You Have Just Been Bitten by a Snake

You've just been bitten

The Number of People Bitten by Snakes

Never wound a snake but kill it
Never wound a snake but kill it

Each year may be as high as five million.  They result in about 2.5 million poisonings and 20,000 to 125,000 deaths.  The frequency and severity of bites vary greatly among different parts of the world.  They occur most commonly in Africa, Asia, and Latin America, with rural areas more greatly affected.  Deaths are relatively rare in Australia, Europe and North America, but in the United States, about seven to eight thousand people per year are bitten by venomous snakes (about one in 40 thousand people) and about five people die (about one death per 65 million people).  40% of those bitten had a blood alcohol of .10 or higher.

Prevention of snake bites can involve wearing protective footwear, avoiding areas where snakes live, and not handling snakes.  Treatment partly depends on the type of snake.

What is Recommended if Bitten by a Snake

Snake Bite Do's and Dont's•    Washing the wound with soap and water and keep the limb still.  Immobilization of the bitten limb is recommended to prevent the pumping action of the skeletal muscles.
•    Identify the snake if possible.  Dead snakes are still deadly.
•    Take off all jewelry and tight clothing to avoid problems with swelling.
•    Keep the area of the bite below the heart to keep venom from spreading.
•    Keep the person as still as possible to keep venom from spreading.
•    Cover the bite loosely with a clean, dry bandage.
•    Help the person stay calm to prevent shock.
•    Don’t Delay: Get medical help as soon as possible or transport the victim to the nearest hospital.

Signs and Symptoms of Snake Bites

There is vast variation in symptoms between bites from different types of snakes.

Symptoms of Snake BiteThe most common symptom of all snakebites is overwhelming fear, which contributes to other symptoms, including nausea and vomiting, diarrhea, vertigo, fainting, tachycardia, and cold, clammy skin.  Television, literature, and folklore are in part responsible for the hype surrounding snakebites, and people may have unwarranted thoughts of imminent death.

Dry snakebites and those inflicted by a non-venomous species can still cause severe injury. There are several reasons for this: snakebite may become infected, with the snake’s saliva and fangs sometimes harboring pathogenic microbial organisms, including Clostridium tetani.  Infection is often reported with viper bites whose fangs are capable of deep puncture wounds. Bites may cause anaphylaxis in certain people.

Most snakebite’s, whether by a venomous snake or not, will have some type of local effect. There is minor pain and redness in over 90 percent of cases, although this varies depending on the site.  Bites by vipers and some cobras may be extremely painful, with the local tissue sometimes becoming tender and severely swollen within five minutes.  This area may also bleed and blister and can eventually lead to tissue necrosis. Other common initial symptoms of pit viper and viper bites include lethargy, bleeding, weakness, nausea, and vomiting.  Symptoms may become more life-threatening over time, developing into hypotension, tachypnea, severe tachycardia, severe internal bleeding, altered sensorium, kidney failure, and respiratory failure.

What is Not Recommended if Bitten by a Snake

The following treatments, while once recommended, are considered of no use or harmful, including tourniquets, incisions, suction, application of cold, and application of electricity.  Cases in which these treatments appear to work may be the result of dry bites.

Snake Bite Kit•    Application of a tourniquet to the bitten limb is generally not recommended. There is no convincing evidence that it is an effective first-aid tool as ordinarily applied.  Improper application of a tourniquet is dangerous, since reducing or cutting off circulation can lead to gangrene, which can be fatal.  The use of a compression bandage is generally as effective, and much safer.
•    Cutting open the bitten area, an action often taken prior to suction, is not recommended since it causes further damage and increases the risk of infection; the subsequent cauterization of the area with fire or silver nitrate (also known as infernal stone) is also potentially threatening.
•    Sucking out venom, either by mouth or with a pump, does not work and may harm the affected area directly.  Suction started after three minutes removes a clinically insignificant quantity—less than one-thousandth of the venom injected—as shown in a human study.
o    Suctioning by mouth presents a risk of further poisoning through the mouth’s mucous tissues.
o    The well-meaning family member or friend may also release bacteria into the person’s wound, leading to infection.
•    Immersion in warm water or sour milk, followed by the application of snake-stones (also known as la Pierre Noire), which are believed to draw off the poison in much the way a sponge soaks up water.
•    Application of a one-percent solution of potassium permanganate or chromic acid to the cut, exposed area.  The latter substance is notably toxic and carcinogenic.
•    Drinking abundant quantities of alcohol following the cauterization or disinfection of the wound area.
•    Use of electroshock therapy in animal tests has shown this treatment to be useless and potentially dangerous.
•    Do not take aspirin.  It can make the bleeding worse.

