Snakebite – Find the Snake or Not?

One of the treatment issues in wilderness medicine that seems to generate the most amount of debate, even confusion, involves how to best care for a patient in the backcountry who has been bitten by a venomous snake.  In particular, the general consensus, including some popular first aid manuals, is that it is important to find and identify the snake, whether to simply eyeball it, or take a photograph, even to kill it in order to transport it to the hospital.  Sounds reasonable, right? … It is only logical that physicians would want to know the exact snake so that they can administer the exact antivenin, right?

Wrong on both counts.

The initial reason is that of simple scene safety.  First off, if you are the victim of the bite, there is no sense risking the increased spread of the venom through your system as you exert yourself, not to mention that you risk another, potentially even worse, bite.  And, likewise, if you are coming to the aid of a snakebite patient and attempt to find the offending snake, you risk becoming a second patient for rescuers.  Either way, critical medical care is delayed.

The Wilderness Medical Society reports that 98% of all venomous bites are caused by pit vipers (such as the Rattlesnake, Copperhead, and Water Moccasin, variants of which are found all across the United States) which deliver a hemotoxin (in short, it helps pre-digest the prey), while only about 1% of bites are caused by native neurotoxic snakes (such as the Coral Snake which is limited mostly to the Southeast and Southwest) which interferes with the prey’s nervous system, affecting breathing and muscles among others.  The other 1% of bites are also neurotoxic, but they tend to be confined to those of exotic species that have been smuggled into the country, only to bite their owners while being handled.

So what about the antivenin?  The primary antivenin used in emergency departments, then, is CroFab, which is used to treat all pit viper bites.  As for neurotoxic bites, American hospitals no longer use antivenin, instead they provide only supportive care as needed, like ventilation.  In short, physicians treat only the snakebite, not the snake.  So, while, yes, you could take a photograph with your smartphone which might be helpful, the chances are that you and your patient will be freaking out such that it’s not worth the risk of identifying the snake.

So how do you treat a patient with a venomous snakebite?  True North will save that answer for a later article … So stay tuned!