Snake bites 101

It’s said that everything’s bigger in Texas. That is certainly true when it comes to snake diversity. Among the varied snake species are a number of venomous snakes and when large groups of people co-exist with a great number of snakes, there is the potential for envenomation. This snakebite season we are urging families to be prepared and have a plan in place in case your child is bitten. Snake bites are most prevalent between the months of April and October so with spring and summer vacations looming, the sooner a family can make a plan, the better.

The biggest deterrent to being bitten is avoidance. Never blindly reach into a hole or a bush because a snake may be resting there. Do not jump into “watering holes” known to house snakes. It is also important to maintain an appropriate distance from a snake. Most pit vipers (the subfamily of snakes which includes rattlesnakes, copperheads and water moccasins (or. cottonmouths)) can strike at a target up to two-thirds of their body length when provoked.

Have a plan in place:

The most important thing a family can do is have a plan in place prior to any emergency. This will keep family members from panicking and will most likely result in quicker treatment as the family will be able to jump right into action. Some important things for families to do ahead of time include:

Know which hospitals are closest to you and the route you will take to get there in case of an emergency.

Make sure to have a list of hospitals that carry antivenom. Though there is absolutely no manufacturing shortage of CroFab, which is currently the only FDA-approved and available antivenom for U.S. pit viper bites, some hospitals choose not to carry antivenom for various reasons.

It is also important to know which hospitals have snakebite experts. Texas Children’s Hospital employs the only board-certified medical toxicologist in Houston, and envenomations are best managed by physicians with specific training in the subject. If you’re at a hospital without an expert and you are concerned about the treatment plan they are proposing, speak up and request they contact a medical toxicologist through the local poison center (1-800-222-1222).

What to do if bitten:

One of the biggest misconceptions when it comes to snake bites is the person bitten must have provoked the snake. This is often not the case. Regardless of the precautionary steps you take, sometimes bites just happen. If you or a loved one is bitten, some of the steps I recommend include:

Call 911 immediately to be evaluated.

Take off anything that is constricting the affected area, such as a ring or watch.

Position the affected area at or above heart level. This means if you are bitten on the hand, bring it to heart level and if you’re bitten on the leg or foot, elevate it if possible. This minimizes the amount of local tissue swelling, which is the most common finding following pit viper bites.

Go to the emergency center – the sooner the better. If you can safely and quickly take a picture of the snake, do so. But do not delay treatment – and definitely do not put yourself or someone else at risk – to take a photograph. Exact snake identification is not necessary to correctly treat an envenomation.

Treatment options:

The management of snake bites has changed over the years; the currently available antivenom has been shown to be safe and effective in minimizing pain, bleeding complications, swelling and tissue damage. Recently Texas Children’s was one of 18 hospitals around the nation that participated in a study that proved conclusively that even copperhead bites do better if they are treated with antivenom. Although antivenom is most effective in the first six hours after a bite, it has been found to be beneficial even a few days after the bite. At the hospital, physicians will determine if antivenom and hospital admission are necessary. When administered correctly, antivenom can eliminate the need for almost all surgical intervention.

If at any time you’re uncomfortable with the proposed treatment plan, always seek a second opinion, ideally from a medical toxicologist trained in the management of envenomations. Realize that antibiotics, corticosteroids and surgical intervention are no longer considered appropriate therapy in the acute management of snakebites.

Myths about treating snake bites:

It is not necessary to bring the snake – dead or alive – to the hospital with you. In fact, it is highly recommended you not bring it.

Don’t apply a tourniquet or a constriction band.

Don’t apply ice; it can cause local tissue damage.

Don’t apply heat.

Don’t cut the affected area and attempt to suck the venom out. This increases the amount of local tissue damage.

Don’t use a commercially-available extraction device. These have also shown to be ineffective in removing venom and actually increase the amount of tissue damage.

Don’t use electrical therapy.

Don’t apply any type of lotions or ointments.

Regardless of the species of snake, all bites should be taken seriously. Even though most people who are bitten by venomous snakes have good outcomes, there is the potential for serious tissue damage and, on rare occasion, even death from every species of copperhead, cottonmouth, and rattlesnake in the U.S.