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Cary Elwes was hospitalized for a rattlesnake bite. What to do if you get a snakebite

Snakebite season is upon us as “The Princess Bride” actor Cary Elwes recently discovered while working outside his home in Malibu, California. Elwes suffered an envenomation from a rattlesnake bite to his finger but he was quickly evaluated and treated with antivenom at a local emergency department.

The majority of snakebites are recorded between April and October when both snakes and humans are the most active outdoors and likely to cross each other’s paths. In the ER, I am most concerned with venomous snakebites – from either the coral snake or pit viper family, which the rattlesnake that bit Elwes belongs to.

In the U.S., approximately 7,000 to 8,000 people per year are bitten by venomous snakes. While both coral snakes and pit vipers live in the United States, the vast majority of envenomation bites are from pit vipers such as rattlesnake.

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Although dying from envenomation is very rare – about five deaths annually – the risk of long-term disability or permanent injury is higher. Fortunately, that risk can be mitigated by quick action after a bite and by seeking prompt medical attention.
What you need to remember about snakebites

First and foremost, be mindful of your surroundings. Whether you’re hiking the wilderness – or working around your house – remember that we live in their backyard. Keep in mind that snakes will not bite if they are left alone. And they are usually more active early in the morning or late at night.

Depending on where you live in the country, there is a wide range of snake species in your area. If you are bitten, try to remember what the snake looked like or take a picture if it’s safe to do so, but do not try to capture it. Where I live in California is home to eight species of rattlesnakes, for example. South Florida is home to 47 species of snakes, but only four of those are venomous.

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Plus, keep in mind some of the guidelines for managing snakebites out in the wilderness have changed recently.
Here’s what you should do if you are bitten by a snake:

Gently wash area with water (and soap if available). Do not use peroxide, alcohol or antibiotic cream (snakes do not carry bacteria in their mouth).
Reduce movement and apply a pressure dressing to the bitten limb. Any movement will assist venom in entering the blood stream. For example, if the bite is to your ankle, wrap the leg with an elastic or pressure bandage starting at the foot and progress up the leg as high as possible.
Immobilize the affected extremity in a neutral position with s splint. A straight branch or piece of wood or plastic or metal will do. So, for an ankle bite, you want to extend the splint past the ankle distally and past the knee proximally.
If you have a phone, call 911 or your local poison control office. You’ll likely be directed to your nearest ER and given additional instructions.

It’s also worth mentioning what you should NOT do if you get a snakebite:

Do not apply ice or heat
Do not apply a tourniquet
Do not cut or apply suction to the wound
You no longer need to elevate the bitten extremity “above your heart.” The key is immobilization.

In the ER, here’s what you can expect:

Close observation for multiple hours: 25% of snakebites are “dry bites,” meaning no venom is released. This is the best-case scenario but likely won’t become obvious until after six hours of observation. Your doctor will mark the border of any edema – tissue swelling – and track it every two hours until progression stops. They will also measure and track the limb circumference at several sites above and below the bite.

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Laboratory analysis of blood work. Venom from the crotaline family of snakes, such as rattlesnakes, causes damage to capillaries via metalloproteinases and hyaluronidase. Your doctor will look for evidence of clotting and bleeding disorders in your lab tests. This can also become evident by bruising, called ecchymoses, that can appear in the skin within minutes to hours.

Antivenom. Adults and children are treated with the same initial dose of antivenom, either 4-6 vials of Crofab or 10 vials of the newer Anavip, if they meet the following criteria:

Progression of swelling
Signs of systemic spread of the venom including change in mental status or unstable vital signs like low blood pressure

An additional 2 vials can be given six, 12, 18 hours after the initial dose if symptoms are not controlled but most patients respond to the initial dose. Any patients who receive antivenom will be admitted to the ICU.

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