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Snake bite.

It is springtime, heading into summer, and one of the hazards of the season we must keep in mind, especially in my part of the country, is snakes. I was reminded of this the other day when the EMS brought in a seven year old boy who was bitten by a coral snake.

Although not one of the most dangerous, bites by this snake certainly require aggressive medical attention and, in his case, a few vials of anti-venon. Since the regional poison center possessed many more vials of anti-venin and was located just down the road, we transferred the boy to where he could receive the best care. He was stabilized, treated effectively and no doubt has returned to continue another summer of wonder.

Last summer Florida was hit by four hurricanes in the space of six weeks. Two of these pounded our usually sheltered corner of North Florida with over 20 inches of rain, very high winds, fallen trees and prolonged power outages. It was, indeed, a summer we won't soon forget.

One of the undesirable effects of such extreme weather is the disruption of many animal habitats, particularly snakes. I found this out, early one evening near sunset, when I was walking our 90 pound Labrador in the woods adjacent to our house. The storm had passed several days earlier, but the ground and air lay heavy with moisture.

Our dog suddenly became interested in something in the high grass alongside the trail. At first, I thought nothing of it since she is always sticking her curious nose into something. Then it hit me, it might be a snake. Unfortunately, by the time I realized what had peaked her curiosity, she was stricken by a four or five foot diamond back rattlesnake.

She ran past me down the trail and at first I thought it might have missed her. But then she turned to look at me. Her expression was that of confusion mixed with terror. There was a bleeding puncture wound between her eyes and another one lateral to her left eye. Her eye, face and then her entire head began swelling immediately.

She tried to run toward the house but soon became wobbly and unable to support herself. Luckily I had my cell phone with me, called the house and told my wife to notify the vet immediately, and then proceeded to carry this dog the size of a small adult back home.

We loaded her in the car where she soon became sleepy, drifting in and out of consciousness. The vet immediately directed us to the vet school where they had anti-venin available. They began working on her right away, and I say without exaggeration that it was their quick action that saved her life.

Although this is obviously not the story of a child, it points up many issues that must be considered when kids are playing in the woods, particularly in the southeast quadrant of the United States.

Prevention is the most important aspect of dealing with snakes. Certainly most snakes are not poisonous, but most also have teeth and will bite when feeling threatened. Knowledge makes prevention much more effective. Several facts are worth keeping in mind when enjoying the wilderness.

Snakes are rendered more active by extremes in weather, like sudden abundant rainfall. During the extreme heat of mid afternoon, they stay out of the sun just as we do, and will usually not be seen unless hunted. Spring is their most active season as they are mating and hunting for new habitats. Rattlesnakes prefer drier areas with access to water, while water moccasins and cottonmouths prefer water habitats. Extra care must be taken around streams, ponds and lakes. In general stick to well worn trails where there is good visibility on either side. A common encounter occurs when one is stepping over a log, discovering a slumbering viper just on the other side, as surprised as you are by your step into its immediate vicinity.

If you or your child, or your dog for that matter, has the misfortune of being bitten, the most important piece of first aid equipment is the telephone. If the snake can be identified, great. But if not, don't risk another bite trying to get close enough to make a positive identification.

The most important action to be taken is to have the victim transported immediately to the hospital. Survival and minimizing adverse effects depends most on rapid administration of anti-venin (which consists serum containing antibodies to snake venom) and good supportive medical care.

The degree of evonomization, and thus toxicity, depends on several factors. The size of the snake, the size of the victim, how recently the snake has expelled its venom, and the location of the bite on the body are all factors that affect outcome. Children tend to be bitten on their extremities, either as a result of curiously picking up a snake, or stepping into a snake's personal space by accident. Pets tend to be stricken in the face or trunk, which can have more serious consequences.

It is best to immobilize an extremity that has been bitten, thus a child who has bitten in the leg should not walk or run home if at all possible. Tourniquets, however, should never be used. The swelling that occurs with poisonous snake bites, along with the restriction of blood supply by the tourniquet may result in the unintended consequence of loss of limb.

The bite should not be cut and/ or sucked on either. Although dramatically portrayed in the movies, these actions do little more than delay getting the victim to where definitive care can be rendered. For further information on snakes and snakebite management I refer you to any number of websites and articles devoted to the subject.

So if your family's lifestyle includes wandering in the woods, particularly in areas where snakes are expected to inhabit, common sense and a little basic understanding of these amazing creatures will help to insure a safe experience. Our woods are now much clearer than they used to be, and we are careful not to venture back after extremely heavy rains.

This time of year, we assume that a snake could be under every log, and sleeping in every gopher hole, and thus approach these areas with caution. Even our dog has learned to stick a little closer to us and not be quite so curious about every movement in the tall grass. The wilderness remains a huge part of our lives, but like all great things, must be treated with respect and care for optimal enjoyment

John E. Monaco, M.D., is board certified in both Pediatrics and Pediatric Critical Care. He lives and works in Tampa, Florida. He welcomes your comments, suggestions, and thoughts on his observations.
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Title Annotation:Children in Hospitals
Author:Monaco, John E.
Publication:Pediatrics for Parents
Geographic Code:1USA
Date:Nov 1, 2004
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