Re: Rattlesnake bite in Yosemite story

Did I miss the part where he mentioned that he was in PATE VALLEY?

B

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Bee
Did I miss the part where he mentioned that he was in PATE VALLEY?

B

It didn't say anything other than 4.5 miles from the trailhead. While Pate Valley is infamous for rattlesnakes (and I personally confirmed it) it isn't the only place to find them in Yosemite. Coming down the Snow Creek trail my foot came down about 3 cm from the head of a rattlesnake that had decided the middle of the trail was a great place to hang out and blend in with the dirt.

Did I miss the part where he was aware of his surroundings?

The last rattlesnake I saw was among some boulders along the dusty trail at the top of Nevada Falls. For those that don't know, the sound is more like "hissing" than rattling, in my opinion. It reminds me of a sprinkler purging the air just before the water comes out. I have encountered at least 6 rattlesnakes over the years and had one dog bitten by them. The story does illustrate how bad some bites can be. There is not absolute uniform consensus on how to treat all snake bites initially, but generally the best treatment is to get the victim to a facility as soon as possible that can administer antivenom and provide supportive care. Generally should minimize activity but this must be balanced against availability of emergency evacuation and getting the victim to medical care. Tourniquets, incisions on the bite marks or "sucking out the poison" are definitely not advised. Those snake bite kits should be banned. Best to take a picture of the snake if possible. Dead snake heads are still dangerous have resulted in fatal injuries from accidental envenomation.

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The cure for a fallacious argument is a better argument, not the suppression of ideas.
-- Carl Sagan

FF: Dead snake heads are still dangerous have resulted in fatal injuries from accidental envenomation.

....and I thought that spiders were bad enough.....

B

Reinforcement for advice about tapping that walking stick! And some of my non-hiking friends and relatives are worried about me meeting a bear alone. Go figure.

Jim

It's odd that he had no warning, unless he just wasn't paying attention. I've always had plenty of warning from that unmistakable sound, but I guess it's possible to surprise a snake.

I've always had a hard time with the 'seek medical help, nothing else works' advice. Certainly if there's any way to do that, it's the best, but if you're a long way away, with no communication, it seems like you might as well try using what's available.

I have one of those Sawyer vacuum pump kits, and a few years ago my daughter got stung by a bee or wasp, I forget which. I had just gotten that kit, and thought we might as well try it, so I put on the small cup and sure enough, we got a healthy sized drop of a clear viscous liquid, which I assume was venom. She got no reaction at all from that sting. It seems to me that there can't be much harm in sucking out at least some of the venom from a bite. Maybe I'm wrong, but since the venom causes the problem, if you can't get to medical care, what else are you going to do? Or even if they're coming soon, why not get out what you can?

The folks who run the tests should be a bit more free with the info of how they've reached their conclusions. Basically, it seems to be "trust us, there's no benefit to sucking out the venom, you need to get to a medical facility". OK, I'll trust you if you tell me exactly how you reached those conclusions, what tests and under what conditions. No doubt it's tough to do the tests...who's going to submit their leg for a test bite...but I guess I just don't have enough faith in the medical community to just accept their word on something and have faith they've done it right.

Those photos are pretty scary though; good thing he warned people in advance.

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Gary
Yosemite Photo Galleries: http://www.pbase.com/roberthouse/yo

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we got a healthy sized drop of a clear viscous liquid, which I assume was venom.

More likely is was just plasma or lymph.

Sierrafan: Those photos are pretty scary though; good thing he warned people in advance.


Yup, I am one of those people who took the warning....and moved on. The spider that I was "kissed" by damaged a whole part of the venous system in my lower leg; there is permanent leakage due to the weakening of the walls. Bears? HAH!

B

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Sierrafan
It's odd that he had no warning, unless he just wasn't paying attention. I've always had plenty of warning from that unmistakable sound, but I guess it's possible to surprise a snake.

I've always had a hard time with the 'seek medical help, nothing else works' advice. Certainly if there's any way to do that, it's the best, but if you're a long way away, with no communication, it seems like you might as well try using what's available.

