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RE: Bite protocol
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by HerpHunter63 on June 14, 2010
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Hey have a look at this its for all the Crotaloids not just for canebrakes. Still worth having a look at though.
http://drdavidson.ucsd.edu/Portals/0/snake/Crotalus.htm
Andrew
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RE: Bite protocol
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by agkistrodude on June 15, 2010
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Andrew, that looks like pretty old protocol. They are using Wyeth, which hasn't been around for awhile, and I wouldn't put a constricting bandage on a limb that was about to swell to 2 or 3 times it's normal size. With a canebrake bite, you definitely want the victim to lie down, maybe even slightly elevate the legs, as his/her BP is about to fall through the floor. Mine fell to 60/25. Transport ASAP to the nearest medical facility. The antivenom used today is CroFab. Maybe some medical personnel will chime in on this. Take care, Marty
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RE: Bite protocol
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by HerpHunter63 on June 15, 2010
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To be honest I was recommended this site I just stumbled onto this page I didn't read through it though it's still worth a read... Even If it's not too accurate anymore! ;)
Andrew
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RE: Bite protocol
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by Cro on June 15, 2010
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Chris,
Here are a couple of good resources:
http://drdavidson.ucsd.edu/Portals/0/snake/Crotalus.htm
Also, this article goes a long way in discouraging the use of fasciotomy, which far too many nit-wit doctors are all too anxious to try:
http://www.emedmag.com/html/pre/tox/0501.asp
Also, Joe Pittman is selling bite protocols.
http://www.facebook.com/JoeVenom
Best Regards
John Z
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RE: Bite protocol
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by agkistrodude on June 16, 2010
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John, this too says to apply a constricting band. I thought that was no longer recommended for crotalus bites do to swelling and keeping the venom localized to the effected area, thus causing massive tissue damage. It also recommends the Sawyer Pump Extractor. I believe it too has been debunked unless used literally within a couple of seconds of the bite. Which is the correct protocol? I could see a constricting band maybe if you were more than a couple of hours to medical help. Take care, Marty
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RE: Bite protocol
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by Cro on June 16, 2010
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Marty, the use of a constricting band is useful in Crotalus bites, in that it does just that, keeps the venom localized to the effected area.
That can help prevent death from dilation of the blood vessels, which causes a decrease in blood volume, which causes a drop in blood pressure. That can starve the brain from oxygen carrying blood, and lead to rapid shock and death all within a very short time.
This is especially the case in the bites of some Canebrake rattlesnakes, some Mohave rattlesnakes, some populations of Timber rattlesnakes, and some populations of Eastern Diamond-backed rattlesnakes, and some of the Red Diamond-backed rattlesnakes.
It is true that restricting the venom to a localized area can increase tissue damage to that area. But, is it better to loose a finger or hand, or a life ? You do not see a mouse that has been bitten by a snake dissolve into mush within 15 minutes of a bite, or, even within a couple of hours. For the most part, the tissue remains intact, but, does break down over time.
In most of this country, one can get to a hospital within 15 to 30 minutes. In that amount of time, there will not be significant tissue damage due to venom being restricted to a small area. On the other hand, if the venom were restricted to a small area for a hour or two, then one would expect a lot more tissue damage, but, even then, damage to a limb is still better than loosing a life.
If swelling becomes excessive, the constricting band can be moved up the bitten limb in advance of the swelling, and still serve to keep the venom from reaching the core of the body.
Dr. Sean Bush and others are actually experimenting with Compression Bandaging, like is used for Elapid bites, to keep venom from rattlesnakes isolated in the bitten limb. We just might see a major change in the recommended first aid for Crotalid snake bites in the future due to that research.
As far as the Sawyer Extractor, Dr. Sean Bush experimented with it using pigs that had been injected with snake venom. Unfortunately, he waited 3 minutes before using the Extractor. Even then, the device removed venom from the wound, however, he decided that the amount of venom removed was not significant. (That is a bit of a value judgment, as I see ANY venom that is removed from the wound to be significant).
His logic was that in the average bite, 3 minutes would be a reasonable time to find an extractor kit, assemble it, and put it into use. In the real world, if you have an Extractor kit in your back pocket or backpack while field herping, or, in your snake room, it is very possible that it could be put into use within 30 seconds to one minute following a bite, without much problem. In that case a lot more venom could be removed. Unfortunately, Dr. Bush did not bother to test the device that way.
You have to remember that he gets a lot of support and money from CroFab, so, it is in his best interest to come up with "research" which supports getting to a hospital quickly, and using CroFab to treat a bite. It is unfortunate that CroFab is not all that good though. A close read of his "research" will show that the Extractor Kit did remove venom, even after waiting 3 minutes.
If you go to any reptile show, you will find folks who have been bitten by venomous snakes, and many of them will tell you that they believe that an Extractor Kit saved their lives, or, at the least made a bite less dangerous. Many of them will tell you of seeing clear or yellowish liquid being pulled from the bite by the Extractor Kit.
