Wilderness Medicine: Snake Bite Treatment

Wilderness Medicine: Snake Bite Treatment


I’d like to talk to you a little bit
about treatment, and immediately after somebody’s bitten I guess the first
thing you’d advise is for them to panic and maybe scream that’s what I’d
probably do but of course the way we teach and the best thing to do is to not
panic easy to say in a lecture easy to read in a book but people are going to
be freaking out once you gather yourself lay low don’t panic and those around you
let them do the work of going for help the best thing you can do is remain calm
take a deep breath as we discussed before it may be a dry bite and you’re
not even envenomated or poisoned that’s the best advice I could get so what
about all the stuff that we read about in first-aid books cutting sucking etc
well those are all dramatic again I love them in movies I’ve done it myself
self-inflicted snake bites but the best thing to do first let’s talk about
cutting and sucking again dramatic you’ve seen it where they take out their
buck knife they’ll cut through the fang mark and then just start sucking the
gojira’s out of the person’s arm or leg or name a body part
don’t do it the human mouth has bacterial flora nastiness that’s even
worse than the snake’s mouth so you’re going to infect the wound by sucking on
it and worse yet your knife although you mean well is going to cut through
valuable structures like tendons nerves arteries veins you need those so people
who cut then suck are actually doing more harm than good
don’t do it people have probably heard that cold might be helpful how do you
feel about cold we used to feel that cold usually it’s also called
cryotherapy applying cold or ice to the wound would help and in some bites like
bee stings some spider bites a little ice isn’t such a bad thing
snake bites we discourage it and we’ve even seen people trying to immerse an
entire arm in an ice bath don’t do it it’s actually going to cause more damage
than best thing to do is just to elevate the
arm above the level of the heart push some moral fluids because that’s
probably all you’re going to have in the wilderness you’re not going to have IV
fluids remain calm send someone else to get help the best
thing you can have are car keys and a cell phone and if so the treatment is
antivenom it is and it’s getting to a facility that has it there have been
some folks saying why don’t we have anti-venom in the wilderness with
paramedics ready to go anti-venom also has risks when you
administer it it’s taken from horses it’s taken from sheep so when you give
that to humans you may have an allergic reaction so it’s best to give the
anti-venom in the hospital setting so in the wilderness the best thing you can do
start up a car make a cell phone call 9-1-1 to a hospital facility so what’s
the deal with cro fab and why is it better than the old stuff
I love Crowe fab I think they’ve done a good job they have taken the anti-venom
and refined it to a much more pure type of anti-venom so there’s not as much of
a chance of an allergic reaction as with the old anti-venom it is more costly
like supercouple 20 or $30 per does ah times that by 10 exactly so it’s about
three four hundred a vial it’s expensive so you don’t want to give it out
willy-nilly I know that’s not much of a medical term but don’t give it out
willy-nilly but you don’t want to give it out just for every snakebite you want
to make sure there’s actual evidence of envenomations swelling of the arm
blistering systemic or total body effects blood toxicity lab abnormalities
that reflect a systemic or total body and venom ation or poisoning that’s when
you give the anti-venom less chance of allergic reaction with the new Crowe fab
it is more expensive and we’re finding it’s safer in kids and what’s
interesting about children is the snake is confused by the size of the human
it’s a toddler or an adult like yourself the snake is going to inject the same
amount of venom so kids need the same amount of anti-venom as adults you’re
you’re essentially treating the venom not the patient in that way exactly we
always say treat the patient not the poison treat the patient not the numbers
here you’re treating the poison the snake is going to inject the same amount
of venom into little Johnny as it does in to Grandpa Rex so because of that
you’re going to treat the patient whether a toddler or a full-sized adult
with the same amount of anti-venom when you’re in the emergency department and a
patient’s been bitten you’re not sure yet if they’ve been envenomated do you
wait an hour do you wait two days at what point can you decide that the
patient’s probably good to go home most bites you can see something within about
6 hours 4 to 6 hours you’re going to start seeing swelling in the arm the leg
depending on where they were bitten the glands you look for swelling most pit
vipers rattlesnakes cottonmouths water moccasins you’re going to see that
pretty rapidly particularly if there’s maybe a vein or an artery involved in
the envenomations so if you watch them six maybe even stretch it to 12 and you
