A Parent’s Guide to Treating Snakebites

By Sandra Merino, clinical pharmacist and Jennifer Nguyen, clinical pharmacy resident at CHOC Children’s

Summer is here! That means more time for camping, hiking, and other outdoor activities. With the amount of rain we’ve received this year, Orange County experts are predicting an increase in snake encounters this summer. Part of the reason is flash floods have destroyed many snakes’ homes, forcing them out to look for new homes, shade, and water. The other reason is rain allows for more vegetation, and more vegetation allows for more rodents, and – you guessed it – more rodents mean more food for the snakes! With all this in mind, we encourage parents to learn how to prevent or treat a snakebite, just in case you encounter one on your adventures.

If you or someone you know is bitten by a snake:

  • Step One: Seek medical attention as soon as possible or call local Emergency Medical Services (EMS). First aid is important, but only to hold you over until you can get medical attention. Do not treat the bite by yourself, since the anti-venin is only available at medical centers.
  • Step Two: Keep the person still and calm. This prevents the venom from spreading, whereas moving around would allow the venom to spread to other parts of the body. Although it may seem strange, it’s best for the venom to stay in one place if possible.
  • Step Three: Try to remember the color, patterns, shape and sounds of the snake. These details can sometimes help emergency responders determine whether the snake is poisonous, which may impact treatment. Not all snakes have venom!
  • Step Four: While you wait for medical attention to arrive, practice these first-aid techniques:
    • Lay or sit the person down with the bite below the level of the heart
    • Keep him/her calm and still
    • Cover the bite with a clean, dry dressing
  • Step Five: Don’t overthink it. You might start remembering all sorts of crazy techniques that your neighbor, uncle, or childhood friend told you; but remember: the list of good first aid techniques is short. It’s better to do minimal first aid than bad first aid.
    • Do NOT suck out the venom
    • Do NOT slash the wound with a knife
    • Do NOT pick up the snake or try to trap it
    • Do NOT apply a tourniquet
    • Do NOT apply ice or immerse in cold water
    • Do NOT drink alcohol to ease the pain
    • Do NOT drink caffeinated beverages

What if you’re alone on a remote trail? What if there’s no cell service?

  • Stay calm. Slowly move yourself 20-30 feet from the snake and find a safe place to sit down. Sitting down can reduce the chances of fainting within the first couple minutes.
  • Remove any rings, jewelry, or restrictive clothing from the area of the bite.
  • Try calling 9-1-1. If you don’t have cell service, yell out loud for help. If someone is within earshot, they may be able to help you.
  • Take a minute or two to come up with a plan.
  • If you truly find yourself alone on the trails with no cell phone service, start walking to the nearest place where you can get help. This may be the trailhead, a park ranger station, or the last place you had cell phone service. The risk of spreading the venom while walking is less than the risks of staying in one place without medical help.

Signs and Symptoms of a Venomous Snake Bite:

  • Extreme pain
  • Ulceration, redness and swelling at the bite site
  • Excessive bleeding or bruising
  • Blood clots
  • Low blood pressure
  • Increased sweating
  • Disturbed vision
  • Nausea and vomiting

If you have a marker or pen, mark the area of swelling with the time noted. This can help emergency providers calculate how fast the venom is spreading.

Other dangers of snakebites:

Snake venom can cause bleeding problems. Do not take ibuprofen, naproxen, Aleve, Advil, Motrin or other non-steroidal anti-inflammatory drugs (NSAIDs) to relieve the pain from a snake bite. These medications increase risk of over-bleeding. Acetaminophen (Tylenol) is usually fine.

There is an antidote available at healthcare facilities called CroFab (crotalidae polyvalent immune fab, ovine). This is an antivenin specifically for some venomous snakebites. In the rare situation where you may find yourself needing this antidote, it is important to let your healthcare provider know if you have an allergy to sheep, papaya, papain, or pineapple enzymes. Having these allergies increases your risk of having an allergic reaction to the antidote, which your health care provider needs to take into account to manage treatment.

