Supporting cartoon at URL below
INDEPENDENT RECORD (Helena, Montana) 24 July 08 Snakebites: what not to do (Eve Byron)
After 23 years as an emergency room physician, Dr. Mark Rabold still takes his business seriously but can’t help but wonder in amusement about some of the situations he’s encountered involving rattlesnake bites.
One of his favorite stories involves an anesthesiologist who had just recently moved to Montana. The guy ran over a rattler with his dirt bike, but the tire spun up the snake, which hit the biker in the stomach and bit him.
Then there’s the one — Rabold’s had so many patients he can’t remember if he treated this guy or just read about it —where a man was struck by a rattlesnake, and the guy’s buddy tried a home remedy to treat the wound.
“His buddy got the jumper cables and hooked him up to a giant battery for his semi, then fired up the engine. He probably had to put down his beer first to put the clamps on each side of the snake bite,” Rabold said, laughing. “The guy is screaming, yelling and seizing from this treatment; they thought it would somehow break the venom down.
“Someone actually did a study, and found that electric therapy doesn’t work. It’s just an interesting layman’s myth. This guy ended up with third-degree electrical burns.”
The reality of rattlesnakes is that they do cause a painful bite and their venom can kill a person, although that’s rare. But for every true aspect of rattlers, there are also plenty of tall tales.
For example, reports aren’t true about a shortage of snakebite antidotes, known as antivenin.
There were shortages in the supply of CroFab, the only widely distributed snakebite antivenin available in the United States, from 2001-2003. But a representative of the company that makes CroFab — short for Crotalidae Polyvalent Immune Fab Ovine — said it has an adequate supply antidote to treat the approximately 7,000-8,000 snakebites each year that involve venomous species in the United States.
Peggy Stebbins, a spokeswoman for St. Peter’s, said the hospital’s pharmacy has a dozen vials on hand, and they usually treat one or two people each year.
“That’s enough for one patient’s treatment, on the average,” Stebbins said. “If we need more, we can always borrow from (Fort Harrison Veterans Hospital), Benefis in Great Falls, or Butte. Plus, we can order more overnight.”
But it’s not cheap. One vial wholesales for $1,572, and some patients need up to 20 vials, which comes out to a bill of $31,440 for medication alone. In clinical trials, patients received an average of 12 vials, with a range of three to 18 vials, according to the drug manufacturer Fougera.
“It’s wildly expensive; that’s a side effect,” said Rabold, who has worked in the St. Peter’s emergency room for 10 years. “But it works. I saw a kid with a direct hit to his finger and thought he might lose the finger. But we gave him CroFab and I can’t believe how good he did.”
Luckily, rattlesnakes often give “dry bites” without injecting venom, he added.
“The venom is supposed to kill small animals for them to eat. When they strike a human, there’s no chance they’ll eat us, so no venom is injected,” Rabold said.
The possibility of a dry bite, along with the high cost of the antivenin, is why Rabold and other physicians often watch a patient to see if symptoms develop before administering drugs. Symptoms typically become evident within a half hour and include painful swelling, tingling and burning at the bite site, a coppery taste in the mouth, nausea and vomiting.
“I have no problem watching an asymptomatic person,” Rabold said. “If your symptoms are minor, I might not give you any of the antivenin. I had one guy last year who we watched for three to four hours, and he just had localized pain.”
The high cost also is one reason smaller rural hospitals carry a minimal amount of antivenin.
Kari Durbin, head of nursing for the Broadwater Health Center in Townsend, said they stock one dose.
“When we get a possible snake bite call, we get one dose in them and send the person to St. Pete’s,” Durbin said. “Last year we had two patients that we gave antivenin to. This year, we haven’t had any, as far as I know.”
Eva Kerr, a nurse at the Mountain View Medical Center in White Sulphur Springs, said they don’t see many rattlesnake bite victims so they don’t carry the antivenin.
“The option we have is the Great Falls (Mercy Flight) helicopter can get it to us in 45 minutes,” Kerr said. “We don’t have rattlesnakes around us for about 30 miles because of our elevation, and it’s really expensive to keep the antivenin around.”
In a news story in May, the Associated Press reported that toxicologists in Arizona, Colorado and California said they were seeing an increase in potentially deadly symptoms from rattlesnake bites. At least five people have died from rattlesnake bites in Arizona since 2002, with three or four of them succumbing to the extreme symptoms. Prior to that, they had only had five fatal rattlesnake bites in the 20 years prior to 2002.
In those extreme cases, the victims had traditional snakebite symptoms, but their mouths and throats would swell, making it difficult to breath. The victims then became lightheaded, collapsed and died within minutes of the bite.
Rabold said he hasn’t seen any of those extreme cases in Helena. But in September 2006, Robert Finley, 58, died after being struck by a rattlesnake twice on the hand. Finley apparently saw a snake in the road and bent over to pick it up when he was bitten. Finley killed the snake, went to a hospital in Roundup, then was flown to a Billings hospital where he died.
Medical experts say there’s no need to kill a snake to prove what administered the bite.
“If you say a snake bit you, I’ll believe you,” Rabold said.
He has a long list of other things people shouldn’t do —using a tourniquet after being struck; cutting the wound and trying to suck out the venom; or washing the bite with soap, water or whiskey.
And especially, not electric shock therapy.
“The only treatment by a layman is a construction band, lightly placed above the bite — like a rubber band loose enough that you can put your finger through it,” Rabold said. “And only do that if you’re out in the boonies and can’t get to a hospital for a while. And you don’t need to fly 80 miles an hour to the emergency room. Relax, don’t panic, because people generally do well.
“Far more people die from bee stings, or from hitting a deer on the highway.”
Snakebites: what not to do
