Reptile & Amphibian Forums

I read your bite story and a few things caught my attention- you wrote--
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I could feel my body going into Hyper drive like a freshly bitten mouse. I informed the firemen that I had two Epi-pens on hand & I was going to use one as I slammed it into thigh. That was the last thing I remember until I regained consciousness around 3:00 p.m. on Fri

They had me out of ICU in 24 hrs. & released me 24 hrs. after that. They initially told my wife they didn’t think I was going to make it & couldn’t believe how quickly I recovered

I was not able to find out how many bags of Cro-Fab I received but 3 – 7 was the answer depending on who I asked

At one time, my diastolic blood pressure was 50 & they said the pH level in my blood was “not typical of a living person.”

have Epi-pens on hand. I’m not familiar w/ the details of the Rhino bite that took the life of the OH fireman last year, but I believe (?) he died from Anaphylactic shock. I also believe I would not be here today if I didn’t have the Epi-pens on hand
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now first
you don't administer adrenaline unless the symptoms of anaphalaxis are present.
ie. swelling itching falling blood pressure its unmistakeable.
it might make things worse since it is a sitmulant and will make your heart beat faster causing a faster absorption of the venom.
you may pass out and have convulsions from the adrenaline alone.
Sounds like what happened to you after you injected the e-pen.
The symptoms of A_SHOCK are very clear and you must know what they are before you just jam a epi pen in for the hell of it.

Second the guy in ohio took a IV BITE FROM A BIG BITIS which is almost instantly fatal.
if he died from A_SHOCK the doctors would have said it was the cause of death.

bags of crofab?
you must have meant vials since its in vials.

a diastolic of 50 is not a grave reading since I have had a 53 and its normal.

so reviewing your bite zone and the pic and the size of the snake the reason you were released in 24 hours is because you had a MILD BITE and thats it.
it might have been tramatic for you since its your first bite.
you may ask who do I think i am?
I have treated nearly 200 envenomations and only 2 had a anaphalactic reaction.
yes they were my personal bites.
so personaly I keep adrenaline handy but never administer it before symptoms present themselves.
and faciotomy is totaly a farce not needed and anyone that knows about it does not do it.
so I hope nobody thinks a epi-pen is all that you need to survive a bite.
you need antibodies -----
remember this is only my opinion.
feel free to roast me. but the truth is the truth

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Bud

Budman,

Are you an MD? or an EMT? Since Mike is not either I could see some of the information being "garbled" certainly after his weekend. I'm sure Mike meant "Vials" when mentioning Antivenom and "Systolic" when discussing his nearly non-exsistant blood pressure. I have points of clarification about his account too but I will ask them off forum away from "Medical Nit Pickers", since they will not serve the community by asking them publicly.

Al Coritz

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You can take the snake out of the jungle but you can't take the jungle out of the snake.

I think Buds a doc., I saw it on his NG doc. when he injected mamba venom!. Maybe not though, how would he know about these things? Glad your okay MJ, stick with it, I like your animals! Tim Friede

Those were exactly my thoughts as well Al.

Also, there is really no relationship between Bud's blood pressure and Mike's. Bud may very well normally have a lower blood pressure. We have no idea what Mike's blood pressure is usually at though and are therefore not in the position to say it was not at a dangerous level. If someone is normally very hypertensive, a sudden fall to a "normal" level could pose a very significant risk.

Jason

When it comes to epi-pens they are only to be used when a severe reaction happens, itchyness, rash is not a severe reaction. You need to be looking for sudden drop in BP, swelling of the lips, face, tounge, neck, unable to swallow, chest tightness, difficulties in breathing. As mentioned the last thing you want to be doing is injecting adrenalin into highly vascular muscle when you dont need it. Doctors may administer adrenalin as a caution when there is a possibility of a reaction happening, this is normaly via subcutaneous route(fatty tissue below the skin), absorbtion is slower and does not have such a drastic affect on the heart and BP. It would be nice to know more accurate medical details, but that's up to the patient if he wishes to disclose that type of info on a public forum.

As for fasciotomys they are very rarely needed, its imperative that you get the doctor to physicaly measure the pressure and not just presume. And also make sure your blood is clotting before they slice you open! When it comes to bites on digits due to the tight compartments, there is always the possibility that a fasciotomy may be needed to save that digit.

John
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"Its no help to hide behind the statement that snake bite accidents are a rarity and that the average Dr seldom or never will treat one. For the bitten patient, it is a matter of life or death, and the rarity of the event is of no interest to him."

