Rattlesnake Bite Info

Things that are likely to happen in the event of a rattlesnake bite:

Immediate/Medical Emergency:

-Respiratory malfunction/failure- as venom is a paralytic and depletes blood platelet counts, it often causes breathing to stop before getting to the hospital/vet.  It is important to know CPR for people and pets.

-Shock- the bite victim may go into shock. Wikipedia describes shock as: a serious medical condition where the tissue perfusion is insufficient to meet the required supply of oxygen and nutrients.  This hypo-perfusion state is a life-threatening medical emergency (mortality rate of 30-50%) and one of the leading causes of death in a critically ill person.  There are many types of shock but they all end in organ failure if not treated. To treat: first get help if at all possible, second prepare for and/or give CPR, third stop any hemorrhaging, fourth keep the victim as warm as possible with a sweater, blanket or anything you can use, give as much information as possible when help arrives. Do not offer the victim anything to drink. This is really serious and wikipedia has a very informative section on it.  Go to www.wikipedia.org

-Compartment Syndrome- is a situation created by pressure buildup in one fascial compartment. If the pressure in the compartment rises above 30mm Hg the blood supply to the muscles can be completely cut off leading to death of the tissue in the compartment.  This is a medical emergency requiring immediate treatment by fasciotomy (the fascia is cut  to relieve tension or pressure, this will save the limb but can cause accidental damage to a nearby nerve, surgical scars and a loss of mobility of the joint involved)  to allow the pressure to return to normal. If compartment syndrome develops and a fasciotomy is not done there is will most likely be a need for amputation.

-Lethal drop in Blood Platelets- Dogs generally have between 100-200,000 blood platelets (essential for blood clotting), rattlesnake bites can cause a drop below 20,000 platelets, which can cause internal bleeding.  Death from hemorrhage can generally occur surprisingly quickly.  This is because of ‘positive feedback.’ An example of this is ‘cardiac repression’, when poor heart contraction depletes blood flow to the heart, causing even poorer heart contraction.  This kind of effect causes death to occur more quickly than expected.  Symptoms include: pale, clammy skin, an increased heart rate and a stupor or confused state.  The only step you can perform as first aid is to raise the casualty’s legs; however, if the bite was on the leg, you need to keep the leg with the bite on it below or neutral to the heart.

-Anaphylaxis- If given the anti-venom or anti-venin, there is a chance of anaphylaxis. This is a severe and rapid multi-system allergic reaction.  Anaphylaxis does not ALWAYS cause anaphylactic shock, but anaphylactic shock is as common as anaphylactic reactions in this circumstance.  Anaphylactic shock is a medical emergency, as brain and organ damage occurs rapidly due to the rapid constriction of airways, decreasing oxygenation throughout the system.  Normally anaphylaxis is treated by the administration of epinephrine (or adrenaline), however, this is not something you want to be administering to a patient whose blood you want to circulate as little as possible so as not to spread the venom.  Therefore, the anti-venom/venin must be administered at a veterinary facility through an I.V. over the period of several hours… it can only be administered as quickly as an anaphylaxis can be treated.

Note: Recently new brands of anti-venom have been created and the likelihood of anaphylaxis is much, much less.  It is a possibility though. 

Note: One vial of anti-venom/venin is over $600 and does not HAVE to be given.  It is given upon request and most vets don’t carry it.  Despite the cost and the possible adverse reaction I highly recommend it if given within 12 hours of the bite.  It cannot reverse any damage already done but it can prevent more damage from being done.  This could include organ failure, muscle tissue loss, etc.

 

Immediate but not a medical emergency:

-Excruciating pain- the pain, I hear, comes in waves and drags on.  Even if not bitten on a limb it is likely that the victim will be incapacitated by the pain and will not be able to move much.  The venom is a neurotoxin and paralytic as well.

-Swelling- swelling is the enlargement of organs caused by accumulation of excess fluid in tissues, called edema. The swelling can increase to the point that it damages (possibly permanently) the fascia of the area (fascia is a sheet or band of fibrous connective tissue that separates or binds together muscles or organs) called compartment syndrome.

- Inflammation- Swelling is one of four symptoms of inflammation.   Inflammation is characterized by the following quintet: redness, heat, swelling, pain and dysfunction of the organs involved.