A couple of years ago, I had one of my Carolina Pygmy rattlesnakes move in an unexpected way when I offered it a mouse, and the snake moved up as I moved the mouse down into the cage with tongs. The snake made a quick strike and hit my thumb. One fang was deflected by a band aid that I had from a previous cut, and the other fang did not go very deep as it hit the bone in the side of my thumb. Never the less, some venom was injected. I keep an extractor kit in the snake room, and started squeezing the fang wound immediately to cause bleeding. I had the Extractor Kit applied to the fang wound within 30 seconds following the bite. The Extractor pulled thick light yellowish liquid from the wound, which had to be venom. I took four Benadryl antihistamines, and continued to apply the Extractor for 30 minutes. During that time, it removed the clear liquid, and blood from the wound. I wound up with a bit of swelling and pain, and not much more. I attribute the Extractor to removing venom from that wound quickly enough so that it could not do much damage. If I had set a stop watch and waited 3 minutes like Dr. Bush did, then the venom would have had that much time to be picked up and spread around. So, anyway, I am a believer in the use of the Extractor Kit, despite what Dr. Bush says.
The thing is, one should get to a hospital as quickly as possible if they recieve a snake bite. However, if one can use an Extractor Kit quickly, and not let that cause a waste of time in getting to a hospital, then it can remove some of the venom from a bite. The Sawyer folks showed that it still could remove some venom after 20 minutes following a bite. Another thing that Dr. Bush got all worked up about in his "research" was that there was more bruising around snake bites where a suction device like the Extractor was applied. So what ?
Perhaps the bruising was due to the power of the vacuum, or, perhaps it was due to venom that was kept in the area of the bite due to the device. That would seem to be a good thing.
Anyway the use of an Extractor Kit is not going to hurt, and just might help, in the case of a snake bite. But, as I said before, your first priority would be to get to a hospital. If you can use a wide constrictor band, I think you should do so, as there is no doubt that it will slow the spread of venom.
Many snake bite treatment specialists and Curators will tell you privately that they would still make a cut on top of a snake bite, to the depth of the bottom of the fang puncture, which would cause bleeding, and help flush venom from the bite. Venom is fairly thick, and can stay in the area of the bite for some time, until it spreads through the body.
Of course, they will never recommend cutting to the public, for obvious liability reasons.
I know this will probably stir the pot some, and the folks will come out of the woodwork who will blindly say things like "Dr.Bush says snake bite kits don't work." Fine with me if they want to blindly follow his advise. Most of them have not even read his research.
Was not all that long ago that a fasciectomy was a standard part of snake bite treatment from cut happy surgeons who thought it would help relieve compartment pressure from a bite. Folks who were considered the top snake bite specialists in the country routinely used it, and disfigured a lot of folks unnecessarily because of that. Folks like Dr. Glass of Texas.
Unfortunately, some nit-wit doctors still want to use that, simply because they do not know enough about what they are doing in treating a snake bite.
Best Regards
John Z
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RE: Bite protocol
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by agkistrodude on June 17, 2010
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I'm well aware of the dilation of blood vessels and severe dropping of blood pressure with canebrake bites as I stated above. And I agree, the Extractor won't hurt anything, and might help if used quickly, but I was certain that I've heard/read that constricting bands did more harm than good unless medical help was not available for a fairly long period. But, I could be wrong. I was in the ER in less than an hour, (about 50 minutes) and my BP had already severely dropped.
Here is one link I was using. Click on "treatment and medication".
http://emedicine.medscape.com/article/771455-overview
Take care, Marty
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RE: Bite protocol
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by Cro on June 17, 2010
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Marty, in the link you posted, Sean Bush says:
"Lymphatic constriction bands and pressure immobilization techniques may inhibit the spread of venom, but whether they improve outcome is not clear. Limiting venom spread actually may be deleterious for pit viper envenomation if it increases local necrosis or compartment pressure. Tourniquets are not recommended."
Seems like a non-committal comment to me. He uses terms like "may," which means that he really does not know, and does not want to say one way or the other, due to the possibility that some one will sue him. Most doctors, (and politicians) have learned the art of non-speak, LOL.
The fact is, every snake bite is an individual emergency, and there will never be a "one size fits all" first aid treatment. Dr. Bush says tourniquets are not recommended, however, an arterial tourniquet could be a life saver, (but not a limb saver), if someone were bitten by a venomous snake in a remote area where getting to a hospital could take many hours or even days.
Once someone reaches a hospital, then someone like Dr. Bush would be great to have managing the treatment, as he has a lot of experience from treating many bites, and would be likely to use enough CroFab to treat the bite. And, he would be familiar with the possible side effects from a bite.
Anyway, I think that the use of a constriction band is still indicated in the event of a bite. I have been told privately by Curators that they would even use a constrictor band if they were bitten by a Naja kaouthia, as they are far more concerned about what the venom might do immediately to respiration and blood pressure, than the well known massive tissue damage that might result. But, they also know that they can be at a hospital within 15 minutes, and they also know that they will have the appropriate antivenin with them.
I think as scientist, we need to be open to change, and new technologies and research. While it is nice to have a "chiseled in stone" protocol sheet, we also must realize that an written instruction sheet just might not match the individual situation of a bite.
My protocol would be to use a wide constriction band in the event of a Crotalid bite. Also, I might use that band around the upper limb, because of the single arm bone, which would allow more arm volume to spread the venom into, thus perhaps lessening the concentration of venom to a localized area just above the bite, which would happen if the compression band were placed a couple of inches above the bite, as is recommended in many first aid texts. That would still keep most of the venom from reaching the body core, and would hopefully prevent the blood pressure changes. In a case like that, I would not allow the compression band to be released / removed, until antivennin was set up and started.
Best Regards
John Z
Best Regards
John Z
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