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t m c » p u l s e | j u ly 2 0 1 9 19 t m c » p u l s e | j u ly 2 0 1 9 D id you know that snakes can still bite and kill you after they are decapitated? It's the stuff of nightmares, but also potentially life- saving information—and one of the many facts surrounding envenom- ation that Spencer Greene, M.D., is spending his career setting straight. And the facts are surprising. "Aggressive surgical interven- tion, we now know, is one of the worst things you can do for snake- bites," said Greene, director of the medical toxicology consultation services for Baylor College of Medicine. Why? Because snake venom is often essentially a "soup of antigens"—full of dozens of components that each attack a victim differently. "They can affect the way your blood clots, they can affect your muscles, they can affect your skin, and they can have neurological effects. The envenomation is best treated by neutralizing the various venomation components with antivenom," he said. Antibiotics are also unnecessary, unless there is an infection—which Greene said is exceptionally rare. Steroids, too, are only useful when there's an allergic phenomenon— otherwise, they can actually impair wound healing. Other potentially harmful prac- tices? The use of venom extraction devices, sucking out venom, tourniquets, pressure immobili- zation, electrical shock therapy, applying ice or heat and positioning the affected extremity below the heart—all first aid treatments that are sometimes recommended by the well-meaning but ill-informed. "One of the most important things we do when someone arrives at the hospital with a typical snake bite is to elevate," Greene said. "A lot of places keep the extremity flat or, even worse, below heart level, thinking it will decrease systemic absorption. That may or may not be true, but what it does do is result in more damage to the affected extremity." That, Greene said, is what he worries about the most. "Here's the thing—people almost never die from snake bites. There are about 5 to 10 deaths a year in the entire country. It's not something you should expect. What you should expect—what you need to worry about and what you need to treat or prevent—is permanent disability." When snakebites go untreated or undertreated, Greene said, permanent deficits are common and the opportunity to reverse the damage caused by the venom diminishes as time passes. "I had a patient who was a triathlete who was admitted to another hospital and wasn't treated with antivenom and now, seven months later, she can't walk for long distances because her leg swells up. She certainly can't run and she certainly can't run competitively," Greene said. ➟ B y A l e x a n d r a B e c k e r EVERYTHING YOU NEED TO KNOW ABOUT BITES AND TREATMENT A Mojave green snake, also called a Mojave rattlesnake, is part of the Death By Natural Causes exhibit at the Houston Museum of Natural Science. Venom from the Mojave green snake is considered the world's most potent rattlesnake venom.