Poisonous Snakebites

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Summer seemed to start late this year. Maybe it was the cool, rainy spring or maybe it was the prolongation of the flu season due to the late appearance of the swine flu. I am still seeing cases of the flu even now in the UVA Emergency Department. Fortunately, despite the media hoopla, the swine flu turns out to look mostly like a common cold.

But now it finally feels like summer to me. This is a good thing when I am at home but not always a good thing when I am at work in the Emergency Department. Among the many perils that summer brings to the ED, one of the most terrifying to most people is venomous snakebites.

In our region there are only two venomous snakes, the copperhead and the timber rattler. Both are members of the Crotalinae family (as are water moccasins which do not live in central Virginia). At UVA, we don’t see many timber rattler bites because the rattle serves as an effective warning to keep people away before the snake feels compelled to bite. When we do see patients bitten by rattlers they often display the four T’s of snakebites due to intentional exposure to a venomous snake.

Testosterone; the majority of victims are male (80 percent in one study)

Two carbon fragments; this is medical slang, based on the chemical structure, for alcohol. Ninety-two percent of patients with intentional exposures to venomous snakes were intoxicated.

Tattoos and other markers of impulsive or risk-taking behavior.

Tee shirts, the preferred summer attire of the idle drinking class.

Most of these “intentional” bites are on the hands or the upper limb as the victim attempts to handle the snake. In unusually injudicious exposures, the bite can be on the face including the lips. Ugh!

Copperhead bites are far more common here in central Virginia and most display a different demographic presentation.

Because copperheads are so well camouflaged, their survival strategy is to tend to freeze in place when approached rather than flee. Thus most of the victims never see the snake before being bitten and many of the bites are on the lower limb.

Copperhead bites are virtually never fatal. Many hardy country folks know this and will ride out a copperhead bite at home. I admire the grit and homespun wisdom of this approach, but having treated many copperhead bites over the years, I would never recommend this strategy. Copperhead bites are very painful and debilitating for a prolonged period. Some of the swelling and loss of function can take weeks to resolve.

There is an effective antivenin which will decrease some of the tissue damage a copperhead bite incurs and of course we also have potent pain medicines. Hospital treatment is the only effective therapy and field first-aid treatments for snake bite have all been discredited. Tourniquets don’t help, cutting the bite site doesn’t help and it is impossible to suck out the venom. Electrical current applied to the victim was widely believed by outdoorsmen to be effective, but it is not. The only useful thing you can do in the time before you reach the hospital is remove any rings or bracelets near the bite site before the swelling turns them into garrotes around the appendage.

This all reminds me of a story I heard recently. Two young men were hiking in the woods and sat down for a break. One of them was bitten in the butt by a venomous snake and became very ill. The other hiker used his cell phone to call 911. The 911 operator advised the caller that he should attempt to suck out the venom directly at the bite site.

“What if I don’t?” the caller inquired.

“Well, then, he will die,” was the answer.

The young man returned to his companion.

‘What did 911 say?”

After a long thoughtful pause he replied sadly, “You’re going to die.”