The Expert's Guide to Snakebites
Feel helpless after a snakebite?
Congratulations! By reaching this article, you have taken the first, most critical, step towards understanding what you should do in the event of a snakebite. Even though this is a single, cohesive article that is best read in its entirety, I have attempted to subdivide it into logical/manageable sections so that you may quickly navigate to the area of particular interest to you.
Although the following step-by-step instructions represent the best general guidelines for dealing with snakebite, please keep in mind that they do not necessarily encompass all possible permutations that are advisable for every situation. Sure, you can't change the fact that you were bitten, but you do have complete control over how you deal with the situation in order to remedy the problem at hand.
In this article, I will cover the following topics:
- What snakes are venomous/poisonous?
- Snake Fangs 101
- Front- versus Rear-fanged Snakes
- Front- and Rear-fanged Snake Envenomation Systems
- Snake Venom Composition and Variability
- The Utility of Snake Venom Research
- The Expert's Guide to Snakebite
Being bitten is painful, but be mindful of the snake, itself!
What should I do about the snake after it bites me?
- If the snake is biting and holding onto you and has coiled/constricted around you, first grab the snake by the end of the tail and unravel it until you reach the head (don't start unraveling at the head, since that is the anchor/start point for the coil).
- If the snake's mouth is still attached to you after you unravel its body, then grab the snake right behind both sides of the jaw (using just your finger and thumb for most snakes while using your whole hand for very large snakes) and apply an increasing amount of lateral ("inward," towards the throat) pressure to disengage the jaw while pressing "forward" (towards the snake's nose) to dislodge the teeth (since virtually all snake teeth are "recurve," facing backwards to assist in securing and moving prey into the throat) and then lifting the upper and lower jaws "out and away" from you (basically, opening the snake's mouth even further so that you are out of harm's way). Once the snake's mouth is no longer attached to you, find a safe/secure location to place the snake (in a cage, off to the side, etc.) and gently release it (while doing so quickly enough so that the snake doesn't have an opportunity to bite you again) by letting go of the tail/body first and head last.
- If the snake has already released you after it has bitten you and you don't have a hold of the snake, then distance yourself from the snake ASAP to prevent subsequent bites.
- It is inadvisable to attempt to capture or kill the snake for identification purposes since people are often bitten during the process (not to mention, the snake doesn't tend to fare so well, either).
- Take good-quality pictures of the snake's head, back, and tail only if it is feasible to do so and does not risk further injury to yourself or the snake. Unless you are specifically trained or experienced in snake identification, you will need this picture in order to definitively establish which species bit you. The picture can then be shown to an expert or used in conjunction with a snake/reptile field guide to ascertain the snake's identity.
First Aid for Snakebite
What should I do when a snake bites me?
- First of all, remain calm and restrict your movement! You need to keep your heart rate down so that you can limit the spread of the venom (if any was injected) throughout your body. Do NOT panic, as doing so would only stress you out, increase your heart rate, and scramble your thoughts (which impedes your ability to make logical decisions). If you were bitten on a limb, applying a splint will help immobilize it. Walk, don't run, to get help.
- Be optimistic! Think positively about your situation instead of telling yourself that you are going to die. If you cannot identify the snake, remember that ~83% (5/6) of all snake species are harmless to humans. Also keep in mind that the snake may not have injected any venom at all (in what is called a "dry bite"). That said, it is better to be safe than sorry and assume that venom was actually injected. *Please note the section below on the importance of being optimistic!*
- If you were bitten on an extremity, keep the limb at heart level to prevent swelling or the hastened distribution of venom throughout the body.
- Remove any constrictive clothing or jewelry (rings, watches, etc.) near the bite site, as these may cut off circulation if/when your body swells as a result of the bite.
