Reptile & Amphibian Forums

If bitten on the extremity by a small copperhead (24 inches or less) would most of you go immediately to the ER or would you wait to see how things develop first?????
please answer and explain your answer.
Thank you in advance.

I would go immediately to the hospital for any bite from an elapid or viper. Things can go pear shaped very very quickly and it is better to be in a hospital bed with an IV line and the doctors brought up to speed (which may take a while). There are many variables at work and death may be only indirectly caused by the venim e.g. if you have a low grade, undiagnosed kidnety problem, the venom may tip it over the edge. Kidney failure may end up being the first domino in multiple organ failure, which can kill very quickly.

Seeking peoper, prompt medical care is part of responsible venomous keeping. Trying to ride it out not only can make things much worse but is also bad public image. This is one of my main arguments against prohibition of venomous snakes. By allowing private keepers who have demonstrated competence to keep the snakes, public safety will actually be improved. Rational regulation such as this allows keepers to be above board and thus seek proper medical care in the event of an envenomation rather than 'trying to ride it out' so that they don't risk losing their snakes. Further, a system such as Florida's will better ensure that the snakes are kept in secure enclosures rather than banning them. If the snakes are banned, then no system will be in place to make sure they are kept properly. People will still keep the snakes, they just will be more furtive about it.

Cheers
B
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Dr. Bryan Grieg Fry
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Department of Biochemistry,
Bio21 Institute,
University of Melbourne
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http://www.venomdoc.com

It is very unlikely you would die from such a bite, though Dr. Fry's cautionary comments are well founded. More likely, the folks in the ER would be happy to provide some morphine and potent antihistamines to reduce the very, very painful swelling you would most likely encounter, which can also cause serious long term tissue and/or nerve damage, infection, etc. Time was, some decades ago, you could find a lot fo old farmers out in the country with either missing fingers from machinery accidents or claw-like hands from that time back in ought-nine when Old Jake got nipped by a copperhead out in the corn crib . . . ain't been the same sense.
Aa Dr. Fry says, any bite from a pit viper should be treated by medical professionals, if only via watchful waiting and use of palliative medications to reduce pain and help prevent permanent or long-term damage.

Dr. Fry does make great points. Until a few years ago, I really had the same question. I just keep coming across really bad copperhead bites.

One was a person I know. He was bit on the finger. His initial stay in the hosptial was 10 days. For the next 30 days, he needed an IV drip due to a bone infection. Yeah, "great starter venomous snake...". This indivdiual almost died. He's still not out of the woods either. He needs tissue debridement once it heals up just a little more. There's also talk of skin grafts, but that could be speculative at this point. He's probably out of the woods as far as dying goes, but he's got a lot of work ahead of him. It's a good thing he went to the hosptial right away.

This bite was in response to a handling protocol violation. It could have been avoided.

did he get anti-venom?
my understanding is most who get copperhead bites dont need/get anti-venom...is that true???
The reason I ask is because Sunday my doberman who weighs 70lbs got her 3rd copperhead bite on the nose....she responded as she always does by getting a bit lethargic, lots of facial swelling for 24 to 36 hrs, but NO tissue necrosis or sequelae...The first and last time she didnt go to the vet and the second time she went to the vet who gave her fluids for a couple hrs by IV and benadryl and cortisone...It really didnt matter....My concern is we do have plenty of cottonmouths, pigs, and a few EDBs....We may not be as lucky with the larger Mocs or EDBs. I talked to the people at Red Rock Biologics....I want to vaccinate her for some partial protection (their vaccine is really geared for western USA crotalus).
BTW, I never keep hots...I just love the green>>>>>>>>>>>>>

My understanding was that yes, he got antivenom. I was also surprised as it was my impression that often just supportive treatment and monitoring was given.

Update... he said that he's back on IV antibiotics for the bone infection. He said that he wants this experience as a lesson for others... both about not taking copperheads seriously and about following all handling protocol.

It should be obvious that the infection is not a result of the venom but probably came from some poor husbandry or some other action that would allow bacteria to get into the wound. Sounds like a messy bite!

Puncture wounds can lead to very nasty infections by anaerobic bacteria.
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Dr. Bryan Grieg Fry
~~~~~~~~~~~~~~~~~~~~~~
Department of Biochemistry,
Bio21 Institute,
University of Melbourne
~~~~~~~~~~~~~~~~~~~~~~
http://www.venomdoc.com

Dr Frye, That is also my understanding of one of the problems with cottonmouth bites. The question is, does prophylactic antibiotic use help or hurt? does it select out for a more resistant organism?
My dog was given keflex for one of her bites yet I am not sure of the rationale for that.
Dr Frye, would you want prophylactic antibiotics if you were bitten IN THE FIELD?
In fact, if you were bitten by a copperhead in the field and went to a relatively inexperienced ER doc in a small town what would you tell him to do????? I myself am an MD and I carry a protocol with me in the field in case of a bite but I have never been bitten (knock on wood) nor have I treated anyone for a bite so I feel very unprepared w/o that protocol.

It really depends is the best answer. For bites involving deep puncture wounds, severe infection is a very real concern (no different than stepping on a dirty nail). This should be addressed by an MD competent to make the assessment appropriate to the individual situation.

I would be interested in your thoughts in this regard.

