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Najakcharmer -> RE: advice: too many tan spiders (7/17/2008 11:32:17 PM)
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ORIGINAL: DomAviator
Just to add something to the discussion between Rule and Naja... Rule, being totally serious, if envenomated by a snake in the United States - it is HIGHLY unlikely that the doctors found in an emergency room will have a clue of what to do for you.
If you mean exotic snakes, that is correct. For native snakes the results are a little better, though unfortunately not much.
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Ironically, the doctors are probably going to call a group of Paramedics in Miami (VenonOne) to ask what to do and if its an exotic non-native species and you are really lucky one of those Paramedics will come to the ER with a cooler containing the appropriate antivenim and will tell them how to manage your bite. There are a few doctors who are experts in snakebite - but the real "national authority" is VenomOne of Miami Dade Fire Rescue.
Yes and no. That team has had a lot of practical experience in delivering antivenom and getting people through envenomations, but they are paramedics, not doctors, and they have made a number of judgment calls that are controversial to say the least. I would call Richard Dart, Barry Gold, Julian White or Sean Bush long before calling VenomOne, if expert advisement was what was wanted. If delivery of exotic antivenom is what is required, there are no other options if you don't stock your own. Which, IMO, is pretty fucking stupid because time is tissue in these cases and you really want to start that AV drip goddamn quick if envenomation symptoms are confirmed and as soon as you have paramedics present. In practice that means you start your own AV drip at your own facility if you're a smart cookie. Waiting for Venom One to arrive, not so much. They are as fast as humanly possible, but they can never be faster than the local ambulance and your own AV drip started the moment they walk in the door.
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There are HORROR STORIES of people who have been bitten. The few doctors who will even pretend to "know what to do" think thta means "Administer CroFab Antivenin" regardless of whether the bite is an actual envenomatiion or if it is a species that is covered by CroFab! If bitten by an exotic, or a m fulvis, or anything other than a crotalid or cottonmouth CroFab is useless as tits on a bull.
CroFab and Wyeth have limited cross reactivity against some New World species, but the range is very limited. I've heard those horror stories too, and worse. Fasciotomy in a purely neurotoxic bite, for instance. *shudder*
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Equally bad is premature administration of the antivenom. Most north american hots deliver a "dry bite" with little or no venom. In such a case what you really need in the ER is observation, monitoring, prophylactic antibiotics and a tetnus booster. (Hence the reason you dont go nuts with the debridement and the cutting and sucking etc...) However, if there is a "real" bite then it can be VERY severe and it requires treatment with antivenom, the right one, and things can get funky fast.
So true on the dry bites. I wouldn't say it's equally bad, but it wastes expensive antivenom. Good protocol is to start an IV drip and reconstitute the AV as soon as symptoms are confirmed.
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If you go into the hospital in the USA with a snake envenomation- you damn well better be prepared to tell them how to treat you, or to tell them to get on the phone with VenomOne or the local zoo / serpentarium. Your average ER doctor withh NEVER in his career see a snake envenomation from even a North American native, much less some foreign exotic. In a place like South Africa the doctors do know how to treat Mamba bites, Cobra bites etc ...
Very, very true. In the case of exotic snakebite, I suggest having Richard Dart's Medical Toxicology and Julian White's Clinical Toxicology physically on hand when you hit the hospital, and someone experienced in snakebite management to advocate for you if you lose consciousness, or you're potentially fucked as a lot of ER docs still use the old, harmful protocols and do not know about the new ones. If you don't have those things, get on the phone to Colorado Poison Control to get Richard Dart or the Maryland Poison Control to get Barry Gold. There are some unbelievable horror stories from keepers who didn't do that and were left to the management of doctors who hadn't a clue but thought they did.
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(Hell even the hunting guides do and carry a kit with 2 vials of SAIMR Polyvalent and a needle) However, these conditions are not generally seen in the US and the antivenin isnt even in the hosptial pharmacies its at the zoos, serpentariums, and private hands.
SAIMR is not hugely effective administered intramuscularly; I'm too lazy to get up and read the package insert just now, but if memory serves the efficacy goes down to something like 10-20%. Given the starting dose is 5 vials IV, 2 vials IM is not going to be a whole lot of help. An intravenous push with a standard syringe carries a very high risk of anaphylaxis, which will kill you faster than the snake bite. Also the stuff precipitates out of solution in unstable temperatures, so carrying it in the field is of dubious value unless you're also carrying epinephrine, IV drip equipment and a manual ventilator or bagging mask to manage the potential risk of anaphylactic shock.
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