- Utilize basic first aid techniques. Begin by cleaning the bite wound with soap/water, alcohol, and/or hydrogen peroxide. After drying the bite area, smear some antibacterial ointment cream on the bite marks and then cover with a bandage or piece of gauze. *Please note the section below on first aid techniques that you should not utilize for snakebite!*
- Get to a hospital as soon as possible and don't forget to remain calm! This is important regardless of the identity of the snake, whether or not venom was injected, and despite any envenomation symptoms or lack thereof.
The Do's and Don'ts of Snakebite
What are some of the things that I shouldn't do for snakebite?
- Do NOT attempt to "suck out" the venom from the bite wound.
- Do NOT try to make incisions to "drain" the venom from the bite site.
- Do NOT apply a tourniquet to "contain" the venom to the area of the bite.
- Do NOT utilize any homeopathic remedies to "neutralize" the venom.
"But I see these techniques used in movies all the time...why shouldn't I do them?" Well, are those scenes ever filmed under the direction of a doctor skilled in treating snakebites? The answer is no, of course not. The reason why the first two methods ("cut and suck" techniques) are ineffective is because snake venom, by its very nature, diffuses almost instantaneously into the surrounding tissue once it is injected into the body. This is due to most venoms containing compounds like hyaluronidase and phospholipase, which enable the venom bolus to "punch through" cells and the spaces between them. Basically, the venom becomes interspersed with your tissues at the instant of the bite and continues spreading with time, eventually getting picked up by the lymph and circulatory systems to reach the rest of the body. Think of it this way: trying to "suck out" or "drain" venom is like trying to spoon out a droplet of food coloring after it falls into a glass of water (an impossible feat since the color immediately begins to diffuse into the water upon contact). The same thing happens when a droplet of venom enters your body, which is ~70% water.
The reasoning for the third method being ill-advised is that only medical personnel or people with training should attempt to tie a tourniquet or wrap a pressure bandage. Laymen often secure a tourniquet too tightly such that it cuts off blood circulation and causes permanent damage. Laymen also don't tend to check and re-apply the tourniquet as time progresses in order to adapt to any swelling that may occur as a result of the snakebite. The only thing that can neutralize snake venom is antivenom. Applying an electric shock to the bite site will do nothing but cause undue pain and tissue damage. Hot/cold packs and any "local" or "homeopathic" remedies do not reduce the effects of snake venom and often result in greater harm (see the section below on the importance of remaining optimistic to understand the power of the placebo effect). This includes eating or drinking anything (other than water), as doing so will speed up your metabolism and heart rate. All in all, making these attempts to "suck out, drain, contain, or neutralize" snake venom will not only result in a greater amount of tissue damage, but will also increase your chances for infection.
Do Not Use Snakebite Extractor Kits!
How effective are snakebite extractor kits?
There are many commercially-available kits that claim to be specifically designed to treat venomous snakebites and typically go under the name, "Snakebite Extractor," or something very similar ("Venom Pump," etc.). These kits claim to be effective in removing the venom from the bite site using a suction device to "suck it out." Sometimes these kits also include a scalpel (for "draining" the venom), a small rope (for creating a tourniquet and "containing" the venom), and something to sterilize the bite site (alcohol, iodine, etc.). With the exception of something to sterilize the wound, all of the other common contents of snakebite extractor kits encourage activities ("sucking, draining, or containing" venom) that frequently increase morbidity/mortality (as stated in the section above on things not to do for snakebite). Therefore, NEVER purchase or use these kits for treating snakebite.
Get to a hospital ASAP after snakebite!
What can a hospital do for snakebite?
- Hospitals can provide basic supportive care. They are capable of maintaining the cleanliness of the bite site while keeping you hydrated (I.V. fluid) and medicated (painkillers, etc.).
- They can also help combat infection and make certain that you are up-to-date on your tetanus immunizations.
- They can help remedy any swelling/inflammation/hemorrhage (sometimes by making incisions in order to allow the skin to expand).
