Category Archives: snake

Everything you know about snakebites is wrong

Well, maybe. The 6 T’s though? Testosterone, Tank, Teasing, Tequila, Tattooed, and Tanktop? Yeah, they’re not correct. The terms “legitimate” and “illegitimate” as pertaining to snakebites imply a perception of the patient that may cloud your judgement in treating.

White-lipped Pit Viper, Trimeresurus albolabris showing its fangs in Kaeng Krachan national park By: Tontan Travel

Of course, it’s only used in the pejorative for Americans generally, although maybe the Australians have a similar description for some of their snakebites. Which is interesting, because there are probably 8000 bites in the US, while there are between 1 and 5 million worldwide. Between underreporting and lack of seeking treatment these numbers are very hard to pin down. Death rates, while lower, are still nothing to ignore with between 90,000 and 125,000 deaths worldwide, but that number drops to single digits in the US. Snakebites are truly a neglected tropical disease.

These authors decided to take a nontraditional approach, namely searching Google News daily for two years,from Dec of 2011 until Dec 2013. . They had to retroactively search the rest of calendar year 2011.

National and local news outlets, as well as medical and outdoor activity websites were used, and short articles and blogs were not. Articles were assessed for date, state, victim sex, victim age, whether the bite occurred in a natural setting or in captivity, the activity of the victim at the time, whether the victim was aware of the snake before the bite, the location on the victim’s body, and whether the bite was fatal.

Unsurprisingly, the media didn’t report on a lot of them. There were only 332 victims. What does that have to do with the 6 T’s though? Namely that the breakdown differed from what would be expected. Males were more common, but only represented 67% of the bites. Tanks were only present 7.5%. Teasing? Illegitimate bites were recorded only 32 percent of the time.

Of particular curiosity is that the media reported more  total deaths than the National Poison Data System, and also had higher rates of children and adolescents and more rattlesnake bites. Of note, illegitimate bites (teasing) did result in more serious envenomations, with 8 of the ten deaths coming from that, and only 1 from stepping on a copperhead.

Sadly, the detailed analysis did not go into alcohol consumption, prevalence of tattoos (particularly ones with snakes depicted), or whether the victim was wearing a tanktop. And yes, if there are 8000 bites per year, and this article describes roughly 100 per year, perhaps the statistics do trend more towards the classic teaching. The media may portray more stories of women and children because their job is to sell newspapers and clicks, not just to report the data. But maybe we can tone down the stereotyping of snakebite victims.

An Analysis of Media-Reported Venomous Snakebites in the United States, 2011–2013
http://www.wemjournal.org/article/S1080-6032(16)00007-7/pdf

No really, snakes can hurt you after they’re dead

Even though we have all (hopefully) been taught that dead snakes can still envenomate people, apparently it hasn’t been reported much in the literature. I say this because this case report is in press as of 18 Nov 2016.
Southern Copperhead
In this instance a young man killed a copperhead by cutting it into three pieces. While holding the piece containing the snake’s head, “his right index finger brushed against the fang and was inadvertently punctured.” I’m sure all of us think that is exactly how this happened. Pain and swelling followed, so the patient went to his local hospital where he received 4 vials of antivenom.
There was further progression of the swelling and ecchymosis, so another 4 vials were administered. The patient was then transferred to a tertiary center “with concern for compartment syndrome of his hand.” Another 2 vials were given and the hand was elevated, and no operative intervention was done. Of note, his labs showed he did not have a bleeding diathesis, but readers of this blog already knew that.
I wish I didn’t have to say it, but sadly some people out there still believe that fasciotomies are required after snake bites. Truthfully, based on the evidence, the best treatment is antivenom and elevation, not surgeries that can cause complications and haven’t been shown to give benefit.
This paper does note that there have been multiple case reports of envenomations by dead rattlesnakes or rattlesnake heads. One even had been freeze-dried, bought at a gift shop, and used as a tie tack. Almost all of those required antivenom. This is an interesting thought, as recently deceased snakes likely retain the ability for the venom gland to contract reflexively. Envenomation from a freeze-dried snake has to be retained protein on the fang itself, as the ducts aren’t functioning anymore. This particular episode is the first documented case involving a copperhead that required antivenom.
So it is more than just an old wives tale. Dead snakes can still evenomate you, even if they’ve been dead for quite a while. So stay away from the pointy ends of snakes, and stop killing them for crying out loud.

Clinically Significant Envenomation From Postmortem Copperhead (Agkistrodon contortrix)
http://www.wemjournal.org/article/S1080-6032(16)30225-3/abstract