***************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.venom1.com
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Hunter Serpentology (Ray Hunter, Sc.D.)
24hr Emergency direct #: (772) 215-7625
Address: P.O. Box 8563, Port St Lucie, FL 34985
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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