Copperhead bite

[Gadfly]

It may not be a “deadly” bite, but it looks like it sucks. That has got to be painful... I am surprised I don’t see them more often. My cats bring in lizards and little garter snakes all the time. I am afraid they would go after a baby copper head.

(From google image of “copperhead bite”)




Sent from my iPad using Tapatalk

[mtnbkr]

Agreed. When my friend got bit by a rattlesnake at the police range, she went to the hospital and was told she would be there 6 hours minimum. After an hour the swelling set in and there was s nurse in the room every 15 minutes with a sharpie marking the spread.

I've known people who were bit by Copperheads. I have not directly known anyone bitten by rattlesnake, but I know people who have known those who were bit.

Based on that, I would say the two are not the same and not even close. The last guy I knew who got bit by a copperhead didn't seek treatment and the bit healed on its own after a lot of swelling and pain with no permanent damage. I've heard of folks with rattlenake bites and immediate medical care suffering permanent and disfiguring damage.

That's not to say I would ignore a copperhead bite, but they're certainly a different level of risk compared to a rattlesnake.

Chris

[scjbash]

Why is it so expensive? Shkreli run the company that makes it?

There are two companies making copperhead antivenom and both are stupid expensive. This is the breakdown someone came up with for one of them.

"After examining cost data from every step of the process, from the factory floor to hospital billings, Boyer developed a pricing model that shows how much each part contributed to the ultimate expense. Fees and costs for licensing, regulation and hospital profits amounted to 27.7 percent of the overall cost and clinical trials made up just 2.1 percent. The cost of making the antivenom, including research, development, animal care and plasma harvesting? A mere 0.1 percent. As for the remaining 70.1 percent, Boyer found that the cost was due to hospital markups used in negotiations with insurance companies."

https://www.smithsonianmag.com/smart...000-180956564/

[TGS]

Ah, so it "costs" $50k, but you won't actually pay that much.

Kind of like my appendectomy being priced at $60k but the actual amount paid to the hospital being a small fraction of that.

[JHC]

There's a good chance he wouldn't have received antivenom anyway. Until very recently care for a copperhead bite virtually never included it. It wasn't until a couple of years ago that a study showed that the current antivenoms were even worth giving at all. It's also expensive as hell and can run well over $50K just for a starter dose.

We're infested with copperheads in this area but as a healthy adult I would most likely turn down antivenom for a single bite on the foot.

I read that the avoidance of administering antivenom for what is believed to be a dry bite is the risk of allergic reaction to the antivenom. That risk was alleged to be not insignificant. Does that sound legit?

[Sensei]

Maybe, maybe not. A handful of states regularly require EMS to get training on various types of snake bites. If particular snakes are problematic in certain areas, they probably get more training on those specific types of snakes. When I did SAR, I got a lot more training on copperhead bites than I ever did in EMS. It going to depend on what their protocols are as well. Most EMS agencies used to focus on transporting everyone because of legal liabilities. Today, since everyone goes to the emergency department when they have a cold, some places are specifically trying to avoid taking people to the emergency department.

Unfortunately, what happens a lot in EMS is:
-people with little training recognize it is over their head.
-people with lots of training feel they are equipped to handle it.
-people with even more training recognize it is still over their head.

The paramedic in question may have had significant training and been given the impression that reducing the amount of patients to the ED was important.

Sent from my iPhone using Tapatalk

There is no reliable way to determine if someone had a significant envenomation in the first few hours of many domestic US snake bites. Many people will have some pain at the site, but swelling and even hematologic effects can be delayed by hours. We have an envenomation protocol in our ED which involves observation for 12 hours with serial measurement of limb circumference. I’ve never seen an EMS protocol for envenomation that allows a paramedic to look at a bite to determine if transport to a hospital is needed. I have seen plenty of people with initially benign looking hand / foot bites in the first couple of hours develop into moderate envenomations with swelling up to the knee or elbow within 12 hours.

There's a good chance he wouldn't have received antivenom anyway. Until very recently care for a copperhead bite virtually never included it. It wasn't until a couple of years ago that a study showed that the current antivenoms were even worth giving at all. It's also expensive as hell and can run well over $50K just for a starter dose.

