Sunday, February 3, 2013

Lesson Two: Snakebite Kits

Lesson Two: Most snake bite kits are a waste of space, time, and money.
(Nota bene: I’m writing this from the U.S. If you’re out playing anywhere else, some or all of it may not apply. Now you’re warned.)

Bold words, I know. Allow me to try some math on you.

I’m assuming most prepared people won’t be wearing an anti-lightning strike rod on their gear. Why? Because dying from a lightning strike in the U.S. is about a 6,000,000:1 occurence, in terms of likelihood. Your chances of dying from a venomous snakebite in the U.S. are 25,000,000:1. So unless you're in charge of feeding the rodents at the zoo's reptile house, or you regularly go to brushy canyons and stick your arm armpit deep into holes in the ground to collect field mice, or you're trying to perfect a new act to get on the Tonight Show, you probably have a higher risk of being trampled to death by rogue mimes than of getting snakebit. QED.

If you’re a white male, 15 to 35 or so, your odds go up somewhat. If you’ve also had a couple of beers, they go up a bit more. If all the above is true, AND your last words before reaching down to play with Mr. Reptile are “Hey guys, watch this!”, your odds of being bitten approach the actual need for a snakebite kit. On the other hand, you’re probably too stupid to use one, and probably not reading this either.
If you’re out hiking around, some common sense, heavy footfalls, looking where you put your body parts, and a good walking stick will warn snakes of your approach, and you’ll never see them. And if you do cross paths, they aren’t going to chase after you. They’ll recognize you’re too big to eat, and as long as they aren’t cornered or pestered, they’re not interested in biting you either.

And 5-8 months out of the year, depending on where you are, it’s probably too cold for them to be out playing anyway.

There are always a few (in this case - very few) exceptions. Maybe you’re out in the spring, sneaking around, and manage to step over a log right next to a nest of younglings who don’t know the rules I just laid out. It happened to a know-it-all college biology grad student on Camp Pendleton, even though we’d warned him the years’ hatch of rattlesnakes was wildly high. He made it about 20 yards across a grassy meadow before he got nailed - half a dozen bites on both legs, right above his Birkenstocks. Effing stupid hippie was too smart to listen to a bunch of dumbass Marines. 

So maybe you’re with him, or your friend was the one who said said “Hey, watch this!” So now what?

Get out that snake bite kit you had to have, because you’re mega-prepared. Open it up. Is it one of those little  rubber green Cutter’s/yellow Coghlan's kits, with a skinny dark string, an X-acto blade, etc.? Perfect!
Grasp it firmly in your dominant hand, take careful aim, and throw it at the offending snake, just as hard as you possibly can. That’s the best use you can ever make of it. Don’t ever use it on anyone, unless you really, really don’t like them. If you have one now, and you haven't used it yet, go down to a local lake or river, and practice this drill, imagining the snake was floating on a log offshore. Never buy another one.

But why?

1. The little halves provide less suction than your 5 year old’s dart gun tips.
2. The constricting band they supply will cost you a body part.
3. We don’t slice open bites.

But I saw in this movie where...

No! Bad doggie!
1)First, 25-33%  of all venomous snakebites are “dry”, i.e. no poison was injected.
2)Second, the “wet” bites won’t respond to most suction devices, except right away, and it has to be very strong.
3) Third, your bite is very likely on an extremity, esp. a hand or a foot. Note the amount of extra space in your hand or foot. There isn’t any. It’s pretty much all important stuff—blood vessels, tendons, ligaments, and nerves in amongst a lot of bones. The last thing you ought to be doing is trying to sever important machinery in your limbs. That’s about as sensible as blowing a finger off with a 12 gauge. Cutting on it is mutilation. Technically, it’s “practicing surgery without a license”. Resist the urge.
4)Fourth, that tiny string will become a drastically too-tight band, cutting off blood flow as the bitten part swells. We can work with envenomization in the ER, but cutting off the blood flow is going to cost you your digit or limb. And seriously, wouldn’t you rather dilute that venom with your big body, rather than concentrate it in a part of your body loaded with pain receptors, like a hand or a foot? Of course you would.

And if you were really going to help yourself or your buddy out by sucking the poison out with your mouth...just don’t. Be smarter than that, please?