I have one of those Sawyer vacuum pump kits, and a few years ago my daughter got stung by a bee or wasp, I forget which. I had just gotten that kit, and thought we might as well try it, so I put on the small cup and sure enough, we got a healthy sized drop of a clear viscous liquid, which I assume was venom. She got no reaction at all from that sting. It seems to me that there can't be much harm in sucking out at least some of the venom from a bite. Maybe I'm wrong, but since the venom causes the problem, if you can't get to medical care, what else are you going to do? Or even if they're coming soon, why not get out what you can?

1. The kid thought that he was in "Beautiful Downtown Burbank" (another Laugh-In reference).

2. Gary, I agree entirely. I also have a Sawyer kit. About 5+ years ago, it was actually mentioned/"recommended" on a University of California poison response website (I think that it may have been the UCSF Med. Center site) as the only useful first-response, on-site treatment that would somewhat mitigate the effect of the bite (their studies showed that up to half of the venom could be removed) and would not risk causing additional problems (like the old Cutter scalpel/suction cup procedure). A couple years later, I noted that this information had been removed from the website - my presumption is that the liability lawyers told them to delete it. Of course, they also said to get the person to a hospital for treatment ASAP.

Recording of a rattlesnake:

http://deepcreekhotsprings.net/Rattlesnake.ogg

My daughter and I were coming back toward Hetch Hetchy a few years ago and I heard a rustling by my right foot. A rattler left the side of the trail and coiled up in some rocks shaking his little tail but there was only a blunt stump. They do on occasion loose all their rattles. That's why I let Billy-e-g go first.

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Old Dude

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That's why I let Billy-e-g go first.

So he riles it up and moves on leaving you to get the bite?

>The folks who run the tests should be a bit more free with the info of how they've reached their conclusions. Basically, it seems to be "trust us, there's no benefit to sucking out the venom, you need to get to a medical facility". OK, I'll trust you if you tell me exactly how you reached those conclusions, what tests and under what conditions. No doubt it's tough to do the tests...who's going to submit their leg for a test bite...but I guess I just don't have enough faith in the medical community to just accept their word on something and have faith they've done it right.<

Definitely wise to question everything. There is a fallacy that it is always better to do something. Sometimes in medicine the best is to do the least. (I can give you many examples if you are interested.) One of the best teachers I had, said "Don't just do something, stand there" to correct my overly aggressive actions and remind me to stop and think before acting. I think the suction cup program continued so long for the very reason that people felt helpless and needed to feel like there was something to do.

There is a very good section in the medical textbook "Wilderness Medicine" dealing with just the stuff I mentioned on snakebite. It has references and summarizes the information available on management of rattlesnake poisoning. The Australians have had some success with a wrapping technique involving Ace type bandages as first aid but that was for a different kind of snake toxin and has not been proven clearly helpful for rattlers and may be harmful. I will paste selected sections of the Wilderness Medicine book for your review. The numbers refer to the bibliographic citations at the end of the chapter.

PM me if you want the references to specific points.