see no swelling lab just look good nor abnormalities you can safely send them
home and reassure the patient the exceptions are mojave rattlesnakes they
may only have a little blood toxicity they have a neuro or brain central
nervous system toxicity there may be a delay I would observe them for 24’s same
with coral snakes we don’t get that many certainly in the East in Florida into
Texas here where we are Arizona New Mexico this type of coral snake is
really docile its shy you have to pick it up let it chew on your finger for
about an hour then you may get envenomated
if you have those envenomations you probably want to watch them for 24 hours
otherwise you can watch these patients in the ER
if you’re going to see it it’ll manifest itself pretty quickly in some books they
talk about lymphatic or venous constrictors what’s your feeling about
any kind of constriction okay the other word for constriction is using
tourniquets or taking a bandana and wrap tight knot around the arm or leg that’s
been bitten there’s really no role for that particularly in the US with pit
vipers mostly because we have hospitals ers clinics that are pretty close
good paramedic system so I would advise against it now if you’re away in the
wilderness and you’re a day or two out you may want to do the 127 hour risk the
limb to save the life but that is really uncommon you’re probably not going to
need to do a tourniquet now internationally where we have neuro
toxic snakes like cobras crates you can loosely put them on even rotate them to
stop or impede lymphatic drainage that spreads the neurotoxin
but Australians people from India Africa they’re very good at that leave it to
them in the US I’d shy away from tourniquets avoid it and if you do put
it on put it on loosely so when we say tourniquet we’re not talking about the
tourniquet that most people imagine which is in arterial tourniquet correct
correct so it’s more of a superficial tourniquet and in the wilderness it’s
probably going to be like a rag a bandanna something like that
maybe the tubing from your Camelback or water receptacle would be a good
tourniquet but you’re not going to need to use those and in theory they say if
it’s too tight when you release it you’ll get this bolus or injection of
venom not true but probably what you’re going
to do is cause more limb arm leg constriction and bad healing and that
you don’t want to do I know that in Australia people are using ace wraps
just for gentle lymphatic compression what’s the deal with with kostik
compress as in something like an ace wrap I think
that’s fine as long as it’s not again too tight to taunt there’s nothing wrong
with that particularly if you’re out in a bit of ways from your closest ER
clinic hospital that’s going to be able to see you I don’t see a problem with
that and certainly if there’s any other trauma bleeding that can kind of help
with that and it gives the patient a feeling that you’re doing something and
the people that are around the patient they may feel like they’re doing
something but again calm oral fluids call 9-1-1 calmly drive them to the
closest ER is the best thing you can do there are some commercial devices one in
particular is the Sawyer extractor right what’s your feeling about the extractor
well there are extractors the one that is most common is Sawyer it still talked
about even in Boy Scout manuals and the idea is as soon as the snake strikes
you’re going to take a little suction device kind of cause a hickey and pull
back on a syringe and pull out some of the venom and in original studies they
thought we may get out maybe a quarter to a third of the venom and it may help
but what we’re finding now particularly with good animal studies that it doesn’t
help in fact it may cause a little more damage in the local area I know the
Sawyer people they’re outstanding folks I wouldn’t recommend it however a plug
for Sawyer they do a lot with water purification internationally and I think
they’re a fabulous product with their water treatment devices so I don’t want
to diss the Sawyer family but the suction devices for the most part even
though there’s still advertised still and wilderness kits still in emergency
kits are probably not going to help is it hard to explain the Hickey when you
get home it is particularly if you were struck on the neck by the snake Tim I
know that you work at a big center where you see everything and I know part of
your practice includes treating exotic snake bite right what you’re feeling
about people having exotic snakes as pets I’m against it I think it’s a
machismo thing i underst and why people want it leave them be
particularly exotic snakes to get them in they have to be flown in or shipped
in internationally you’re taking them out of their habitat it’s the wrong
thing to do and then you’re not being very humane putting them in a confined
area you’re only going to get into trouble and when people get bit by
exotic snakes in the US no one knows really how to treat them and other than
zoos you’re not going to have the proper anti-venom it’s very dangerous it’s the
wrong thing to do don’t do it