To MJ: very glad you're doing well and I hope your recovery continues to go so quickly. I'd like to give some clarification to the whole epinephrine issue and possibly temper some of this forum's enthusiasm regarding its use. As I'm not too familiar with MJ's case I'll assume you were in fact 1 of the very rare cases of anaphylaxis after rattler bite. As Bud and others have mentioned in this forum, epinephrine use after a rattler envenomation is ONLY useful if you have an anaphylactic reaction to the snakebite. This does occur, but is exceedingly rare. It is so rare, in fact, that most cases are reported in the medical literature (there was only 1 recorded case prior to 1990). And true anaphylaxis can only occur with prior exposure or sensitization to the offending agent--meaning a prior snakebite or other venom exposure. So it's not going to happen if you haven't been bit before or don't self-immunize. Anaphylaxis symptoms include airway compromise, hives, drop in blood pressure, itching etc. However, anyaphylaxis is NOT unmistakable: many of these symptoms overlap with the symptoms of any severe envenomation and so anaphylaxis is often overdiagnosed and misdiagnosed. If a patient does have anaphylaxis with a bite, an epi injection will almost always result in rapid improvement of symptoms. Within a couple minutes the respiratory compromise would significantly improve. Going into respiratory failure despite epi injection would indicate to me that respiratory symptoms were due to systemic severe envenomation rather than anaphylaxis, and therefore an epi injection would not help at all.
Epi-pens' main utility might be in individuals who are allergic to anti-venin, where prior administration of epinephrine will reduce the risk of an anaphylactic reaction to the anti-venin. As Bud mentions, a theoretical risk of just sticking yourself with an epi-pen anytime you're bit is that the epinephrine will speed your heart rate, thus spreading the venom through your system more rapidly and worsening its systemic effects.
As someone in the medical field, and with 9 years of handling rattlers and other hots, I can tell you that I don't keep epi-pens handy as I'm more concerned about that theoretical risk. a venom suction device is all I have at home.

Hi,

Your post was very interesting. I found it to be written very intelligently. I am not a doctor. I have ZERO experience in the medical field. However, based on my personal research into anaphylaxis, I would definitely keep epinephrine on hand, considering true anaphylaxis can kill in MINUTES. Keep in mind, keepers are exposed to venom in the form of dried venom being inhalded during routine chores such as cleaning cages, which is a consistant affair, especially for those with large collections. I know friends who keep Crotalus who have had specimens who regulary "spit" their venom, rather, they strike and the force of the strike expels their venom toward the handler. While not as accurate by any means as a true spitter (Naja sp.), it can still expose the handler to the venom.

I would much rather lose a finger or even a limb (I play guitar, so my hands and fingers are important to me...plus I keep snakes ) than my life. I would strongly urge ALL venomous keepers to keep injectable epinephrine on hand. At the very least, keep some Benadryl.

If you never have to use it, great. But since the risk of anaphylaxis is there, it is better TO have than NOT to have.

Very good points. Thanks for bringing up the underappreciated exposures to venom other than bites. I did a literature search for benadryl use after envenomation and all I could find was that it was not effective as a pre-medication for people allergic to anti-venin, although epinephrine was effective as a pre-med to anti-venin allergies. I would like to re-iterate, however, that the injection of epi after a hit from a rattler is not a benign treatment. Although you are right that it could be potentially life-saving in the case of anaphylaxis, it could be potentially catastrophic in non-anaphylaxis cases in that it could potentially increase the systemic distribution of the venom. And again, we hear about severe (systemic) envenomations almost daily, but anaphylaxis occurs extremely rarely. So with probably 100's (if not 1000's) of severe envenomations for every case of anaphylaxis, I think that the risks of epi injections outweigh the potential benefits. So personally, I do not keep epi around and I won't unless I learn that I'm allergic to anti-venin. Peanut anaphylaxis kills dozens each year in the US. I eat peanuts, but I don't carry epi when I eat them despite my chronic exposure to them--I think most of us would agree that to do so would be overkill. With envenomations I believe it is an even greater overkill.

Thanx for the info. - I doubt if I'll ever quit learning about envenomation as that is not my field but appreciate everyone's expertise. I had been bitten (grazed - 2 yrs. ago - just broke the skin - no anti-serum necessary) before by a WDB on the opposite (left) hand (ring finger) & you may be able to see the swelling & redness of that finger in the pic. It is still swollen, itchy, & red. I am familiar w/ allergies & knew this may increase my chances of A_ reaction.....I did feel like I was on my way out of conscienceness & that is why I made use of the epi.....

