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Snakebites

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Offline tjavery

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Snakebites
« on: May 12, 2006, 04:04:59 PM »
Moderator note:  This topic was split off from this trip report topic

Thanks everyone for your great comments! I'm glad this site exists to share these great memories.

Quote from: Joe
...I wonder about what you said about snakebite, though (be prepared with proper gear and knowledge to treat a snake bite). I've been through lots of wilderness first responder courses, and the latest treatment I've heard for snakebite is do nothing except remove jewelry, loosen clothing, immobilize the bitten area, and evacuate....

Joe- about the snake bite: Just before I left Del Rio, I spoke with a good friend of my wife's family who has taught courses in survival. He told me that the lastest first-aid response in the field is to use only a rubber band, and use it sparingly. Most of the field treatment is knowledge and proper action.

After being bit, place a rubber band above the bite (assuming it's on an arm or leg; if you get bit in the head, don't put it around your neck!). Try to keep calm and keep your physical activity at a minimum. Walk slowly towards help (e.g. your vehicle, other people, etc.). Every 10 or 15 minutes, stop for a 2 or 3 minute break. During that break, take the rubber band off. When you resume your slow pace, put the rubber band back on. Unless absolutely necessary, don't attempt any activity that will raise your heartrate.

Never attempt to suck out the poison and never put an all-out tourniquet on (completely stopping blood flow). The poison will travel in your lymphatic system and not your blood.

Most likely you'll be okay and live. You may sustain local tissue damage around the bite area. So try not to get bit on a toe, finger, or other small extremity. You may lose it!

Before I left town, I stopped at HEB and bought a snake bit kit and a few hundred extras (a sack of rubber bands :-))
« Last Edit: January 21, 2008, 02:50:12 PM by RichardM »

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Offline Bobcat

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Snakebites
« Reply #1 on: May 12, 2006, 06:35:41 PM »
When I was bitten(left hand), I knew within seconds that a Timber unloaded on me.  Your bleeding, so instinctively, you try to suck out the area(totally ineffective,of course). I used a stretch headband above the bite.  I really don't think I would of made it to my car which was ~ 2 miles down river.  I had to get down off a bluff and was very lucky to get a boat ride to a small river town.  I was totally out of it when we arrived.  I was told by the ambulance people that my B/P was 60/40 when they arrived. Conclusion: Best of luck to you if you are solo, bitten and far from help.  You may not be able to drive your veh even if you do reach it.
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Offline EdB

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Snakebites
« Reply #2 on: May 12, 2006, 07:32:43 PM »
Great report TJ. I tried to do a trip similar to yours in March, although I had to skip Old Ore because of a minor Jeep mishap. I camped at TA #4 though - won't make that mistake again.  :?

So, a question about snake bites? Are y'all saying don't even bother using a snake bite kit to try to get some of the venom out? I thought that was at least somewhat helpful, but it seems like the consensus here is to not waste your time. What about if you're (as Bobcat mentioned) solo and really far from help? Would it then be more helpful to try to get some venom out to minimize the effects, or just get to hiking and hope for the best?

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Offline Joe

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Snakebite Treatment
« Reply #3 on: May 12, 2006, 08:34:08 PM »
Quote from: "EdB"
So, a question about snake bites? Are y'all saying don't even bother using a snake bite kit to try to get some of the venom out? I thought that was at least somewhat helpful, but it seems like the consensus here is to not waste your time. What about if you're (as Bobcat mentioned) solo and really far from help? Would it then be more helpful to try to get some venom out to minimize the effects, or just get to hiking and hope for the best?


Here's a link to the best synopsis I've seen on snakebite first aid:

Self-Care Snakebite Treatment

The old cut-and-suck method is no longer recommended, especially the cutting part. I used to carry a Sawyer Extractor, which is a fancy suction device, but the last time I did my WFR (Wilderness First Responder) refresher, I was told it didn't do any good. The way it was explained to me was to envision getting an intra-muscular injection and then imagine trying to suction any of the drug out of your muscle. I was told it doesn't work.

