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EMS, You Make the Call

You Make the Call – Bit

This weekend was to be the first camping trip of the year.  Staying local, visiting a state park that we had never visited takes the strain of a few hours transit out.  On a clear day you can see most of our region, 60-70 miles in all directions.  Seemed like a fun spot and provisions were secured.

Universe Warning #1: No alcohol allowed in the park.

Now I know how CHL folks feel when they can’t take their weapon with them certain places.

Universe Warning #2: Extreme Fire Danger in effect. Only charcoal and gas stoves allowed, no open burning.

How am I supposed to do SMORES over a charcoal built in? We’ll make do.

 

And that was before we even packed the car.  Looking back, the Universe, God, Karma, something was trying to send me the signal NOT to go camping this weekend.  I wasn’t listening.

I’m getting to the You Make the Call…trust me.

Arriving at the park we picked out a shady site with a large enough spot for our tent and the girls to run around and exhaust themselves.

As I open the back of the van to get the gear I hear from commotion from the next site over, “Oh God he got bit by a rattlesnake!”

 

A 58 year old male walks in from the open space nearby holding his left hand.  He sits at a nearby bench, 1st finger with a single puncture wound, the bleeding has stopped but the site shows initial edema.  He is smacking his lips while speaking in full sentences and is in good spirits considering.

Being the kind camper you are you approach and offer assistance.  A woman is tying a twine tourniquet on the finger which you quickly remove and they raise his hand which you quickly restore to it’s natural position and ask if anyone has called the Ranger Station.

Another woman has appeared (It was a Girl Scout outing, moms and girls) with a snake bite kit.

Your situation:

What might pass for a BLS camping kit plus a dose of epi 1:1000 back in your own camp.

New in package Coleman brand Snake Venom Removal Kit.

Campsite is 15 linear miles up a mountain, the drive took you 35 minutes avoiding bikers.

The Ranger Station is maybe 2 miles back down and just a few minutes ago had 2 Ranger vehicles parked there.

The man has no pertinent medical history, is alert and oriented and in the few moments it takes to assess the situation the edema has not changed.  His pulse rate is elevated, 130, but he is anxious as well.

 

What do you do?

You Make the Call

 

This will be a 2 part YMTC and will expand on what I did and what happened then.

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9 Comments

  1. Edzook June 10, 2012 5:44 pm

    There is no definitive pre-hospital treatment for snakebite, and evacuation to a hospital that can treat with antivenom is the only real treatment.  The Coleman snakebite kit is useless.  No snakebite kit, either the old “cut and suck” or the newer extractor models actually do any good as the venom was already injected too far to be removed.  All of us in wilderness medicine used to carry them, until we realized they didn’t really work…  Wrapping the injured extremity is indicated with Australian snakes, but is not recommended for American snakes.  
    Assuming (and this is the doozy) that he has actually been bitten by a rattlesnake, scene safety becomes pretty important.  Clear the area so nobody else gets bit.  I’d begin evacuation towards definitive care while my patient is still in good condition, as evacuation after he crashes will be much harder.  Attempt to keep the patient calm, as his anxious state with elevated heart rate will spread the venom through his body more quickly, and keep the bitten extremity below the level of the heart.  Call the ranger station, and have them get an ambulance started towards you; plan to meet it somewhere on your way to the hospital.  You have about 45 minutes before the patient really starts having trouble, so you might as well start moving towards additional help to shorten the trip. 

    I have some doubts about whether he was actually bitten; did anyone actually get eyes on the snake?  Rattlesnakes leave two punctures when they bite, and only one puncture makes me wonder.  A quick google search shows that you’re in the area of the Western Rattlesnake, so if in doubt, though, don’t hesitate to evacuate!  

    • Thehappymedic June 10, 2012 8:07 pm

       Sounds good so far Edzook.  I’ll fill in that this was a “one bud” baby rattler who only got one fang in.  The side of the finger is where he got hit and he was a good 200 meters from us when it happened.  How did he get bit you ask? He tried to pick it up to show his young son.
      Evacuation was my first thought as well.  More soon.

      • EDZook June 11, 2012 4:19 am

        Ah, baby rattlesnakes.  I’ve heard that baby rattlesnake bites can be actually more dangerous, as the snake hasn’t learned how to regulate his/her (it’s?) venom yet, and will usually inject lots.  

        I’ve also heard that most rattlesnake bites are suffered on the hands and face, because folks are trying to do just what this guy did.  Any ETOH on board this guy? 😉

  2. Greg Friese June 11, 2012 5:21 am

    Edzook like your treatment and evacuation plan. 

    HM – charcoal grill is ideal for s’mores. Either use the even temperature coals for a perfectly roasted marshmallow or place a cracker with chocolate and marshmallow on the grill grate. Cover for about a minute and then enjoy.  

  3. Daniel June 11, 2012 9:14 am

    Edzook pretty much nailed what I was thinking. Activate EMS, Get the PT horizontal, extremity lower than the heart, and begin transport towards the ranger station. The clock is already running.

  4. BGMiller June 11, 2012 9:44 pm

    I suppose smacking the patient upside the head for being an idiot kinda goes against the idea of treatment huh?

  5. Michelle June 12, 2012 10:58 pm

    Just for my own personal info. here I knew snake bite kits were useless, but what about immobilizing the extremity and applying some ice? (you are camping and since happy doesn’t have cold beer I bet he has cold soda, or cold “adult soda”)  What I’ve been told (last I recall) immobilization and cold compress could help prevent additional spread?  But…like the kits, does it actually work?

    With the story and info I have on hand, I’d be moving towards transport and meet the ambulance in route.  Better safe then sorry, especially with the history and its pretty clear cut that it was a snake bite.  The baby snake bite I believe does make it worse. 

    Best case scenario snake isn’t poisonous, no severe reaction occurs, guy goes to hospital and gets evaluated and discharged with a clean wound and updated tetanus shot.

    Worst case….life and/or limb threatening reaction, and or other transmittable diseases….hence ambulance ride.

  6. Michelle June 12, 2012 11:04 pm

    More importantly tho, raise propane or charcoal grill to elevated area, place gram cracker and piece of chocolate UNDER elevated bbq till heated.  Get marshmellow sticks and roast marshmellows over fire (take grill off if needed) then assemble smore.  Chocolate will LOOK like normal square, however if done right, once you touch the marshmellow and chocolate together it will be gooey and soft and IMHO much better then room temp chocolate on traditional smoore.  (found it out when I was a kid in a similar situation while camping.)

    Ohh and my weapon is much more important to me then having a cold beer.  One is to save my life, the other tastes good.  But I get what you were saying. 

  7. Shilah October 16, 2014 3:24 pm

    but… but… teacher, I heard that heat actually , like, nullifies the snake venom or something. What about that ? So maybe the guy should hold his finger over your charcoal campfire?

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