Cheers
Bryan
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Dr. Bryan Grieg Fry
~~~~~~~~~~~~~~~~~~~~~~
Department of Biochemistry,
Bio21 Institute,
University of Melbourne
~~~~~~~~~~~~~~~~~~~~~~
http://www.venomdoc.com

Thanks for the response.
The reason I specified 24 inch or less copperhead was because
I felt the puncture wound would be relatively shallow (compared to EDB) relatively clean(compared to cottonmouth) and relatively
less tissue damaging(based on anecdotal evidence).
I dont feel competent to comment on snakebite therapy despite having a medical degree.
I was just very surprised by the lack of tissue damage and sequelae to my 70 lb dog from 3 separate copperhead bites.
I do understand of course if the bite is inta-arterial there could be a whole different outcome VERY quickly.
personally I dont keep or free hand any hot...I use a hook and a camera only in the field....but I want to be prepared if it happens. and right now that involves simply keeping a protocol with me since I could get a bit confused if bitten and want written directions that an inexperienced ER doc could use.

The question of antibiotics yes or no for infection prophylaxis in snakebite victims has been examined in retro- and prospective studies (some with fairly large Ns and placebo controlled). There isn't much evidence supporting a benefit of antibiotic prophylaxis in these patients.

I personally wouldn't feel uneasy about antibiotic prophylaxis being withheld if myself or a family member were bitten by a snake. Of course, I do agree that patients should be evaluated and treated based on individual circumstances and, in some rare situations (i.e. bite victim is immunocompromised or perhaps has cardiac conditions predisposing him/her to endocarditis), erring on the side of caution is warranted. But giving or requesting antibiotic prophylaxis as part of routine snakebite management goes against the principle of evidence-based medicine.

Regards,
WK

Im way out of my league here but I wanted to comment on immediate first aid for a snake bite in the feild. Though bacterial infections can be extremely problematic as has been said that generally is not the main course of concern when first tagged out in the field. Counteracting potential shock should be the number 1 priority. I personally feel one should always travel with an Epi Pen just to be safe. Number 2 should be getting to a hospital asap, as calmly as possible, regardless if the species in question. If the species can be identified as having neurotoxic properties associated with their venom then a pressure bandage should apply immediately. If the symptoms are primarily localized then I personally would probably for go the pressure bandage.

I would love to hear BGF and WK's opinions on this. My thoughts have always lead me to believe that applying a pressure bandage when tagged by a primarily hemotoxic snake (i.e. most US Crotalids) would prove more harmful then helpful since you are isolating the venom to a tiny area instead of letting it dilute a little but on the same note you wouldn’t want to succumb to the other systematic effects associated with some of these bites. I guess in the end, knowing the species that bit you and the clinical aspects of their envenomations is the best solution. If you know this then you can way out potential dire circumstances a make the proper call.

Anyway, back on topic. Having been tagged by a copperhead before I can tell you this for certin. The main thing you want is a pain killer!!! The pain associated with a hemotoxic bite is horrendous to say the least. It literally feels like having a hot poker stabbed into you and someone has the handle and is constantly moving it around. The pain starts instantly as I would assume it does with most tissue destroying venoms. I never even second guessed going to the hospital. The pain I felt was so bad that I couldn’t stand not getting something for the pain. Oh and over the counter pain relivers do nothing for it. This aspect alone is enough for most people, aside from maybe those on PCP at the time to run for the hospital. Then again I may just be a pansy LOL

Anyway, I don’t know if this was addressed or if this is even that relevant to the topic at hand but with all the talk of administering antibiotics in the field I felt it was important to mention this.

Oh and as for the very first question, if I were tagged by something and didn’t feel any effects of the envenomation I probably would for go going in to the ER. I would definitely sit in the hospital parking lot though while I made up my mind lol Probably not the most intelligent answer but as BGF mentioned, with the current system, or lack there of in most states with regards to keeping venomous, the consequences of getting the envenomation made public can be disastrous to the hobby and your collection, not to mention the fact that most insurances will not cover bites from captive animals. If you were to waltz into an ER with a bite from a captive animal, have the ER flip out and start administering AV, putting you on various machines, demanding you stay for observation etc, well, you could be stuck with a bill well over S100,000 US for no reason at all. If the bite was from a wild animal however I would go regardless since most insurance will cover “natural” bites.

BTW, I apologize for using generic terms like hemotoxic and neurotoxic. I know there are many other factors and toxins associated with snake bite but I think these generalized terms helped get the point across.

Thank you for your responses, esp Dr Frye and the last post by the fellow actually tagged by the copperhead.
I found the comment about hanging out in the hospital ER parking lot the type of thing I would tell my patients NOT to do but the type of thing I could see myself doing (LOL).

He did NOT receive antivenom. Sorry for that conflicting report. Also, what was thought to be the recurring bone infection turned out to be something else. Sorry for the conflicting report there.

He's now scheduled to have the last joint of his finger fused with a metal rod. The rod will then be removed and the wound will be healed up with a skin graft.

From what i have seen small copperhead bites are alot worse, because they cant regulate thier venom well, i once met a lady who couldnt walk for a month because she got bitten by a baby copperhead (her fault for trying to kick it)
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Theres no need to ask directions if you ever lose you mind...

There are severe cases with any injury-My dog is an Italian greyhound(12 pounds, knee high). Most people don't need stitches if they get bitten, but even this small she could get it in her head to attack and all but destroy a hand. Stories like the above mentioned bite are what keep me from jumping into venomous when I know better(that and the recent Iowa laws, now I have to move first).

Principally: With a venomous snake bite, ALWAYS go to the hospital. My wife and I have seen baby viper bites to digits leading to amputation. Furthermore, bites by Viperidae to digits should always be treated with AV, if available! For bites by Elapidae, hospitalisation is strongly advised anyway.

Best,

Klaus