A special thank you to Myles Francis of Archangel Dynamics for allowing me to publish his Tactical Medicine posts here on Vigilant Wolf. Myles is a friend and past guest of Ever Vigilant podcast (episode 59).
Today’s topic? Snake Bite Management. I often field questions from our students about so called “Snake Bite Kits,” and what our opinion on these kits are. Well, here it is: THEY ARE USELESS AND DANGEROUS. They do not work as advertised, and are in fact harmful. . So, why don’t they work? You cannot “suck” venom out of your body. Think about it for a minute. If I gave you a Tetanus vaccine, could that injection of fluid be “sucked” out of your deltoid? No, it can’t, because it has already entered your blood stream. The same thing happens when you are bitten by any North American Viper. That venom rapidly gets absorbed into your blood stream and circulated throughout the body.
Why are they dangerous? Many of these kits include some type of constructing band, which can worsen tissue damage by containing the venom around the bite site. Some include a scalpel or razor blade, which again, causes a worse injury. But the real reason that we find them harmful? They delay transport to definitive care. Don’t waste your money on these kits, and don’t waste space in your bag. What should your snake bit kit look like? A Cell phone, and a well planned out medical evacuation plan. If you are heading out into an area with snakes, take a few minutes and develop a plan. Don’t be careless. Watch where you step and where you reach. Some rattlesnakes no longer rattle. And remember, these are beautiful animals that play a vital role in our ecosystem. You are in THEIR back yard. Please respect and observe them from a safe distance. If bitten, do not apply a tourniquet or constricting band, cut the bite site with a blade, attempt to suck out the venom, apply ice, electricity or any other “remedy.” So, if bitten, what SHOULD you do?
1. REMAIN CALM. This is critical. Try to keep your heart rate under control. I know its hard to do, as you have just been bitten, but remain calm. If you haven’t already done so, get away from the snake. Walk, don’t run.
2. Get help, call 911. It’s ok to sit down and wait for help. Again, watch the heart rate!
3. DO NOT BRING THE SNAKE WITH YOU!! Trust me, we will believe you. We don’t need to see the snake. Describe it to us, google a photo, but don’t bring it with you. Again, CroFab will treat any American Pit Viper envenomation, gone are the days of snake specific antivenom.
4. For the First Responders reading this? Trust your patient. If they say the were bitten by a venomous snake, then they were bitten. Transport them to definitive care rapidly. Be sure to transport to a center that carries CroFab, so check with your medical director for guidance. Here’s some pearls on management: Use a Sharpie or similar to mark the area of redness and swelling around the bite. Re assess and re-mark expansion every 15 minutes. (Protocol dependent): immobilize the extremity loosely. Obligatory IV / O2 / Monitor. Fluid resuscitation and Vasopressors if needed to treat hypotension and shock. If you need to do so, take the airway and provide positive pressure ventilation support. And of course, TREAT THE DANG PAIN. Snake bites hurt, be nice to your patient. Fentanyl is my preferred agent, but follow your protocols. Empiric treatment with antibiotics is generally not indicated, nor is empiric escharotomy. Again, transport too the closest APPROPRIATE facility is paramount. You wouldn’t transport a STEMI to a facility without PCI capability, this should be the same decision process. A facility with Toxicology and ICU capability and a large stockpile of Antivenom.
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