Snake antivenom expertise required

[Led Lolly Yellow Lolly]

Without going into details, my work puts me in regular face to face contact with snakes. Our business is very rural and forested, I cut through undergrowth a lot and maintain remote networking and switchgear, often finding live snakes in electrical cabinets (also sometimes dry and desiccated snakes after they put themselves across 380 volts). Sometimes I'll go weeks without seeing one, then I'll have flush of encountering them several times a day. The most common ones I see are harmless Kukris but I also encounter a lot of extremely dangerous varieties, including numerous Banded Kraits, Malayan Kraits, Pit Vipers, various Cobras etc etc. . .

 

I've become very good at snake identification over the last 20 years, but I have a huge knowledge gap when it comes to snake antivenin. I've done the maths and in an emergency I could be in the nearest ER within 30 minutes, which is the best place to be of course. However, around 30 minutes ago my son almost stepped on a Monocled Cobra. For some reason I've seen a number of this species on our land in the last few weeks, I don't know why, I've never encountered them before. They seem to be everywhere now though. My son having this near miss really scared me. It was FAST, really aggressive. So if there is any expertise on treating snake bites, I'd sure be interested if you could share it with me. . .

 

 

 

 

 

[Kwasaki]

Best google snakes in Thailand most expert advice is there from my experience.

[Hummin]

You might ask thatcquestion on one of the many regional snakes groups on facebook, they are updated on antivenom. 

[Photoguy21]

The snake farm in Bangkok should be able to give you good advice. They milk snakes there.

[Led Lolly Yellow Lolly]

2 minutes ago, Kwasaki said:

Best google snakes in Thailand most expert advice is there from my experience.

It's mostly amatuer herpetologists online copying and pasting from eachother. I class this information as worse than useless.

 

1 minute ago, Hummin said:

You might ask thatcquestion on one of the many regional snakes groups on facebook, they are updated on antivenom. 

Can you post me an example? I am in Chiang Rai

[Hummin]

3 minutes ago, Led Lolly Yellow Lolly said:

It's mostly amatuer herpetologists online copying and pasting from eachother. I class this information as worse than useless.

 

Can you post me an example? I am in Chiang Rai

FB Snakes of Chiang Mai

[VocalNeal]

Surely the best advice would be where is antivenom available in Chiang Rai. ????

[Led Lolly Yellow Lolly]

7 minutes ago, Hummin said:

FB Snakes of Chiang Mai

So basically just a Facebook forum of farangs chewing the cud. I know there is medical expertise on these forums, this is what I'm interested in (emergency first aid etc etc)

[G Rex]

I would suggest that the best option is normal post bite treatment : for extremities - apply bandage to whole limb (not tourniquet) , limit movement & keep patient calm - and take somewhere (nurse/hospital) to have treatment administered.

You can self medicate with antihistamine, and even corticosteroid - but for antivenom to be effective it must be administered intravenously (diluted in normal saline)- which most of us are unable to do

As you are experienced in snake identification - your information will enable the experts to give the correct antivenom for the snake that has bitten you/the patient

[G Rex]

a major part of snake bite therapy is the administration of very large volumes of intravenous fluid - to help flush the venom  that has not been 'bound' by the antivenom from the circulation before it does too much damage. It will still give the liver and kidneys a hiding on the way out!

This is another reason why educated medical intervention is required.

[Sheryl]

Moved to the Health forum.

 

As you seem to know, antivenoms are snake specific and you would need to go to the nearest government hospital to receive it (preferrably a large hospital e.g. provincial hospital as smaller ones might not have antivenom in stock).

 

Immediate first aid is simple:

 

1. Immobilize the area (movement will help the venom spread quicker)

2. Keep the affected area lower than the heart if possible (slows the spread of the venom a little)

3. If there is anything tight or restrictive on the affected area (like a ring or tight clothing) loosen it

4. Apply ice if available (but don't delay hospital transfer seeking it)

Do NOT attempt to suck out the venom or make an incision to drain it out

Do NOT apply tourniquet

 

If possble, kill the snake and bring it with the patient to the hospital, or get a photo of it (to aid hospital staff in selecting the right anti-venom) - but do not delay sending the patient to the hospital for this purpose.

 

Not all snake bites, even from venomous snakes, result in envenomation. And the venom dose depends on many things such as when the snake lat bite something.

 

Prevention is obviously best approach. Most snake bites occur from accidentally stepping on or near the snake. From what you describe of your situation I would strongly urge wearing thick, high rubber boots when entering the forest, and donning thick gloves before opening electrical and other cabinets where snakes might be lurking.

 

[Hummin]

10 minutes ago, Led Lolly Yellow Lolly said:

So basically just a Facebook forum of farangs chewing the cud. I know there is medical expertise on these forums, this is what I'm interested in (emergency first aid etc etc)

It is snake herpes who do call out, and also keep updates of where snake venom is updated. So the admins is snake experts by interest or professional.

 

Great place to keep your self updated on valid information and also snake id when not sure.