80 comments

  1. Very instructive video, thank you!  
    One question: Why should  the bitten arm be elevated above the heart? (video at 2.13). It might only move the venom into the circulation quicker in a situation (waiting for help) where you would want the opposite. For that reason Dutch first aid protocols advise to let the bitten limb hang down below the heart and move it as little as possible.

  2. Dr. Erickson is a wealth of knowledge and thanks for the education. I have never had to deal with a snake bite but,  I guess making sure you and those in your team know where the closest care facility is would be your best measure of protection.  I usally map  out ER's when working in a new area which  includes knowing where the closest Level 4 is at.   Having alterantive routes to get there is also a good idea. Great video… Thank you!

  3. I am a girl scout camp nurse.  I am gearing up for camp this year and thought I would do some review, on my own as the camp does not provide this (insert sad face here).  I found this video to be very helpful and informative.  What about brown recluse bites?  And scorpion stings?  Thanks again.

  4. I saw a video about Sawyers Bug and Snake Venom Extractor and  a story was told of the price for the  Anti-Venom being 80.000 dollars – that's eighty thousand  dollars. This guy had insurance but What if you dont? Who's gonna pay for that? This  is another tactic from Big Pharma the FDA, AMA and your not so For the People government to control the masses. They should sell this stuff over the  counter in all med kits so everyone can have cheap access to this life saving medicine when they need it most- just after they are bitten- no time to get to the hospital.

  5. That price probably included all the technicians and all they did for the guy  but according to his bill, all 80 thousand was related to administering that anti venom. If this is incorrect, whats the true cost and what do  you do if you live off the grid and cant get to a doctor?

  6. What about using SAM splints to immobilize the limbs or apply pressure to them? Are they effective with snake bites? Worth taking a SAM splint into the wilderness for them? I am talking on a global level in terms of the snakes you could use them for.

  7. I did consider myself a Sawyer pump guru but as a Veteran and Eagle Scout I've preached & taught the value of using this device in the 1st ten minutes. I catch rattlers for anti-venom purposes and now can lighten my pack. To all my students, Scouts and soldiers, please accept my apologies for my lack of up to date info. Thank you Dr. Erickson. Jamie

  8. dr Tim, thanks for your educational videos,i have a question for you…
    do you think inject antivenon can help for gain immunity against snake venom? i ask this because here in thailand is so easy find snake in bangkok too, can imagine go inside a forest how could be dangerous…pratically i ask….if i start to inject antivenom, both tipes, neurotoxic and emotoxic, for 5 times each type, my body start to produce antivenom and could be safe in case of real bite?
    Thx for your reply

  9. Wouldn't it be bad to elevate the bite above the heart? It could make the venom flow faster towards vital organs.

  10. You DO NOT elevate the bitten area above the heart as he instructed. You keeping level w the body. Neither above or below the heart. Restrict movement until help arrives

  11. Medications and treatment for pain was not discussed. Is that something that could be addressed in a video. Realistically, on extended backpacking trips, a bite may not receive definitive treatment for at least 24 hours. Although pain never killed anyone, it does make patient treatment cumbersome and sometimes very difficult. As a trauma nurse, experienced paramedic and wilderness guide I must say that these videos are outstanding!!!! Thank you for everything that you are doing and sharing.