From Auerbach: Wilderness Medicine, 5th ed. - 2007 - Mosby

.. Attempts to secure or kill the snake are not recommended because of the risk of additional bites to the victim or rescuer, and because precious time can be wasted. All emergency personnel should be able to distinguish a venomous from a nonvenomous snake (described previously). However, if the personnel are uncertain about whether a particular snake is venomous, photographs may be taken of the snake from a safe distance (at least 6 feet away) using a digital or Polaroid camera. These images can be seen immediately and may help make clinical decisions. Although it may be helpful to identify the species of snake, [16] [18] transporting it (alive or dead) is discouraged because of inherent dangers. On scene, snakes should be moved or contained only if absolutely necessary (i.e., for safety). A snake hook or long shovel may be helpful to move a snake into a large, empty trash canister where it can be recovered by a professional, such as an animal control agent. Serious morbidity and even death have been reported after envenomation by decapitated rattlesnake heads. [27] [98] [173] In addition, an apparently dead snake or a decapitated snake head can have a bite reflex for at least 90 minutes after death. Therefore, emergency personnel and hospital care providers should exercise extreme care if handling any specimen accompanying the victim, even if it appears dead. Recommendations for first-aid and prehospital treatment of pit viper envenomation have historically been based on speculation and anecdotal experience, although better evidence is accumulating in the literature. In one large retrospective series, first-aid treatment had no relationship to ultimate envenomation severity.[192] Some first-aid measures recommended in the past have caused more injury than the snakebite itself, and delays in care have been shown to increase morbidity and mortality. [45] [71] It is inappropriate to use any technique that could potentially injure the patient or impede immediate travel to the nearest facility where antivenom can be administered. General support of the airway, breathing, and circulation should be provided, depending on the capabilities at hand. Oxygen, cardiac monitoring, and intravenous (IV) fluids should be used in the field when available. Although it may be necessary for the victim to hike out from the scene of the incident, activity should be minimized as much as possible. Alternative methods (e.g., stretcher, helicopter, boat) of extracting the victim from a wilderness setting can be used when available and when conditions such as weather and terrain allow. Jewelry and tight-fitting clothing are removed from the involved extremity in anticipation of swelling. The border of advancing edema is marked with a pen every 15 minutes so that emergency personnel can estimate the severity of poisoning by following the rate of progression. These measures suffice as adequate prehospital care for the vast majority of cases of pit viper bites in the United States. The following measures are not recommended for first aid: incision, suction, tourniquets, electric shock, ice, alcohol, and folk therapies. Until recently, the Sawyer Extractor Pump (Sawyer Products, Safety Harbor, FL) was recommended. However, at least three studies, done independently of each other and using different methodologies, arrived at the same conclusion—that the Extractor does not work for venomous snakebite and could make things worse. [2] [14] [19] [20] Mouth suction is contraindicated for the additional concern of potentially contaminating the wound with oral flora. Incising the bite site across fang marks is contraindicated. This creates additional injury and has never been shown to be effective. Because viperid fangs are curved, incisions may miss the track along which venom is actually injected. Incisions made by laypersons can cause serious injury to underlying blood vessels, nerves, or tendons. Because of venom-induced coagulopathy, bleeding from such incisions can be severe.[73] Furthermore, the lack of sterile conditions in a field setting increases the risk of infection. Venom sequestration techniques, such as application of a lymphatic or superficial venous constriction band or pressure immobilization, inhibit the systemic spread of venom. [13] [174] It is not clear, however, whether such measures improve outcome after pit viper envenomation. Some argue that restricting the spread of potentially necrotizing venom to local tissues may intensify injury.[75] Because local sequelae are the predominant complications after pit viper envenomation, and because permanent systemic injury and death are rare, especially in North America, such attempts to limit venom to the bite site are ill-advised.[45] Tourniquets have worsened injury when used for snakebite and are contraindicated.[73] Pressure immobilization has been used effectively in Australia for field management of elapid snakebites (see Chapter 49 ).[175] Pressure immobilization resulted in significantly longer survival, but higher intracompartmental pressures after artificial, intramuscular western diamondback rattlesnake (C. atrox) envenomation with a pig model.[17] This technique involves immediately wrapping the entire snakebitten extremity with an elastic ACE wrap or crepe bandage as tightly as would be done for a sprain, and then splinting and immobilizing the extremity ( Fig. 48-27 ). Studies have shown that lay people as well as physicians have difficulty properly applying the bandage, generally underestimating the necessary tightness for effective application.[135] Furthermore, the victim must be carried out of the field following application of pressure immobilization, because any walking stimulates pumping of venom into the systemic circulation and negates any benefit even in upper extremity bites.[88] Although pressure immobilization is not recommended widely, certain scenarios may warrant its use. Although it is difficult to predict snakebite severity at the time of the bite, certain factors may reflect an increased likelihood of a more severe envenomation: large snake size, dangerous snake species, small patient size, prolonged fang contact, previous venomous snakebites (treated or not) or exposures to snakes, or delays to medical care and antivenom administration.[91] Individuals who consider applying pressure immobilization must assess risks versus benefits versus alternatives on a case-by-case basis. An informed decision should take into consideration the potential severity of the bite (see earlier). However, once pressure immobilization is placed after any snakebite, it should not be removed until antivenom is ready to infuse (if asymptomatic) or is infusing (if symptomatic) because of a potential bolus venom release after its removal.

