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***************ANTIVENOM SOURCES************************

MIAMI ANTIVENOM BANK  (Miami-Dade Fire Rescue) Venom Response Team

24hr. emergency office #: (786) 331-4454 or (786) 336-6600

24hr emergency cell #: 786-229-0736

Address: 9300 NW 41st Street, Miami, FL 33178

Email: MDFRantivenom@miamidade.gov

Web page: http://www.miamidade.gov/fire/about-special-venom.asp

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Hunter Serpentology (Ray Hunter, Sc.D.)

24hr Emergency direct #: (772) 215-7625

Address: P.O. Box 2459, Miami Gardens, FL 33055

Email: RayFHunter@gmail.com

Web page: www.Cobraman.net

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Miami Serpentarium Labs

Phone: 941-639-8888

email: Nancy@miamiserpentarium.com

Web page: www.miamiserpentarium.com

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Reptile World Serpentarium (George VanHorn)

Phone: (407) 892-6905

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*****************QUICK POST-BITE REPORT***********************

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The purpose of this is to quickly write down important details that can effect treatment, and bring to E.R. with bite victim, in case something happens to the victim before arrival at hospital (eg - car accident, patient goes unconscious)

Name: _____________________________________ D.O.B.:________________

Address:___________________________________________________________

Next Of Kin (emergency contact):______________________________________

Phone:___________________ Address:__________________________________

Family Physician:________________________Allergies:_____________________

(the above fields should be pre-filled out to save time)

Bite Date:_______________________Time of Bite:_________________________

Location of Bite (on body):_____________________________________________

Type of Snake:___________________________Scientific Name:_______________

Size of Snake:_____________________Is Snake Secured ? :__________________

ACTION TAKEN:

Time:____________ Action Taken:_______________________________________

Time:____________Action Taken:________________________________________


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*****************EMERGENCY DISASTER PLAN***********************

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               DISASTER PLAN   for Hunter Serpentology, LLC

 

 

 

In the event of a natural disaster or crisis, these steps will be implicated in order to preserve the safety of the animals and people with in the facility.

 

·       ALL venomous snakes will be double bagged and placed back inside their locked enclosures.

 

·       ALL species of special concern and non native exotics will be either single bagged or placed in secure enclosures.

 

·       The HOT room will remained locked and access granted only to facility owner/manager.

 

·       In the event the facility must be abandoned, warning signs will be strategically placed as to alert rescue personnel of the inherent danger. Signs will include owner/managers name and contact information. (Emergency and or cell number).

 

·       When operations return to normal, the facility owner /manager will contact FWC to confirm status of facility.

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*************** DO's & DON'Ts of SNAKEBITE **********************

The only proven effective first aid for a snake bite is antivenom.....Get the patient to hospital ASAP


Following the correct snakebite protocol when treating a snakebite victim is extremely important.
There are countless myths and fallacies concerning the first aid treatment of snakebite.
Incorrect procedure more often than not increases the damage already done by the venom, and could lead to further complications.


What NOT TO DO:

* Do not try to suck out the venom. This is ineffective and a total waste of valuable time.

* Do not attempt to cut open the area around the bite. By doing this, you are only aggravating the situation, doing more damage by exposing more tissue and cutting veins, arteries and nerves.

* Do not apply ice to the bite area.

* Do not rub any substances into the bite.

* Do not apply a tourniquet. By restricting the blood flow with a cytotoxic (tissue destroying) venom, you will only succeed in creating further tissue damage to the affected area, and cause morbidity of the limb.

* Do not inject anything, including antivenom unless you are qualified to do so. Anyone prone to allergies and asthma may go into anaphylactic shock as a result of the antivenom entering the bloodstream which results in a sudden drop in blood pressure and may prove just as fatal as the venom itself. Hospitals and medical staff are equipped to deal with such an eventuality.

* Do not give anything orally to the victim.

* Do not kill or try to catch the snake for later identification. This is unnecessary as the venom can be correctly identified symptomatically. By trying to catch and kill the snake you are risking another bite.

* Do not use traditional remedies. Any treatments offered by traditional healers, witchdoctors, and Shamans are ineffective. Antivenom is the ONLY proven effective treatment for snakebite.