- They can monitor and treat any coagulopathies (by taking blood and administering medication to increase/decrease coagulation as necessary).
- They can ensure the proper functioning of the respiratory (CPR, ventilator, etc.), circulatory (CPR, AED, etc.), and excretory systems (kidney dialysis, etc.).
- They can administer antivenom to counter the effects of snake venom.
- They can counter the effects of an allergic reaction (or anaphylactic shock) to the venom, antivenom, or medication (by using antihistamines, epinephrine, prednisone, etc.).
Antivenom Comes from Animals
What is antivenom/antivenin?
Antivenom (also called antivenin) is the only proven way to counter snake venom, period. As stated in the above section on things that you shouldn't do for snakebite, homeopathic remedies are ineffective and often harmful. Antivenom is produced by injecting raw snake venom into some animal (horse, goat, sheep, etc.), allowing that animal to produce antibodies, purifying the antibodies from the animal's blood, and then injecting those antibodies into people as antivenom. PlantForm, a Canadian company specializing in the low-cost production of antibodies using plants, announced on 8/1/13 that they have successfully produced an anti-cobra toxin using modified Nicotiana plants, opening the door for plant-produced antivenoms.
Antivenom is commonly used as a "general" cure by being created from the venom of a few, representative species in order to treat the envenomation symptoms of many species (since some of the most relevant venom compounds are similar between species and cross-react accordingly). Antivenom does not have a long shelf life, nor does it remain in the body for very long. Snake venom, on the other hand, can "hide out" and sequester inside tissues, being slowly released over time, thus requiring the periodic or continuous infusion of antivenom. Antivenom is typically used as a last resort, however, when envenomation has been confirmed and when life/limb is at stake. The reasoning for this comes down to how antivenom is made and what it consists of. Since antivenom is produced from the serum of animals, there exists a chance for an allergic reaction (and even anaphylactic shock) to the antivenom, itself. Basically, your body's immune system might treat the injected antivenom like a dangerous foreign agent and go into overdrive, with potentially fatal results.
Diseases from Snakes
What diseases can I get from snakes?
To the best of my knowledge, the only things that humans can contract from snakes include the following diseases, with the routes of transmission in parentheses:
- Salmonella (handling)
- Influenza A and B (handling)
- Tetanus (snakebite)
Salmonella is common in areas that are contaminated with animal excretions (such as snake feces), including certain food items (undercooked foods, chicken eggs, etc.) and kitchens. Influenza can be spread by inhalation of the aerosolized virus and contact with infected individuals (snakes or people) or surfaces that they have contaminated. So long as you wash/clean any areas of your body that have come into contact with a snake, then you should be able to adequately guard against infection by salmonella or influenza. Tetanus can be contracted from anything that might harbor anaerobic bacteria and effectively introduce the spores deep into human tissue (where oxygen levels are low and ripe for tetanus growth), such as snake teeth. Whereas salmonella can be easily cured with antibiotics, influenza and tetanus are best prevented by regular immunizations (once every year for flu and once every 10 years for tetanus in adults). What about rabies, you ask? The rabies virus cannot infect snakes, so you're in the clear there!
Think positively after snakebite!
What is the importance of remaining optimistic after a snakebite?