For a while people were using electric shock treatment to try to neutralize the proteins in the venom, but this is no longer recommended. I used to lead trips in southern Mexico and northern Central America and we carried a tazer (as well as antivenin) but luckily we never had to use either.  We used to wonder how this particular treatment ever got started. I can just see a group of guys standing around after someone is bitten - "Hey, Joe just got hit by a fer-de-lance; let's hook him up to the battery and see what happens!"

I was also taught in the past to use a constricting band, such as a rubber band like TJ described (not a tourniquet), between the bite and the heart.  In the last few years I've also been told not to use this.

If I was day-hiking by myself in the U.S. and was envenomated by a poisonous snake, I think I'd monitor myself and try to walk out slowly. If I had a cell phone, satellite phone or radio I'd call for help, but unless I'm leading a trip I don't carry things like that.  Maybe this is one argument for carrying a cell phone and providing service. If I couldn't walk out, I guess I'd try to make myself as comfortable as possible and hope for the best.
The real desert is a land which reveals its true character only to those who come with courage, tolerance and understanding. - Randall Henderson

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Offline tjavery

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Re: Snakebite Treatment
« Reply #4 on: May 12, 2006, 10:04:24 PM »
Quote from: "Joe"
Here's a link to the best synopsis I've seen on snakebite first aid:

Self-Care Snakebite Treatment


Thanks for the great link, Joe. I noticed two important points:

1.  Second, the affected limb should be used as little as possible to delay absorption of the venom.

2.  Do NOT use tourniquets or constriction bands. These have not been proven effective, may cause increased tissue damage, and could cost the victim a limb.

I'll foward this to my survivalist-friend and see what he says  :wink:  Perhaps he's not fully up to date, or there's still conflicting theories out there.

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SHANEA

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Re: Snakebite Treatment
« Reply #5 on: May 28, 2006, 05:40:27 PM »
Quote from: "tjavery"

1.  Second, the affected limb should be used as little as possible to delay absorption of the venom.

2.  Do NOT use tourniquets or constriction bands. These have not been proven effective, may cause increased tissue damage, and could cost the victim a limb.


I wish I'd have really read this snake bite stuff before we left.  NO, no one got bit by a snake or anything, but me and my hiking buddy got into a discussion on what to do if you are bit say up on top of Emory Peak or the south rim, a long ways from the basin and help.  He's an Eagle Scout and a Scout Master and his understanding of what we would do up there would be to restrict the limb as much as possible - ie. arm/hand - tie it up behind the head, get rid of the packs except water, and make it down the basin.  My thought would be for the person bit to stay put with water and the other make a quick decent to the basin for help.  He said that it would take too long for help to arrive, they wouldn't send a copter, etc.

It would be interesting to hear the take on the proper official procedure by the NPS BIBE staff.  Surely someone has been bit by a rattlesnake at BIBE before up in the Chisos mountains a long way from the basin or out in the desert along Black Gap or River Road - a long ways from help - of course, if you are in the desert you might be close to a vehicle.  Eric Leonard?  WindChime? Terlingua Medic?  

Of course, the best treatment is to not get bit in the first place.  Be Careful out there.

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Offline JeffB

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Snakebites
« Reply #6 on: August 08, 2006, 10:15:53 PM »
Sounds like a great adventure.  Thanks for the report.

About poisonous snakebites.   No snakebite kits.  The best advice is very simple:

Get to the emergency room as quickly as possible and keep your heart rate as low as possible (stay calm).  Important:  Know what kind of snake bit you as the treatment is different for each species
If you cant identify the snake then take it with you (dead is OK in this case).

In Big Bend it will most likely be a western diamondback but could be a mojave.  Or a copperhead.