-Bruising- is a kind of injury in which the capillaries are damaged, allowing blood to seep into the surrounding tissue. Sometimes bruises can be serious, leading to hematoma (internal bleeding- excess fluid accumulation, forming a hard lump). If bruising is severe, complications may arise. If internal bleeding inside the tissue is very severe, compartment syndrome may occur, leading to disrupted blood flow due to swelling; this can require surgery. Treatments for severe bruising can include RICE: Rest, Ice, Compression bandages and Elevation, and painkillers.  Massaging severe bruises will worsen the injury. Later in recovery, some light stretching exercises may be appropriate, but it is probably best to consult a doctor If a severely bruised muscle is used too early in the recovery process, bone tissue may be formed inside the muscle, leading to lasting stiffness and pain. The bruising is bright red, purple, black and blue... and there is lots of it. OUCH!!!

-Hematoma- a collection of blood, generally the result of hemorrhage, or, more specifically, internal bleeding.  Hematomas exist as bruises but can also develop in organs.

-Nausea- The extreme pain can be one of many causes of nausea.  Another cause may be adverse effects of many drugs, or the development of ulcers from the many drugs needed to stabilize a patient after a bite.  It is likely the victim will have to take anti-nausea medication during recovery…if nothing else so that the patient can keep other drugs (such as anti-biotics and pain killers) down.

-Painful swelling of the lymph nodes- Mostly in the armpit and/or groin, but potentially in the neck, chest and abdomen as well.  Lymph nodes act as filters, with an internal honeycomb of connective tissue that collect and destroy bacteria and viruses.  These small, bean-shaped body cleansers will attempt to clean the venom out of the system and are likely to swell, bruise, and become hard and painful.

 

Not necessarily immediate but very likely:

Note: many of the symptoms listed above may happen later too.  Just because your pet did not get some of the above listed symptoms immediately, does not mean they will not get them- you need to keep an eye out for ALL of these symptoms for the duration of recovery.

-Stomach and Intestinal Ulceration- Doctors and Vets have no choice but to administer a chemical cocktail when a rattlesnake bite victim enters their care, unless the victim received a "dry" bite with no venom (which would be obvious by the time they got a doctor anyway).  The mixture of drugs used to stabilize and treat the patient often interacts and causes stomach ulcers.  Ulcers are open sores of the skin, eyes or mucous membranes (stomach, etc).  Ulcers have a lengthy healing time, are painful/ uncomfortable, can become necrotic and/or can become infected.  This doesn’t happen immediately, and may not happen at all, but if it does it will require treatment for awhile.

-Muscle Twitching/Fasciculation- These are small, local, involuntary muscle contractions visible under the skin arising from the spontaneous discharge of a bundle of skeletal muscle fibers.  I don't know if this is from the body detoxifying the venom (Wikipedia does indicate this as a ‘side effect’ of ‘poisoning’) or from the multitude of drugs, or from stress and anxiety or something else... either way, it's a little scary.  Calcium and/or Magnesium supplementation may help this condition if it persists.  I wouldn’t give supplementation without a blood test and a recommendation by the doctor/vet first during treatment.

-Post hospitalization infection- For the first several days after the bite the wound and the area around it will seep.  For a 30lb dog with a bite from an 18-24" snake the "seepage" area that we experienced was 4-6" by 1.5-2" of constant drainage.  This is good, as the venom will come out of this drainage with the blood.  Over the period of several days the blood will decrease to a watery drainage.  In some instances it is said to be better to drain the area by "sucking" this out... I personally, am not sure how that would be entirely possible, but I've read that sucking it out might help prevent the necrosis; I don't know that for sure though.  However, the area is extremely prone to infection.  The area cannot be wrapped because wrapping it would hold the toxins in.  So it must be open to air and, therefore, bacteria.  Broad-spectrum anti-biotics must be administered.

-Dermal Necrosis- necrosis is the localized death of living cells. In this case it will be caused by the venomous injection as well as by inflammation.   If this happens, and it likely will, it MUST be treated because cells that die by necrosis may release harmful chemicals that damage other cells.  Treatment is surgical removal of the dead tissue and skin/tissue grafting for tissue replacement.  I have researched everywhere to try and find a way to prevent necrosis after a venomous bite but I can’t find anything.  You can try giving di-methyl-glycine internally for the duration of recovery (as it helps to oxygenate the tissue and may help) and you might try Zinc Oxide ointment topically (only if it doesn’t have other chemical preservatives in it though).  However, there is nothing stating that there is any way to prevent the necrosis.  Either the victim will get it and need surgery, or will get lucky and not need it.  The amount of surgery needed can vary dramatically.  It can be anywhere from a skin scraping to an entire amputation.  If it requires skin grafting it could be as simple as cutting the necrosis out and sowing the gap back together or as difficult as cutting the necrosis out and bandaging the leg to the body for 2 weeks while they grow together, then cutting them apart, leaving skin tissue on both sides.  This could cost anywhere from $200 to $2,000 depending on the circumstance.

