🚀 go-pugleaf

geoffm@netcom.com (Geoff Miller) writes:
> Would you mind elaborating on this?  The principle behind the kits 
> certainly seems reasonable enough: to remove the venom in order to
> limit the damage that it can do.

When my dad got his rattlesnake bite about two years ago, I remember
hearing how useless those Cutter-type snakebite kits were.  Surprised
me though.  I remember how important we used to think having 'em was
when I was in Boy Scouts.

> And it also seems reasonable enough that even an incomplete attempt
> to suck out the venom would be better than leaving it in, and thereby
> doing nothing to limit the exposure of blood an tissues to something
> that is rather unambiguously Not Nice.

Yeah, it would seem that way.


> Also, if the Cutter's kits are so counterproductive, why isn't that
> better known to the public at large?  Wouldn't the nation's physicians
> be ethically obligated to get the word out with as much fanfare as
> possible?

I think maybe because rattlesnake bites are relatively rare, it just doesn't
rank as a very high priority issue.  Judging by all the commotion around my
dad both in the emergency room (at Stanford Hospital), I concluded that an
honest to goodness rattlesnake bite patient was a rare treat for the docs
and students there.  All the time I was there in the ER with my dad, there
were doctor types (students?) coming up to him and saying, "you mind if I
take a look at that", etc.  Everyone seemed fascinated.  (He was bit on his
index finger by a baby rattler while out on a bike ride in the east bay
hills.  He was trying to fling the snake out of the roadway so it wouldn't
get run over... and it turned on him FAST and got him on the index finger.)


> And this being the U.S. of A., wouldn't the Cutter company be needlessly
> exposing itself to product liability litigation by marketing a product
> that was potentially harmful?

> Do you have any statistics on the success of treatment of rattlesnake
> bites with various types of treatment, including the "cut and suck"
> treatment, and without any treatment at all?

Great questions.  I'd like to hear more about this too, but from
knowledgeable sources...


>> I've only seen one patient (out of  hundreds) who even needed 
>> antivenin (and he needed a whole bunch of it, something on the 
>> order of 14 vials, more than the total the 5 hospitals in the
>> area (Ft. Hunter-Liggett, CA) had available.
> 
> What determines whether or not a patient "needs" antivenin?  I'd think
> that simply having been bitten by a rattlesnake would be sufficient.
> It would certainly be enough for _me_ to insist on it rather vehemently,
> if I were in that position.  Isn't it the nature of hemotoxin that once
> the "need" for antivenin becomes apparent, the damage has already been
> done to a significant, if not fatal, degree?

When I got to Stanford ER, my father had been there for at least an hour
already.  It probably took him *at least* a half hour or more to get back
to his car and drive himself over to Stanford ER from the east bay hills
where he was bitten.  He said he was feeling a little tingly on the drive,
but felt like he was perfectly able to get himself to the ER safely.  By
the time I got in to see him, he was not feeling so great and his finger
looked gross.  It was turning funny colors and was impossibly huge.  His
entire hand looked like a well-inflated rubber glove.  The ER staff was
still not prepared to administer the antivenin.  They were waiting and
watching how he reacted to a test scratch/patch they had made on his inner
thigh.  I don't know how long, but that took quite a while before they
dared put any of the antivenin into his IV line.  When they did, I noticed
they dilute it in what looked like at least a pint of saline solution and
then set the infusion rate a some very low level.  For the first 5 or 10
minutes of antivenin infusion (at the low rate), they were closely watching
his vital signs for any sign of a bad reaction.  Only when they felt he
was okay with the stuff did they crank up the infusion rate a little more.  
And then a few minutes later, they cranked it up a little more...  The
antivenin, as it turns out, can kill some people pretty fast.  So they
want to be real sure that you're not allergic before you get it.  Also,
an interesting aside, I heard it called "horse serum."  Apparently it is
somehow made from, or derived from, horses in some way...

Meanwhile, they marked his finger with a marker and kept tracking the
swelling.  They explained that if it reached beyond a certain level, or
if he could no longer feel a pin prick on the tip of his afflicted finger,
they would make a lengthwise cut along the finger to relieve pressure
and so that the skin wouldn't tear.  With a cut, they presumably can sew
it up more nicely later than with a random tissue-swelling pressure-
induced tear.  I watched them do the pin prick test on his fingertip.
In order to see if he was trying to fool them, they asked "do you feel
this?" when he couldn't see that they were only faking a pin prick.  Then
they did a real one and he said "yes!".  Interesting.  I guess some folks
will lie just to avoid the unpleasant consequences of saying, "No, I can't
feel that."

At any rate, he spent the next 3 days in the hospital and to this day his
finger is not normal.  He was lucky in that he only got away with a very
stiff finger.  My mother knows a Palo Alto man who did require a partial
hand amputation...

I *definitely* have a new-found respect for rattlesnakes and the damage
they can do.  I must admit, I had this idea that bites were bad and all
that.  That you try to avoid them at all cost, but I had no idea just what
havoc these suckers can wreak!  Avoid bites at all cost.  It was very,
very miserable watching what my father went through with his--and his was
a baby little snake, and one fang hit him right on the knuckle and we
think didn't even get much, if any, venom under the skin!

-- 

Adrian Brandt
(408) 565-7291 / ab@nt.com