Issue link: https://tmcpulse.uberflip.com/i/1138339
t m c » p u l s e | j u ly 2 0 1 9 20 t m c » p u l s e | j u ly 2 0 1 9 SNAKE BITES: 7 FAST FACTS Antivenom, Greene reiterated, is the best treatment for snake bites. "Antivenom is the definitive treatment and it's most effective when started early," Greene said. "Think of envenomation like a fire. If you have a little fire and you take some water and extinguish it, you minimize damage, cost and you use fewer resources. If you wait until that fire gets really big, then it takes a lot more resources to extinguish patient in order to administer the antivenom. Patients should not bring live or decapitated snakes to the hospital, mistakenly believing that physi- cians need to see them, he added. "You can still be envenomated by a dead snake," Greene said. "There are multiple cases of people being bitten by decapitated snakes … they have such low metabolic rates and they maintain brain into the hospital alleging a brown recluse bite, maybe one person actually has a brown recluse bite," Greene said. "I only see two or three a year." Nevertheless, Greene stressed the importance of knowing how to treat venomous spider bites, since treatment differs widely depending on the type of spider and whether it is a spider bite at all. "If you have an infectious abscess, you want to cut into it, but if it's actually a spider bite, you don't want to cut into it—that will make it worse," Greene said. "Spider bites— legitimate spider bites—do not need antibiotics, but abscesses require incision, drainage and antibiotics." As for jellyfish stings? Don't pee on them. The best treatment, Greene said, is to submerge the affected extremity in water as hot as tolerable to neutralize the pain. Becky Futch, who worked for years at the Houston Zoo as their "jellyfish keeper," said that it's also important not to touch the affected area, since the tiny nematocysts will continue to fire and "sting" their victim if any pressure is applied. Instead, she said to use a knife or credit card edge to scrape them off and, if possible, administer oral antihistamine. Finally, Greene stressed the importance of clinicians learning proper protocols and the general public recognizing when clinical or specialist care is necessary. "Most hospitals carry antivenom, but most hospitals lack a snakebite expert," Greene said. "You need to go to someone who knows what he or she is doing when it comes to bites." Greene said he and his two partners, who together serve Ben Taub Hospital and Texas Children's Hospital, make up the only in- hospital medical toxicologists in Southeast Texas. "If you're far away, go to the closest hospital, get stabilized, then request a transfer," Greene said. "Not all hospitals are created equal—this is a specialty service, an obscure topic, and you want to go where the specialists are." it, and at that point, you've already allowed damage to occur." In Southeast Texas, Greene said, clinicians should use CroFab, the only FDA-approved antivenom for North American pit vipers, which include copperheads, rattlesnakes and cottonmouths (a different antivenom exists for coral snake bites). Because CroFab covers all of these pit viper bites, Greene said that clinicians do not need to know exactly what kind of snake bit their activity for minutes to hours. So not only is it cruel to the snake, but it's dangerous." Specialty service While snakebites are the most com- mon envenomation Greene sees, he also treats individuals exposed to other venomous creatures, includ- ing spiders. Brown recluse bites, which cause tissue damage, are extremely rare. "For every 100 people who come 1 People rarely die from snake bites. More often, untreated bites leave people permanently disabled. 2 Baby snakes are not more poisonous than adult snakes. 3 Snakes in Southeast Texas are not typically aggressive and generally only attack when threatened. 4 A person can still be envenomated by a dead snake. 5 Snake bites should be elevated. 6 Antivenom is the best treatment for snake bites. 7 Sucking out snake bite venom is not recommended and is a potentially harmful practice, along with applying a tourniquet, using pressure immobilization, electrical shock therapy or applying ice or heat.