LLUMC emergency medicine - safety

Venom ER

Snake safety in the Inland Empire

By Sean Bush, MD

Rattlesnakes bit dozens of Inland Empire residents last year. Many of the stories surrounding these bites are chronicled on the new "Venom ER" series, which premiered on Animal Planet March 30.

March marked the beginning of snakebite season. There have already been lots of snake sightings, and soon there will be many bites. The impact of the wildfires on the number of snake encounters we can expect this year remains to be determined.

If a rattlesnake bites you, the best first aid is a cell phone and a helicopter. Call 911. Emergency Medical Services will determine the fastest route to get you to medical care and antivenom. Because of the size and terrain of San Bernardino County, the fastest route from the field to the hospital is often via helicopter. Additionally, because antivenom supplies are still low, many patients require transfer to another hospital for continued treatment. Meanwhile, skip the first aid. It adds no benefit to the outcome after snakebite and could make things worse.

If bitten, you should remove rings and watches in anticipation of severe swelling. Do not cut across fang marks and do not try to suck out the venom with your mouth or a suction device. This could lead to complications and infections.

Don't use a tourniquet--the loss of circulation could be more damaging than the bite.

Do not take aspirin or ibuprofen after snakebite. Many snake venoms can thin the blood and these medicines may compound this effect, leading to bleeding.

Also, don't apply electric shock or place ice directly on the bite wound. Avoid further injury by staying away from the snake. NEVER handle a rattlesnake, even if you believe it's dead.

After they are called, paramedics should arrive shortly and start you on intravenous fluids. They should transport you directly to the hospital. Shortly after you arrive at the hospital, physicians may start treating you with antivenom. Pain medication may also be necessary.

If you are treated for snakebite, there are a few things you should watch for after being discharged from the hospital. You should watch for unusual bleeding, such as bleeding gums or bruising easily. If you develop any unusual bleeding, you should return to the emergency department immediately. Also, watch for signs of allergy to antivenom, such as an itchy rash, fever, swollen lymph nodes or painful joints. This reaction can be easily treated.

It is very rare to die from snakebite, but it can happen. Long-term injury and disability, such as the loss of a finger or the loss of function at a joint, is much more common. While recovering from these types of injuries, you may need to be referred to a physical therapist.

Six species of rattlesnakes are found in or around the Inland Empire: red diamond, western diamondback, southern Pacific, Mojave, speckled, and sidewinder. There are no copperheads, cottonmouths, or coral snakes native to the Inland Empire.

To avoid snakebites, leave snakes alone. Don't handle or try to kill a rattlesnake. That's how many people get bitten. Fangs can still inject venom even after a snake is believed to be dead. Snakes that were presumed to be dead have killed people. If you see a snake in the wild, maintain a distance of at least six feet. Look but don't touch. Snakes are amazing creatures that deserve our respect.

For more information on snakebites in the Inland Empire, tune in on Tuesday nights to Animal Planet for "Venom ER."

Learn more about Southern California snakes.

Sean P. Bush, MD, FACEP, is associate professor of emergency medicine and envenomation specialist at Loma Linda University Medical Center. To suggest topics for future columns, please call (909) 558-4419.

[Venom ER]