  12. what about applying 20,000 Volts DC at less than 1 milli-amp to the venomous snakebite wound to detoxify the effects? Lancet, the famous British medical journal published an article about it.

  13. Great answers from Dr Tim!
    As for the Sawyer extractor, I found it is great for insect bites such as bees and wasps and helps to alleviate the swelling although it would be great to carry an Epipen injector or similar.

  14. In a collapse situation in society and getting to a hospital for medical treatment is not an option. What can one do short of immediate amputation above the snake bite location.

  15. Finally good calm advice on wilderness snake bites. Pit viper bites need be treated by relaxing the victim and evacuation. Relaxing the victim begins with the rescuer not overreacting to the the event. Coral snake bites do benefit from compression bandaging but not too tightly. Thanks for the video. The more the responder cam model the voice and the affect of the Doctor the better.

  16. sir yo talking about the advanced country.my question is that if you are in a country like india where medical and Ambulance facilities are not much available some of the rural areas dont have cell phone facilities in that case what we can do if someone bitten by snake???about a week age one of a guy from my village died because of snake bite…..

  17. Being out in the boondocks is not the only place to get bitten. I found a Rattlesnake in my dog kennel 30 feet from my back door. It was a black night and I was putting the pups away for the night, I am also hard of hearing, it took awhile for me to recognize that the pups were not going near their dog box, I finally heard the buzzing, The pups and I got out of the kennel and I went for a flashlight, found that little sucker behind the dog box, he was about 18" . I normally leave all snakes alone but with my gkids, dogs and other relatives around I dispatched this one. The next week I found a calif King snake in my living room, this one was about 30", I released this one out near my pond.

  18. $300 TO $400 A VIAL?!?! Um…no! Not even close. Try more like $6,000 to $8,000 a vial, and CroFab, while might be better than the old stuff in some ways, is still not so effective that it takes 15 to 20 vials. The cost of a snake bite is about $80,000 to $100,000 just for the anti-venom alone. Then you have the hospital stay on top of that.

  19. Finally some real advice. I have watched videos with crazy advice and techniques. Obviously this guy has credentials beyond refute and I can trust his advice. Thanks for the data and the video.

  20. If you are bit by a rattlesnake and invenomated you will know it immediately, it will feel like you got hit with a baseball bat. A rattle snake bite hurts like hell. He never mentions the pain aspect at all. Also the extractors do work well if the strike is on the bone area. The venom will pool on the bone and you can extract it. If you get bit above the shoulder close to your heart, you got about an hour. The most useful advice is this, know your environment, you are strangers in their home is a good way to look at it, wear protection, high cowboy style boots and if not chaps. Step on top of things and not over them, such as rocks and logs. Snakes are more active in late spring and early summer than cold fall and winter weather.

  21. You forgot to mention 6 to 8 drops of your urine under your tongue 30 seconds after the bite, Been hidden from us for years. "Man shall die from a lack of knowledge".

  22. Yes, every Tom, dick and Harry shouldn't have exotic snakes. However, the doctor, should keep his comments, to his area, of expertise. He is not an expert, on the proper keeping of snakes, nor on law and policy on management related to such things. There are quite a few youtube channels of folks who take very good care of exotic snakes. Oh and they have their own antivenin and a medically written bite protocols, on each kind of snake, to take with them, to the hospital, in case of bites. It never ceases to amaze me, someone earns a doctorate, in 1 thing, and it makes them an expert, in everything else. Like the idiot doctor, in Ohio, that didn't follow a woman's bite protoco,l when she was bit by South American lance-head, and she then died, b/c he treated her with crofab (not intended for specified species). Please keep comments to your expertise, I don't claim to be an expert, by my expertise, is in law, and policy. The state of Pennsylvania, has an exotic law and policies, to follow while keeping them. Great video up until the end.

