My thoughts on anything & everything

Sunday, June 24, 2012

BehindTheMedspeak: Snakebite — Everything you were taught is (dead) wrong

bookofjoe

M

That goes for me as well, though it's only dimly — if at all — that I remember the subject from 2nd year med school pharmacology and various rotations on the medicine wards.

David Maurer's first-person account of being bitten by a copperhead while working in his garden appeared in the June 18, 2012 Charlottesville Daily Progress; excerpts below.

Caption for the photo by Sabrina Schaeffer (above), which accompanied the Progress story: "Dave Maurer's left arm on May 14, two days after the snakebite, still shows significant swelling.  Emergency medical personnel made a series of marks on his arm to track the progress of the swelling."

Don't be confused as I was by Maurer's right arm being closer to the camera.

Encounter with a Copperhead

I recently had the good fortune to be bitten by a copperhead snake.

Of course, I wasn't seeing it that way as I lay in Martha Jefferson Hospital with CroFab antivenin coursing through my veins and my left arm swelling to Popeye-esque proportions.

It was only after the considerable pain, bruising and swelling had subsided that I started to have a more enlightened take on my experience with envenomation. My awakening came as I learned fascinating facts about the poisonous snakes indigenous to Virginia — copperhead, cottonmouth and timber rattlers — and the blessings of modern medicine.

My encounter with the copperhead occurred around 9 a.m. May 12. That Saturday morning, I was topping a stand of bamboo that grows under the power lines leading to my Albemarle County home.

I was using short-handled clippers and had reached into a clump of bamboo to lop off a long shoot. I felt an unusual pain on the inside of my left wrist that made me think I had stabbed myself on a sharp piece of bamboo.

My second thought was that I had somehow gotten a cramp in my wrist. I quickly changed that assessment when I saw the two small puncture marks just above my work gloves.

In one of those remarkable displays of the brain's recall ability, I immediately pictured the U.S. Army Special Forces instructor who had given my class a lesson on poisonous snakes during my training in the mid-1960s. His first remark on what to do if bitten: "Don't panic. You're probably not going to die, but get medical attention as soon as possible."

I took him at his word. Being dirty and sweaty, I showered, changed clothes and made sure my dog had plenty of food and water.

All this took about 10 minutes, and in that time the swelling above the red bite marks had become noticeable. The pain was also increasing, but nothing I would term excruciating.

I called my primary physician, Dr. John Lanham, who told me to come right in. He has had experience with snakebites from his time practicing medicine in a remote area of Sudan. It took him about 10 seconds to assess the situation and send me off to MJH's emergency room.

"The nature of the venom is hemorrhagic, and that's why you had the bruising," Lanham said. "Some of the venom ruptures red blood cells and some of it lets the blood leak out, which causes the swelling.

"Then there's also certain types of enzymes that cause local tissue necrosis. It was primarily the pain you were experiencing and the local swelling that had already occurred that got you out of here and to the emergency room pretty fast.

"It looked like there was more going on than just the pain from the strike."

Aside from the pain, which had escalated to a burning sensation along the length of my left arm, I felt fine. I had no problem driving the few miles to the hospital.

At this juncture, I already had learned two valuable lessons.

The first: During warm weather, never put your hands or feet into grass or bushes where you can't see where they're going.

Secondly, never assume the snake is going to be on the ground. The copperhead that bit me was at least 5 feet up in the bamboo.

I never saw the snake, but it had to have been small in order for the bamboo to support it.

Victoria Brianna Hovey was bitten twice by a young copperhead on May 22. It was the day before her 12th birthday, and she was visiting her sister in Stanardsville.

"I was in the driveway getting ready to get in the car when I startled the snake, and it bit me," Victoria said recently as she recovered in her Greene County home. "I screamed, and when I jumped back, I stepped on its tail and it bit me again [on the other leg].

"It felt weird, like a pinch. My sister's boyfriend tore his shirt in two and tied it around my ankles so the poison wouldn't go up my leg, and then he called [emergency].

"They told him to take the shirt off [the ankles] and get me to the hospital."

Dr. Christopher P. Holstege, director of the Blue Ridge Poison Center at the University of Virginia, said applying a tourniquet is an absolute no-no. So are other widely believed practices.

"There's so much misinformation about first aid for snakebites, even from somewhat reliable sources," Holstege said. "I've seen probably more harm done by cutting and tourniquets than from the snakes themselves.

"Before we had good studies on this, people would do some very crazy things. They would put tourniquets on with the thought it would keep the venom in one place, but this does more damage than good.

"People would cut open the site of the bite and try to suck out the venom. We know suction doesn't work at all, and, in fact, studies have shown it does more harm.

"Many of the snakebites we see are on the feet and hands. If you cut in those areas, there's a good chance you'll cut tendons, nerves or other structures."

Cutting the proverbial "X" at the site of the bite only creates a more serious wound and greatly inhibits healing. And not only is it impossible to suck the venom out, but the attempt can deliver bacteria from the mouth into the wound or venom into the mouth.

"The venom goes into the subcutaneous tissues, so you're not going to get it out by sucking; you're just not," Holstege said. "There's a number of snakebite kits on the market, and I'm absolutely appalled they're allowed to sell them.

"In the kits are a suction device, scalpel and a shoestring you can use for a tourniquet. All the things we know that cause harm and don't work.

"We now know that even applying ice to the swelling does more harm then good. You think because there's swelling, ice would be a benefit, but studies show that's not the case."

Mendoza said another danger of a snakebite kit is that it gives a false sense of security to the user.

"You think your snakebite has been treated and it hasn't," Mendoza said. "The best snakebite kits are car keys and the nearest hospital."

Below, a sidebar that accompanied Maurer's story.

L

An aside: Maurer is, in my opinion, the best writer on the Daily Progress staff, good enough to fit right in on the New York Times, Washington Post, Wall Street Journal, or any English-language publication in the world.

Why he's stayed with my Podunk town's paper for decades is a mystery to me.

Full disclosure: Maurer came to my house in January, 1993 to interview me for a story on my first book, "Baby."

The article appeared in the Daily Progress on February 25, 1993.

Sent with Reeder


Sent from my iPad

No comments:

Post a Comment

Followers

Blog Archive