Could also be a rock rattlesnake.  if it is a rock rattler you are probably very high up and far away from transportation and hospital. The venom is neurotoxic. Just go ahead and die. :shock:

Here's an old poisonous snakes post in the Pic Post section:
http://www.bigbendchat.com/portal/forum/index.php?topic=211.0&highlight=
Jeff Bullard
Dallas, TX

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Offline Windchime

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snakebites in the park
« Reply #7 on: August 10, 2006, 07:50:07 PM »
Checked with Gino in Maintenance who was raised in this area and has been with the park for many years. He recalls no one being bit by a rattler in the mountains...if it happened, he said, they made it out OK or he would have heard about it. He has seen a lot of Diamondbacks up there, but never got close to being bitten. Copperheads are found along the river. Mojave are not usually found above 4,000 ft. elevation. Gino says they are much slower than a Diamondback, but deadly. From what I understand, the rock rattler is neurotoxic, but not nearly as much as the Mojave. When Tom was bitten by a rattler a couple of years ago...the jury is out as to whether it was a Mexican Blacktail or a Diamondback...they gave him synthetic anti-venom which is good for Eastern Diamondback, Western Diamondback and, if my memory is correct, Mojave. Tom might want to refresh my memory here and add any recollection of anyone being bit up in the mountains...he has been in the pack 20 years or more. Not giving away his age...he must have been 15 years old when he got a job with the park :)
The opinion expressed above is my own and not that of the National Park Service or the Federal Government.

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Offline JeffB

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Snakebites
« Reply #8 on: August 10, 2006, 11:28:34 PM »
Quote from: "Windchime"
From what I understand, the rock rattler is neurotoxic, but not nearly as much as the Mojave. When Tom was bitten by a rattler a couple of years ago...the jury is out as to whether it was a Mexican Blacktail or a Diamondback...they gave him synthetic anti-venom which is good for Eastern Diamondback, Western Diamondback and, if my memory is correct, Mojave


If you are bitten by any poisonous snake you'll universally get Crofab antivenom.  There is only one other antivenom that I know of and it is no longer produced and rarely administered.  

I've read conflicting reports about the neurotoxicity of Banded RocK Rattlers.  Its variable between Type A and Type B neuro-venom.  All reports say it is not as neurotoxic or as voluminous as Mojave venom.  The blessing is that Majaves are found in lower elevations and therefore closer (hopefully) to rescue transportation.  The banded rock rattler tends to be found in the highest, most difficult terrain.  The one we found was on top of Casa Grande.  The hike down would be treacherous enough without paralyzing neurotoxic venom.  

A vital difference in terms of treatment between hemotoxic (w.diamondback, black-tail, copperhead) and neurotoxic (Mojave, Banded Rock rattler)  is diagnosis.  Neurotoxic venom can be decieving because it results in minimal local tissue necrosis.  The hospital may delay giving antivenom because of lack of tissue necrosis and risk of a severe allergic reaction to the Crofab.  Knowing the species of snake helps determine severity of envenomation and how aggressively to treat with Crofab.  

It is not recommended to try capture or kill the snake because you risk another bite.  But it is very helpful to know the difference between hemotoxic or neurotoxic snake.



From Sean P Bush, MD, FACEP, Professor of Emergency Medicine, Loma Linda University School of Medicine; Consulting Staff, Envenomation Specialist, Department of Emergency Medicine, Loma Linda University Medical Center:


Prehospital Care: Do nothing to injure the patient or impede travel to the ED.

    * Provide general support of airway, breathing, and circulation per advanced cardiac life support (ACLS) protocol; use oxygen, monitors, 2 large-bore intravenous lines (but minimize sticks when possible), and fluid challenge. In addition, minimize activity (if possible), remove jewelry or tight-fitting clothes in anticipation of swelling, and transport the patient to the ED as quickly and as safely as possible. Mark and time the border of advancing tenderness and edema often enough to gauge progression. No benefit was demonstrated when a negative pressure venom extraction device (eg, The Extractor from Sawyer Products) was evaluated in recent studies. Incision across fang marks is not recommended. Mouth suction is contraindicated.

    * Maintain the extremity in a neutral position of comfort.