We're infested with copperheads in this area but as a healthy adult I would most likely turn down antivenom for a single bite on the foot.

CroFab was given to moderate to severe (defined by Snake Bite Severity Score) Copperhead envenomations for the 14 years that I practiced emergency medicine in NC. Use in mild to moderate bites was hit or miss depending on the provider and poison control recommendations. There has been some debate about the cost effectiveness of CroFab for all but severe Copperhead envenomations. However, the recent study by Gerardo el al in Annals of EM pretty much guaranteed that it will at least be offered in mild to moderate envenomations although I still do not feel that this trial adequately addressed the issue cost-effectiveness. https://www.annemergmed.com/article/...510-3/fulltext

[txdpd]

I've known people who were bit by Copperheads. I have not directly known anyone bitten by rattlesnake, but I know people who have known those who were bit.

Based on that, I would say the two are not the same and not even close. The last guy I knew who got bit by a copperhead didn't seek treatment and the bit healed on its own after a lot of swelling and pain with no permanent damage. I've heard of folks with rattlenake bites and immediate medical care suffering permanent and disfiguring damage.

That's not to say I would ignore a copperhead bite, but they're certainly a different level of risk compared to a rattlesnake.

Chris

My point being that there’s no way an EMT can accurately assess a snake bite in the field, without an observation period. She didn’t need antivenom and ended up with a hole hole in her skin that looked like a MRSA infection and a quarter size scar.

Anecdotally the only thing I’ve heard about copperhead bites was a neighbor that disturbed a copperhead nest, clearing out a brush pile on his farm, and was bit death. Now that I have better understanding of white trash lingo and the synonymous use of “drug overdose” and “snake bite”, the lack of fire, I have some doubts about that story.

[TGS]

We have a guy at work on crutches due to a copperhead bite on his foot. He was walking his dog at night (it's been warm here this week) and got hit. He called the paramedics and the paramedic assured him that he didn't need antivenom due to it being a "dry bite." Well, it wasn't a dry bite the next day and it was too late for antivenom. It sucks, but he seems alright and won't have any permanent effects.

I'm not the kind of person that advocates people sue for anything possible, but speaking as a former EMS chief I'd say that at the very least your coworker should bring this to the attention of that EMS agency's management for quality assurance.....in particular the Clinical Coordinator. The Clinical Coordinator is usually a senior medic that doesn't have operational duties, but rather QAs medical care administered by the agency and has oversight of clinical competencies and training.

Even if he doesn't want to sue and isn't looking to get someone fired, there's some learning/correction that needs to occur. I would not assume that the hospital is conveying anything to the EMS agency.

[Mjolnir]

My point being that there’s no way to accurately assess a snake bite in the field. She didn’t need antivenom and ended up with a hole hole in her skin that looked like a MRSA infection and a quarter size scar.

Anecdotally the only thing I’ve heard about copperhead bites was a neighbor that disturbed a copperhead nest, clearing out a brush pile on his farm, and was bit death. Now that I have better understanding of white trash lingo and the synonymous use of “drug overdose” and “snake bite”, the lack of fire, I have some doubts about that story.

Four or five bites could possibly do that to a human being.

I dunno.

I’m in southeastern Louisiana and we have a metric shit ton of venomous snakes here.

Snake Boots are mandatory. Just north of me we have timber rattlers (St. Francisville, LA). In the Greater Baton Rouge Metro Area we have cotton mouth water moccasins. I believe we have copperheads wherever there are rattlers but copperhead venom is less dangerous. We even have coral snakes (which the nation has little anti-venom for; so keep that in mind if you choose to try to handle one).


Sent from my iPhone using Tapatalk

[ST911]

No experience with copperhead bites, but have seen bunches of folks bit by (prairie) rattlers. Adult bites tend to be dry bites to extremities. Many rural patients don't seek medical attention for extremity bites. Treatment for healthy patients is wound cleaning and monitoring. Some docs may do antibiotics and a tetanus. Vulnerable patients or bites elsewhere on the body are more likely to seek care and get more attention. In an EMS response, patients either refuse or no transport is indicated. EMS protocol is Benadryl p.o. and prepare for anaphylaxis. Last fatality I know of was an elderly patient with health issues, who got a dry bite and panicked into cardiac arrest.