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Fri Mar 23 12:27:28 GMT 2012

My favorite snake stupidity story involves a diabetic with advance retinopathy who kept a live Western diamondback rattlesnake as a "pet" in a glass herpetarium at home.

Most common pre-mortem "last words" in Texas-- "Hey, y'all, watch this!"

I was born and raised in Texas, so I can make fun--the rest of you better watch it!

Al

On Mar 22, 2012, at 9:14 PM, Ian Seppelt wrote:

> Thinking of all the snakebites I have treated:
> 
> - the vast majority involve sheer stupidity (amateur herpetologists beyond their skill levels, or individuals with impaired sense due to various substances "let's poke this snake and see what happens" etc).
> - professional herpetologists hardly ever get bitten
> - the occasional person gets bitten in remote areas eg down a canyon (bad luck)
> - children touch things they shouldn't
> - I have had one patient who was a middle aged woman just minding her own business gardening ...
> 
> Snakes are common but are more scared of us than we are of them. I have snakes in my backyard and occasionally around the house. I teach my kids to be sensible, not put hands anywhere dark without looking first - especially careful of the woodpile and behind the shed (where I know a black snake lives), and if they do see a snake 'look don't touch, walk away don't panic'. No point trying to get rid of them - if you have a nice snake habitat then another will move in just as soon as one has been relocated. Treat them with a bit of respect and they are fine.
> 
> I also have a breeding colony of redback spiders in the shed if anyone wants some, and some funnelwebs up the back near the arena ......
> 
> Ian Seppelt,
> in a semi-rural area in the west of Sydney.
> 
> On 23/03/12 11:43 AM, John Holmes wrote:
>> Australia !   You really have to either grossly stupid or unlucky to get bitten.  It's just not an issue unless you're deep in the outback looking for trouble.
>> 
>> :)
>> 
>> John
>> 
>> Dr John L Holmes
>> Senior Staff Specialist
>> Department Emergency Medicine
>> Caloundra Hospital
>> Queensland  4551
>> 
>> Australia
>> 
>>> Date: Thu, 22 Mar 2012 20:38:10 -0400
>>> Subject: Re: Fasciotomy after viper bites
>>> From: bryanboling at gmail.com
>>> To: trauma-list at trauma.org
>>> 
>>> Not to change the subject, but as someone who loves tropical and
>>> semi-tropical weather but is absolutely TERRIFIED (i can BARELY stand being
>>> in the reptile house at the zoo, i probably need professional help, huh?
>>> :-) of snakes, is there anywhere on Earth I can get the great weather
>>> combined with a lack of the slithering devils? :-)
>>> Bryan
>>> 
>>> On Thursday, March 22, 2012, John Holmes<docjohnholmes at hotmail.com>  wrote:
>>>> Totally agree with Ian; the treatment of snake envenoming needs to be
>>> specific to the different snakes in different continents.
>>>> Here in Australia our elapids' toxins comprise varying combinations of
>>> neurotoxins, myotoxins and most significantly haemolysins and
>>> coagulotoxins.  Local tissue necrosis is only a minor component of
>>> Australian snake venoming.
>>>> There has also been a long development of antivenom development in this
>>> country and current antivenoms are (relatively) antigenically "clean".
>>>  Interestingly new evidence points to much lower dosage of antivenom
>>> whereas a few years ago much larger doses were being advocated.  Despite
>>> this, there is no doubt that in severely coagulopathic snake bite
>>> envenomings, the use of appropriate amounts of antivenom has saved
>>> countless lives in this country.
>>>> John
>>>> 
>>>> 
>>>> Dr John L Holmes
>>>> Senior Staff Specialist
>>>> Department Emergency Medicine
>>>> Caloundra Hospital
>>>> Queensland  4551
>>>> 
>>>> Australia
>>>> 
>>>>> Subject: Re: Fasciotomy after viper bites
>>>>> From: seppelt at med.usyd.edu.au
>>>>> Date: Fri, 23 Mar 2012 07:15:17 +1100
>>>>> CC: trauma-list at trauma.org
>>>>> To: trauma-list at trauma.org
>>>>> 
>>>>> This advice may well be perfectly correct for many (most?) snakes around
>>> the world but completely wrong for Australian elapids (which include many
>>> of the world's most venomous).