    * Lymphatic constriction bands and pressure immobilization techniques may inhibit the spread of venom, but whether they improve outcome is not clear. These techniques may actually be deleterious for pit viper envenomation if they increase local necrosis or compartment pressure. Special consideration of these techniques may be warranted for confirmed Venom A Mohave rattlesnake bites because local tissue injury is usually less. However, this application has not specifically been studied. Furthermore, it may not be possible to distinguish Venom A from Venom B snakes just by looking at the snake. The use of tourniquets is not recommended.

    * First aid techniques that lack therapeutic value or are potentially more harmful than the snakebite include electric shock, alcohol, stimulants, aspirin, ice application, and various folk and herbal remedies. Cost and risk of acute adverse reactions generally preclude field use of antivenom.

    * Although identification of the snake in suspected Mohave rattlesnake bites may be helpful, attempts to capture or kill the snake are not recommended because of the risk of additional injury. If the venomousness of a particular snake is uncertain, consider taking photographs of the snake from a safe distance of at least 6 feet away using a digital or Polaroid camera.

Emergency Department Care: Adequate hydration with intravenous fluids is indicated. Patients with hypotension should be resuscitated first with 2 isotonic sodium chloride solution challenges (eg, 20 mL/kg). Treat persistent shock with colloids, followed by pressors as indicated.

    * Patients with Mohave rattlesnake envenomation may present with predominantly systemic and laboratory abnormalities, with only mild local and no hematological effects.

    * Administer antivenom for signs of envenomation progression or imminent risk of an acute complication of envenomation (see Complications).

    * Because Crotaline Fab antivenom (CroFab) appears safer than Antivenin Crotalidae Polyvalent, it is indicated even if the envenomation is minimal mild. It should be given as a preventative measure if there are any signs of envenomation at all. Do not wait for it to get worse—permanent injury could result.

    * Grading envenomations is a dynamic process; administer additional antivenom as indicated by a worsening clinical course. When considering the use of antivenom, weigh the risk of adverse reaction to antivenom against the benefits of reducing venom toxicity.

    * Nonenvenomation, ie, dry bite (probably occurs in <10% of rattlesnake bites)

          o Local effects - Puncture wounds only

          o Systemic effects - None

          o Coagulation abnormalities - No laboratory evidence of coagulation abnormalities and no clinical evidence of abnormal bleeding or clotting

    * Minimal or mild envenomation

          o Local effects - Swelling, pain, tenderness, and/or ecchymosis confined to the immediate bite area

          o Systemic effects - None

          o Coagulation abnormalities - No laboratory evidence of coagulation abnormalities and no clinical evidence of abnormal bleeding or clotting

    * Moderate envenomation

          o Local effects - Swelling, pain, tenderness, and/or ecchymosis extending beyond the immediate bite area but involving less than the entire part

          o Systemic effects - Present but not life threatening; may include nausea, vomiting, oral paresthesias or unusual tastes, fasciculations (myokymia), mild hypotension (systolic blood pressure <90 mm Hg), mild tachycardia (heart rate <150 bpm), and tachypnea

          o Coagulation abnormalities - Laboratory evidence of coagulation abnormalities may be present, but no clinical evidence of abnormal bleeding or clotting exists; rattlesnake venom–induced coagulopathies commonly include thrombocytopenia, decreased fibrinogen, and/or elevated PT

    * Severe envenomation

          o Local effects - Swelling, pain, tenderness, and/or ecchymosis extending beyond the entire extremity or threatening the airway

          o Systemic effects - May include severe hypotension or shock, severe tachycardia or tachypnea, respiratory insufficiency, and/or severe altered mental status

          o Coagulation abnormalities - Markedly abnormal with serious bleeding or severe threat of bleeding
Jeff Bullard
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SHANEA

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Dang
« Reply #9 on: August 11, 2006, 12:59:21 AM »
I think I'll just continue to do my best and not get bit.   Based on the prescribing information, should be admin. w/i 6 hours.   Isn't it true if you are hiking in a line that the first person won't get bit, it's the 2nd and/or 3rd that get bit?  Reminder to self - always be the lead dog.  My Pappy used to say all you had to do was put your lariet around your bed roll as them snakes won't cross a rope.  

http://www.rmpdc.org/crofab/packageinsert.cfm

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SHANEA

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Out of Curosity..
« Reply #10 on: August 11, 2006, 01:01:18 AM »
Quote from: "JeffB"

I've read conflicting reports about the neurotoxicity of Banded RocK Rattlers.  Its variable between Type A and Type B neuro-venom.