How Can You Tell if a Snake Bite is Poisonous?

To identify a snake bite, consider the following general symptoms:

•    two puncture wounds.
•    swelling and redness around the wounds.
•    pain at the bite site.
•    difficulty breathing.
•    vomiting and nausea.
•    blurred vision.
•    sweating and salivating.
•    numbness in the face and limbs.

The Cost of Snake Bite Antivenom

Cost Breakdown of AntivenomWhy is the bill for a rattlesnake bite so high? It has to do with the necessary medical attention. In particular the antivenin, this is required to treat a venomous bite. It is included under the pharmacy cost portion of the bill. There’s only one commercially available antivenin for “treating venomous snakebites in the United States – CroFeb, manufactured by U.K.-based BTG plc,” according to The Washington Post. There are no other competitors in the market, and because of that, in 2014, BTG closed out around $100 million. For one hospital vial, the price is around $2,300. Treatments can require four to six vials. So for a single, smaller rattlesnake bite that would need four vials of antivenin, the cost is $9,200.

Over 70 percent of the comes from hospital markups that are used as instruments in negotiation with insurance providers. Depending on the hospital and the insurer, some percentage of this amount later gets discounted during the final payment process.

New Development in Snake Bite Treatment

Sample billing for Snake Bite
Sample billing for Snake Bite

Time is of the essence for treating venomous snakebites, and a product being developed by researchers at the University of Arizona College of Medicine — Tucson may extend that window for treatment.

The product, which still must undergo lengthy lab and clinical trials, is intended to act as a “bridge” that buys time for a person who faces the potentially life-threatening effects of a snakebite, which may occur far from medical care. The treatment might be stocked in ambulances, or included in first-aid kits for campers and hikers, said Dr. Vance G. Nielsen, professor and vice chair for research in the Department of Anesthesiology.

Nielsen led the research, collaborating with toxicologist Dr. Leslie Boyer, founding director of the UA’s VIPER Institute and associate professor of pathology, who develops antivenom treatments for snakebite and scorpion stings. Boyer also is a member of the BIO5 Institute.

The product consists of a combination of carbon monoxide and iron, which — if given soon enough after the bite — could block the venom’s effects, preserving fibrinogen and allowing blood to clot. That, in turn, could delay or prevent the serious bleeding from snakebite.

The treatment would be given to people bitten by rattlesnakes and other “pit vipers,” a family of snakes found throughout North and South America. Some toxins in pit viper venom destroy fibrinogen, while other toxins work on different paths of the coagulation (clotting) pathway, Nielsen said.

“We don’t want people to think this is going to be available to them tomorrow,” Boyer said. “It will take awhile to put it through the tests for safety and efficacy required to prove its value. For now, I’m delighted to be part of this innovative approach that may lead to a better outcome for patients. Dr. Nielsen brings an entirely new perspective to the field of snakebite treatment.”

Acknowledgements
WebMD

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Born in Toledo, Ohio circa 1950. I was the oldest of four children and had the good fortune to be inquisitive about wildlife and specifically rabbits and pheasants that were abundant in the area that I was raised in. With later moves to Michigan, I found that exploring the great outdoors was just a short bike ride away and I invested in a Havahart trap at age 11. Raccoons, skunks, squirrels and possum became the choice of prey and that stayed my mainstay until college. I knew that elk were abundant and of trophy class in Arizona so it sealed the deal for relocating here. Since 1986 I have spent as much time as possible learning about elk and trying to become a better hunter.

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