One of the very dramatic medical emergencies is the person who has received a rattlesnake bite.  Every year in the United States approximately 8,000 people are bitten by poisonous snakes.  Most of these are rattlesnake bites.  To quell and reassure concerns, there are only 15 deaths per year due to snake bites.  In fact, 30% of rattlesnake bites do not result in injection of any venom.  Although 70% of bites that did result in evenomation appropriate treatment and expectation is outlined below.

     First, it must be realized that medical recommendations are primarily based upon experience.  Thus, if a doctor is going to prescribe a blood pressure pill or a cholesterol pill, the recommendation is based upon a large number of people who have taken these pills in trial and then successfully treated without side effects.  Appropriate treatment for individuals who have rattlesnake bites isn’t really based upon that kind of experience.  This is primarily because we have such a terrible time trying to find normal volunteers to give rattlesnake bites so we can find out what treatment works best.  Thus, over many years time, there have been substantial myths generated on how to treat the person before they get to the hospital and even the appropriate treatment once they arrive.

     To begin with anyone who has snakebite needs to be seen by medical personnel as quickly as possible.  If the attacking snake can be killed and transported with the patient that is always useful so that identification of the type of bite can be made.  Please note that there are many reports in the medical literature of people who are bitten and seriously envenomated by “dead” snakes or even by the head that was cut off of a snake.  If this creature is to be transported, please do it with thick leather gloves or don’t pick up the snake’s head with your hand.

     When a person has been bitten, Step 1 is to keep the person as rested as possible.  Rather than have the person walk a half-mile to the car, drive the car to where the person is and pick them up that way.  I wouldn’t say that you should try and calm the person who has been bitten. After begin bitten by a poisonous snake, I don’t know how a person would stay calm.  But the rule would be to stay as calm as you can.  A tourniquet should be placed several inches above the bitten site and moved periodically as swelling progresses up the bitten arm or leg.  Obviously, a tourniquet will be of no help on bites that occur on the body or the face.

     Things not to do include:   1.  Do not pack the bitten area in ice.  This has no demonstrated benefit and can cause additional tissue damage to areas that are already envenomated.  2.  Do not cut or excise over the bite marks.  The idea that you can produce bleeding and have the poison run out by making X’s over the fang marks is not valid.  Most of the time this will lead to increased infection problems and increased tissue injury.  3.  Don’t bother to suck on the wound.  The idea that you can suck the poison out has no validity whatsoever.

     Once the person reaches a site for definitive medical care, assessment can be made regarding the degree of evenomation.  As swelling and pain  progress from the site of the bite, modern anti-venom can be injected.  The modern antivenom comes from sheep that is manufactured in such as way as to avoid allergic reactions that where so prevalent with the horse serum that was used for so many years.  The advantage of the modern antiserum is that it is much, much safer.  The disadvantage is that the antivenom for a significant evenomation costs $20,000.00.  Thus, the healthcare personnel in an emergency room need all the information they can before embarking on a treatment that may not be necessary.

     Certain populations require special consideration.  While there are only 15 deaths per year in the United States due to snake bites, the damage that can occur to the person’s bitten area can be very severe and disfiguring for a lifetime.  Children are especially prone to having the muscles and tissues in their limb badly damaged.  This can require repeated surgeries and a month or more of hospitalizations with permanent disfigurement.  The sooner antivenom is injected, the better the outcome and avoidance of tissue damage.

     The medical literature mentions that a significant member of snake bites are associated with individuals who became intoxicated while drinking happened upon a rattlesnake and decided to “play with it”.  These macho show off sessions around the campfire can be disastrous because the person bitten is usually far from medical help and already intoxicated which increases the rate of progression of the venom.  Rattlesnakes are not toys; they should never be “played with”.

     As a closing note, individuals who had a fatal snakebite generally live 4-6 hours after the bite.  While the bite maybe very, very painful several hours are available in order to get to the emergency medical care and receive antivenom.  In the past several years, there have only been three people treated with modern snakebite antivenom in the Pierre Emergency Room.  Because of the excessive cost of the antivenom, the outlying clinics around Pierre do not stock the antivenom and it would be important to proceed to Pierre as quickly as possible so that definitive treatment can be provided.  The healthcare providers in the Gettysburg, Onida, Highmore, Presho, and Murdo Clinics are all aware of these and would be the first individuals to contact when snakebites occur in their area.