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Snakebite prompts examination of procedures
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by tigers9 on July 1, 2008
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http://www.contracostatimes.com/living/ci_9730530
Snakebite prompts examination of procedures
By Tom Lochner
West County Times
Article Launched: 06/28/2008 04:37:20 PM PDT
Click photo to enlarge
Norma Jean Brearley talks about the bite on her foot from the baby rattlesnake while she was...
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A Pinole woman who was bitten by a rattlesnake and spent three hours in a hospital emergency room waiting for antivenin hopes her experience will awaken some medical authorities from a state that could be described as snakebitten.
Norma Jean Brearley, walking barefoot, was rolling her trash can to the curb the afternoon of June 5 when she accidentally ran over a baby rattlesnake and was bitten. Pinole firefighters attended to Brearley, and a short time later, an American Medical Response ambulance took her to Kaiser Permanente Medical Center in Richmond.
But when Brearley got to Kaiser Richmond, there was no antivenin.
AMR crews always call the receiving hospital to communicate the patient's age, vital signs, treatment received and the emergency code, AMR paramedic Taylor Houston said.
Greg Kennedy, emergency medical services coordinator and clinical educator for the Contra Costa Fire District, said calling ahead also gives the hospital lead time to prepare the antivenin. CroFab, the rattlesnake antivenin of choice, comes in powdered form and must be "reconstituted," which can take from 20 minutes to well over half an hour, said Dr. Joseph Barger, medical director for the Contra Costa Emergency Medical System.
In Brearley's case, Kaiser called nearby Doctors Medical Center San Pablo, which shipped eight vials. The standard initial dose is four to six vials, several experts said.
Kaiser spokesman Marc Brown said a courier
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from Kaiser Walnut Creek arrived at Kaiser Richmond with a larger amount of antivenin at the same time as the Doctors' courier, so Kaiser Richmond used its affiliate's antivenin.
It is unclear why Kaiser did not redirect the ambulance to Walnut Creek. Brown said he did not know whether AMR or firefighters placed an advisory call to Kaiser Richmond, and said he would check into the matter.
"Richmond is three times closer to Pinole than Walnut Creek," Brown added, and "shuttling antivenin from stocked hospitals to those in need is a long-standing practice not only among hospitals in Northern California, but elsewhere in the country as well."
There is no formal protocol in Contra Costa County regarding the destination hospital for snakebite victims and how much antivenin each hospital must stock, and a quick search of other emergency systems in the state reveals they do not have such special protocols either, Barger said.
California Poison Control System, based at the University of California, San Francisco, recommends hospitals stock enough antivenin to treat one patient for 24 hours — in rare cases, up to 24 vials in that period. But "we don't say you have to keep it on hand; you either have to have it or have a way to get it," Executive Director Stuart Heard said.
Kennedy said he checked with all the hospitals in Contra Costa County and that as of last week all had rattlesnake antivenin on hand except Kaiser Richmond, which was going to get a supply within days.
Brown, of Kaiser, said Friday, "Going forward, Richmond will be among our hospitals in Northern California stocked with antivenin."
Firefighters from several agencies along Contra Costa's Urban Wildland Interface — where suburb meets wilderness — say rattlesnakes abound this year and are being driven by the hot, dry weather to seek coolness and moisture in people's yards. One person was bitten in Concord in May; a woman was bitten in Antioch on June 3.
In the Antioch case, "the paramedic identified that it was a rattler," Kennedy said. "The captain called dispatch to call the receiving hospital, Sutter Delta (Medical Center). She (the patient) received it (the antivenin) within 30 minutes from getting to the door of the ER."
About 7,000 people are bitten by snakes in the United States each year, according to the federal Centers for Disease Control and Prevention; one in 500 dies.
But the low mortality rate does not tell the whole story. Rattlesnake bites, especially when left untreated for long periods, can lead to swelling that can cut off circulation to nerves and render a limb useless, and in extreme cases, require amputation. Muscle damage can lead to kidney damage. Rattlesnake bites also can trigger a drop in blood pressure and lead to organ damage.
More than three weeks after she was bitten, Brearley still felt a stinging sensation in her toe and experienced slight swelling and discoloration, she said. But she's facing her experience with humor.
"I've taken my share of good-spirited ribbing about this incident, the most recent being last night," she wrote last week. "I was sent via e-mail a YouTube version of the song 'The Snake' by Al Wilson (1968). It's a great song, and now I'm told that 'This is your new favorite song.' You just got to laugh."
Reach Tom Lochner at 510-262-2760 or tlochner@bayareanewsgroup.com.
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RE: Snakebite prompts examination of procedures
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by JoeCrotalid on July 2, 2008
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To quote Dr. Richard Dart (Rocky Mountain Poison Control)-"Any hospital with the potential of treating a snakebite should have antivenom on hand." The only reason that any hospital does not have antivenom available is because of cost, yet they will stock alledged cancer fighting drugs that cost thousands of dollars more which many times don't work vs. antivenom which is the proven treatment for snakebites. It should not matter whether it is a small or large hospital-if you have the potential of receiving a snakebite due to a native species-you should have antivenom available or at least the initial dose.
Here in Central Florida when I did a survey of all the facilities that my Poison Center covers to locate on-hand coral snake antivenom-every facility reported at least having the initial bolus of CroFab on hand. With regards to the coral snake antivenom-at our center we will direct EMS or the patient to a facility that has the coral antivenom if they call to prevent any delays in administration.
Many EMS systems call the destination hospital with report, and if that hospital doesn't have antivenom they should advise EMS of that fact so that they can be redirected. In addition, many times poison control is not called until the patient reaches the Emergency room when the hospital is looking for recommendation. Unfortunately dry bites can not be determined immediately since effects can be delayed for several hours. Based on the article it sounds like she was symptomatic and required antivenom which was delayed-Time equals tissue!
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