By Jorge Rubal, CEO & Medical Director,
Laguna Beach Community Clinic
If you haven’t come across a rattlesnake while hiking on our local trails, walking your dog, or tending your garden, then no doubt you’ve seen alarming rattlesnake posts on social media.
The good news is that death by rattlesnake is extremely rare. Here’s what you need to know in case you or a friend is bitten:
Consultation with a medical toxicologist or other clinician with experience in managing poisonous snake bites is recommended prior to antivenom administration. Phone consultation with a medical toxicologist is available through a United States regional poison control center by calling 1-800-222-1222.
Rattlesnake venom will typically cause:
–Local tissue damage
–Ecchymosis and progressive tissue swelling
–Non-specific systemic effects
–Nausea, vomiting, diarrhea, weakness, light-headedness, diaphoresis, or chills
–Rhabdomyolysis with nephrotoxicity
–Increased vascular permeability, tachycardia, tachypnea, and hypotension
–Neurotoxicity (e.g. oral paresthesia, unusual taste, fasciculation, altered mental status, seizures)
The appropriate management of snake bites is controversial, and management strategies are primarily based on case series and clinical experience. Numerous field measures have been advocated, but none have been shown to improve outcome.
Methods, such as tourniquets, incision and oral suction, mechanical suction devices, cryotherapy, surgery, and electric shock therapy have been advocated in the past, but are no longer recommended. Tourniquets can damage nerves, tendons, and blood vessels, and oral suction can lead to infection.
Furthermore, venom removal by mechanical suction is minimal. In a study of mock venom extraction with a mechanical suction device in human volunteers, suction reduced the total body venom burden by only two percent.
Also avoid pressure immobilization. Most snake bite experts do not support pressure immobilization for rattlesnake bites because the venom causes local tissue toxicity and sequestering the venom in the affected limb may increase local tissue damage.
Instead, follow these recommendations prior to definitive hospital care:
–Remove the patient from the snake’s territory, and keep him or her warm, at rest, and calm.
–Immobilize the injured body part in a functional position at the level of the heart initially. Further actions should be guided by an experienced clinician. Decisions regarding dependency or elevation of the bitten part must balance a potential increase in local injury with that for increased systemic venom absorption.
–Placing the extremity below the level of the heart may lead to increased tissue damage in some patients but may be appropriate in patients who have systemic effects of envenomation.
–In contrast, elevation of a swollen extremity to prevent acute swelling in patients without systemic symptoms may subsequently increase systemic venom absorption but may be acceptable if the time to definitive care, including antivenom administration, is short.
–Remove any rings, watches, or constrictive clothing from the affected extremity.
–Do not apply pressure immobilization, tourniquets, or constrictive dressings.
–Cleanse the wound.
–Withhold alcohol and drugs that may confound clinical assessment.
–Avoid potentially harmful therapies.
Transport the patient in the supine position to the nearest medical facility as quickly as possible, preferably using emergency medical services.
Attempts to identify the snake should not endanger the patient or rescuer and should never delay transport to a medical facility. A digital photo taken at a safe distance may be useful. Snake parts should not be handled directly because the bite reflex may remain intact in recently killed snakes and result in additional envenomation.
Avoiding a bite in the first place is always preferable but being knowledgeable on what to do when the unexpected occurs will help you successfully weather rattlesnake season.