Eastern Coral Snakebite: Part II

The Eastern Coral Snake:

More Lessons Learned

Note: In the first part of this article, which appeared in the July Newsletter, the author described the events that led to the capture of, and subsequent bite from, an Eastern Coral snake.

As we searched for a hospital, I tried to relax while keeping my left hand elevated. With my right hand, I continued to squeeze the bitten finger. From the instant that I was bitten, barely a moment passed that I was not applying strong steady pressure to the finger. Fortunately, the bite was near the tip of my finger, making it easy to extract blood/venom without the use of an extractor kit, which I did not have along with me on the trip.

The wound was small and relatively painless, but it bled more freely than any colubrid bite that I have ever experienced. (Of course, there would be no reason to squeeze, and thereby induce bleeding from a bite by a nonpoisonous snake.) Despite the amount of blood and the clear fluid that was initially drawn from the wound, I was confident that I had not been seriously envenomated. When I compared the bite to others that I had sustained from eastern kingsnakes (Lampropeltis g. getulus), which may open their mouths nonchalantly and then chew on your skin for all their worth, I realized that I had merely been nipped by the coral snake. The total bite time was less than a second and involved no chewing.

We located a small hospital in rural Georgia approximately 15 minutes after the snakebite occurred. As we approached the emergency room, my mood further soured to one of extreme aggravation at myself. Perhaps it was the conveyance of my mood or maybe it was the staff's unfamiliarity with the potential gravity of a coral snakebite; but my announcement that I had been bitten by a coral snake did not evoke the emergency-like response that I had expected. In fact, the staff seemed unsure of exactly what should be done. The staff's uncertainty is understandable considering there are only about 20 coral snakebites per year in the entire U.S.. However, it is not so understandable that I (an experienced herper) would also be clueless. I guess it had never occurred to me that I would find a coral snake; much less be bitten by one.

The first step taken by the emergency room staff was to attempt to identify with certainty, the species of snake responsible for the bite. Of course, I never considered risking harm or death to the snake by bringing it to the hospital for identification purposes. Therefore, the staff had only my description as evidence. On this point, I showed poor judgment. Imagining the following headline: MAN HOSPITALIZED AFTER ATTEMPT TO CATCH DEADLY SERPENT WITH BARE HANDS, I feared attracting too much attention to myself and my party. I had no interest in being the next recipient of the Darwin Award. So, I mischaracterized the events that led up to the bite. Okay, I lied. I played the role of the rookie outdoorsman who found a pretty "kingsnake" in the grass, only to be bitten by it. I said that I examined the snake and remembered the rhyme, "Red on yellow, kill a fellow." Having no interest in becoming that "fellow", I had rushed to the hospital. Although, I said that I was absolutely certain that it was a coral snake, the staff was rightfully skeptical. Their skepticism (along with, perhaps, my excessively calm demeanor) significantly delayed treatment of the bite.

More than 30 minutes after arriving at the hospital, I was still filling out admittance papers and answering questions. Finally, I was led to a bed where my finger and hand were washed thoroughly and I was given a saline IV. There, I noted a peculiar numbness at the wound site. The bite felt unlike any other that I have ever experienced. The skin on the end of my finger felt as if it had a thin shell over it, similar to scar tissue. Under the skin, there was a mild pain that felt like a small splinter. I described these effects to the doctor and repeated to him the details that explained my certainty that the snake was, indeed, a coral snake. He confessed that his only previous snakebite experience was with cottonmouths (Agkistrodon piscivorus) and rattlesnakes. He dutifully hurried to his books to "brush up" on appropriate protocols.

Soon, I could hear a nurse telephoning other hospitals to check on antivenin availability. After a couple of unsuccessful attempts, he called the hospital in Waycross, Georgia. After a short discussion, I overheard, "Hmmm... All you have is Micro fulvio (sic)? Nope, I need coral snake antivenom (sic)."

Just as he was about to hang up, I intervened, "Micrurus fulvius is the scientific name for coral snake. If they have that antivenin, then it is what I need." He and the rest of the staff were more than a little surprised that a rookie outdoorsman would know the Latin name for coral snake.

It took nearly an hour for a nurse to complete a round-trip antivenin run to Waycross. During that seemingly interminable hour, I just sat waiting under close supervision. I wondered if/when the nausea would come, or the fatigue, or the bleary vision. Thankfully, they never did.