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At-Home Wound Care Tips for Parents

By Ruchi Bagrodia, physical therapist at CHOC Children’s

Did you know that the physical therapy team provides wound care for the kids at CHOC Children’s?

Part of their scope of practice, both physical therapists and physical therapist assistants complete coursework in wound management during their higher level education. Several PTs and PTAs at CHOC have received specialized training in wound care and many have gone on to receive board certifications in wound care. With this training, a therapist is able to evaluate wounds, decide on the best treatment, and create a comprehensive wound care plan in collaboration with the patient, family, and medical team.

Physical therapists are able to use their expert knowledge of anatomy, tissue healing, movement and positioning to develop an individualized plan of care that also aims to improve movement and function. Successful wound healing may allow a child to more quickly return to school, participate in gym class and enjoy a summer trip to the beach with their family.  The ultimate goal of physical therapy is to restore function and allow people to get back to the things they love doing!

How do PTs provide wound care at CHOC?

At CHOC, PTs and PTAs provide wound care services for kids on both an inpatient and outpatient basis. During an evaluation, a PT will decide how to best clean, dress, and protect the child’s wound, and also provide recommendations to the parent to encourage wound healing and to prevent complications.

Here are some tips to remember when caring for your own minor wounds or skin injuries at home:

  • Keep dried scabs moist using a healing ointment or petroleum jelly for faster healing time. While it may be challenging, try your best not to pick at scabs!
  • If a wound is open (appearing wet, bleeding or draining liquid), cover it with some type of bandage. Leaving it open to air will increase the risk of infection.
  • Common signs of infection include redness, swelling, pain and warmth. Call your doctor if you notice an increase in signs of infection that are not already being treated.
  • When using over-the-counter antibiotic ointments for minor cuts and scrapes make sure to follow the dosage instructions. It is not recommended to use many of these ointments for more than seven days unless stated by your doctor. Many people have allergic reactions to triple antibiotic ointments. If you notice a wound is getting worse with an ointment, stop using it and talk to a health care professional.
  • Hydrogen peroxide and rubbing alcohol are commonly used to clean wounds, although both are damaging to your healthy skin cells. Instead, simply use mild soap and water to clean a cut or scrape.
  • Different types of sandals, shoes, plus foot and ankle braces can all cause areas of redness caused by too much pressure to the skin. If the redness does not go away after 15 minutes upon removing the pressure, the fit needs to be modified to avoid further injury to the skin.
  • Nutrition makes a difference in wound healing! Incorporate foods that are high in protein, Vitamins A and C, and Zinc into your diet to help with healing. Learn more by visiting ChooseMyPlate.gov for tips on how to create a balanced diet.

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How to Build a Basic First Aid Kit at Home

iStock_000054492154MediumMost parents are bound to face a small “medical emergency” at home with their child at some point, whether it’s a nasty scrape, nosebleed or bug bite. Knowing what to do and having some supplies handy can make minor injuries easier to care for when they occur.

“Everybody should have a first aid kit. They also should have a card in their kit with their pediatrician’s phone number on it in case someone else is watching the child and needs to know who to call if needed. They can also call 9-1-1 for a severe emergency,” says Dr. Mary Jane Piroutek, an emergency department physician at CHOC Children’s.
To build your basic first aid kit, Dr. Piroutek shares a list of supplies to include:

  • Gauze or dressing
  • Antibiotic ointment like Neosporin, for bites, cuts, stings and scrapes. This will help keep wounds lubricated and prevent infection.
  • Bandages
  • Antiseptic spray to help clean the wound.
  •  Tweezers to remove splinters. To remove a stinger that is still in a puncture wound, use something firm like a credit card to swipe it away.
  •  Non-latex gloves to keep hands clean.
  • Antihistamines for minor bites or allergic reactions (* talk to a medical professional for giving antihistamines to a child under the age of two)
  • Acetaminophen or ibuprofen – not aspirin – for pain.
  • A water bottle in case you are somewhere that lacks clean water and you need to wash a cut.

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