You've just been bitten by a snake — what you do next could save your life!
Author: Nick Kilvert Date Posted:5 December 2017
You have just been bitten by a small snake. You are pretty certain it is just a harmless python, but it disappeared before you could get a proper look. Do you administer first aid and go to the hospital or keep gardening?
When Pat Ryan saw a little brown-looking snake disappear under his fence earlier this month, he decided to check himself over, even though he had not felt a bite.
He had been gardening barefoot in his yard in Agnes Water on the Queensland coast about an hour north of Bundaberg.
"[My wife] washed my foot off to have a look … then washed it a bit more and said, 'Yeah I can see two little strike marks'," Mr Ryan said.
Like in many of the 3,000 or so reported snake bites in Australia each year, there are a number of snakes fitting Mr Ryan's description that are native to the region, some harmless and others potentially deadly.
First minutes is crucial before venom enters bloodstream
If Mr Ryan had been bitten by a brown tree snake, over the next few hours he might experience some very mild local irritation around the bite and its weak neurotoxic venom might cause some nausea.
But if the snake was a similar-looking eastern brown, a deadly cocktail of neurotoxins, myotoxins, and coagulants would be making its way toward his bloodstream before attacking his nervous system and muscles, putting him at high risk of cardiac arrest.
This is where treatment is crucial. If the right procedure is followed, the snake venom can be all but stopped before it reaches the blood, according to toxicology expert Dr Brian Fry.
"When you wipe out when you're running or something like that and you scrape your knee and you get that clear liquid coming out, that's actually lymphatic fluid," Dr Fry said.
"Lymphatic fluid is fluid around our blood vessels, bathing everything that's not inside the blood vessels.
In Mr Ryan's case, after being bitten on the foot, the venom needed to travel via his lymphatic fluid all the way up his leg to the lymph nodes behind his knee and in his groin, where it would then drain into his bloodstream.
Compression bandage can buy bite victim hours
Mr Ryan works in the mines and does regular first-aid training, including snake bite treatment. Three years earlier, his wife Jazz was bitten by an eastern brown and rushed to hospital in Rockhampton where she recovered without the need for antivenom.
Not knowing the exact identification of the snake, Mr Ryan sat himself down with his leg hung over the verandah railing while Jazz grabbed "whatever [she could] get [her] hands on" to make a compression bandage — in this case, garbage bags.
Starting at the bite and working up the limb, they used the bags to apply pressure evenly and firmly without cutting off blood flow completely.
If done well, this technique can slow the movement of lymphatic fluid to a near stand-still, according to Dr Fry.
"There's been cases of people arriving [at hospital] with a taipan or a brown snake bite seven, eight hours post bite — no symptoms," he said.
In contrast, an untreated eastern brown snake bite can kill in under half an hour.
"It's arguably the quickest killing venom in the world. No other snake in the world has killed people so quickly, so regularly," Dr Fry said.
Flying doctors update advice as wrong identification common
Between 2005 and 2015, eastern browns were responsible for 17 of the 23 snake bite deaths in Australia, with most victims dying from out-of-hospital cardiac arrest or bleeding on the brain.
Of the 296 eastern brown snake bites in that period, 18 per cent caused acute kidney injury, and other ongoing complications were common.
Although they typically only inject a small amount, hatchling eastern brown snake venom is capable of killing an adult, so being bitten by a small snake does not mean it is harmless.
Adding to the difficulty, eastern browns range from red-brown to black or grey, can be striped, mottled or have a reddish band behind the head, and can look very similar to other harmless species.
The Royal Flying Doctor Service (RFDS) no longer advises bite victims to attempt to identify the snake after a paper published in the Medical Journal of Australia (MJA) in July found that snake identification was unreliable for people presenting to hospital with bites.
Remaining at home an unnecessary gamble
When the ambulance arrived for Mr Ryan, they replaced his improvised compression bandage before transferring him to Bundaberg hospital.
"They tried doing swabs to see what sort of snake it was and they couldn't [tell] because I had to wash it to see if I was actually bitten," Mr Ryan said.
"So yeah, I did the wrong thing there but at the end of the day I needed to see if I'd actually been bitten as well."
Several swabs did not reveal any venom, so the hospital removed Mr Ryan's bandages and began to monitor his blood pressure, coherence and pupil dilation.