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With Summer Comes Snake Bites
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It's no secret that these reptiles, like some humans, hibernate in colder weather and emerge when it's warm. Every state in the union has poisonous snakes, except Maine, Hawaii and Alaska, said Dr. Garry Gore, an assistant professor of humanities in medicine with the Texas A&M Health Science Center College of Medicine and an emergency medicine physician at College Station Medical Center. That means you can get a bite almost anywhere in the country, although the preponderance of incidents tend to happen in the southern climes.
The good news is a little venom won't necessarily hurt you, at least not fatally; there are usually only eight to 10 deaths a year from poisonous snakes, Gore said.
And snake bites tend to be clustered in a certain demographic, namely young men who have been drinking too much, according to Dr. Jeffrey Bernstein, medical director of the Florida Poison Information Center at the University of Miami/Jackson Memorial Hospital.
The other vulnerable group includes people handling snakes at the rattlesnake round-ups that are popular in the Southwest, Gore added.
Most snake bites will come from pit vipers like rattlesnakes. Why? There are just a whole lot more of them, Gore said.
Most of the remaining injuries come from coral snakes. The good news here: Coral snakes have to hang on for a while to really do any damage. "They have real small teeth, and they have to hold on while the venom drips out of their hollow little fangs," Gore said. "Most of the time, you can just shake them off or pull them off." Bites, then, are usually mild, with some local pain, numbness and swelling.
But these little snakes, who lash out successfully in the United States some 60 to 80 times a year, do emit a nasty neurologic toxin that can affect the nervous system and respiratory muscles. And the bad news is, there is currently no coral snake anti-venom approved in the United States.
"Without the anti-venom, you can get paralysis of certain muscles, and people can end up on a ventilator for six weeks or so," Bernstein said. "When the venom wears off, they do just fine."
Pit vipers, on the other hand, strike, let go, then wait for the venom to take effect. Not too many deaths occur from rattlers, but they can cause scarring, massive swelling, limitation of function, days off work, days in rehab, even loss of a limb, Bernstein said.
"The worst-case scenario is you're allergic to the venom and have an anaphylactic reaction or other systemic reaction, or there's intravascular injection of the venom into the vein or artery," he said. "I've had patients who didn't make it to the hospital, but that's a minority."
Gore tells of a man who died in his vicinity last year of a copperhead bite. "He died within a matter of hours, and we think the venom was injected straight into one of the blood vessels," he said.
There is ample supply of rattlesnake anti-venom, but it's expensive, about $1,200 a vial, Bernstein said. And a nasty bite could take 18 or so vials to clear.
But anti-venom is not always needed. "When someone is bitten, we use the 'snake bite severity scoring index.' We have a protocol that allows us to put a number to the bite," Gore explained. "We don't give the anti-venom until the score reaches a certain number."
Those with less severe bites get supportive care in the form of pain relievers, Benadryl and other measures, to get the patients comfortable.
Most snakes are shy. "Every snake really would like to avoid you," Gore said.
Unfortunately, inebriated young men stumbling out of a bar aren't so shy. "The majority of patients are male. The majority are intoxicated," Bernstein said. "And two-thirds of bites we see in this country are upper extremity, so someone picked the snake up. The majority of bites in other countries are lower extremity."
"Don't touch the snakes," he added. "You have to remember that you are larger than anything these snakes would go after as a meal. When people get bitten by snakes, it's almost always in self-defense."
SOURCES: Jeffrey Bernstein, M.D., medical director, Florida Poison Information Center, University of Miami/Jackson Memorial Hospital; Garry Gore, M.D., assistant professor, Texas A&M Health Science Center College of Medicine, co-director, Leadership in Medicine Program Emergency Medicine, St. Joseph Regional Health Center, and emergency medicine physician, College Station Medical Center, Texas
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