Im positive they can answer your question and also give updated answers when it comes to antivenom

[scubascuba3]

Surely you need to check with the local hospitals, try and get a coherent answer from them, very difficult i know

[Led Lolly Yellow Lolly]

6 minutes ago, Sheryl said:

Prevention is obviously best approach. Most snake bites occur from accidentally stepping on or near the snake. From what you describe of your situation I would strongly urge wearing thick, high rubber boots when entering the forest, and donning thick gloves before opening electrical and other cabinets where snakes might be lurking.

Thanks for your input. One thing I repeatedly drum into my son is he shouldn't just be looking on the floor. He must have his eyes to the trees and bushes as well. Many Pit Vipers strike at head height.

 

Is Antivenin not something someone like me could be trained to keep for emergency use, for example if I'm working really off the track?

 

 

 

[Cake Monster]

4 minutes ago, Sheryl said:

Moved to the Health forum.

 

As you seem to know, antivenoms are snake specific and you would need to go to the nearest government hospital to receive it (preferrably a large hospital e.g. provincial hospital as smaller ones might not have antivenom in stock).

 

Immediate first aid is simple:

 

1. Immobilize the area (movement will help the venom spread quicker)

2. Keep the affected area lower than the heart if possible (slows the spread of the venom a little)

3. If there is anything tight or restrictive on the affected area (like a ring or tight clothing) loosen it

4. Apply ice if available (but don't delay hospital transfer seeking it)

Do NOT attempt to suck out the venom or make an incision to drain it out

Do NOT apply tourniquet

 

Not all snake bites, even from venomous snakles, result in envenomation. And the venom dose depends on many things such as when the snake lat bite something.

 

Prevention is obviously best approach. Most snake bites occur from accidentally stepping on or near the snake. From what you describe of your situation I would strongly urge wearing thick, high rubber boots when entering the forest, and donning thick gloves before opening electrical and other cabinets where snakes might be lurking.

 

As always, good and practical advice from Sheryl.

Further to her post, there are " Ninja Leggings " available on Lazada, at a very affordable price.

Could possibly help with lower Leg protection.

 

[simple1]

In addition to advice already posted, here in Australia it is always recommended not to clean the snake bite area as medical people can swab the venom to identify he snake for appropriate anti venom.

[Lacessit]

The pioneer of developing antivenoms was Dr Struan Sutherland in Australia. I don't know if his work extended beyond Australia. There is a clinician's handbook on the subject, it may be worthwhile contacting CSL to find out if they have antivenoms for Asian snake species.

 

https://biomedicalsciences.unimelb.edu.au/__data/assets/pdf_file/0004/3216739/A-Clinicians-Guide-to-Venomous-Bites-and-Stings-2013.pdf

 

Otherwise, IMO you would need to do the legwork of going to each hospital and finding out what range of antivenoms they stock for the nasties here.

[Sheryl]

13 minutes ago, Led Lolly Yellow Lolly said:

Thanks for your input. One thing I repeatedly drum into my son is he shouldn't just be looking on the floor. He must have his eyes to the trees and bushes as well. Many Pit Vipers strike at head height.

 

Is Antivenin not something someone like me could be trained to keep for emergency use, for example if I'm working really off the track?

 

 

 

1. Yes, there are Pit Vipers in the trees but their venom won't kill you fast, there is time to get to a hospital. What you have to worry about are cobras and kraits, especially King Cobras and Monocled Cobras as these last two can kill in less than an hour.

 

2. Not really. Aside from the fact that no place is likely to issue it to you, and that it requires skill in IV insertion etc, it carries a significant risk of anaphylaxis so life support equipment (including ability to intubate and sustain respiration artificially) and skills are also needed.

[G Rex]

24 minutes ago, Led Lolly Yellow Lolly said:

Thanks for your input. One thing I repeatedly drum into my son is he shouldn't just be looking on the floor. He must have his eyes to the trees and bushes as well. Many Pit Vipers strike at head height.

 

Is Antivenin not something someone like me could be trained to keep for emergency use, for example if I'm working really off the track?

 

 

 

Learning how to administer large volumes of fluid intravenously - even the initial placement of a simple intravenous catheter - is not something that can be easily trained. It is a skill honed with practise .  Even if you knew how to do it - in the pressure of the situation - you would be unlikely to be successful. (No disrespect)

[KhunLA]

Monocled cobra bite.  In this vid here @ 11:20, his body was starting to shut in < 30 ish minutes ... scary stuff.

 

 

 

 

[Hummin]

It is two common things that put people at risk, surprising a snake, stepping on it, cornering a snake, and try to kill them.

 

Snakes just want to flee to safety, unless they are threatened, they will warn you, and also protect themselves.

 

I believe in Thailand they id the snake venom by blood and urine test, so bringing the snake is not necessary. They will not give antivenom by just looking at the snake.

 

 

 

[Led Lolly Yellow Lolly]

18 minutes ago, G Rex said:

you would be unlikely to be successful. (No disrespect)

None taken. As I said, this is a big gap in my knowledge. I'm more interested in the things that can be done to give the patient the best chances while en route to skilled care.