  23. Please note: at 2:15 Dr. Erickson misspoke and generally recommends placing the arm at the level of the heart (to manage local swelling but not encourage systemic absorption).
    That said, in settings where neurotoxicity from envenomation is likely (and local tissue swelling is of secondary concern), keeping the bite below the level of the heart may slow lymphatic venom absorption.

  24. Thanks for this video. Awesome video! Filled with great advice and information. I also love the sense of humor that goes on throughout the video.

  25. Serving in the middle east theatre of war, I was bitten by a HUGH "Palestinian Viper" known as the "Vipera xanthina palestinae" and taken immediately to an Israeli hospital where I was treated with anti-venom over 15 vials of it.

    Within one hour of being bitten, I was basically paralyzed. I was in extreme pain for one hour and then the paralyzation. I felt HOT and my muscles were cramping, It was horrible! I couldn't breathe. And felt as if I was dying.

    The Israeli doctors were excellent, very knowledgeable, the nursing staff gave me wonderful treatment and the hospital did not charge our military a cent. it was all on the house.

    I was tranferred to our hospital in Germany but the treatment in israel was the best!

  26. COOL …YOU DID CORRECT THE BITE SECTION ABOVE HEART RATE COMMENT…WE RECOMMEND KEEPING BITTEN LIMB BELOW HEART LEVEL…AND KEEPING PATIENT CALM…BLOOD FLOWING UP IS HARDER THAN DOWN….DONT CLEAN OR WASH BITE…YOUR MEDIC NEEDS TO SWAB IT …PRESSURE BANDAGE STARTING FROM BOTTOM OF LIMB ALL WAY TO TOP AND BACK DOWN AGAIN NOT TO TIGHT NOT TO LOOSE…MARK WHERE BITE IS..IF DONT HAVE MARKER…JUST MAKE THAT AREA DIRTY..SPIT WITH DIRT…SO MEDIC CAN GET TO AREA IMMEDIATE DOESNT NEED TO LOOK FOR IT…OH AND THAT SUCKER THING TO SUCK POISON OUT IS A LOAD OF SHIT!!!…KEEP PATIENT CALM AND THEIR HEART RATE DOWN….GET HELP IMMEDIATE🇦🇺🇦🇺🇺🇸🇺🇸

  27. thank god. I was reading a boy scout pamphlet and it said to not use a tourniquet. I'm very sorry, but I would certainly use the tourniquet if I could I usually always have a cat tourniquet on my person and I know that according to tccc (tactical combat casualty care) rules that using a tourniquet is not sacrificing the arm at all. if you stop blood flow in the case of an arterial bleed you would have to release it every 2 hours and let the blood circulate for about 1-2 minutes and re tighten the tourniquet. and, I figured that by that point rescue would have arrived because I would be very hesitant to let the blood flow when there is a possibility for venom to travel through the body.

  28. A well done and very informative video. I was also taught to lightly wrap an Ace bandage around the bite area if "doing something" will help to calm the patient. Knowing where the closest ER is and how to get there is just about the most important snakebite "treatment". Thanks for posting. Peace.

  29. To remain calm after snakebite, chew one or more qualudes and swallow. Next drool on wound to clean bite site and, if phone is working, attempt to contact emergency services and/or pizza and beverage delivery. If still conscious, place mental bet of who might arrive first, then sit back and embrace situation as experiment into understanding ancient man's spiritual trials…..hot and delicious pizza not withstanding. If affairs not already in order, using finger dipped in tomato sauce, scratch out last will and testament on inside cover of pizza box. Yeah, that about covers it.

  30. Several years ago I was doing an 8 day hike in the middle or nowhere. Not a single person on the trail other than me. I knelt down next to a water source. I reached over to my left to place my hand on a rock for support. Just prior to planting my hand I looked over that way. There was a timber rattler resting on the rock, just looking at me. Needless to say I withdrew my hand. If I had been bitten that day I wouldn't be here now, as I was alone and many miles from a road or civilization. My situation was a worst-case event. None of what Dr Erickson mentions here would have saved me. I'm still frightened now just thinking about the potential outcome. Luckly the rattler wasn't too upset.

