What You Need to Know about Snakebites and Treatment in the Wilderness

by | Jun 16, 2021 | Evacuation, Wilderness Medicine Case Studies | AWLS, Wilderness Survival Tips | AWLS, Wildlife encounters

Venonous Snakes

The three major families of venomous snakes are:

  1. Elapidae (cobra, king cobra, krait, and coral snake): These snakes have heads that are of about the same width as their necks, round pupils and short, fixed fangs. They cannot bite through clothes and usually deliver only a sublethal dose of venom.
  2. Viperidae (vipers): Triangular wide head, elliptical pupils, long needle like mobile fangs.
    • Crotalinae (pit vipers) like Rattlesnakes have a “pit” organ on the head to detect their warm-blooded prey
    • Viper bites mainly affect the vascular system. Rapidly swelling, necrosis, dry gangrene. Systemic absorption is slow; via lymphatics. Hemorrhage and increased capillary permeability leads to shock and pulmonary edema. Kidney failure is common in the sickest.
  3. Hydrophidae (sea snake): Coastal. Small head and a flattened tail. They seldom bite.

 

Systemic Symptoms

Snakebite severity can be gauged by evaluating the following parameters in the field:

  • Pulmonary – degree of shortness of breath
  • Cardiovascular – elevation in heart rate, decrease in blood pressure
  • Gut – abdominal pain, nausea, vomiting and diarrhea
  • Heme – bleeding more easily than normal (i.e. oozing from the bite site), degree of local and systemic bleeding and bruising
  • Central Nervous System – apprehension, difficulty breathing, confusion, coma
  • Wound – amount of swelling and/or bleeding/bruising at or near the bite site

 

Estimated yearly number of Snake Bite Envenomations

Antibody Considerations

In North America, the need for preformed antibody to snake venom is determined by the severity of the envenomation. About 25% of pit viper bites are “dry” without significant envenomation. Mild bites -those with no systemic symptoms, no spread of bruising/swelling beyond the bite site- can be observed. However, because envenomation may progress over time, re-evaluation is critical.

Delayed extraction of the bite victim may allow envenomation to progress in the field.

 

Plan of Action for Suspected Venomous Snakebite

In general, the best plan of action for a suspected venomous snakebite in the field is immobilization and evacuation. Get the victim in proximity to anti-venom, surgical capabilities and life support.

Identifying the snake may be of benefit – photos are ideal. Avoid the snake to avoid a second victim. Leave the area.

Tourniquets have had limited to no success. Compression wraps, as recommended for Australian snakebites, may be of use in that situation. In the US there is no proven benefit.

Prevent excessive blood flow: keep the person still and as flat as is reasonable.

Reassure:  the vast majority of snakebites are non-fatal. No alcohol consumption, which is a vasodilator.

Mark the area of the bite and sequentially mark and time the spread of bleeding and/or swelling.

Remove potentially constricting items from the affected area (usually a limb)

Periodically reexamine – specifically for the parameters mentioned above.

Do not attempt wound care/incision/suction or indeed anything other than evacuation.

 

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Interested in learning more about the special skills required to save lives in the wilderness?  If you’re a medical professional, consider our one week hand-on course.

You don’t have to be a medical professional to take our online courses.   The courses are are a way for medical professionals to earn CME credits, but anyone can take them for current, in-depth information on a variety of topics including fevers in travelers, submersion injuries, parasites, lightning and more.

 

References:

 

Syed Moied Ahmed, et al. Emergency treatment of a snake bite: Pearls from literature. J Emerg Trauma Shock. 2008 Jul-Dec; 1(2): 97–105

AWLS: Introduction to Wilderness Medicine. (2010). Richard Ingebretsen, ed.

 

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