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The cure for a fallacious argument is a better argument, not the suppression of ideas.
-- Carl Sagan

I couldnt get Eeek's OGG file to play on my computer but here is another link to the sound of a California rattler in case anyone else had similar problems:

http://www.californiaherps.com/snakes/pages/c.s.scutulatus.html

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The cure for a fallacious argument is a better argument, not the suppression of ideas.
-- Carl Sagan

I've seen rattlesnakes in:
Pate Valley
Rancheria Campground Area
Trail up to Tiltill Valley
Racheria Mountain
Grand Canyon of the Tuolumne
Switchbacks up to Beehive out of HH
Between Wapama and Tiltill Creek
On the 75 switchbacks up out of Pate towards Table/Rodgers
Other way up to White Wolf near Morrison Creek
Little Yose Valley
After Moraine Dome
and...
Near Baseline Camp (just below Cottonwood Meadows)
SOOOO...
they are everywhere!
run...
run away...
(I'm taking a picture of it)

Frank, thanks for that information. I'm curious what the citations are that refer to the Sawyer pump specifically. The incisions, mouth-sucking, and tourniquet warnings all make some sense to my logic, but the Sawyer one escapes me. On one hand, they have studies that show up to half of the venom can be successfully extracted, then they turn around and say it's ineffective and even dangerous. Why? wouldn't less venom cause less damage? What other dangers would there be? (if it's that they figure you can't be seeking medical help if you're working the extractor, if medical help is hours away, you may never get there anyway, and having half of the venom may just give yoiu the edge it takes to survive). Or have they disproven that, and if so, how?

Science and the medical community are famous for reversing themselves, and for approving things that kill or damage us, and that's why when they reverse themselves like this, I'm skeptical.

Example (unrelated) from another board; we all know the best procedure if confronted by a mountain lion is to stand up to it, be ferocious and large, even aggressive. But then there's this bonehead article:
http://www.sciam.com/article.cfm?id=should-you-run-or-freeze-when-you-see-a-mountain-lion

Now anybody that's ever owned a cat, and/or observed how their behavior, from housecats to lions, is all very similar, knows that if anything runs from a cat, it will pursue, no doubt about it. But they've misused statistics, and in fact ignored the one effective action, which is the one I mentioned above. Who has ever thought you should freeze? And yet they use that as the alternative to running away? Maybe, just maybe, you could justify walking slowly away in hopes of not triggering its chase instinct, at least if he's just observing you, but with any aggressive action, obviously the best way, no question about it, is to make the cat think it's just not worth it. And you do that by standing up to them and fighting back if necessary; no one, including cats, likes to get hurt, and if they think they're going to get hurt, they'll be more likely to move on. Outrun a mountain lion??? Give me a break, that's utterly ridiculous. As someone else pointed out, none of us could outrun a house cat. But this demonstrates how they've misused and manipulated statistics to prove a point and reach a conclusion that most certainly will get people killed. And this article was in Scientific American.

So that's why I can be hard to convince unless I see the reasoning behind something, regardless of what the source is.

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Gary
Yosemite Photo Galleries: http://www.pbase.com/roberthouse/yo

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Sierrafan
Frank, thanks for that information. I'm curious what the citations are that refer to the Sawyer pump specifically. The incisions, mouth-sucking, and tourniquet warnings all make some sense to my logic, but the Sawyer one escapes me. On one hand, they have studies that show up to half of the venom can be successfully extracted, then they turn around and say it's ineffective and even dangerous. Why? wouldn't less venom cause less damage? What other dangers would there be? (if it's that they figure you can't be seeking medical help if you're working the extractor, if medical help is hours away, you may never get there anyway, and having half of the venom may just give yoiu the edge it takes to survive). Or have they disproven that, and if so, how?