  31. There is no reason for CroFab to be as expensive as it is. Antibodies are easy to make, the Fab fragments are easy to purify, and the final product is very stable. Antibodies can sit in a refrigerator for years and not lose effectiveness. (the expiration date on antibodies is arbitrary.) I have antibody stored in my fridge at work that is still good after 20 years. Why is it so expensive? Because you need it to save your life, and hospitals are in business to profit. Also, you have to help cover the cost if the snake keeper gets bitten. But it is much cheaper in Mexico ($100 per vial). So if you gonna get bit, get bit in Mexico.

  32. Finally, a decent resource on this topic. Sooo many people just throwing their opinions around on the Internet about snake/insect bites with nothing to back them up.
    Is there anything in specific to put into a first aid/emergency kit for snake bites? Or is the only thing that will work until you get to a hospital the usual bandages, gauze, etc.?

  33. The snake's venom is going to cause an infection worse than your mouth and elevating the arm above the heart? Doesn't that increase blood flow to the heart?

  34. Carry a lyophilized vial of aprotinin a syringe and bacterio static water. Get bitten mix it up and dose yourself close to the bite. It won't stop the venom but it will slow the effect and negate the damage.

  35. In the wilderness the best thing you can do is to hold down a snake milk it take its venom water it down greatly and slowly inject a small amount into you everyday for like 2 weeks then you gains the enzymes to fight the venom you could also possibly drink it but that would be risky but it all is and this is kinda just a joke but if you can then do so I suppose

  36. So the question for me has always been when I’m solo, am I better off “hiking strenuously” to get out or just staying where I’m at?

  37. I would think that evidence of envenomation by a snake with cytotoxic venom (most rattlesnakes) would be clear after a much shorter time than he suggests. While antivenom carries risks, the longer treatment is delayed, the worse will be the outcome in terms of local tissue damage and possible necrosis: a difficult balancing act.

  38. So basically if you are bitten by a venomous snake, you are alone hundreds of miles away from civilization and your phone is broken then the best course of action is finding a nice sturdy structure to neck yourself from? There are no other options? Without modern medical treatment you're automatically just dead?

  39. i didn't see any 'wilderness medicine' to cure snake bite in this video? do u? all i get is get your car key and quickly drive to the nearest doctor…in the wilderness…shaman doctor i guess.

  40. Researchers are now trying to get funding for a nanoparticle Epi Pen you can stick into the snake wound as soon as it happens.
    This will greatly delay injury until you can get help. All hikers, all soldiers should have one.

  41. If only the paramedics had resources to handle possible anaphylaxis, they might be able to carry antivenom… 🙄

  42. Basically as far as he's concerned if you're out in the cuds with no phone coverage your dead so you might as well bleed the hell out of it blood vessels and muscle tissue aren't much use if your a stiff.
    Yahoo doc thanks for not so much seems that if you see a snake waste it and keep away from the mouth venom is just as toxic from a dead snake as a live one and the smaller snakes ie young tend to give all they have so they are worse than an adult.

  43. I've been doing some research and I've found two sources that say you should keep the bitten area below the heart, not above. This makes more sense to me since you are trying to keep the poison away from your heart.

  44. Dear All, for ARIZONA snakes I did not get how much life time a person has after the bite to get the antivenom ?? Thank you for your answer.

  45. Very good advice! I would only advise not to use an Ace Bandage with Pit Viper/Rattlesnake bites. This can restrict the venom from spreading, but it does so at the cost of the limb suffering the damage. Tissue loss and muscle damage can be aggressive when you use any kind of constriction on the bitten limb.
    Please just get the victim to medical treatment as quickly and calmly as possible.
    Remember, when you are calm, you calm those around you in a crisis. Reassure the victim, stay calm, and get help as safely and quickly as possible.

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