Pit Viper Bites Research Articles

Treatment of Snakebite

To the Editor.— The publication of the article on treatment of pit viper bites has been brought to my attention. I regret the publication of this article without conflicting opinions of others. Here in Florida, a recent survey indicates close to 600 venomous snake bites each year are treated in emergency departments. In the last three years we have averaged one death per year. It is highly probable, therefore, that the mortality is not affected anyway by the method of treatment. The only question, therefore, is the extent of morbidity and disability resulting from the bite and subsequent treatment. The best information available to this office indicates that about half of the venomous bites in the state are treated solely or primarily with antivenin. Depending on the location and reaction, massive doses of antivenin may be given, sometimes 10 to 12 vials. The results that have been reported have been

Treatment of Snakebite

To the Editor.— Dr Thomas Glass' article on the early debridement of pit viper bites (235:2513, 1976) we believed was excellent in its content and clarity, and was most helpful in correcting some earlier widespread misconceptions regarding treatment. We were disappointed, however, in his wide-reaching allegation that recommendations made by physicians for nonmedical first aid were for the purpose of having someone to blame in case of treatment failure.

Early Debridement in Pit Viper Bites

BITES by common pit vipers create complex problems in the human victim that require complex solutions. No panacea is available, regardless of statements by some authorities. In the continental United States, common pit vipers include the rattlesnake, copperhead moccasin, and water moccasin; in south Texas, they are represented by the western diamondback rattlesnake (<i>Crotalus atrox</i>), copperhead moccasin (<i>Agkistrodon contortix contortix</i>), and water moccasin (<i>Agkistrodon piscivorus leucostoma</i>. Any physician who treats a pit viper bite must know the mechanical and physiological effects of the venom on the human victim, and he must apply the latest methods of medicine and surgery to prevent death, loss of limbs and digits, and loss of function (especially of the hand and fingers).¹ Since 1966,I have seen and treated 200 patients with pit viper bites and have performed surgery on 140. These 140 patients are classified according to type of viper, sex, age, and area

Early debridement in pit viper bites

From my observations of snakebite over the last 22 years and the studies I have done, several things are important: (1) Pit viper envenomation is a surgical emergency as is any disease in which gangrene of human tissue occurs. (2) Severe pit viper envenomation causes complex problems similar to those seen in Gram-negative septicemia, and they require complex methods of treatment. (3) Early surgical inspection of the snakebite wound is as essential as early appendectomy in appendicitis. Its results are as gratifying. (4) Present knowledge of anesthesia, coagulation problems, infections and antibiotics, blood gas changes, electrolytes and fluid therapy, and other advances in the surgical field allow the physician to treat severe pit viper envenomation by scientific means rather than by hocus-pocus. (5) Crippling from pit viper envenomation is caused by too little treatment, too much first aid, or both.

DIFFERENCES IN THE PATTERNS OF BITES OF VENOMOUS AND OF HARMLESS SNAKES

Some students maintain that when a pit viper bites in self defense it merely sticks its fangs into the victim as a stab, whereas others insist that such a snake uses both its jaws in a true bite. Early reports of the last century, such as the classic ones of Weir Mitchell and Joseph Fayrer, vaguely describe pit vipers as actually biting, but the fact was not emphasized because then much more important aspects were crying for attention. Nearly all recent instructions for the treatment of snake poisoning flatly state that the bite of a venomous snake leaves only one or two fang punctures and is therefore readily distinguished from that of a harmless one, with its six rows of punctures made by small teeth (fig. 1). The purpose of this paper is to settle the question, which has practical value in the treatment of snake poisoning as well as