Snake bite management in Trinidad/West Indies:

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Posted by Uli Wagner on September 20, 1999 at 11:38:37:

Ten days ago in our beautiful rainforest I was bitten by a small viper (40 cm), suffered much pain, a swollen foot and lower leg, with haemorrhages extending up to my groin, acute severe headache, and bleeding gums. I survived the first three days on the balcony of a cosy little hotel on the beach, with a bit of rastafarian bushdoctor treatment and rum, did not even get a local tissue necrosis, but still have a swollen leg if I stand or sit for more than half an hour.

Being a physician, I updated myself afterwards on what I should/shouldn’t have done, and have some questions and remarks:

1. The snake was probably a Mapeypi (local name) which seems to be Bothrops atrox or Fer-de-lance, apparently the most common cause of snakebite in S.America, with less than 2% fatality.
- So in my avoidance of antivenom treatment I was right, you agree? (my reasons: 3 hours on rough roads with very painful leg, anaphylaxis risk, intensive care conditions, no benefits for local tissue damage)
- With 40 cm length, was this a baby? Are baby snakes less venomous than adults, do they inject a lower volume?

2. The main venom effects seem to have been blood and plasma leaking out of the blood vessels into the tissues. While this has stopped now, it still feels as if the vascular endothelium is damaged, in-cluding the veins’ valves, which causes foot & leg swelling if I don’t position the foot up. Is endovas-cular damage a possible longer-term effect?

3. In the first 2 days I had to keep my foot higher than heart level to tolerate the pain (which is against the rules). The best effect was when I held it above head level. But then I developed a terrible head-ache and lowered the foot again, which shifted the pain from the head back to the foot. It felt like a system of communicating pipes, with the venom sloshing back and forth between foot and head. Only later I realized that that headache was probably due to blood leaking from my subarachnoidal and meningeal blood vessles, the same process I was seeing in my foot and my gums. Is that plausible?

Snakebite protocols say:

4. no sucking out of venom – why? My wife sucked the bite immediately for 5 minutes, washed her mouth often, but still got a numb and tingling mouth/throat and nausea. So she must have removed some venom which probably benefited me even if it was only 5% or 10%.

5. No icepacks ? I applied them for 2 hours, it suppressed the excruciating pain. From my under-standing, the cold constricts the blood vessels, reduces the absorption of the venom but may thus en-hance local tissue damage. This seems to be similar to the effects of applying a bandage which is recommended. So why not using cold?

6. nothing about heat therapy. I somehow remember that many venom components are heatlabile proteins etc. By applying hot water or cloths to the bite at just below the scalding temperature, one could destroy at least part of the venom. Is this not correct?

Any answers or comments?
Is there a forum where I might get professional answers?

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