides more venom for antivenin production than any other source.

You are dead on regarding the use of ice, but the decision to use antivenin

is a crucial and controversial one. There have been several documented cases

of anaphylaxis due to the indiscriminate administration. The antivenin is

obtained from equines hyper-immunized with snake venom, and your patient may

prove to be hypersensitive to horse serum. the antivenin also contains other

horse proteins besides the neutralizing antibodies which may cause problems

of their own. Some texts (Callaham, Current Therapy in Emergency Medicine)

indicate that incidence of serum sickness may occur in up to 75% of cases

where antivenin is used. Before antivenin is administered skin testing should

be done to rule out hypersensitivity. In a severely envenomated patient who

tests positive for antivenin hypersensitivity the ED staff must administer

the antivenin, but should be prepared to deal an anaphylactic emergency.

On another note, not all snakebites result in envenomation. Many bites are

" dry " bites and the only resulting harm is a patient needing a change of

underwear.

Best regards,

---------------------------------------------------------

D.E. (Donn) , REMT-P

Safety & Training Coordinator

R & B Falcon Deepwater & International

donn@...

http://www.phudpucker.com/

http://www.rbfalcon.com/

---------------------------------------------------------

Re: [texasems-L] Snake Envenomation

NO, NO, NO, NO, NO to ice. This has been proven to actually increase

morbidity of limb loss. And no tourniquets either. A constricting band

and

transport to ER. Anti-venin is the treatment.

For a comprehensive article on the subject of snakebites go to:

http://www.emedicine.com/emerg

This is Emergency Medicine Online, a free emergency medicine textbook

written

by acknowledged experts.

I spend lots of time in Tucson where they treat many snakebites, and ice

is

an absolute NO-NO.

Gene Gandy

In a message dated 9/7/2000 12:42:23 Central Daylight Time,

anorris@... writes:

[Guest guest]

Ice bad. Ice increases circulation to the site which spreads the venom

faster. This is generally a BAD thing. Or so I have been told.

Lymphatic constricting bands above and below the bite location. IV NS TKO,

O2, EKG, Pulse Ox., keep patient calm (yeah, sure they are going to be calm

after being bitten), smooth transport. Keep the bite location below the

level of the heart. Monitor the constricting bands.

The bite location will swell. If you aren't careful your constricting bands

will become tourniquets and the patient will suffer worse injury from you

treatment.

Generally, unless you patient suffers an anaphylactic reaction to the venom

itself (treat as any other allergic reaction per your local protocols), or

is bitten by a snake with neurotoxin type venom you have a while before any

real troubles set in. Most of the time treatment at the hospital is

supportive. Up here in the great white north they don't give antivenom very

often. Mostly they give antibiotics and pain relief. If you give pain

relief, only do it AFTER you consult with medical direction to make sure you

aren't going to make the problem worse (at least that is how I would handle

it).

Webb

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[Guest guest]

Hi: I was wondering if you are allergic to Tetanus Toxid, which I believe to

be made from horse serum, would you also be allergic to the snake venom?

Also one other question. I just recertified as an EMT/I and there were

atleast 6 questions on MAST trousers. We don't use them and I've only seen

them used once in the field, & most of the services in the Houston based area

don't even carry them! So why were there so many stupid quustions? Aren't

they considered out-of-date now?

We have killed 2 coral snakes this past month and a copperhead, we live very

far in tthe woods, and it scary to know I might not have an anit-venom that

would work. My brother, until 3 weeks, ago was a helicopter pilot for one of

the Texas hospitals and has been doing this for 20 years, and some of his

best stories are about snake bites and getting a patient to the ER and some

of the funny things the women (girls)want to do BEFORE being transported, as

most have been sunbathing when bit!

Glenda

[Guest guest]

Tetanus toxoid is a non-toxic version of the tetanus exotoxin used for tetanus

active (as opposed to passive) immunization ex.) Td or DTP shots....it is not

made from horse serum. I believe you refer to tetanus immune globulin, which was

in the past made from horse serum and contained, among other proteins, horse IgG

which is an anti-tetanus toxin antibody. Now Human tetanus immune globulin (TIG)

is available and has no interaction with snake antivenon. Again, I think you

meant to ask if allergy to tetanus Ig would lead to cross-reaction with snake

antivenin, not snake venom. The answer is yes, back in the day that horse serum

was used for tetanus passive immunization. This is not the case with today's

human TIG. The same would apply to any other horse serum derived product, such

as black widow antivenin. Put another way, hx of anaphylactic reaction to snake

antivenin exposure = contraindication to black widow antivenin, but not human

TIG. BTW, I found a section in o!

n's that says equine tetanus Ig (TAT) is still available..it's cheaper, but has

a shorter half-life and of course, the awful adverse effects associated with

horse serum products....I'd never use it.

hope this helps,

Blaine Rourke