WHAT TO DO :                                                                                                                * #1 PRIORITY - GET TO THE NEAREST HOSPITAL. No action or measure of first aid should delay transportation of the bite victim to the hospital. 9-1-1 can be called for rapid transport to the nearest hospital.

* If the snake is still visible (or within striking distance), move away to minimize the risk of a second bite.

* If at all possible try to identify the snake if it is still visible as this will help the medical staff in providing the best medical care. If the snake has moved away and is no longer visible do not go looking for it. You are increasing the risk of another bite. Remember, identifying the snake is helpful, but not paramount in treating the victim.

* Reassure the victim. Keep the patient calm.

* Restrict movement. Excessive movement speeds up blood circulation and thus distributes the venom through the body at a faster rate.

* Remove all restrictive jewelry. Remove watches, rings, bracelets etc.

* Cut away restrictive clothing. This exposes the bite area, and allows the venom to spread away from the bite site and reduces the tissue damage.

* Keep the patient warm. This reduces the risk of shock.

* Be prepared for CPR. Maintain airways and ensure proper ventilation and maintain cardiovascular integrity.

* Immobilize the affected limb with a splint or sling to reduce the venom distribution.

* Monitor the vital signs until you reach a medical facility.

* Contact the hospital informing them of the patients arrival. This will save valuable time.

* If at all possible be aware of the victim’s medical history. This will also assist the medical staff in treating the bite.




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**************** CORAL SNAKE BITE PROTOCOL *******************


Coral Snake Envenomation

Background

Approximately 40-50 species of venomous coral snakes exist in North America and South America, with the greatest variety from Mexico to northern South America. All coral snakes belong to the family Elapidae; Micrurus fulvius (eastern coral snake) and Micrurus tener (Texas coral snake) are the most important species in the United States. Another US coral snake is Micruroides euryxanthus (Sonoran or Arizona coral snake); this is a relatively innocuous snake, and no deaths have been attributed to its bite. The mnemonic "Red on yellow, kill a fellow," may be helpful in the United States, but south of Mexico City, the banding patterns vary and are much less helpful, and bicolor (red and black) species are also present.

Coral snakes tend to be relatively shy creatures, and bites are uncommon. Coral snakes account for fewer than 1% of venomous snakebites in the United States. Most people bitten by coral snakes are handling them intentionally.

Pathophysiology

The coral snake venom apparatus is composed of a pair of small, fixed, hollow fangs in the anterior aspect of the upper jaw. Unlike pit vipers, such as rattlesnakes, copperheads, and cottonmouths, which strike quickly, coral snakes must hang on for a brief period to achieve significant envenomation in humans.


Coral snake venoms tend to have significant neurotoxicity, inducing neuromuscular dysfunction. They have little enzymatic activity or necrotic potential compared with most vipers and pit vipers. These venoms tend to be some of the most potent found in snakes, yet the venom yield per animal is less than that of most vipers or pit vipers. Because of the relatively primitive venom delivery apparatus, as many as 60% of those bitten by North American coral snakes are not envenomed. Probably fewer than 20 bites per year are reported in the United States.

 

Mortality/Morbidity

No deaths related to coral snake bites have been reported in the United States since coral snake antivenom became available. Before that time, the estimated case-fatality rate was 10%, and the cause of death was respiratory or cardiovascular failure. Patients who survive the bite may require respiratory support for up to a week and may suffer persistent weakness for weeks to months.


Symptoms may include the following: Onset of symptoms may be delayed up to 10-12 hours but may then be rapidly progressive. Metallic taste, Local paresthesias (may be painful, but usually not), Soft tissue swelling (usually mild) Alteration of mental status, Complaints related to cranial nerve dysfunction (eg, diplopia, ptosis, difficulty swallowing)

Physical

Physical findings of snake bite may include the following: Impending respiratory failure Respiratory distress Pharyngeal spasm Hypersalivation Cyanosis TrismusNeurologic dysfunction Altered mental status Ptosis Generalized weakness Muscle fasciculationsCardiovascular collapse Hypotension TachycardiaWorkup

Laboratory Studies - No laboratory studies are of diagnostic benefit. Baseline laboratory studies (eg, complete blood count [CBC], electrolyte tests, renal function studies) may be obtained in severe bite cases or if the patient has significant underlying medical problems. Coagulation studies are not indicated. An arterial blood gas (ABG) determination may be helpful if the patient's respiratory status is of concern.