I know it seems a tad unnecessary for me to focus on the importance of optimism in an entire section, but please bear with me for a moment and allow me to explain. It is imperative that you do NOT panic after a snakebite and establish a positive state of mind by being optimistic. Due to the "mind over body" phenomenon, the state that your mind is in can have a strong influence on the rest of your body. Simply stated, you can "will" your body into physically manifesting your strong thoughts/beliefs to a certain degree. There are two opposing "mind over body" effects that are relevant to this discussion on snakebite:
- Placebo effect ("+")
- Nocebo effect ("−")
When a neutral stimulus is applied to someone who strongly believes that it will help them, then their body can manifest a positive (placebo) effect along those lines, but when that someone strongly believes that the neutral stimulus will hurt them, then their body can manifest a corresponding negative (nocebo) effect. Either one of these effects can be effectively demonstrated through the application of a "sugar pill" (aptly referred to as a Placebo) that simply consists of inert ingredients like sugar. For instance, if you are given medicine for your cold and told that it will help you get better, then your condition will likely improve (placebo effect), regardless of whether or not the medicine you took was simply a Placebo. This phenomenon can even combine with the nocebo effect and both effects can occur simultaneously (since they utilize separate biochemical pathways in the body). Let's say that we amend the same scenario as before, but this time we tell you that the medicine you are given has a chance of causing nausea as a side effect. Regardless of whether or not the medicine was simply a Placebo, your cold symptoms will likely subside (placebo effect), but you will also have a higher probability of experiencing nausea (nocebo effect).
Okay, that's good and great, but how does this relate to snakes, again? Well, let's say that you are bitten by an unknown snake [let's say a garter snake (genus Thamnophis)], but honestly believe that it was a rattlesnake. Your body can begin to elicit symptoms typical of a rattlesnake bite (such as swelling, hemorrhage, etc.) due to the nocebo effect. You can even think yourself into needing antivenom to "cure" such symptoms via the placebo effect. These phenomena also apply to some of the ineffective first aid techniques and homeopathic remedies mentioned earlier. If you truly believe that "sucking out" the venom or electrocuting the bite site will help remove/neutralize the venom, then you will likely feel better and/or experience fewer envenomation symptoms (despite the fact that doing so would have done little more than cause more tissue damage). Therefore, you can "think yourself" into creating your own problems and enhancing the effects of snakebite, regardless of whether or not venom was actually injected. So, once more, keep an optimistic mindset (don't just think...KNOW you are going to survive the bite) and you'll be ahead of the game! (But, still utilize first aid and go to the hospital, just in case!)
How do deaths by snakes compare to other causes in the U.S.?
Center for Disease Control
Center for Disease Control
Center for Disease Control
Center for Disease Control
World Health Organization
National Oceanic and Atmospheric Admin.
National Trans. Safety Board
Center for Disease Control
2008 Global Burden of Snakebite Report
Snakebite Doctor Sean Bush
Conclusion - What should I do for snakebites?
Be sure to do the following things when a snake bites you: get away from the snake (or secure it in its cage), remain calm (don't panic), be optimistic (don't think you are going to die), perform basic first aid (do the 4 C's, not the 4 S's), and get to a hospital where they can keep you alive and administer antivenom, if necessary. Regardless of whether or not the snake is venomous, keep in mind that you can still contract certain diseases from snakes (flu, salmonella, tetanus), all of which are preventable through vaccination and proper hygiene.
You may take the quiz below to test whether you know what to do when a snake bites you. You can also check out the video below, which shows an example of a snake that is having its venom extracted (via manual massage of the venom gland) for the purposes of creating antivenom.
Do you know what to do when a snake bites you?
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Extracting Venom to Produce Antivenom
This article is intended to educate people ranging from snake experts to laymen on the things that they should do after a snakebite. This information contains generalizations and by no means encompasses all exceptions to the most common "rules" presented here. This information comes from my personal experience/knowledge as well as various primary (journal articles) and secondary (books) literature sources (and can be made available upon request).
I wholly believe feedback can be a useful tool for helping make the world a better place, so I welcome any (positive or negative) that you might feel compelled to offer. But before actually leaving feedback, please consider the following two points:
- Please mention in your positive comments what you thought was done well, and mention in your negative comments how the article can be altered to better suit your needs/expectations
- If you intend on criticizing "missing" information that you feel would be relevant to this article, please be sure you read through my other articles on this topic (I've written extensively about snakes and their venom). You can easily find my other articles by clicking on my author profile. You may find that your concerns about missing information are addressed elsewhere.
Thank you for reading!
© 2013 ChristopherJRex