There could be more added to this list but I have only compiled the list as of 6 days after the bite.  These are the things I have seen happen or have read are likely to happen.  Keep an eye out for any change in health or attitude, whatsoever.

 

Now, what to do in case of snakebite:

 What TO DO:

-DO keep the victim as calm/immobile as possible.  Increasing the blood flow will also increase the flow of venom throughout the system.  This can increase the likelihood of dermal necrosis and internal bleeding, etc.

-DO try to determine the basics on the snake WITHOUT PUTTING YOURSELF IN DANGER.  Try to assume the snakes size (approximate length and width) color, distinct markings or patterns, and take note of the number of rattles. 

Baby rattlesnakes are born with one rattle, which does not make noise as it doesn't have an additional rattle to rattle against.  Each time the snake sheds it skin (once every 3 to 8 months) it grows an additional rattle.  Four or more rattles is "ideal" (as ideal as it can be considering the circumstances) because baby rattlesnakes often don't know how to control the amount of venom they inject and can cause more damage than an adult.

-DO immediately remove anything from the body that may cause increased swelling below the bite area (i.e. rings, watch, shoes, tight clothing, collars, etc.).  Leaving these things on will be like putting on a tourniquet.  This is very important.

-DO immobilize the bite area and keep it in a neutral to below the heart position.  I found out this is very difficult, carrying a dog like a suitcase is just as uncomfortable for you as it is for them. First, CALL THE LOCAL FIRE DEPARTMENT (see below).  If you are going to carry them at all then attempt to make a sling with a shirt or sweater for small animals.  If you are trying to move a big animal you can also try to make a sling and carry it with the assistance of another person and make it as far as you can and try to meet the fire department somewhere closer to a road or easier access point.

-DO get to the vet or hospital IMMEDIATELY

-DO take a cell phone with you; preferably one cell phone per person. If one person has to run for help and another person has to stay behind there is still a need for communication.  In the situation that I personally experienced I ran for help and called ahead to the nearest vet to make sure the on-call emergency vet was there, ready and waiting for us.  I also asked the vet what to do in the meantime.  Then I could call the person that was left with the dog and tell her what the vet said (since we were separated).  Also, she could call me to tell me where she was and where I could pick her up once I got the car.  Cell phones might save your/your pets life.  There are cell phones available for emergency calls only.  

THE MOST USEFUL SNAKEBITE FIRST AID KIT IS CAR KEYS and a PHONE FOR CALLING THE HOSPITAL/VET. 

-If you are going to be more than 100 feet from your car or a fairly busy road then:

1) DO NOT GO ALONE 

2) BRING A CELLPHONE

Especially in the case of large dogs and people, but in any circumstance... I found out that the LOCAL FIRE DEPARTMENT will come and rescue you in such circumstances, even if it's not your dog.   

-BEFORE YOU GO HIKING DO find out the phone number of the nearest fire department.  I'm not sure what would happen if you called 911, but the impression that I got is that it is best to call the fire department directly.

-DO get pet insurance- This covers a lot of stuff.  It will cover at least a portion of everything except regular vaccinations, spay/neuters, and breeding.  It will only cover ACL problems if you’ve had the insurance for more than 12 months but other than that it covers pretty much everything. The cost is monthly and it might be the only thing that will allow you to afford an emergency.  

 

What NOT TO DO:

-DO NOT try to kill/capture the snake because this may lead to additional bites and delay your arrival at the hospital or vet.

-DO NOT use a tourniquet.  Doing this is basically making the decision to amputate.  You can use a ligature and tie off the area with a piece of cloth loose enough to fit your fingers underneath. This will constrict the blood-flow slightly but will not kill the entire limb or cause compartment syndrome, as a tourniquet would.

-DO NOT make an incision at the bite site.  If you are not a trained professional you may cause more damage than the bite itself, causing lethal bleeding or infection.

-DO NOT suck the venom with your mouth.  Not only could this cause you, potentially the only rescuer on site, to get sick, but your mouth is most certainly dirtier than the bite.  It is already likely that the bite will cause necrosis that will need surgery and skin grafting, adding the bacteria in your mouth to this equation could make the injury much worse and much more infected.

-DO NOT pack the limb in ice.  Again, this is making the decision to amputate.  Yes, the venom being in the system sucks but if the whole body takes some there is a chance everything will be fine, rather than needing an amputation.  On average there are 8,000 rattlesnake bites per year (this number is probably very low because many are not reported) and, on average, only 7 people die of rattlesnake bites per year.  Amputating a limb is generally not necessary unless someone does something to CAUSE it.

