PrepperMed 101: Dealing with Snakebite

Snakebite

Snakes. 

They frighten or just creep out more people than does any other animal with a backbone. 

In a sense, that’s unjust:  Many animals, including cattle, kill far more people per year.  Only a small percentage of snakes in North America are even poisonous (sorry, Australia); and only one bite in five thousand  from poisonous American snakes are fatal to people.

On the other hand, poisonous snakes do kill some people, and make many more miserable.  Preppers should know how to deal with these bites; not least because emergency situations are likely to have us sharing space with the critters more often.

Don’t do it this way

When I was a kid, I knew perfectly well how to treat a snakebite:  You put a tourniquet above it and made a cross-shaped cut over each fang mark. Then you sucked and spit over the wounds.  That’s kind of like an MRE (Meal Ready to Eat), Three Lies for the Price of One!

The first problem is the tourniquet.  Compression (of the entire limb, not just a tourniquet) does have value for some kinds of snake bites, but not the vast majority of snakebites that envenom people in North America.  There are two problems:  One is the type of venom.  Some kinds of snakes (including coral snakes that live around Florida) make venoms that have to spread body-wide before they’re a real danger.  For this kind of venom, compression is useful if done correctly.

The chompy majority

However, 99% or so of American snakebites are from the group that includes rattlesnakes, cottonmouths, and water moccasins.  (These are the snakes with the really triangular shaped heads and the little pits under their eyes, that I hope you are not close enough to see.) . These venoms kill tissues directly, and the higher the concentration of venom, the greater the damage.  Compression concentrates the venom around the wound site and leads to more tissue death. (1)

Even if you are trying to help someone who got bitten by a coral snake or a sea snake and the compression would in theory help, it’s actually pretty difficult to do it right:  Tight enough to work but not so tight as to prevent enough blood flow to keep the tissues from having damage from lack of blood flow. (1)  Besides, the main value is to slow venom until you get somewhere where anti-venom is a available, and that’s something preppers can’t count on.

The second problem with the way I was taught was with the cuts.  The idea was to bleed out the venom.  That reminds me somewhat of ‘drinking from Mr. Fire Hose.’  One of the main problems caused by most venoms is excessive bleeding.  Making intentional wounds where venom concentrations are high is likely to lead to way more bleeding than anticipated … but since the venom is more in the tissue fluid than the blood; that doesn’t really help you get rid of the venom.

The third problem is with the ‘sucking the poison out’.  Even the commercially produced suction devices (better than mouth suction for that job) do a really poor job, getting out only about 3% of the venom injected into the tissues. At the same time, they do considerable tissue damage just by the suction, sometimes causing whole chunks of tissue just the size of the suction attachment to die. (2) . Mouth suction, whether in a lab or in the desert with a snakebite victim, is always a very bad idea anyway, as it exposes the suctioner to whatever he’s trying to get rid of.  

When I was a kid, they never told me to try electrocution of a snake bite.  I just found that ‘remedy’ on the web when researching this article.  Some people suggested hitting the bite area with a stun gun. Some loser even claimed to have ‘saved’ his dog by using the dog’s face to short circuit hot spark plugs.  The theory, such as it is, must be that the heat of the electrical current passing through destroys the venom. Which it would.  Just like it would destroy every other protein in the tissues.  Good thing you don’t need those?  Though I found this idea pretty horrifying, I did do a lit search on it in case I was wrong.  This lit search did not support the use of electric current to get rid of venom. (3)

What does work for snakebite?

Sadly, the only thing that works really well is antivenin.  These are antibodies prepared ahead of time and administered after the bite.  It’s ‘sadly’ because using these realistically requires good medical care.  Antibodies are not an item that stores well without an ultralow freezer, and some of the side effects of the antivenins (such as anaphylactic shock) are more dangerous than the snake bite without good medical care available.

When you’re faced with a situation with no good solution, what you do is clear:  The best you can.  Here are some elements of ‘the best you can’ for snakebite.  The bulk of the information relayed below comes from the Advanced Wilderness Life Support center of the University of Utah. (4) . I picked them because they provide certified courses in wilderness medicine for continuing medical education for physicians and double-checked them against various other sources. I myself am not a physician and so don’t make recommendations of my own.

1. Wash surface with water to remove any surface venom.
2. Slow the spread of the venom by having the patient lie down and be inactive.  (Although they didn’t explain this, it’s probably because worse symptoms arise when the venom hits the circulation in one big spike.  Slow and steady may get as much venom out there, but you have time to destroy some of it.
3. If the person has to move, if it’s a hand bite splint the limb and restrain it as if it were broken, but higher, about at the level of the heart. (This is likely to reduce exchange of fluids with the envenomed arm.)
4. If you have opiate painkillers (such as hydrocodone), it may be better to use them then NSAIDS, the over-the-counter drugs for pain such as ibuprofen, aspirin, and naproxen.  All of those drugs impair blood clotting, and so do many venoms. (5)  I didn’t read it anywhere, but I’d use acetaminophen if I didn’t have opiates, because that’s what my surgeons suggested when they didn’t want extra bleeding tendencies.
5. Some sources recommended giving antibiotics for possible infections injected with the venom, some didn’t.  There was a common feeling that this would be a good time to have had a tetanus vaccination recently.

Low blood pressure and excess bleeding are the most dangerous effects of many venoms.  None of the sources I read wanted to talk about this level of self-care, but it seems to me this might be a good time to pause any drugs being taken for hypertension or ‘blood thinners’.  

How do you know if there was even any venom injected?  Not all bites inject, even from poisonous species. If there isn’t significant swelling within ten minutes or so, there was probably little or no venom injected.  Blood oozing from the punctures for what it seems too long is a bad sign, as are blood blisters at the wound site.  If the gums start bleeding and the person tends to get faint when standing up, there’s venom in the general circulation.

After care, once the parts about antivenim use are set aside, seems to be the normal sort of injury recovery; keeping the wounds clean and giving antibiotics if there are signs of infection.

By the way … if you get bitten and can get to good medical care, most of the sources said not to try to capture or kill the snake.  Try and remember what it looks like; the added risk of trying to capture, kill, or even handle the dead snake was not deemed worth it.

1) Norris, R. L., Ngo, J., Nolan, K., & Hooker, G. (2005). Physicians and lay people are unable to apply pressure immobilization properly in a simulated snakebite scenario. Wilderness & Environmental Medicine, 16(1), 16-21. doi:10.1580/PR12-04.1

2) Bush SP1, Hegewald KG, Green SM, Cardwell MD, Hayes WK.Effects of a negative pressure venom extraction device (Extractor) on local tissue injury after artificial rattlesnake envenomation in a porcine model.Wilderness Environ Med. 2000 Fall;11(3):180-8.

3) Ben Welch E1, Gales BJ. Use of stun guns for venomous bites and stings: a review. Wilderness Environ Med. 2001 Summer;12(2):111-7.

4) Advanced Wilderness Life Support, U of Utah. 11-28-17.

 https://awls.org/wilderness-medicine-case-studies/our-recommendations-for-snakebite-treatment/

5) Lavonas, E. J., Ruha, A., Banner, W., Bebarta, V., Bernstein, J. N., Bush, S. P., . . . Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority. (2011). Unified treatment algorithm for the management of crotaline snakebite in the united states: Results of an evidence-informed consensus workshop. BMC Emergency Medicine, 11(1), 2-2. doi:10.1186/1471-227X-11-2