Current snake bite management?

[Firepac]

At the risk of taking the thread slightly off topic, I would also suggest those who have a higher risk of snakebite such as snake catchers, elapid keepers etc familiarise themselves with the protocols for the medical treatment of snakebites.

There have been 2 instances at my local hospital where these protocols have not been followed. In the first case the doctors just removed the PIB from an asymptomatic patient without taking blood urine or swabbing the bite site and instead of removing it slowly and progressively whilst monitoring for onset of any symptoms. Fortunately the patient had not been envenomated. In the second case a local catcher got scratched by the tiny fang of a juvie EB. The PIB was applied and she went to hospital again displaying no symptoms. This time the bite site was swabbed by cutting a hole in the bandage and the SVDK indicated the venom was of Brown Snake immunotype. At this point she was still completely symptomatic yet the doctor was about to give her a dose of antivenom until nurses and others intervened.

I don't blame the doctors as such as when you consider how many doctors there are and how few patients actually require antivenom treatment I think you would be lucky if you presented to a doctor who had treated an envenomation in the last couple of years. Having said that if they don't know or are unsure they should refer to their health districts protocol.

I have mentioned this on previous occasions but as a snake catcher I carry with me a laminated card with first aid on one side and medical treatment on the other.

information on medical treatment is available on the AVRU website.

 

[longqi]

At the risk of taking the thread slightly off topic, I would also suggest those who have a higher risk of snakebite such as snake catchers, elapid keepers etc familiarise themselves with the protocols for the medical treatment of snakebites.

There have been 2 instances at my local hospital where these protocols have not been followed. In the first case the doctors just removed the PIB from an asymptomatic patient without taking blood urine or swabbing the bite site and instead of removing it slowly and progressively whilst monitoring for onset of any symptoms. Fortunately the patient had not been envenomated. In the second case a local catcher got scratched by the tiny fang of a juvie EB. The PIB was applied and she went to hospital again displaying no symptoms. This time the bite site was swabbed by cutting a hole in the bandage and the SVDK indicated the venom was of Brown Snake immunotype. At this point she was still completely symptomatic yet the doctor was about to give her a dose of antivenom until nurses and others intervened.

I don't blame the doctors as such as when you consider how many doctors there are and how few patients actually require antivenom treatment I think you would be lucky if you presented to a doctor who had treated an envenomation in the last couple of years. Having said that if they don't know or are unsure they should refer to their health districts protocol.

I have mentioned this on previous occasions but as a snake catcher I carry with me a laminated card with first aid on one side and medical treatment on the other.

information on medical treatment is available on the AVRU website.

Very good points
I always kept a card in my wallet when I kept vens

Stated name age blood type and the vens I kept

May have saved me if someone found me face down one day?

 

[eipper]

Blue,

first off I am away at the moment and typing on a phone so bear with me a bit. My first aid is aimed at a keeper, I did not talk about how to apply a pib in my original post, but in response to something that was said. My suggestion is to follow that was originally described by broad et al 1979. This is repeated on the Avru website for people to look at with diagrams showing how to correctly apply a pib.

A broad compression bandage and a crepe bandage are very different. I suggest people buy Setopress bandages. These have rectangles that turn into squares to show correct pressure application. The way that many people check is how albino woma described by viewing blood slowing returning to the digits of the limb by depressing a nail.

Basic first aid is designed for stabilization, advanced/senior first aid is designed for longer periods of stabilization eg people trained for high risk/ remote areas eg people surveying down in a gorge in the middle of nowhere vs your office in the middle of the cbd. Both are effective just one is a lot more in depth than other.

The same goes for snake bite, I have applied a pib 7 times in a real circumstances, on three of those occasions systemic envenomation had been completely halted by my application of the pib over at least 4 hrs.