Imaging Studies - A chest radiograph is beneficial in patients who have severe envenomation, who require intubation, or who show evidence of cardiopulmonary failure.Treatment

Prehospital Care

Of utmost importance is prompt transportation of the victim to a medical facility capable of rendering advanced care, including possible airway support.Briefly attempt to identify the snake (especially, note the color pattern). If possible, take a digital photo of the snake from a safe distance. Efforts to catch or kill the animal can result in wasted time and further bites. No incisions are indicated. Suction is of no benefit and may be harmful. Avoid applying ice or initiating any other cooling measures.

Emergency Department Care - Aggressively manage any signs of impending respiratory failure with endotracheal intubation to prevent aspiration. Immediately institute cardiac and pulse oximetry monitoring. Monitor vital signs closely. Start at least one large-bore intravenous line of normal saline or Ringer's lactate at a maintenance rate. If evidence of hypotension or hypoperfusion is present, select an appropriate, faster rate. Although numerous recommended grading scales are available for judging the severity of pit viper bites, these scales rely heavily on local findings, which are often minimal in coral snake bites. Do not use such scales for coral snake bites. Because of the lack of early signs and symptoms, the severity of coral snake bites may be underestimated at presentation. Maintain a high index of concern. Historically, if the snake was positively identified as an eastern or Texas coral snake and the victim was asymptomatic, or if signs and symptoms of envenomation were already present, the recommendation was to obtain and immediately administer appropriate antivenom. In the United States, however, as of October 2008, all available stocks of Wyeth's North American Coral Snake Antivenin will have expired, and this country will find itself without a commercially available antivenom. Some research centers may have access to other Micrurus antivenoms that may be useful on a research or compassionate care basis in cases of severe bites.

 Absent an available antivenom, victims can be managed with sound supportive care (as outlined above) with an expectation of excellent outcome as long as airway management and respiratory support are adequate, though ventilator dependence could persist for many days following serious bites.

As with any form of bite, tetanus status should be updated as necessary.

Antibiotic prophylaxis is not indicated. Because of the relative paucity of enzymatic necrotic components in their venoms, coral snake bites tend to cause little local tissue damage, and secondary infections are rare.

Admit all persons bitten by a coral snake to a closely monitored facility, whether or not antivenom is given. Observe asymptomatic patients for at least 24 hours because delayed signs and symptoms may occur. Considering the potential delay in onset of signs and symptoms, it is unwise to discharge asymptomatic patients with possible coral snake bite.

ConsultationsConsult a toxicologist or expert in snakebite management.

Robert L Norris, MD, Associate Professor, Department of Surgery; Chief, Division of Emergency Medicine, Stanford University Medical Center

Updated: Dec 17, 2008

Edited by Ray Hunter, Sc.D. Hunter Serpentology


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********************* Rattlesnake Bite Protocol ***********************

IMMEDIATE FIRST AID
for bites by
United States Rattlesnakes
(Crotalus species)

 

Edited by Ray Hunter, Sc.D.
 

In the event of an actual or probable bite from a U.S. or Canadian rattlesnake, execute the following first aid measures without delay.

Snake: Make sure that the responsible snake or snakes have been appropriately and safely contained, and are out of danger of inflicting any additional bites.

Transportation: Immediately call for transportation.

Telephone:

Victim: Keep the victim calm and reassured. Allow him or her to lie flat and avoid as much movement as possible. If possible, allow the bitten limb to rest at a level lower than the victim's heart. Identify the bite site, looking for fang marks, and apply the Sawyer Pump extractor with the largest cup possible over the bite site. If there are two or more fang marks noted on the limb, apply the pump extractor over at least one fang mark. If more than one pump extractor is available, they may be applied to the additional fang marks. Immediately wrap a large constricting band (ACE WRAP) snugly about the bitten limb at a level just above the bite site, ie. between the bite site and the heart. The constricting band should be as tight as one might bind a sprained ankle, but not so tight as to constrict blood flow. DO NOT remove the constricting band until the victim has reached the hospital and is receiving Antivenom.