Out of curosity, what do you do for a living or what is your educational background?

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Offline RichardM

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Re: Dang
« Reply #11 on: August 11, 2006, 08:49:42 AM »
Quote from: "SHANEA"
I think I'll just continue to do my best and not get bit.

Time for the classic Last Chance to See interview by Douglas Adams:

Quote from: "Douglas Adams"
There is in Melbourne a man who probably knows more about poisonous snakes than anyone else on earth. His name is Dr Struan Sutherland, and he has devoted his entire life to a study of venom.
"And I'm bored with talking about it," he said when we went along to see him the next morning, laden with tape recorders and note books. "Can't stand all these poisonous creatures, all these snakes and insects and fish and things. Wretched things, biting everybody. And then people expect me to tell them what to do about it. I'll tell them what to do. Don't get bitten in the first place. That's the answer. I've had enough of telling people all the time. Hydroponics, now, that's interesting. Talk to you all you like about hydroponics. Fascinating stuff, growing plants artificially in water, very interesting technique. We'll need to know all about it if we're going to go to Mars and places. Where did you say you were going?"
"Komodo."
"Well, don't get bitten, that's all I can say. And don't come running to me if you do because you won't get here in time and anyway I've got enough on my plate. Look at this office. Full of poisonous animals all over the place. See this tank? It's full of fire ants. Venomous little creatures, what are we going to do about them? Anyway, I got some little cakes in in case you were hungry. Would you like some little cakes? I can't remember where I put them. There's some tea but it's not very good. Sit down for heaven's sake.
"So, you're going to Komodo. Well, I don't know why you want to do that, but I suppose you have your reasons. There are fifteen different types of snake on Komodo, and half of them are poisonous. The only potentially deadly ones are the Russell's viper, the bamboo viper and the Indian cobra.
"The Indian cobra is the fifteenth deadliest snake in the world, and all the other fourteen are here in Australia. That's why it's so hard for me to find time to get on with my hydroponics, with all these snakes all over the place.
"And spiders. The most poisonous spider is the Sydney funnel web. We get about five hundred people a year bitten by spiders. A lot of them used to die, so we had to develop an antidote to stop people bothering me with it all the time. Took us years. Then we developed this snake bite detector kit. Not that you need a kit to tell you when you've been bitten by a snake, you usually know, but the kit is something that will detect what type you've been bitten by so you can treat it properly.
"Would you like to see a kit? I've got a couple here in the venom fridge. Let's have a look. Ah look, the cakes are in here too. Quick, have one while they're still fresh. Fairy cakes, I baked 'em myself."
He handed round the snake venom detection kits and his home baked fairy cakes and retreated back to his desk, where he beamed at us cheerfully from behind his curly beard and bow tie. We admired the kits, which were small, efficient boxes neatly packed with tiny bottles, a pipette, a syringe and a complicated set of instructions that I wouldn't want to have to read for the first time in a panic, and then we asked him how many of the snakes he had been bitten by himself.
"None of 'em," he said. "Another area of expertise I've developed is that of getting other people to handle the dangerous animals. Won't do it myself. Don't want to get bitten, do I? You know what it says on my book jackets? "Hobbies: gardening ­ with gloves; fishing ­ with boots; travelling ­ with care." That's the answer. What else? Well, in addition to the boots wear thick, baggy trousers, and preferably have half a dozen people tramping along in front of you making as much noise as possible. The snakes pick up the vibrations and get out of your way, unless it's a death adder, otherwise known as the deaf adder, which just lies there. People can walk right past it and over it and nothing happens. I've heard of twelve people in a line walking over a death adder and the twelfth person accidentally trod on it and got bitten. Normally you're quite safe if you're twelfth in line. You're not eating your cakes. Come on, get them down you, there's plenty more in the venom fridge."
We asked, tentatively, if we could perhaps take a snake bite detector kit with us to Komodo.
"Course you can, course you can. Take as many as you like. Won't do you a blind bit of good because they're only for Australian snakes."
"So what do we do if we get bitten by something deadly, then?" I asked.
He blinked at me as if I were stupid.
"Well what do you think you do?" he said. "You die of course. That's what deadly means."

