Mineral Wells Index, Mineral Wells, TX

August 25, 2010

Snake-bit! Local woman bitten by moccasin

By Libby Cluett
CNHI

MINERAL WELLS — A Mineral Wells resident bitten by a water moccasin Monday morning, after being initially treated at Palo Pinto General Hospital, was sent to Fort Worth for emergency care.

According to sources, a woman in her early 60s was bitten by a snake shortly after 8:30 a.m. Monday in northeast Mineral Wells.

PPGH CEO Harris Brooks confirmed that a snake bite patient was treated with the antivenin Cro-Fab at PPGH Monday morning before being transported to Texas Health Harris Methodist Hospital Fort Worth.

This antivenin is used to counteract venom from water moccasins, copperheads, or rattlesnakes (all in the pit-viper family), and hospitals like PPGH carry enough to get someone started.

Dr. John Jones, medical director for the PPGH Emergency Department, said this was the worst snake bite reaction he has seen, but understands the patient is doing better.

According to Mineral Wells Fire Chief Robin Allen, EMS responded after the woman became ill after being struck by an unknown snake.

Jones said he understood a dog perhaps found the snake and was bitten first and the individual intervened before being bitten. He said the patient called 9-11 within minutes and was at PPGH in about 25 minutes.

This venomous snake bite is at least the second for the month in Palo Pinto County.

Earlier this month a young girl, almost 2, died after being bitten by a rattlesnake in the Caddo area of Possum Kingdom Lake on the evening of Aug. 10.

Despite these two Palo Pinto County cases, hospital officials have not seen a marked increase in the number of snake bites.

“The sheer numbers aren't up, but the severity seems to be up,” said Brooks.

Jones estimated PPGH has treated about eight to 10 snake bites for the year, which he said wasn't above average.

“This particular bite has been the worst for the year and the worse I've seen regarding complications,” he said, adding he believes Monday's snake-bite victim received a large amount of venom. He said he was also surprised by the short period of time the venom took to react.

Dr. David Smith, a trauma surgeon and medical director of the trauma program at Texas Health Fort Worth, said he has seen “quite a few bites – 10 early in the season, and since the end of June we've had two more.”

Smith said the worst so far for the year came from the Cottonmouth Water Moccasin bite. He said, in addition, THFW has seen bites from “multiple copperheads – more than rattlesnakes – and from three to four rattlesnakes.”

He said the copperhead bites tended to come closer to the water and the rattlesnake “can be found anywhere.”

“More than half [of the snake bites] were at night,” he said, adding that these are typically bites on the extremities – legs/feet and arms/hands.

Smith said he is familiar with the incident involving the toddler who died of a rattlesnake bite incurred at PK Lake. He said the child was struck in a vein on her lower extremities.

He said getting struck in a vein is similar to receiving an injection directly into a vein, versus an injection in a muscle. He said if struck in a vein the snake's venom “spreads rapidly through the system with each heartbeat.”

Regardless of where on the body it occurs, Smith and Jones warn that time matters when dealing with an injection of snake venom.

“Time is of the essence,” said Smith. “If you get struck, get to a hospital as soon as possible.” He added, the antivenin Cro-Fab, “is the only way to treat snake bites.”

“While we're not a large hospital that can support multi-system failure, we do have a starter dose of Cro-Fab antivenin to get the antivenin on-board, coursing through a patient's veins,” said Brooks.

He explained that a rattlesnake's venom prevents blood from being able to clot and can cause systems to fail. Brooks said getting treated with Cro-Fab right away “helps until we can get you to a tertiary hospital.”

“Certainly seeking attention immediate;y is important,” said Jones. “[Cro-Fab] is much more beneficial when it's indicated – in moderate to significant envenomation.”

Jones explained that they use clinical symptoms to determine whether Cro-Fab is indicated for a snake bite.

“The quicker we can give you the Cro-Fab, the better you will be,” Smith seemed to echo. “Thank goodness rural hospitals have doses on hand.”

He said that since most of THFW snake-bite cases come from west of the Metroplex, “with open areas that snakes like … most [THFW patients] come with the treatment already started – from Palo Pinto or Weatherford.”

Smith recommends getting in the car, preferably with someone else driving, to get to the nearest hospital and only as a last resort should the patient drive themselves to the hospital.

Jones adds, “If you get bit, seek attention immediately. Don't raise or lower [the extremity bitten], no ice, no heat, no tourniquet – just come on in to the hospital.”

Summer is the time for snakes and some county residents have reported seeing many more rattlesnakes this year than in years past.

“Know where you are putting your hands,” said Allen, who said MW Fire and EMS sees snakebites frequently from people reaching into shrubbery.

 “Use a rake or a stick. And don't think it's safe to handle a snake,” she added. “We see that sometimes and they don't know it's a venomous snake.”

Smith suggests that people working in the garden or around plants look before reaching under a bush, in a shady area or into a hole, since these are all areas snakes like.

“Snakes like to hide away from everybody – in dark, cool places under the house, in holes in the ground, in burrows and under bushes and rocks,” he said. “A lot of people get in trouble when they are gardening. Make sure you look where you are about to put your hands.”

But this also goes for ankles and feet. Smith said about half the snake bites this year have been to the lower extremities and many occurred at night – one in a pasture and another in a yard. The THFW trauma director suggests carrying a flashlight, look before walking and “do not go out at night in bare feet or sandals. This is Texas – wear your cowboy boots.”

Staff writer Libby Cluett can be reached at (940) 325-4465, ext. 3422, or lcluett@mineralwellsindex.com.