If you’re bound and determined that you’ve gotta have something just in case, pay attention. The only device I’m aware of that might, just possibly, do any good, is the Sawyer Extractor. If you have it, if you whip it out and slap it on within a few seconds, you might manage to draw out some fraction of the venom. And it won’t hurt to try, or do any demonstrable harm in the first few minutes you use it.
Other postive reasons are that 1) it’ll keep you from doing anything stupid like trying to catch, kill, or further piss off or annoy the snake; 2) using it forces you to stop, slow down, calm down, and concentrate on doing something deliberate, rather than panic or run around.

Okay, what next?
Stay calm. If Mr. McFang is still nearby, and probably trying his best to retreat, observing the snake, with a view to giving a species ID to medical professionals later on, is acceptable. But the priority is treating and evacuating the patient, not apprehending the suspect.
Clean the bite wounds. (Snakes eat rodents and such, and they don’t brush after meals. Thus they have nasty cooties in their mouths. The bite WILL get infected.) The better you clean it the less worries about that later on.
Remove everything (tight bootlacess on a foot, rings, watches, etc. on a hand, and any constricting clothing) that might be a problem after things swell up. Because if it was a venomous bite, things WILL swell up. Possibly a lot. If you’re with someone, let them help you out to civilization. If you’re alone, call someone, or as a last resort, get yourself back to the World (assuming this is an option, and not during your escape from TEOTWAWKI). Ideally, you want to immobilize the extremity, lower than the heart level, and carry the victim to transport and evacuate them to definitive medical care.
In North America, your odds of dying from a snakebite are very, very low. That doesn’t mean it’s not gonna hurt, or that you won’t need medical help. But you probably aren’t going to die, and if you get to help in a timely fashion, you’ll do fine.
What about carrying antivenom?
You aren’t going to fix it by carrying antivenom. The last guy I treated in the ER* for snakebite needed 20 vials of the stuff for a bite on a finger, it’s a cast-iron b###h to re-constitute even under hospital conditions, and you won’t likely have nor find that much of it. That’s assuming you even know what kind of snake bit you. You sure aren’t going to carry 20 vials of antivenom, sterile equipment, syringes, etc. for every venomous snake in the continent, or even your area. So get thee to a hospital.

Ice, stun guns, etc.
And for the inevitable "I read this on the Internet" questions: Using ice on a bite that may cause decreased circulation isn't just worthless, it's jackassically stupid.

And using stun guns on the pt. has no - as in nada, zip, zero, zilch - demonstrable positive effects on the injury whatsoever.
That said however, if the guy who got bitten was the biggest dickhead in your group, I can understand the urge to try it out on him a few times, just because watching him flop around is kind of funny. But be advised, it doesn't have any therapeutic effects, except to your own twisted sense of humor.

Hopefully, this info will either save you $10 and a few ounces of dead weight, or if the worst happens, keep you from doing more harm than good.
*(Brilliant guy, classic snakebite victim: 30 y.o. WM, found a nest of baby rattlesnakes, likely Western Diamondbacks (Crotalus atrox sp.), freshly hatched on spring day behind a Wal-Mart - I can't make this stuff up - and decided that he could catch them all and sell them to friends for a few bucks. Somewhere in the process Huey, Dewey, or Louie chomped on his right ring finger about halfway up, and probably gave him the full bag o' nasty juice. When I got him, 24 hrs. later from a local smaller hospital, his right arm from fingertips to upper bicep was discolored and about the size of a thigh. Because of the time passed from the initial injury to my receipt of pt., I can't tell you if he'd been drinking any adult beverages prior to the bite. Hmm, catching rattlesnakes in the open field behind a Wal-Mart to sell to his do the math on that. He didn't lose any body parts, but his right arm was in severe pain, the specialists standing at bedside were discussing the possible necessity of doing long-direction relief cuts on his entire arm to keep the internal pressure from giving him permanent nerve damage from compartment syndrome, and when I rolled him up to the inpatient ward, I'm betting the pain he was experiencing, despite quite a quantity of IV pain meds, was enough to bump his IQ up a solid 10 points over what it was 48 hours earlier. Don't be that guy.)

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