From what I know now, the doctor did a good job of following protocol after the arrival of the antivenin. First, he administered a sensitivity test to determine if I was allergic to horse serum. Upon receiving a negative result, he prescribed three vials of Wyeth Antivenin (Micrurus fulvius). I was admitted to a private room where I was given oxygen and placed on a cardiac monitor. I was kept under continuous observation for the first hour after the antivenin was administered. Then, nurses checked on me every 15 minutes for the duration of my stay. The doctor correctly noted that it could take as long as 18 hours for the onset of symptoms of envenomation. Thus, it was necessary for me to spend the night at the hospital.

As it turned out, I never experienced any systemic effects from the bite or the antivenin. The doctor's determination was that it had been a dry bite or that I had misidentified the snake (implied). But neither he nor I could explain the numbness and mild swelling in my finger, which persisted for more than a week after the bite. Personally, I believe that I received a minute dose of venom. I believe that the following factors contributed to my good fortune: the coral snake did not chew on me; the snake was a small specimen with small teeth and a small venom yield potential; and the bite occurred on the tip of my finger where I could easily squeeze out any venom which may have made its way into my skin.

Several weeks after the incident, I received a hospital bill for more than $5,000. After much haggling with my insurance company, I was able to reduce my share of the bill to about $1,500. Thus, the following lessons came with a high price tag:

• It is the responsibility of the snake enthusiast to be familiar with appropriate snakebite treatments for any snake that he/she may encounter in the field, especially if he/she may handle the snake. It is unreasonable and irresponsible to rely on medical personnel to be experts on snakebites that they may never encounter in their entire careers. In the future, I plan to take along on all herping excursions, a copy of the Snakebite Treatment protocols that were distributed by the SHHS in its first newsletter. These SHHS outlines, which are up-to-date and concise, could be invaluable in a field or home emergency. (My brother-in-law, who is a family physician, even requested a copy of these protocols for use as a quick reference at home and at work.)
• It is important to be honest and forthcoming with medical personnel so that they can make informed decisions as quickly as possible. Remain calm and alert and relay as much useful information as you can. Remember that snake misidentifications are common with the general public. Therefore, it is necessary for medical personnel to be skeptical of eyewitness accounts. They must make every effort to properly identify the culprit before initiating expensive and potentially dangerous treatments. If I had been forthcoming with my credentials, I could have accelerated the treatment process considerably. By withholding information, I sabotaged my own medical treatment, and caused unnecessary risk to my personal health.
• Be an active participant in the snakebite treatment. Do not hesitate to ask questions or provide pertinent information. There were several situations during my hospitalization in which my knowledge, however limited, was helpful to the staff. By providing the nurse with the scientific name of coral snakes, I helped secure a local source for antivenin. I was told that if Waycross did not have the antivenin, the next closest possibility was Jacksonville, Florida, which was considerably further away.
• Any person who handles venomous reptiles, in the wild or in captivity, should have good insurance and a complete understanding of his/her policy. My insurance company at the time used "fine print" technicalities to weasel out of paying their full share of the expenses. By understanding these technicalities in advance or by having a better policy, I could have saved a lot of money. I could have bought a collection of nice tree vipers with the money that I spent on hospital bills!
• Take along a Sawyer Extractor kit on field trips. They are small, easy to use, and inexpensive. Had my bite been anywhere other than my finger, I would have had very little success squeezing out venom and blood with my hand.
• Finally, do not wait 24 hours to notify your spouse after such an incident. The complications from that mistake will remain with you much longer than the complications from any snakebite. (My wife was kind enough to draft the preceding lesson.)

After a restless night in the hospital, I could hardly wait to leave. With my finger slightly numb and tender, I said my good-byes and hopped in the car with my snakehunting crew. We had not yet exited the parking lot when we noticed a dilapidated building across the street from the hospital. Gleefully, we drove over to the site and began turning tin, under which we found a nice eastern coachwhip (Masticophis f. flagellum) less than 10 minutes after my release from the hospital.

Later, out of curiosity, we drove back to where we had found the coral snake. I lifted the same board and there it was! It had returned to nearly the exact same spot as the previous day. This was especially interesting considering the degree of stress it must have experienced. Plus, there were plenty of subterranean tunnels into which it could have sought refuge. This time around, I was much more careful. Derek and I took some beautiful photographs that will always remind us of the lessons we learned during that adventure in the lowlands of Georgia. ~ ym

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