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Snakes & Bites, Oh My!

Intro:

Snakes can be found in many environments ranging from the great outdoors, on planes and even in your boot. For generations, people have lauded a multitude of anecdotal treatments for venomous snake bites. These have ranged from Native American poultices thought to draw out the venom, to suction cups, and even using your mouth! I find the last one especially gross. Below, we will explore why these treatments are ineffective and can often be more harmful. We will also discuss what one should do in case of a venomous snake bite either in the urban or remote setting. 

Categories of Venomous North American Snakes:

Vipers (Family, Viperidae):

This family contains two subfamilies. Most vipers in North American belonging to the Pit Viper sub-family also know as (Crotalinae)

Pit Vipers are called such due to the heat sensing pits located between their eyes and nostrils, giving them a very specific and memorable appearance. These snakes will typically have a diamond shaped head with slitted vs rounded pupils. Pit vipers also have folding fangs which allow them to lay flat against the roof of their mouth when closed.

From this sub family, Rattlesnakes are the most widely dispersed being found almost all regions of North America. In the USA, at least one species is found in 48 states with the exclusion of Maine and Rhode Island. Lucky them.

Coral Snakes (Family Elapids):

This family can be further subdivided into New and Old world but for our purposes we will not go that in depth. 

This species is less widely dispersed across North America. Only 3 species exist in the USA, none in Canada while 16 can being found in Mexico. 

In the USA coral snakes can only be found in Arizona, the Southeast and Texas. 

One can remember the rhyme "Red and black, friend of Jack. Red and yellow, kills a fellow." to help identify a lethal snake from an imposter. This saying typically will only help with coral snakes found in the US. However, coral snakes can have aberrant or abnormal coloration patterns so this saying will not always hold true. This is why it is best not to handle any snake in the wild regardless of your confidence in its non lethal status. 

Aside from their sometimes specific coloration, coral snakes will lack the triangular heads, slit pupils (Coral Snakes are round) and heat sensing pits of their pit-viper counter parts. Although much more elusive and than pit vipers, coral snakes can still pose a significant hazard to those traveling into the backcountry. 

Bite Background:

Snakes, especially pit vipers tend to instill a great deal of unease in those operating in the outdoors. So what is the rate of bites across the North America? Well that were things gets tricky, while there is no uniformed tracking system in the USA to accurately log and track venomous snake bites and fatalities, the Poison Control Center does keep statics on cases that are reported directly to their agency. The Poison Control Center reported that from 2009 - 2013,  35,751 snake bite cases were reported with 11 fatalities. These stats do not take into account those events not reported to the Poison Control Center. Oh and if you don't know the number for poison control, its 1800-222-1222. Put it in your phone it's important. 

Treatment:

Contrary to what many of us have learned from the movies or outdated training, cutting the snake bites, applying poultice, sucking out the venom via commercial device or with one's mouth and tossing on a tourniquet device have not been found to be effective treatments.

According to a article written in a 2016 publication in the PLOS (Public Library of Science) peer review journal, "The Treatment of Snake Bites in a First Aid Setting: A Systematic Review," only pressure immobilization was noted to have any effectiveness in treating snake bites, specifically in the case of elipad (coral snakes). Additional research needs to be done on its usage with viper (Viperidae) bites. All other alternative techniques above were shown to not only be ineffective but possibly increase further injury due to delaying treatment or require further injury to the patient to accomplish. 

Even commercial devices such as the "Sawyer Extractor Kit", that uses a suction style device, offers claims of being able to extract venom and toxins from bite wounds. These claims are are dubious at best with no scientific based testing to support their assertions. So what should you do? 

The ultimate treatment for any patient will be transportation to a hospital with available anti-venom. Early administration of antivenom has been the only therapy or treatment option that has been proven to minimize the effects of a venomous bit. In most cases, especially with rapid administration, signs and symptoms of a bite can be dramatically reduced and speed up overall recovery.

Even with antivenom being the gold standard in care, one can still implement additional interventions prior to arriving at the hospital. The most basic of which is the removal of any and all jewelry or constricting materials. This simple step will remove the risk of these items strangulating the tissue and causing additional injury if swelling occurs secondary to any bite. 

Further steps such as circling the area where the bite occurred and noting the time can provided helpful data to the treating medical team. After making your initial marks, making subsequent marks showing the spread of any additional swelling or inflammation can be extremely helpful and provide useful insights as to the possible severity of the envenomation. 

Additional Nerdy Info:

Fun Pit Viper bite facts:

  • Pit vipers are found to account for approximately 98% of all bites in the USA. As an example during 2013 only 73 Coral Snake bites were reported for the entire year.

  • Although pit viper bites are more common they tend to be less deadly than that of a coral snake. The exception being that of the Mojave rattlesnake. 

  • Around 75-80% of all pit viper bites result in envenomation. 

  • Pit Viper's venom can cause three types of toxic effects in the body,  hemorrhagic (result in impaired clotting ability), neurological (can causes respiratory difficulty to cranial nerve palsy) and proteolysis (the breakdown of proteins i.e. tissue death and destruction) the last causes cell death locally and can spread outward from the site of envenomation as the tissue is digested/broken down.  

  • Mohave Rattlesnakes, specifically those possessing Venom A or Mohave Venom are thought to be especially deadly. This is owed to Mohave venom's potent neurological and minimal hemorrhagic and proteolytic effects.

  • Pit vipers, even when decapitated, can retain the reflexive ability to bite up to one hour after death

  • Size rather than age is a the true predictor of how much venom can be injected. Multiple studies have show that although juvenile vipers have less venom control adults are able to produce and inject significantly higher levels of venom than their juvenile counter parts. 

Funner Coral Snake Facts: 

  • Coral Snakes tend to only envenomate their victims about 40% of the time 

  • Of the three major species found in the US the Eastern coral snake is thought to be the most deadly, followed by the Texas, then Western or Sonoran Coral Snake. 

  • Symptoms from Coral Snake bites can be delayed up to 13 hours and than progress rapidly. Sometimes little to no pain will be present after a coral snake bite has occurred. 

  • Coral snake toxin produces primarily neurotoxic effects. Which can result in pain, n/v, weakness, numbness, tingling and sweating to more severe conditions like depressed cardiac function, respiratory depression and even paralysis. 

  • Coral snakes unlike, pit vipers do no possess hollow front folding fangs. They alternatively, have small, straight, non folding front positioned fangs with detached venom sacs. When a coral snake strikes they secrete the venom into the wound instead of directly injecting the toxin.

Hopefully with this brief synopsis will help you ensure proper and timely treatment of these potential life threatening injuries. Check out or other blog posts for other helpful tips and tricks to treating a wide ranges of common and uncommon remote medical injuries.  


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