"But what about cutting open the wound and sucking out the poison?" I asked.
"Rather you than me," he said. "I wouldn't want a mouthful of poison. Shouldn't do you any harm, though. Snake toxins have a high molecular weight, so they won't penetrate the blood vessels in the mouth the way that alcohol or some drugs do, and then the poison gets destroyed by the acids in your stomach. But's it's not necessarily going to do much good, either. You're not likely to be able to get much of the poison out, but you're probably going to make the wound a lot worse trying. And in a place like Komodo it means you'd quickly have a seriously infected wound to contend with as well as a leg full of poison. Septicaemia, gangrene, you name it. It'll kill you."
"What about a tourniquet?"
"Fine if you don't mind having your leg off afterwards. You'd have to because if you cut off the blood supply to it completely it'll just die. And if you can find anyone in that part of Indonesia who you'd trust to take your leg off then you're a braver man than me. No, I'll tell you: the only thing you can do is apply a pressure bandage direct to the wound and wrap the whole leg up tightly, but not too tightly. Slow the blood flow but don't cut it off or you'll lose the leg. Hold your leg, or whatever bit you've been bitten in, lower than your heart and your head. Keep very, very still, breathe slowly and get to a doctor immediately. If you're on Komodo that means a couple of days, by which time you'll be well dead.
"The only answer, and I mean this quite seriously, is don't get bitten. There's no reason why you should. Any of the snakes there will get out of your way well before you even see them. You don't really need to worry about the snakes if you're careful. No, the things you really need to worry about are the marine creatures."
"What?"
"Scorpion fish, stonefish, sea snakes. Much more poisonous than anything on land. Get stung by a stone fish and the pain alone can kill you. People drown themselves just to stop the pain."
"Where are all these things?"
"Oh, just in the sea. Tons of them. I wouldn't go near it if I were you. Full of poisonous animals. Hate them."
"Is there anything you do like?"
"Yes," he said. "Hydroponics."


P.S.  If I get around to it, I'll probably split this snakebite thread off to its own topic in the advice/recommendations forum.

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Offline Bobcat

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Snakebites
« Reply #12 on: August 11, 2006, 09:00:15 AM »
Dr SS should live in a bubble.  But, seriously, folks... :lol:
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Offline Undertaker

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Snake Bite / Tazer
« Reply #13 on: August 11, 2006, 12:57:15 PM »
After traveling all over the place hiking, hunting, fishing and with Uncle Sam and spending 25 some-odd years as a medic.  Simple rule is don't get bit, watch were you walk (hard to do in BB because of view). Try to remain calm (As a medic, I have never found this hard to do, but I am not the guy shot, having a heart attack or bitten by snake).  Simple rules try not to get bit, if you are bitten, try to remain calm (see above) seek medical help ASAP. Most bites are not "HOT", but waiting to find out in wild is great way of feeding the critters.  

Tazer: Right!!!!, I just got snake bit and while remaining calm (again see above), some AH hits me with 50,000 volts, yep, that will tend to settle you down (again see remain calm above). Undertaker
Visiting BB since 1966, nothing like being lost and finding heaven.

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SHANEA

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Re: Snake Bite / Tazer
« Reply #14 on: August 11, 2006, 03:18:18 PM »
Quote from: "Undertaker"
(As a medic,


And I thought you were a grave digger.  Not sure I'd want a medic that calls himself the undertaker :lol:  :D  :shock:  8)

 


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