Barton Creek West Homeowners Association, Inc.
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Snake Bites 101
“So what should I do if my kid (or an adult) gets bit by a snake?”
As an ER doctor, I get asked this question all the time. And for good reason - there are plenty of snakes out
here. In the past few weeks alone I have seen a moccasin at the creek, a copperhead in my backyard, and
three coral snakes dredged from my neighbors’ pool skimmer.
Venomous Snakes in BCW
There are two categories of venomous snake in the US - crotalids and elapids. Crotalids are pit vipers, a class
of snake that includes moccasins (cottonmouths), copperheads, and rattlesnakes. They can be identified by
the sensory pits behind their nostrils, their triangular heads, and their vertically-slit eyes. Their venom causes
severe local tissue destruction that spreads quickly, swelling, large blisters, bleeding and clotting abnormalities,
vomiting, and sometimes shock and death.
Coral snakes are elapids. They can be identified by the old adage “Red and yellow, kill a fellow. Red and
black, venom lack.” This means that the red stripe on a coral snake is bordered on either side by a yellow
stripe. Elapid envenomation is rather different than crotalid, causing neurologic symptoms such as tingling,
facial palsies, slurred speech, seizures, coma, and often only mild skin swelling. These symptoms can be
delayed by many hours. A coral snake will often “chew” to give its venom rather than delivering the super
effective strike of a crotalid. Generally, coral snakes will avoid you if they can.
Don’t Get Bit!
The best way to handle snake bites is to avoid them in the first place. That does not mean you should stay
inside all day and never hit the trail, but it does mean you should use some common sense. Wear boots or
good shoes when out on the trail. If off-trail, wear boots and pants. Before jumping into the creek to swim,
scout the area carefully. Consider hiking out ahead of your kids if going off-trail. On your own property, remain
vigilant. If the kids are playing alone outside (which is great!) consider doing a quick sweep of the yard first.
This may sound excessive, until you see a copperhead in the same spot your kids regularly play.
Once you see a snake, keep your distance. Snakes can cover a lot of ground very fast when trying to strike.
Believe it or not, in the ER I most frequently see snake bites after someone has reached down to pick up a
snake, or tried to kill a snake that just bit somebody else. This is second only to people getting bit while taking
the trash out to the curb at night barefoot.
Oops, I Got Bit.
If you get bit, try to identify the snake…from a distance. Don’t be a hero or a snake-killing vigilante - that may
result in a second bite. If you can positively identify the snake as non-venomous, treat the wound with
irrigation, soap and water, topical and possibly oral antibiotics, elevation, over-the-counter pain medications,
and a tetanus shot as needed. Seek medical care, but not emergently. If you are unsure what snake bit you,
assume it was venomous.
If you are bit by a venomous snake, quickly get to the nearest ER that has antivenom (both St. David’s at the
Hill Country Galleria and Lakeway Regional Medical Center carry antivenom.) A venomous snake may bite
you without causing envenomation. Time will tell, and you don’t want to wait until symptoms show up before
you seek medical care.
Once you have been bit, you want to move the affected part of the body as little as possible. Example: If you
are bit while on the trail and with other adults, utilize them as a crutch or a shoulder to lean on, and possibly
even be carried. If one of your children gets bit while on the trail, carry him on your back. If you get bit while
alone on the trail, hike very briskly to get to help.
Keep the bite at or just below the level of the heart. Do not use ice. Do not cut the wound and try to suck out
venom. Do not use a venom extractor. Do not apply a tourniquet. Just get to the ER.
Quick! To the ER!
So, should you call an ambulance? If my child had a snake bite but did not seem ill yet, I would drive him to
the St. David’s at the Hill Country Galleria rather than call an ambulance. It would be a very short drive. If I
were the bite victim, I would see if someone could drive me. However, you should call an ambulance if there
are signs of serious envenomation already or if you cannot think clearly.
Once in the ER, the ER doctor will decide whether anti-venom will be necessary. This decision will be based
on obvious and subtle signs of envenomation - severe local injury, extent and speed of swelling, presence of
gastrointestinal and/or neurologic symptoms, and lab values that show blood or clotting abnormalities. A
rattlesnake bite is the most likely to require antivenom, followed by moccasin, and lastly copperhead. Coral
snake envenomation is rare, but when it happens, you will need antivenom. The coral snake antivenom is
different, and harder to find. Just get to an ER, and if they need the coral snake antivenom, they will hunt it
down.
In Short…
The answer to the “what should I do” question has changed over the years. Experts no longer recommend
cutting, sucking, tourniqueting, or all the other cool fun heroic stuff that used to be taught. Stabilize the wound
by minimizing its use and movement, leave the injured extremity alone, keep the bite at or below heart level,
and get to an ER fast.
Perhaps most importantly, don’t let the fear of snakes keep you indoors. We are blessed beyond belief to live
where we do. Go enjoy the great outdoors! Just do so with good common sense, and a healthy respect for
our venomous neighbors.
Tyler Jorgensen, MD
This information has been provided to BCW homeowners in an effort to educate our community about how to deal with poisonous snake bites. You
have a responsibility to address your problem, if it occurs and given your own situation, with common sense and then seek immediate medical attention,
if necessary. If you feel the need to gain additional knowledge on this subject, please consult an emergency care facility or your own personal physician.
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