AS shock can occur with the first exposure, I've had it with my mamba injections about 6 times. It put me out the first time I tried the venom, and then put me out for about a month. You don't need previous exposure, everyone is different. My IgG now overrides my IgE as a blocking protein. The G beat the E, so even if I'm " technically" allergic, I'm still very immune. It's a real mother to experience! Good topic, TF

Well thats a medical first! True anaphylaxis is mediated through IgE, hence you must have some previous exposure to the antigen. It is possible to have a severe reaction first time round but its not true anaphylaxis. There is another reaction called anaphylactoid, clinically the same but has been triggered by first time exposures in snake bites, iodene injections etc. The true mechanism in anaphylactoid is not truely known but may happen without a IG response. Maybe you should publish your finding in a reputable medical magazine?

John
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"Its no help to hide behind the statement that snake bite accidents are a rarity and that the average Dr seldom or never will treat one. For the bitten patient, it is a matter of life or death, and the rarity of the event is of no interest to him."

It was in the Journal of Immunology. There's alot in books you can read, but I lived it first hand. If you want a copy let know. TF

I'd be interested to read that. Thanks
rabies7 AT btinternet.com

John
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"Its no help to hide behind the statement that snake bite accidents are a rarity and that the average Dr seldom or never will treat one. For the bitten patient, it is a matter of life or death, and the rarity of the event is of no interest to him."

I'm fortunate enough not to have any known allergies but in the 13 yrs of being a Paramedic I've treated a number of reactions, from local redness through to anaphylaxis. Only one patient has died enroute to the hospital the initial cause being a wasp.

John
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"Its no help to hide behind the statement that snake bite accidents are a rarity and that the average Dr seldom or never will treat one. For the bitten patient, it is a matter of life or death, and the rarity of the event is of no interest to him."

"now first
you don't administer adrenaline unless the symptoms of anaphalaxis are present.
ie. swelling itching falling blood pressure its unmistakeable.
it might make things worse since it is a sitmulant and will make your heart beat faster causing a faster absorption of the venom.
you may pass out and have convulsions from the adrenaline alone.
Sounds like what happened to you after you injected the e-pen.
The symptoms of A_SHOCK are very clear and you must know what they are before you just jam a epi pen in for the hell of it."

Thanx for the info. - I do not claim to be an expert - just telling my side of things. An Rx is necessary to get epis so a Dr. should advise upon the Rx - I felt myself going out so I couldn't use the epis after the fact....my local Doc. said I could just jam the epi to see what it would do w/out any neg. reaction so that is/was my justification. Didn't want to waste the $80 though so I didn't......

"Second the guy in ohio took a IV BITE FROM A BIG BITIS which is almost instantly fatal.
if he died from A_SHOCK the doctors would have said it was the cause of death."

Did not know if it was an IV bite or A_reaction as I stated before....

"bags of crofab?
you must have meant vials since its in vials."

I am aware the it comes in vials & mixed into (drip bags) but was only told # of bags upon inquiry. Wasn't sure if there was a standard ratio to the mix....

"a diastolic of 50 is not a grave reading since I have had a 53 and its normal."

53 is normal or normal after a bite??

"so reviewing your bite zone and the pic and the size of the snake the reason you were released in 24 hours is because you had a MILD BITE and thats it."

I would also say it was a mild bite but a bad reaction to something....my novice opinion would be the venom not the epis - wish I knew for sure.

I was not going to weigh in on this, but enough of this discussion has prompted me to do so. I caried an epi-pen to Costa Rica basically because I was told by the attending physician on my cottonmouth bite in '93 that I may become sensitized to the venom. He may have been right, or not..and som CR snakes' venoms are close enough that I figured it was worth the cost of the pen.

A friend of mine died a few years ago from a Sufan Cobra bite. Rapidly. From anaphylactic shock. He had become sensitized to the venom over the years from cleaning cages.

I personally would not arbitrarily inject myself with the epi-pen after a bite, but would keep it close & use it if it seemed necessary to do so.

Mike, you have no idea how happy I am that you are back on the boards & breathing air, bro. Hang in & stay safe.

~~Greg~~

Hope this link is not deleted as this topic seems to be poorly understood. I am truly happy & lucky to be alive after my mistake. Here is the link for anyone who wishes to further educate themselves.
http://www.venomousreptiles.org/articles/97