[Sheryl]

13 minutes ago, Hummin said:

I believe in Thailand they id the snake venom by blood and urine test, so bringing the snake is not necessary. They will not give antivenom by just looking at the snake.

 

 

 

 

Not all hospitals have the capacity to do these tests.  In fact many rural hospitals do not.

 

In addition, with quick-acting venoms there will not be time for blood and urine tests.

 

A competent doctor will indeed give antivenom in the absence of lab tests, if these are unavailable or there is not enough time, based on clinical signs in  the patient (these alone will narrow down the possible snake type), whatever information is available on the appearance of the snake, and what is known about snakes present in the area.

 

 

[Led Lolly Yellow Lolly]

37 minutes ago, KhunLA said:

Monocled cobra bite.  In this vid here @ 11:20, his body was starting to shut in < 30 ish minutes ... scary stuff.

Right, this one is the one that really alarms me. There a loads of juveniles around at this time, they seem to strike more readily. I killed this one in our main office a few weeks ago. I prefer to catch and release but I couldn't risk this one getting past me and into the woodwork (child friendly office). . .

 

[Led Lolly Yellow Lolly]

I just watched that video. I really don't understand why these people are so reckless with the snakes they handle.

[KhunLA]

22 minutes ago, Led Lolly Yellow Lolly said:

Right, this one is the one that really alarms me. There a loads of juveniles around at this time, they seem to strike more readily. I killed this one in our main office a few weeks ago. I prefer to catch and release but I couldn't risk this one getting into the woodwork. . .

 

If I see them, sorry, they don't get a pass.  I'm not letting it out of my sight, and it's not getting away, if in our yard.  I'm not going to get bit playing nice with it, or have it play hide & seek waiting for a pro to arrive.  My house, my dog ... you lose.

 

The house, yard will be as snake proof as possible (yea I know), and nothing should be able to 'drop' over the wall.  If dumb enough to come in, better have your exit planned, and be really fast ... ????

 

They scare the hell out of me.  Used to walk the dog on leash at old house, no wall, 2 rai, and couldn't let her run free ????  Surprisingly, only notice 1 cobra, though more than a few unknown tails slithering away.  Damn Russell viper over my foot one day, as we spooked each other, and lucky he evaded instead of defended.  Could have went the other way though ????  Forgot to cut the corner wide, just glad I didn't step on it.

 

Few resident Flying Golden tree snake, and we co-habituated well ... if on the ground, they move up the tree fast.  If dog not out, and I was chilling, they'd actually get within a couple of meters and catch some rays themselves.  Loved sunning on the waterfall.

 

Actually surprised I've seen very few at PKK, as almost monthly seeing at Udon Thani.

[G Rex]

38 minutes ago, Led Lolly Yellow Lolly said:

I just watched that video. I really don't understand why these people are so reckless with the snakes they handle.

I do not think that Phil is reckless with them - maybe somewhat blase - he is confident & comfortable - he knows which ones are dangerous, & what they are capable of.

It is a testament to his expertise - and a reminder to normal folk to 'back off' if they don't know what they doing 

[Led Lolly Yellow Lolly]

Well it nearly killed him, the word I use is reckless. Even the deep penetration wound of a non-venomous snake can do serious harm to the body. I do also handle snakes, a lot, and I don't differentiate between that style of snake handling and juggling a loaded and cocked gun. I mean no ill will, but IMO I'ts complete recklessness.

 

 

 

[Led Lolly Yellow Lolly]

Please change topic title to 'Snake bite survival advise'

[kwonitoy]

Baby snakes have little to no control over the amount of venom they inject, that makes them extremely dangerous.

 

When I worked for PTT building the Yadana pipeline to then Burma in the late 90's they had an expert on snakes give us mostly foreigners a talk about indigenous snakes in Thailand. On a poster their were 8 listed as extremely dangerous.

Most common form of getting bit, doing what you're doing clearing grass and brush, most people step on the snake and it attacks.

Do you wear snake garter's that should come up to your knees or higher?  https://duckduckgo.com/?q=snake+protection+garters&atb=v315-1&iax=images&ia=images. If not buy a set.

 

Bamboo snakes are very dangerous as they climb up into the bamboo during the heat of the day to get shade and a breeze. You jostle the bamboo and you get a just awakened very small highly venomous snake on your head or upper body. https://duckduckgo.com/?q=bamboo+snakes&atb=v315-1&iax=images&ia=images. 

The local Right of Way clearing and surveyors that went into the jungle always cut a banana leaf and wrapped around their forehead with the long part down their back. I saw this in Thailand and also in Central America

 

The advice to us was DO NOT go into bamboo

 

Sheryl has the right advice as always. IF you get bitten, try remain calm. It's not going to happen but...

If your with someone get to your truck as some as possible, crank the AC up as high as it will go, recline the seat or lay down in the back seat. bitten area, usually your leg lower down. That's why you should wear garters.

Identify the type of snake if possible or kill it and throw it in the  back of the truck, this is what we were recommend to do.

Haul #ss to the local clinic.

 

And most importantly, buddy up. Under no circumstance should you be in a remote area alone. Ever