How do I know this, here's an example: the bite occurred at 6.15 (right hand, little finger. Snake physically removed from finger, placed back into enclosure. Bandage applied at 6.16. Ambulence called. 6.28 ambulance arrived, 6.52 arrive at hospital. Rushed into icu, bandage checked by nurse and left alone, cannula placed into left hand. Placed onto saline, blood pressure, heart rate etc monitors(I knew what was coming) doctor pulled back bandage swabbed, took blood from cannula and took urine sample. Negative Elisa's for both the blood and urine while a positive for the bite site.... This is now 7.50. I am alert and happy, while a touch nervous, with a very healthy load of pain in my finger, I am quietly hoping that I will not sustain too bad a bite but I could feel some heat in end of the finger. 8.50 bloods and urine done again... Negative Elisa's. first bandage removed. 9.45 can definatly feel the finger and first knuckle part of the swelling, pain intensifying in hand. 10.15 second bandage removed, injected with anti histamines via the cannula. Antivenom readied, along with steroids, final bandage removed. Over the next 15 minutes, my blood pressure dropped, my whole hand and wrist swelled. My finger and first joint in the hand was purple and black. I felt faint and nauseous, vomited twice. Ptosis became evident, my speech became slurred and i could no longer focus properly. First dose of tiger av given along with steroids and another antihistamine. Bloods taken, after this it becomes a blur, I was given another dose of av about an hour later before starting to improve.

Finally, I suggest anyone that is at risk of snakebite learn the current first aid. Check out Avru and clinical toxicology websites. If your still not sure try and get a hold of some books on Australian Snake Bite eg Venomous bits and sting in Papua New Guinea, Australian Animal Toxins, Bites from "non" poisonous snakes and their clinical management, Dangerous Snakes of Australia by Mirtschin and Davis and the list goes on.

Cheers
Scott

 

[albinowoma]

There was a guy in townsville that got bit by a venemous snake and the idiot ran around in a panick, and dropped dead shortly after. So what was his work mate doing, if there was one there with him? If it came down to it and I was that workmate I would've knocked him out. - heard that at the recent xpo.
And also that the anti-venom is often as bad as or worse then the actual venom in many cases and the effects of the venom last for months afterwards.

 

[redbellybite]

My husband took a few years to get over his bite ...he had on going problems with atrophy and ck levels ...he is a lot better these days...he had a full envenomation from an eastern brown snake.

 

[Chris101]

I have read that if possible ask for fentanyl as pain relief rather than morphine in hospital. Obviously it's the Dr's decision but fentanyl acts a lot quicker on the mu opioid receptor and is considerably stronger than morphine.

 

[eipper]

I have never been given pain relief for any envenomation. I always thought it was because they can act as a suppressant on the nervous system. Maybe I had sadist docs?

 

[-Peter]

None here either. Opiates are worse for me than snakebite anyway. Never wanted to die after a snakebite...

 

[Bluetongue1]

A comment was made that the antivenom is worse than the snakebite. This is straight out incorrect. The antivenom is produced by injecting horses with increasing doses of venom. Their immune systems respond by making specific antibodies that neutralise the toxins present in that venom. Blood is then withdrawn from the horse, treated so it will not clot and the cells filtered off. Blood, minus cells is called serum. This crude serum is then further refined to into antivenom. It still contains some foreign proteins from the horse. It is these proteins that people can react to.

Genuine hypersentivity to a first injection of antivenom is quite rare. It is more likely to occur where an individual has had multiple exposures to horse serum and have developed acquired sensitivity as a result.

When administered at the first onset of systemic signs or symptoms, antivenom is remarkably effective in neutralising the effects of the toxins.

People can develop another form of reaction called serum sickness which is much less severe and sets in several days after of antivenom. Current research is discovering the maximum effective doses and therefore minimising the development of reactions.

Blue

 

[eipper]

Blue,

I think your third paragraph is incorrect. The jury is out at the moment re the best time to give AV. If you were to wait for signs of systemic envenomation in say a species that has predominantly pre synaptic neurotoxins then the damage is done. You will help prevent further damage but you cannot reverse the pre synaptic effects. Same goes for pro coagulants and thrombine, the damage is done when you start seeing changes in the blood work.

Also poor reactions to horse plasma are quite well known. This is one of the reasons along with associated costs, that many antivenoms are being made with sheep among others. Hypersensitivity is more common via repeated exposure but It can occur for "first timers" too.

cheers
scott

 

[cement]

Here is the AVRU's page for the method of snakebite first aid.

AVRU - First Aid