Clinical Reference Systems: Pediatric Advisor 10.0
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POISONOUS SNAKES

Description:

In the U.S. the poisonous snakes are rattlers, copper-heads, cottonmouths, and coral snakes. In about 30% of poisonous snake bites, no venom is injected (dry bites). If venom is injected (envenomation), the fang marks will begin to burn and hurt within 5 minutes and swell within 30 minutes. Begin first aid only if these signs develop.

Call Your Child's Physician Immediately in All Cases.

First Aid for Poisonous Snake Bites:

1. Transportation

   Go to the nearest hospital emergency room as rapidly as possible. The most important part of therapy is antivenin, and it needs to be given within 4 hours. Have your child lie quietly in transit to reduce absorption of venom. If the bite is on the arm, remove any rings or bracelets before swelling occurs.

2. Incision and suction for poisonous snake bites

   If you are more than 60 minutes from the hospital, you are certain the snake was poisonous, and the fang marks begin to swell or hurt, take 10 minutes to try to remove some of the venom. Use a knife or razor blade, preferably cleaned with alcohol or a flame. Make a single cut in the long direction on each fang mark (don't make cross incisions), 1/4 to 1/2 inch long and deep enough to go through the skin to the depth of the bite mark (about 1/8 inch).

   First, squeeze out the venom for 1 to 2 minutes. Then try suction with a suction cup or your mouth for at least 5 minutes. After suction, wash the incisions vigorously with soap and water. You must start suction within 10 minutes after the bite and it is not useful after 30 minutes. (Note: Suction without incisions is partially effective.)

3. Lymphatic tourniquet for bites on arm or leg

   Remove any rings or bracelets. If you are more than 2 hours from the hospital, put a lymphatic tourniquet between the bite and the heart, at least 2 inches above the bite. A lymphatic tourniquet stops lymph flow through the lymph vessels. Use a wide band such as an elastic wrap or stocking. Make it snug but not tight enough to stop blood flow in the veins or arteries. If the veins stand out, the tourniquet is too tight. If the hand or foot turns white or the pulse disappears, the tourniquet is much too tight. The American Red Cross recommends that you not release the tourniquet until after antivenin has been given.

   Never put ice on the area of the bite because ice can cause frostbite, which increases the risk of damage to the skin.

UNIDENTIFIED SNAKES

Description:

Sometimes the snake has disappeared by the time the parent has been notified. In other cases, the snake has been killed but is hard to identify. (Bring it with you after you're certain it is dead.) Most bites are from harmless snakes, but some precautions are in order.

Home Care for Unidentified Snake Bites:

1. Treatment

   Usually, the small teeth of a snake just leave a scrape that doesn't even puncture the skin. There should not be any fang marks. Just wash it well with soap and water. If the skin is punctured, call for a tetanus booster if your child hasn't had one in more than 5 years.

2. Call Your Child's Physician Immediately If:
   • One or two puncture (fang) marks are present.
   • The bite area is swollen.
   • Blood blisters or purple spots are present in the bite area.
   • Your child develops any symptoms in the next 6 hours.

NONPOISONOUS SNAKES

Description:

Most of these are from garter snakes during attempted capture or from pet snakes. All are harmless.

Home Care:

1. Treatment

   Usually, the small teeth of a snake leave a scrape that doesn't even puncture the skin. Wash it well with soap and water. If the skin is punctured, call for a tetanus booster if your child hasn't had one in more than 5 years.

2. Call Your Child's Physician Immediately If:
   • Your child develops any symptoms in the next 6 hours.