By Steve Merlo
A recent incident where local businessman Mike Stier got bitten by a rattlesnake while bass fishing and nearly lost his life raises questions regarding the proper treatment of a snakebite. After lengthy conversations with the victim and his doctor, I was astounded to find that the once-traditional methods of dealing with the injury have nothing to do with the current and correct treatment of a venomous snakebite.
Sucking or cutting the woundsite, using a tourniquet, holding the afflicted area above the heart or icing down the wound are now considered absolute no-nos and can actually cause disfigurement, infection and even death if used for treatment.
With thousands of people tromping around in snake-infested areas, especially in the spring, it's a wonder more folks are not bitten. Obviously, the best way to avoid a confrontation lies simply in avoiding areas that harbor the serpentine critters, but, of course, outdoorsmen know that is not always possible.
Hunters, fishermen, hikers and campers can and do contact rattlesnakes at almost any location in California. All snakes are attracted to areas with shade, brush, rocks, or food and water, where they can lie in ambush mode, feeding on hapless prey that saunters past. Normally, they avoid human contact if possible, but when they feel threatened, they will strike out at what they perceive as an immediate danger.
Oh, and by the way, not all rattlesnakes rattle before they bite, so tred carefully in high percentage areas and wear appropriate footgear to protect feet, ankles and calves. And, never place a hand or extremity anywhere while walking or climbing where one cannot actually see who or what's on the other side.
The amount of venom delivered during a bite depends entirely on the size and attitude of that particular snake. Some may opt to save their otherwise precious venom because they know instinctively they cannot eat the huge intruder invading their lair. Wanting only to defend themselves, they can inject little or no poison at all. Others, for whatever reason, may inject the whole dose, meaning some bites are a lot worse than others, as in the case of Stiers' ordeal.
After snagging the reptile in the side with a crankbait, during a fishing outing at a private lake near Coalinga, Stier tried to retrieve his expensive lure without success, then tried to drown the critter by forcing it beneath the water with his rod. During that process, his hand somehow got too close to the rattler, and even though only one fang found its mark, the damage was done. (Personally, I'm betting that by the time the snake finally bit his captor, it was so angry from being mishandled that it delivered a full dose into Stiers' hand.)
The reaction was almost immediate. By the time Stier's friend Barry Phillips, partner of Barry's RV Sales, docked the boat, Stier began complaining of nausea and vomiting. "I felt like all my extremities were on fire," he later related. "It was a long ways to the hospital and waves of nausea and diarrhea hit me with incredible force. I had more pain than I've ever had in my entire life. Before too long, my throat constricted, nearly shutting off my air, and I was gasping for my next breath. All I could see was a blood-red blanket that draped over my vision and senses. My feet hurt like they were going to explode. My hand and forearm, by then, had begun swelling, finally ending up twice or three times their normal size."
"Before we reached the hospital," said Phillips in a recent interview, "I had dialed 911 for directions to the Coalinga hospital and they guided us into town. Mike looked white as a ghost, his lips were bright red and swelled three times their normal shape. I was very concerned for his immediate welfare. I was driving as fast as I safely could, still pulling the boat. Two hours later, the doctor called me aside and said that if we had arrived 30-minutes later, well, it might have been too late.
"At the hospital," Barry continued, "Mike's blood pressure had plummeted to 60/30 and doctors on duty could not find a pulse. After stablizing him with all the antivenom in the hospital, he was then medivac-ed to Bakersfield, where the doctors at a local hospital began treating him with even more antivenom shots."
Fortunately, Dr. Al Coppola, MD, a long-time friend of Stier and well-known local orthepedic surgeon, conferred with his partner, renowned hand specialist Dr. Mathew Malerich, who was vacationing in Hawaii. They ordered more than twice the dosage of antivenom that had previously been prescribed and forbade any icing or cutting of the swollen hand. Over the next 7 hours, 28 vials of very rare and expensive antivenom was administered and Mike's life was saved.
Dr. Malerich graciously advised 10 things to do for the proper procedure to follow in the event of a snake bite:
1. Keep the victim from panic -- make them settle down and keep quiet.
2. Make them lie down and take it easy, with their legs and head elevated.
3. Do not give any stimulants or alcohol whatsoever.
4. Do not apply a tourniquet.
5. Do not ice the puncture site.
6. Keep the bite below the level of the heart.
7. Apply suction from a snakebite kit as a last resort, but do not use one's mouth.
8. Light the patient up with massive doses of antivenom -- more for children than adults.
9. If possible, it is crucial to kill and keep the snake for identification purposes.*
10. Get immediate medical attention.
*Identification of the rattlesnake is extremely important, especially in Kern County, where several distinct species exist. One, the diamondback rattlesnake, has plenty of cousins up and down the state, and the other, the notorious Mojave green, stands alone and is the more dangerous of the two.
The Mojave green carries a double impacting venom made up of a hemotoxic digestive enzyme, like the diamondback carries, and also a neural toxin which demands special treatment to prohibit paralysis and breathing problems in its victims.
Snakes like the one that bit Stier use their venom to begin the digestive process even before the snake can find its prey after biting it. Using its tongue as a superbly accurate sensing and tasting organ, it literally tastes its way to the dead animal before feeding. The Mojave green does the same, but its venom acts a lot faster because the paralytic nature of its bite causes immediate death.
In any event, more than 8,000 people are bitten in the US each year, but only a dozen or so actually die. Even so, I don't like the odds, so, as the old saying goes, "Don't tread on me!" Don't worry, I won't.