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What to Do When You’ve Been Bitten by a Snake

You have just been bitten by a small snake. You are pretty certain it is just a harmless python, but it disappeared before you could get a proper look. Do you administer first aid and go to the hospital or keep gardening?

When Pat Ryan saw a little brown-looking snake disappear under his fence earlier this month, he decided to check himself over, even though he had not felt a bite.

He had been gardening barefoot in his yard in Agnes Water on the Queensland coast about an hour north of Bundaberg.

“[My wife] washed my foot off to have a look … then washed it a bit more and said, ‘Yeah I can see two little strike marks’,” Mr Ryan said.

“And then a couple of minutes later I felt my left hand, like I had two little pin pricks on my left hand.”

Like in many of the 3,000 or so reported snake bites in Australia each year, there are a number of snakes fitting Mr Ryan’s description that are native to the region, some harmless and others potentially deadly.

First Minutes Crucial Before Venom Enters Bloodstream

If Mr Ryan had been bitten by a brown tree snake, over the next few hours he might experience some very mild local irritation around the bite and its weak neurotoxic venom might cause some nausea.

But if the snake was a similar-looking eastern brown, a deadly cocktail of neurotoxins, myotoxins, and coagulants would be making its way toward his bloodstream before attacking his nervous system and muscles, putting him at high risk of cardiac arrest.

This is where treatment is crucial. If the right procedure is followed, the snake venom can be all but stopped before it reaches the blood, according to toxicology expert Dr Brian Fry.

“When you wipe out when you’re running or something like that and you scrape your knee and you get that clear liquid coming out, that’s actually lymphatic fluid,” Dr Fry said.

“Lymphatic fluid is fluid around our blood vessels, bathing everything that’s not inside the blood vessels.

“Initially the venom is [injected into] that, and it doesn’t reach the blood until it gets to a lymph node.”

In Mr Ryan’s case, after being bitten on the foot, the venom needed to travel via his lymphatic fluid all the way up his leg to the lymph nodes behind his knee and in his groin, where it would then drain into his bloodstream.

Compression Bandage Can Buy Bite Victim Hours

Mr Ryan works in the mines and does regular first-aid training, including snake bite treatment. Three years earlier, his wife Jazz was bitten by an eastern brown and rushed to hospital in Rockhampton where she recovered without the need for antivenom.

Not knowing the exact identification of the snake, Mr Ryan sat himself down with his leg hung over the verandah railing while Jazz grabbed “whatever [she could] get [her] hands on” to make a compression bandage — in this case, garbage bags.

Starting at the bite and working up the limb, they used the bags to apply pressure evenly and firmly without cutting off blood flow completely.

If done well, this technique can slow the movement of lymphatic fluid to a near stand-still, according to Dr Fry.

“There’s been cases of people arriving [at hospital] with a taipan or a brown snake bite seven, eight hours post bite — no symptoms,” he said.

“And then at the hospital when they take the bandage off, 10 or 15 minutes later the venom slams into them like a freight train.”

In contrast, an untreated eastern brown snake bite can kill in under half an hour.

“It’s arguably the quickest killing venom in the world. No other snake in the world has killed people so quickly, so regularly,” Dr Fry said.

Flying Doctors Update Advice as Wrong Identification Common

Between 2005 and 2015, eastern browns were responsible for 17 of the 23 snake bite deaths in Australia, with most victims dying from out-of-hospital cardiac arrest or bleeding on the brain.

Of the 296 eastern brown snake bites in that period, 18 per cent caused acute kidney injury, and other ongoing complications were common.

Although they typically only inject a small amount, hatchling eastern brown snake venom is capable of killing an adult, so being bitten by a small snake does not mean it is harmless.

Adding to the difficulty, eastern browns range from red-brown to black or grey, can be striped, mottled or have a reddish band behind the head, and can look very similar to other harmless species.

The Royal Flying Doctor Service (RFDS) no longer advises bite victims to attempt to identify the snake after a paper published in the Medical Journal of Australia (MJA) in July found that snake identification was unreliable for people presenting to hospital with bites.

“Staying in the area after an attack can be dangerous and recent advances in medication mean we can now treat any snakebite with a generic polyvalent anti-venom,” the updated advice now say.

Remaining at Home an Unnecessary Gamble

When the ambulance arrived for Mr Ryan, they replaced his improvised compression bandage before transferring him to Bundaberg hospital.

“They tried doing swabs to see what sort of snake it was and they couldn’t [tell] because I had to wash it to see if I was actually bitten,” Mr Ryan said.

“So yeah, I did the wrong thing there but at the end of the day I needed to see if I’d actually been bitten as well.”

Several swabs did not reveal any venom, so the hospital removed Mr Ryan’s bandages and began to monitor his blood pressure, coherence and pupil dilation.

“Then they did another lot of tests and my blood started to thin out, and I started getting a headache and started getting sleepy,” he said.

At this point there was no way of knowing if he had been bitten by a mildly venomous snake, a highly venomous snake that had only injected a very small amount of venom, or a highly venomous snake that had injected enough venom to be fatal.

Because he put a pressure bandage on the limb and got to the hospital with a generic polyvalent antivenom on standby, in every scenario he is likely to make a full recovery.

But if he had kept gardening, in the third scenario he could have been dead in under half an hour.

As it was, he was kept at the hospital and monitored hourly through the night.

He was discharged the next day as his symptoms began to improve, although the species of snake that bit him was not able to be identified.

Dr Fry’s advice is to always get to the hospital, even when you think you know the species of snake.

“It’s better to be there and not need to be there, than not be there and really need to be there.”


RFDS’ Updated Guidelines for Treating Snake Bites

  • Do NOT wash the area of the bite or try to suck out the venom. It is extremely important to retain traces of venom for use with venom identification kits.
  • Do NOT incise or cut the bite, or apply a high tourniquet. Cutting or incising the bite won’t help. High tourniquets are ineffective and can be fatal if released.
  • Do bandage firmly, splint and immobilise to stop the spread of venom. All the major medical associations recommend slowing the spread of venom by placing a folded pad over the bite area and then applying a firm bandage. It should not stop blood flow to the limb or congest the veins. Only remove the bandage in a medical facility, as the release of pressure will cause a rapid flow of venom through the bloodstream.
  • Do NOT allow the victim to walk or move their limbs. Use a splint or sling to minimise all limb movement. Put the patient on a stretcher or bring transportation to the patient.
  • Do seek medical help immediately as the venom can cause severe damage to health and even death within a few hours.
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