>>>>> Not every snake bite needs antivenom but severe envenomation certainly
>>> does and it is very dangerous advice to suggest avoiding antivenom and
>>> treat severe coagulopathy with just coagulation factor replacement.
>>>>> Bottom line is that snakes are not the same around the world. You must
>>> know the right treatment for snakebites where you work but do not assume
>>> exotic snakes from elsewhere in the world are the same - seek expert advice.
>>>>> Ian Seppelt
>>>>> 
>>>>> On 23/03/2012, at 4:10 AM, Kenneth Mattox<kmattox at aol.com>  wrote:
>>>>> 
>>>>>> At the BTGH, over the years, we have had our share of poisonous snake
>>> bites, from snakes indigenous to the area (to include water moccasin
>>> snakes, copperhead snakes, rattlesnakes, and coral snakes), to those owned
>>> by snake handlers, to include all sorts of vipers from Africa, India, and
>>> Australia (including cobras, etc), to those used and housed by companies
>>> who own all varieties of poisonous snake in order to make pharmaceuticals,
>>> to those housed in the local zoo snake house and have occassionally bitten
>>> the snake handlers.
>>>>>> We have chosen to evaluate each and every snake bite separately and
>>> have NOT been fans of antivenin for any snake bite, including coral and
>>> cobra bites.    We DO wide and complete fasciotomies for  ANY compartent
>>> syndrome, regardless of the cause IF we demonstrate increased compartment
>>> pressures.     During the past 30+ years we have probably done no more than
>>> 3-5 fasciotomies in patients with snake bites, and those were rattlesnake
>>> bites in the forearm or hand.
>>>>>> Should a snake bite victim develope respiratory insufficiency they are
>>> admitted to the ICU and ventilated for a day  or so..    If they develop a
>>> coagulopathy, we treat the deficit specifically.
>>>>>> For patients who have received antivenin in OTHER hospitals we see
>>> high rates of serum sickness several weeks later.     We have had ONE digit
>>> loss and no extremity losses .     The digit loss was a necrotic finger
>>> which was necrotic and many hours post bite when the patient came in, and
>>> it too was a rattlesnake bite .
>>>>>> K Mattox
>>>>>> 
>>>>>> 
>>>>>> -----Original Message-----
>>>>>> From: Pradeep Navsaria<Pradeep.Navsaria at uct.ac.za>
>>>>>> To: trauma-list<trauma-list at trauma.org>
>>>>>> Sent: Thu, Mar 22, 2012 4:26 am
>>>>>> Subject: Re: Fasciotomy after viper bites
>>>>>> 
>>>>>> 
>>>>>> The treatment of a compartment syndrome, irrespective of cause, is a
>>>>>> fasciotomy!
>>>>>> 
>>>>>> Pradeep
>>>>>> 
>>>>>> 
>>>>>> Trauma Center
>>>>>> Cape Town
>>>>>>>>> Miranda Voss<mvossak at yahoo.co.uk>  2012/03/22 10:56 AM>>>
>>>>>> Dear List Members,
>>>>>> 
>>>>>> It is still pretty much standard teaching in South Africa that if you
>>>>>> suspect a compartment syndrome after a cytotoxic snake bite, you should
>>>>>> do a fasciotomy. I see that there are now recommendations -
>>> particularly
>>>>>> from WHO - that fasciotomy in cytotoxic snake bite should be avoided if
>>>>>> at all possible. I believe the concern is bleeding from associated
>>>>>> coagulopathy, but I am uncomfortable with this. Would anybody here not
>>>>>> do a fasciotomy for a cytotoxic snake bite with limb swelling and pain
>>>>>> on passive stretch of the flexor muscles? We have never measured
>>>>>> compartment pressures because we teach that a suspected compartment
>>>>>> syndrome should be treated with fasciotomy. Does anybody else have a
>>>>>> view? I have seen the pictures on the WHO website of patients bitten by
>>>>>> Asian snakes and needing massive transfusions after "unnecessary"
>>>>>> fasciotomy but they may be dealing with different animals.
>>>>>> 
>>>>>> Thanks,
>>>>>> Miranda Voss,
>>>>>> Worcester, South Africa.
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> 
> -- 
> Dr Ian Seppelt FANZCA FCICM
> Senior Specialist in Intensive Care Medicine
> Nepean Hospital, Penrith NSW
> Sydney Medical School - Nepean, University of Sydney
> 
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> trauma-list : TRAUMA.ORG
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Fasciotomy after viper bites