DO NOT cut or incise the bite site.
DO NOT apply ice to the bite site.

 

 

 

 

 

 

Summary for Human Bite
by
United States & Canadian Rattlesnakes
(Crotalus species)

The bite of rattlesnakes is rarely fatal. Victims will usually complain of pain at the bite site and swelling may be evident. Tremendous local tissue destruction can ensue. Prompt medical therapy avoids this problem. Please read the attached and respond appropriately. First Aid: Apply constricting band if not already present, proximal to bite on arms, legs, hands, or feet. Transport to a medical center emergency or trauma service. Medical Management: Call your local Poison Control Center, or the San Diego Regional Poison Control Center (800 876-4766). They should locate a consultant to help you treat this patient. Observe for Signs and Symptoms of Envenomation. If signs or symptoms are present, perform the following: Apply intradermal skin test. Administer Lactated Ringers intravenously at a

rate of 200 cc/hour. Obtain appropriate blood and urine laboratory data. Wait 20 minutes. Reconstitute 5 vials of antivenom in 50 cc Lactated Ringers. If no reaction to intradermal skin test, administer antivenom by intravenous infusion 1 vial (10 cc) every 5-10 minutes. The constriction band can be removed after the first vial has been infused. Monitor signs, symptoms, and laboratory data and

administer additional aliquots of 5 vials of antivenom as needed to neutralize signs and symptoms. Average treatment is 15 vials (range 0-40 vials). If patient is allergic to horse serum, administer 1 gram Solu-Medrol IV push, wait 30-45 minutes, and then begin intravenous antivenom. Be prepared to administer Benadryl and epinephrine. In case of intravenous envenomation, administer

antivenom IV push, 1 vial every 1 minute, until symptoms improve, then continue by intravenous infusion until signs and symptoms are titrated.

MEDICAL MANAGEMENT
for bites by
United States Rattlesnakes
(Crotalus species)

This person has received a bite and probable envenomation from a rattlesnake. There are several species of rattlesnakes within the United States and Canada, envenomation by all of which will be covered by this protocol. Those snakes which are indigenous to Mexico, Central America, and South America, whose ranges do not overlap into the United States, will be covered in separate protocols. Fatalities in modern times are infrequent. The venom can produce a wide spectrum of clinical manifestations, including local tissue destruction, cardiovascular collapse, coagulopathy, and with some species neurotoxic and neuromuscular symptoms.

Please read and execute the following procedures without delay. A constricting band should be in place proximal to the bite site. If present leave in place, if not apply a penrose drain as if for venipuncture. This retards venom absorbtion. DO NOT remove until the patient has arrived at the hospital and is receiving the antivenom. Make sure that at least 20 vials of Crotalidae Polyvalent Antivenom (Wyeth) are available. This antivenom contains the necessary fractions to neutralize the venoms of all United States and Canadian rattlesnakes. If the patient has been envenomated, the initial treatment is 5 to 10 vials of intravenous antivenom. Envenomation is diagnosed by the presence of characteristic signs and symptoms. Necessary information follows and is organized in sections:

Signs and Symptoms of Envenomation

Medical Management

General Considerations

Special Considerations

Consultants

References

Signs and Symptoms of Envenomation:

The specific signs and symptoms which may manifest in a patient who has been envenomated will vary in presence and in severity, depending on several factors noted in the General Considerations below. The time course of development will also vary considerably from case to case. The following list of signs and symptoms represent a general compilation enumerated from a series of 100 cases of rattlesnake envenomation (Russell, 1983). Not all of the symptoms will necessarily develop, even with severe envenomation.
Sign or Symptom Frequency
Pain 65-95/100
Swelling, Edema 74/100
Weakness 72/100
Sweating and or Chills 64/100
Numbness, tingling
(circumoral, lingual, scalp, feet, etc.) 63/100
Pulse rate changes 60/100
Faintness, dizziness 57/100
Ecchymosis 51/100
Nausea and/or vomiting 48/100
Blood pressure changes 46/100
Numbness, tingling in the affected part 42/100
Decreased blood platelets 42/100
Fasciculations 41/100
Vesicles or boli 40/100
Regional lymph adenopathy 40/100
Respiratory rate changes 40/100
Increased blood clotting time 39/100
Decreased hemoglobin 37/100
Thirst 34/100
Change in body temperature 31/100
Local tissue necrosis 27/100
Abnormal electrocardiogram 26/100
Glycosuria 20/100
Increased salivation 20/100
Spearing of red cells 18/100
Cyanosis 16/100
Proteinuria 16/100
Hematemesis, hematuria, melena 15/100
Unconsciousness 12/100
Blurring of vision 12/100
Muscle contraction 6/100
Increased blood platelets 4/ 25
Swollen eyelid 2/100
Retinal hemorrhage 2/100
Convulsions 1/100

Fang Marks: Fang marks may be present as one or more well defined punctures, as a series of small lacerations or scratches, or there may not be any noticeable or obvious markings where the bite occurred. The absence of fang marks does not preclude the possibility of a bite (especially if a juvenile snake is involved). However with rattlesnake envenomation, fang marks are invariably present and are generally seen on close examination. Bleeding may persist from the fang wounds. The presence of fang marks does not always indicate envenomation; rattlesnakes when striking in defense will frequently elect not to inject venom with the bite, resulting in a dry bite (i.e. no envenomation). Manifestations of signs and symptoms of envenomation is necessary to confirm the diagnosis of snake venom poisoning.

Medical Management: Admit patient to an emergency or trauma service and call the consultant identified by the Poison Control Center. Begin a peripheral intravenous infusion (18 gauge catheter) of Lactated Ringers Solution at the rate of 250 cc/hr. Draw blood from the contralateral arm, and collect urine for the following laboratory tests. Mark STAT. Type and Cross Match TWO units of whole blood. CBC with differential and platelets. Coagulation Parameters: Prothombin Time (PT)Partial Thromboplastin Time (PTT)Fibrinogen levelsFibrin Degradation Products Serum Electrolytes, BUN/Creatinine, Calcium, Phosphorus. Lactate Dehydrogenase (with Isoenzyme analysis). Isoenzyme analysis may indicate multiple targets of venom components which may dictate further management. Urinalysis (Macroscopic and Microscopic Analysis).

Must include analysis for: Free ProteinHemoglobinMyoglobin Electrocardiogram (Sinus Tachycardia would be expected). Intermittent or indwelling Foley Catheter to monitor