 

Six ways to distinguish venomous snakes from their non venomous relatives:

-Rattles at the end of the tail

-Fangs in addition to their rows of teeth

-Facial pits between the nostrils and eyes

Note on facial pits: these pits are the reason rattlesnakes are called "pit-vipers".  These pits detect heat... as a matter of fact they can detect heat differences of 1/10th of a degree difference from the background.  This is how they aim to strike, as they cannot see well and they don't hear at all.  Because of these pits, even if a rattlesnake has been decapitated, IT WILL STILL BITE if the pits detect heat in front of the face.  Do not attempt to pick up the head of a venomous snake even if it is decapitated from the body.

-Vertical and elliptical pupils that may look like thin lines in bright light. (Non venomous snakes have round pupils)

-A single row of scales between the vent and the tip of the tail. (Non venomous snakes have two rows of scales)

-Broad triangular head and narrow neck.

 

When are people/pets most likely to encounter snakes? 

-Medium temperatures- Snakes are reptiles and can, therefore, not regulate their own body temperatures.  Despite popular belief, they cannot tolerate extreme heat (or cold).  On days of temperatures between 50 and 85 degrees they are more likely to be out sunning themselves on rocks, in the middle of trails, in grassy areas, etc.  These are the days that hikers and pets are most likely to receive “surprise” bites, as no one will have to be snooping to step on a snake.  Its likely they will be right out in the open, on a trail, and blending with the background.  Only on mid-temperature days will snakes be out to sun themselves... it was 65-70 degrees on the day that my dog got bit... the snake was sunning itself in the middle of the hiking trail.  NO ONE knew it was there. It did not rattle until after it had done its damage and we had moved away from it.

-Hot/Cold temperatures- They need cool, damp shelters on hot days and are likely to be found in shady areas.  On cold days they are likely to be found in sheltered, rocky or ‘burrow’ type areas.

These are they days that your pet might get into them if your pet is a curious snoop- in which case I hear there are places you can take your dog to GET BIT by non venomous snakes to teach them to leave snakes alone. 

-Interesting fact, just because you go out when it's wet and/or you don't hear a rattlesnake out, doesn't mean they're not out... Rattlesnakes’ rattles can saturate with water and, when rattled, don't make noise.  They may still be out and you just can't hear them.

 

The best preparation/prevention:

-Know enough about venomous snakes to know when and where they might be.  Know what temperatures might cause them to be out, what altitude they don't go above (some rattlesnakes can be found up to 9,500 ft) what seasons they are out and when they mate, etc. 

-Call parks ahead of time to find out if there have been any snake bites or sightings reported in that area and when.

-Find out the phone number of local fire departments and hospitals/veterinarians

-Wear long, loose pants and calf-high leather boots, or preferably snake guards.

-Sweep areas with a long stick (such as a hiking stick) before entering if you think there is ANY possibility there might be a snake ahead... if you can't see an area, such as spot between rocks on an otherwise clear trail, there may be a snake there.

-Keep your pet on a leash and/or take them to snake "classes"

-Never jump over logs, turn over rocks, put your hands in crevices, or sit down without first carefully checking for snakes. 

REMEMBER, RATTLESNAKES DO NOT ALWAYS SHAKE THEIR RATTLES BEFORE STRIKING, so do not rely solely on you sense of hearing. 

-If you are confronted with a rattlesnake, remain calm and still at first, then try to back away slowly and carefully.

 

Rattlesnake repellents include:

Dr. T's Snake-A-Way (7% naphthalene and 28% sulfur), gourd vines, moth balls, sulfur, cedar oil, tacky bird repellent, lime, cayenne pepper spray, sisal rope, coal tar and creosote, liquid smoke, artificial skunk scent, and musk from a king snake (they eat other snakes).

HOWEVER, it has been shown that if a snake really wants to, it will cross into repellent treated areas.  Also, none of these things have been shown to be immediately effective.  They are used to treat backyards, under houses, etc.  Places that can be treated on a daily or weekly basis.

 

More information:

www.ext.colostate.edu/pubs/natres/06501.html

www.emedicine.com/EMERG/topic540.htm

http://coloherb.org/geo/species/specrvi.php

Rocky Mountain Poison and Drug Center

Colorado Toll Free: 800-332-3073

Denver Metro: 303-739-1123

National Toll Free: 800-222-1222

 

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