Sign up with GoogleWillie Trombone
Honorary Master
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- Jul 18, 2008
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One of the forumites at sareptiles.co.za got tagged by a mamba in Liberia. Small speciment with only one fang catching him... just a sober reminder to be careful when handling the things. Accidents happen - more often than not with handlers and professionals.
http://www.sareptiles.co.za/forum/viewtopic.php?f=45&t=26301&p=211623#p211623
http://www.sareptiles.co.za/forum/viewtopic.php?f=45&t=26301&p=211623#p211623
This morning at 09h42 I was unlucky enough to be bitten by a juvenile Dendroaspis viridis on site here in Liberia.
One of the guys came and called me about a snake he had just seen move under one of the accommodation units. I went to have a look, and climbing under the unit I saw part of a snake coiled on top of one of the concrete footings, in a narrow space under the base of the container. It was a greeny blue colour (from what I could see in the shade), and had black-edged scales. I assumed (2nd mistake) that it was only a Bush snake of sorts as they are pretty common around these parts. I hooked the snake out with my hand, and scuttled back out from under the container, and as I was standing up the snake turned its head slowly towards my arm and bit me. It only got one fang in and was attached to my arm for roughly 10 seconds. Immediately I knew this was no bush snake! The immediate area around the bite got goosebumps as the erector pilli muscles in my hairs were affected by the venom, in a circle around 40mm in diameter. I walked back to my room, still holding the snake, who was still lazily trying to bite me (which I avoided) and popped it into a pillow case. By this stage the area where the bite was starting to get a bit tender.
I called the other two Advanced life support paramedics in the camp to meet me at the clinic (thankfully we don't work alone here anymore) and told them I had been bitten by a snake, of which species I was unsure, but it felt like there was some type of envenomation that occurred. Checking up in "Dangerous Snakes of Africa" by Spawls and Branch, I realised that I had been tagged by a D. viridis
By 09h52 all the muscles in my neck going down into my chest had started to ache a lot (the kind of ache you get in your muscles the day after really strenuous exercise, like completing an Iron Man marathon), it hurt when I tried to swallow (like a bad case of tonsilitis), I had a metallic taste in my mouth, and my saliva was starting to thicken. I could only turn my head with great difficulty. The bite site had started to throb quite a bit, and my skin felt like I had recently received bad sunburn and this all within ten minutes of a single bite from a small mamba!
I had actually been through the treatment of snakebite with the other paramedics earlier last week so I guess now was the time to put the training to the test. I have to admit, knowing more or less what to expect, I was quite apprehensive and not a little bit concerned. I told them what they could expect, should I fall unconscious and how to manage the teatment of whatever symptoms I exhibited, had them put up an IV line (Normal Saline 0.9%), and prepare for antivenom treatment. We do keep 20 amps of SAIMR polyvalent and 10 amps of Echis carinatus antivenom in all our clinics here.
Once the line was up and I had a baseline set of vital signs (Blood Pressure 141/94mmHg, Pulse 105/min regular and strong, respiratory rate 12/min regular and deep) I asked them to pre-dose me with hydrocortisone (steroid) and promethazine (antihistamine) as I am an asthmatic and I was worried that the antivenom might precipitate some kind of respiratory problems on top of what I expected from the venom.
By this stage I was having a lot more pain coming from the muscles between my ribs, they felt like lead, and I asked the other two guys to prepare to intubate me and put me on a mechanical ventilator if it got to that point. I could not turn my head very much, it felt like all my neck muscles were taught steel cables, the glands under my tongue were swollen to the point that you could almost not see the front of my neck, and I was completely unable to swallow as my throat felt too small, and my saliva was very thick and gooey. I had to suction myself as the secretions built up. All the muscles in my arms and legs (thighs and calves) were extremely tender, and I was unable to lift my own leg up although I could move it from side to side with difficulty. I was able to use my arms slightly more, although they too felt very heavy. An interesting thing I experienced was that my skin all over my body was very sore, especially on my scalp and face, if it was touched I wanted to just climb through the roof!
We decided to go with 5 amps of antivenom initially, which was mixed up in 200ml of Normal Saline 0.9% with 10ml of 50% Dextrose added in. This was set up in a fast infusion to run in over 50 min. I have to admit that I felt no relief from the symptoms during the time it took to run in this load of antivenom, in fact the same symptoms just got worse. I did however develop a slight reaction to the antivenom, causing me to have a petechial rash develop over my face and chest, my right eyelid swelled a bit, my eyes went bloodshot and I developed asthma-like symptoms. My colleagues put me onto a nebuliser with Ipratropium 0.5mg and Fenotrol 1.25mg over 5 minutes, which helped a lot with relieving the difficulty breathing. My blood pressure had increased to 165/105mmHg, pulse was 127/min, strong and regular, respiratory rate was 20/min, shallow and regular. Honestly I felt awful, and I had the feeling that if this went on much longer I wouldn’t be able to carry on fighting it. Everything was an absolute mission, breathing, trying not to choke on my own saliva, trying to remain calm and assisting my colleagues, who were extremely professional and competent in dealing with something that had almost no idea about. Hats off to them.
With almost no relief from the symptoms after 5 amps of antivenom, I suggested we try another three amps in the remainder of what was left of the 1st drip, and at my estimate by the time I had finished the 7th amp, I was starting to feel noticeably better. I let the last amp run in, and removed the drip. My vital signs remained pretty stable and had by this time pretty much normalised. Now, 10 hours after the bite, my right arm is still rather stiff and tender, I have a slight headache, my sublingual glands are still slightly inflamed but no longer tender, and I feel generally a little achey but 1000% better than I did 30 minutes after that snake zapped me.
I will post some pics tomorrow, and will put up some pics of the snakes under the Goe Fantro thread.
This has been a bit of an eye opener to me, I think it stresses yet again, not to become blasé about handling snakes, even if you think they may not be dangerous. Make your ID 100% before you decide on how you are going to handle them, and react quickly if the poop hits the fan. I think this may have had a way more unpleasant outcome if I had been alone up here (without other MEDICALLY trained people), and I do not like to think how I would have been without antivenom therapy. I was astonished at how fast the symptoms took hold and became serious (within 10 minutes I was feeling the systemic symptoms), and this from a snake roughly 50cm long that only got me with one fang… I do not like to imagine the result of a large Mamba bite.
As a result of this my trip up here might be cut short, as the company wants me back in SA for kidney function tests post antivenom therapy so I may be back in SA in a day or two for that to be all sorted out and get my clean bill of health.
Pics to follow