Science and the medical community are famous for reversing themselves, and for approving things that kill or damage us, and that's why when they reverse themselves like this, I'm skeptical.

Example (unrelated) from another board; we all know the best procedure if confronted by a mountain lion is to stand up to it, be ferocious and large, even aggressive. But then there's this bonehead article:
http://www.sciam.com/article.cfm?id=should-you-run-or-freeze-when-you-see-a-mountain-lion

Now anybody that's ever owned a cat, and/or observed how their behavior, from housecats to lions, is all very similar, knows that if anything runs from a cat, it will pursue, no doubt about it. But they've misused statistics, and in fact ignored the one effective action, which is the one I mentioned above. Who has ever thought you should freeze? And yet they use that as the alternative to running away? Maybe, just maybe, you could justify walking slowly away in hopes of not triggering its chase instinct, at least if he's just observing you, but with any aggressive action, obviously the best way, no question about it, is to make the cat think it's just not worth it. And you do that by standing up to them and fighting back if necessary; no one, including cats, likes to get hurt, and if they think they're going to get hurt, they'll be more likely to move on. Outrun a mountain lion??? Give me a break, that's utterly ridiculous. As someone else pointed out, none of us could outrun a house cat. But this demonstrates how they've misused and manipulated statistics to prove a point and reach a conclusion that most certainly will get people killed. And this article was in Scientific American.

So that's why I can be hard to convince unless I see the reasoning behind something, regardless of what the source is.

I don't understand my own cat, so I won't comment on the Sci Amer. article. And, yes, medicine is not physics (but even physics theories change) and, unfortunately, treatments go through cycles (the good side of that is that medicine is always testing and re-evaluating to re-invent something better).

Regarding snakebite:

These appear to be the references for the argument in the article regarding the Sawyer device:
2. Alberts M, Shalit M, LoGalbo F: Suction for venomous snakebite: A study of “mock venom” extraction in a human model. Ann Emerg Med 2004; 43:181-186.

14. Bush SP: Snakebite suction devices don't remove venom–They just suck [editorial]. Ann Emerg Med 2004; 43:187-188.

19. Bush SP, Hardy DL Sr: Immediate removal of Extractor is recommended [letter]. Ann Emerg Med 2001; 38:607-608.

20. Bush SP, Hegewald KG, Green SM, et al: Effects of a negative pressure venom extraction device (Extractor) on local tissue injury after artificial rattlesnake envenomation in a porcine model. Wilderness Environ Med 2000; 11:180-188.

You can go to PUBMED with National Library of Medicine and probably get at least summaries (abstracts) of the articles.

I would have to look at the study that made the 1/2 the toxin claim. Doesn't make sense. For example, if you have an extensive infection (not an abscess) throughout tissue planes, you cannot suck or even just wash it out.. Another example: High powered paint guns can inject paint into tissue. To get that paint out, the whole area has to be opened up. It doesn't just stay in one spot and wait to be removed. Forceful suction can damage tissue mechanically and if the surface gets damaged by the suction device (like a "hickey" ) there would be an argument against introducing bacteria into an area of tissue that is being digested by the snake toxins and that could cause additional infection as well.

Just sucking and mashing on the skin can breakdown cell walls in deeper tissue, potentially add to the spread of the toxin, increase amount of dead tissue, etc. Mostly I think they are a waste of time and that may be the biggest problem with them (delaying treatment). The snake toxin is composed of all kinds of nasty enzymes that breakdown tissue, kill nerves, interfere with clotting, etc. It is just unreasonable to expect that a person could get the toxin out by sucking. Perhaps if the whole area were cut out quickly after envenomation, that might have an effect. But obviously these events do not occur in hospitals where that sort of surgery could occur. Let me know if you find out anything else.

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The cure for a fallacious argument is a better argument, not the suppression of ideas.
-- Carl Sagan