9/1 Wilderness Medicine Wednesday

Today's post is about snake bites!

 by Coach Nick
Happy Wednesday everyone and happy September! It's crazy how fast this summer has gone by, I hope you have all enjoyed it and getting ready for school to start and fall to begin. Today's post is going to be about something that most of us hate: snakes, specifically snake bites. As the night time temperatures start to cool it can be increasingly common to see our least favorite cold-blooded reptiles sunning themselves during the day on our favorite hiking trail. While the presence of rattlesnakes is less common in some areas around here there are also areas that have a lot of them such as Beartrap Canyon. However, most research says that rattlesnakes can live up to 9,500ft in elevation so we should not completely discount them. Today I am going to go over ways to prevent snake bites, how to treat them, and dispel a few common myths, I hope you enjoy and learn something!

First and foremost the best way to prevent snake bites is to watch where you are walking or reaching. Most snake bites occur on feet and hands which is the result of people stepping on them or reaching into areas where a snake is living. Contrary to popular belief, rattlesnakes are not aggressive and usually will not just "go after" a person. Bites occur virtually every time as a result of a snake feeling threatened and us invading their space. I hope this goes without saying but don't try to pick them up, you'll get bitten. Practice good bite prevention by knowing when you're in an area with a high snake population (think dry, rocky, sage brushy areas, farms, and near rivers) and pay a little extra attention to where you step or put your hands, especially on the back side of rocks and logs. Luckily our rattlesnake friends have rattles that they will typically use to warn you not to come any closer, I advise heeding that warning. A note about dogs: I highly recommend keeping your dog on a leash or under very tight control when you're in these areas. Most dogs are naturally curious and are much more likely to get bitten. Most bites will be on their nose as they will be sniffing these areas and unfortunately will be fatal due to the restriction of their airways so keep an eye on your dog!

As it's impossible to prevent every scenario let's talk about what happens if you get bitten (we are specifically talking about rattlesnakes in Montana here, this is NOT true for all snake bites). If you or a member of your group gets bit the first thing to keep in mind is not to panic. Most snake bites (in the Western U.S) are not fatal as long as you get to a hospital in a reasonable amount of time. The first thing you need to worry about is anaphylactic shock. If this starts to occur it means you're severely allergic to the venom, obviously there's no way to know this until/if you get bitten. This is a serious emergency, if your group has an Epi-pen, use it and evacuate. If not, give the patient Benadryl and get them out of the woods ASAP. Assuming that anaphylaxis does not occur you're more or less in the clear in terms of threat to life. The treatment steps from here are pretty simple: clean and disinfect the wound as if you would any other, bandage it LOOSELY (I'll get into this in a minute) with a wrap, and get the patient out (if they can walk, let them). That's it. Rattlesnake venom is not inherently fatal and the best thing to do is let it run its course through the patient. The best thing to do for the patient is keep them calm, give them tons of water, and get them to the hospital. Continue to monitor them for signs of allergic reaction and be ready to respond to anaphylactic shock. Expect to see them in a lot of pain and potentially running a fever but their life is not usually in jeopardy. Localized swelling is also common, make sure you take off any kind of jewelry they are wearing. For a peek behind the curtain, when they get to the hospital they are not going to be given some kind of anti-venom. The doctors will put them on an IV to help flush the toxin through their system and give them drugs to help manage the pain. 

Now, time for some myth busting and explanation since come of this may be surprising information. There are two general kinds of snakes un the U.S: pit vipers (rattlesnakes, cottonmouths, and copperheads), and coral snakes. The only ones we need to worry about in MT are rattlesnakes. The venom of NORTH AMERICAN pit vipers is not inherently fatal unless you suffer anaphylaxis. There are some dumb myths out there that you should suck out the venom or apply a tourniquet-like device to the patient: don't do that. Sucking out the venom should be pretty obviously not a good idea (remember my post about creating 2 patients?). The tourniquet is a little more nuanced. Since the venom is not fatal we actually want it to spread around our bodies to "dilute" it if that analogy makes sense. This is why it's okay to let the patient walk out on their own if able because it encourages blood flow. There is one exception to this: if you're bitten by a coral snake (not in MT, mostly Florida and the South) the venom works differently and we want to stop that one from spreading, not the case with rattlesnakes. It's also possible to receive what's called a "dry bite" this is when the snake bites you but does not release any venom. You should still treat these bites the same but if the patient doesn't start to exhibit further symptoms this is probably the case. There's a popular myth out there relating to dry bites and it's that baby snakes are more dangerous than big snakes. The theory is that baby snakes can't control their venom release so you will always be fully envenomated which makes them the most dangerous. While it's true that you are more likely to be envenomated it does not follow that baby snakes are more dangerous. Rattlesnakes have more or less venom based on their size so big snakes carry more venom and are therefore more dangerous if they do decide to release venom when they bite. As I have tried to state many times this advice applies only to snake bites in the continental U.S. If you are traveling make sure to look up local wildlife as some parts of the world have much more deadly snake species. 

As always I hope none of you every have to use this information but if the need arises I hope this post was helpful. Have a great week everyone!
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