“The wildfires drove snakes out of the woods and the swamps,” confirmed Scott Thigpen, DNP, RN, CCRN, CEN, assistant professor of nursing at South Georgia College, Douglas. “Be on the lookout since increasing populations of snakes are moving.”
In recent months, Thigpen said firefighters are among snake bite victims, as they frequently have been conducting prescriptive burning, which causes snakes to translocate. Rattlesnakes are prevalent in these woods, which is concerning because they are among the species of snakes issuing poisonous bites.
Assessing Poisonous Bites
For nurses, the most important aspect of treating snake bite victims is determining whether a snake bite is poisonous or non-poisonous.
According to Thigpen, non-poisonous snakes have round pupils in the eye, a body that’s all one color, stripes from head to tail and a spoon-shaped round head. By contrast, poisonous snakes have an elliptical pupil like a cat’s eye, a rattle on the tail, a triangular or arrow shaped wide head, and a small depression in their snout resembling a pit halfway between the eye and nostril.
“The key is looking at the eye and the tail and deciding if it’s an elliptical or round eye,” Thigpen said.
In their panic, people bitten by snakes rarely take the time to note the snake’s physical appearance. Although Thigpen has many hilarious anecdotes about snakes in the emergency departments of his native Georgia, victims are highly discouraged from moving or touching the animal.
“Luckily, almost everyone has a phone with a camera now, [and] it’s very important to bring pictures of the snake,” he said, adding, “If there are timber cruisers or forest management workers around, they know what snakes are native to the area.”
Snake bites aren’t just a problem for the human population. Dogs, cows and horses frequently are attacked with “dry bites” by immature snakes where poison isn’t injected into the victim.
These bites can just be monitored, further demonstrating the importance of proper identification.
Time Is Tissue
Be it pets or humans who’ve been bitten by a snake, time is of the essence for getting to the hospital.
“We can do the most for patients if they get to the ED within the hour,” said Thigpen. “Once venom is bound to tissue receptor sites, antivenom is of little benefit.”
In many cases, the commute from the woods to the hospital is longer than 60 minutes, especially if the bite occurred during a hunting trip. In those cases, starting first aid can decrease the risk of complications.
After removing jewelry, snake bite victims are counseled to splint upper extremities and apply a wide, flat constriction band to block superficial venomous flow (about 20 mm Hg pressure). Leave the band in place until antivenom therapy begins.
Thigpen said the constriction band is controversial in the literature review. Although it’s been proven to decrease venom spread, it can increase complications. Still, if the time to medical care is greater than 60 minutes, he recommends employing the band.
In the case of poisonous snake bites, two treatment options dominate the landscape. In 1954, the antivenin Crotalidae was made from the blood of horses immunized against the venom of four types of poisonous snakes. Patients sensitive to horse proteins must be carefully managed to avoid anaphylactic shock.
A newer option, CroFab, was created in 2000 from immunized sheep. It works by binding and neutralizing venom toxins, facilitating their distribution away from target tissue and elimination from the body. Experts anticipate this may be used more in the future because allergic reactions are fewer; however, at $3,891 per vial, quantities are limited due to expense and availability.
“People traveling to other countries should be aware that they may not have CroFab readily available,” Thigpen added. “If multiple victims are bitten, sometimes inter-hospital networks in the area or multiple pharmacies may mobilize their supply together.”
Robin Hocevar is senior regional editor at ADVANCE.