urine output may be necessary in the conscious, impaired patient. Additional tests as needed or indicated by the patient's hospital course. It may be necessary or practical to repeat some of the above serum and urine tests periodically over the hospital course to monitor the effects of antivenom therapy or to detect late changes in laboratory values. OBSERVE PATIENT CLOSELY for signs and symptoms of envenomation, which usually manifest between 15 minutes and two hours after the bite occurred. If NONE of the signs or symptoms have been noted after two hours, there is a possibility that the patient received a dry bite (no venom injected). Remove the constricting band, watching carefully for any changes in the patient's status. If any changes occur, assume the patient has been envenomed, and prepare to give antivenom immediately (as directed below). If signs and symptoms still fail to manifest, continue CLOSE observation of the patient for an additional 12 to 24 hours. IF ANY SIGN OR SYMPTOM becomes apparent or has been noted during the course of treatment, begin Antivenom Therapy as follows: Patients manifesting severe symptoms or who are suspected of having an intravenous injection of venom, should be treated immediately with antivenom and should not undergo skin testing. Corticosteroid adjuncts may facilitate the delivery of rapid infusion. One should use the dilutions below, but infuse at a rate of 1 vial (10 cc) per minute. If the patient is exhibiting envenomation, inject intracutaneously the skin test sample included in the antivenom package, sufficient to raise a small weal. The skin test should be read after 15 minutes, but it is wise to check the test area and observe the patient constantly during the period following the injection. If there is no evidence of erythema or vesicular response, the test should be considered negative. A positive test IS NOT a contraindication to giving antivenom, but should alert the clinician that the rate at which the antivenom is delivered and/or the use of corticosteroids may need to be adjusted to control potential untoward responses. Assuming that the above skin testing precautions have been done, reconstitute the contents of 5 vials of Wyeth Crotalidae Polyvalent Antivenom in Lactated Ringers Solution. Vigorously shake the vials to assure that the contents are thoroughly mixed, and that there is a minimum of undissolved particles. Transfer the dissolved solution via a syringe to an IV piggyback setup with a volumetric regulator. Make sure that there are no undissolved particles in the solution transfer. Administer the diluted antivenom intravenously over a period of 10 minutes for the first vial (1 cc/minute). Should any signs of ALLERGY/ANAPHYLAXIS (e.g. coughing, dyspnea, urticaria, itching, increased oral secretions, etc.) develop, immediately discontinue the administration of antivenom and treat symptoms with Corticosteroids, Epinephrine, Benadryl, Atarax, and/or other Antihistamines as necessary. As soon as the patient is stabilized, continue the antivenom infusion at a slower rate. After 10 minutes of antivenom administration, the constricting band may be removed. Assuming that the patient is tolerating the infusion well, additional antivenom may be given at a rate of 1 vial every 5-10 minutes. The first 5 vials should be given over the first hour of treatment. Antivenom Therapy is the mainstay of treatment for rattlesnake envenomation. Many of the symptoms are ameliorated or entirely eliminated by the antivenom alone. Other symptoms will require additional modalities of therapy to correct. Hematologic symptoms may present as Disseminated Intravascular Coagulopathy, and are treated essentially as other DICs. Neurological symptoms: If the patient is suspected of having been bitten by the Mojave rattlesnake (Crotalus scutulatus), the patient may develop neurological symptoms including respiratory obstruction or failure which must be treated as an immediate emergency. The neurologic symptoms, as others, should be improved by antivenom. If breathing becomes impaired, respiratory assistance may be necessary, and intubation and ventilation may be appropriate adjuncts in certain clinical settings. Secretions may become copious, necessitating suctioning. It is important to keep venom neutralization current and continuous. The best method to accomplish this is to keep a close watch on the patient's status. If the present condition does not improve, or should it worsen for any reason, additional antivenom should be administered. Give all additional antivenom in 5 vial increments. Again, dilute the antivenom thoroughly in Lactated Ringers, transfer the solution to an IV piggyback setup, and deliver over a period of 5-10 minutes per vial. Most bites today are treated with 15 to 20 vials of antivenom. The range is 5 to 40 vials. It is advisable to check periodic serum and urine analyses during therapy as outlined above. It is always best to keep the patient in an Intensive Care setting until free of major symptoms for 24 hours. The patient should be observed in the hospital for at least 24 hours after the major symptoms abate.

General Considerations: It is important that the patient be placed at rest, kept warm, and avoid unnecessary movement. Symptom variability: As noted above, the variability of symptoms in rattlesnake envenomation can be great. It is important to note the continual progression of symptoms throughout the course of therapy, and give additional antivenom as necessary to titrate these symptoms. Neurotoxic symptoms: In the United States one species of rattlesnake, the Mojave Rattlesnake (Crotalus scutalatus), is known to produce a clinical picture with predominantly neurotoxic symptoms. The onset and progression of the symptoms may be rapid and subtle. In addition, they are more rapidly reversed in their early stages than when fully developed. It may be necessary to wake the patient and perform a brief neurologic check every hour or so to assure that breathing and other vital functions are not impaired. Carefully note the progression of respiratory paralysis which may be present. Be prepared to intubate and ventilate as necessary.

Other rattlesnake species in the United States may have neurotoxic components in their venom. However generally speaking, these are at low levels and do not usually manifest significant clinical symptoms. Compartment Syndrome: It should be noted that fascial compartment syndrome in rattlesnake envenomations is very rare. Limbs may swell significantly, but rarely involve specific fascially bound compartments. If however the logistics of the bite raise a high index of suspicion for Compartment Syndrome, monitoring with a Wick Catheter or appropriate pressure devices may be necessary. Fasciotomy is rarely if ever recommended in these patients.




 
   
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