Monday, May 5, 2014

Writing a Case of Snake Bite in the Wilderness--A Discussion

I'm writing a scene set in a pre-industrial society. Herbal medicines, folk treatments, etc.
One of my characters is bitten by a venomous snake - I haven't really specified what kind. Can you think of ANY treatment for snake bite in this situation that would actually be effective? Right now I have them just sort of treating the symptoms - keeping the wound clean, applying snow when it starts to swell, etc.
Are there any more effective things they could be doing, in the absence of antivenin?


Sure. There are a few measures that you can use, depending on how savvy the caregivers are. Right away, first aid measures should be taken as follows:

--Avoid panic—keep heart rate down, keep victim quiet. Most bites are not fatal. In the USA, less than one percent of bites are fatal.

--No ice/snow application. May cause tissue damage.

--No tourniquet.

--No sucking out the venom—this includes older snake bite kits.

--Wash the wound—helps remove any residual venom on the skin, and helps cut down on bacteria. DO NOT use alcohol—this damages the raw tissue in the wound.

--Keep the heart above the wound. Immobilize the extremity (if bitten on extremity)

--Consider carrying the victim. Walking is exercise and will increase heart rate.

--If possible, try to ID the snake. Don’t let the snake get in another bite by trying to catch or kill it.

If you do kill it and transport it, keep in mind the dead snake can still bite for a couple of hours.

It is possible to use a homeopathic remedy if medical help is unavailable or delayed. This isn’t a definitive treatment, but may help.

Plants to treat snake bite:

--Rattlesnake master (false aloe)—clean off roots; scrape well. Cut up and crush root
pieces between pieces of wood. (see photo left)

--Yarrow root—process as above for false aloe.

--Willow bark (from which comes acetyl salicylic acid, also known as aspirin.) Cut into small pieces.

Combine the above and apply directly to the wound as a poultice. Wrap with cloth (strips of clothing, for example).

Over the next few hours there will be a lot of swelling, bruising, and pain associated with the bite. Chewing willow bark may help decrease pain, as can birch bark. Yarrow may numb the wound.

Ultimately, evacuation to a hospital and treatment with antivenin is ideal. Even if it’s a couple of days away, always travel toward the nearest help.

 Hope this helps!
Questions? Comments?
Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.
Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
Find Kelly’s fiction at


  1. First, thanks for putting this blog up; it's been enlightening. I've got a question that's really a twofer:
    The story is an urban fantasy of sorts in which my main character and a (male) friend of his have a healing ability which makes them quasi-immortal, though far from invulnerable. The friend is pinned against his SUV by the nose of a truck driven by an unknown (female) attacker, who proceeds to try to stab the friend before the MC scares her away. The truck was powered by gravity alone and didn't have a straight and unimpeded shot at the friend, so I can control the impact velocity. The MC is also cut on the arm and whacked on the head, and though his healing factor reduces the urgency of his injuries, it cannot rapidly erase them under these circumstances. This goes double for his friend, who is effectively trapped until emergency personnel arrive.
    I'd like to know what sort of injuries I can expect for the friend and what to see in the emergency response to both characters. (I want to make the friend's bad enough for immediate removal by ambulance, but not so it requires a lot of long-term care and/or observation.) What happens, from first aid to ambulance, including whatever you can give me about non-medical responders?
    I'd also like to know what to expect from the MC's point of view while his friend is in the hospital. Assume slightly better than reasonable for his injuries, due to the healing factor. How long from ER to surgery to ICU, or whatever sequence, and until they're willing to release him? What condition will the friend be in at each stage? What continuing care will they advise, and how long will he have to fake being hurt? Throughout, how hurt must he pretend to be?
    I appreciate your giving time and attention to help me answer these questions.

  2. Hello.
    First aid will be assessing airway--is the guy's trachea open so he can breathe? Breathing--is he breathing? Circulation--is his heart beating? After these are addressed, firefighters/first responders will assess the degree of crush injury, how to best pull the truck back, and what will happen when the truck is pulled back. In other words, is the truck holding pressure on a vessel that might otherwise bleed?
    Once the truck is off, he'll be laid flat on a backboard and assessed now that the truck is out of the way. Pulse rate, respiration rate, and blood pressure will be checked. A paramedic will use a stethoscope to listen to his chest and heart. Then a quick body survey: Is he bleeding? Is he going into shock? Are there obvious fractures that need to be stabilized? An IV will be placed, and possibly oxygen.
    Assuming he is transportable by ground (not in need of airlifting) an ambulance he'll be taken to the nearest Emergency Department. A doctor there will do further assessment. Your guy is likely to end up with a number of X-rays looking for fracture, and a CT scan of the chest and abdomen to look for internal injuries like a ruptured spleen. Lab will be ordered, including a complete blood count and electrolytes, a clotting panel, and a blood typing. If bleeding is extensive, a type and hold (blood held for just in case) or a type and cross (blood the doctor plans to give) will be done.
    A general surgeon is likely to be consulted, and is the most likely doctor to take care of him if he’s admitted to the hospital.
    ER to surgery depends on the extent of the injuries and how stable the patient is. Contrary to TV, patients are not examined on the fly as the gurney whizzes into the ED, and then raced off to surgery.  If the guy is unstable, they’re going to stabilize him as much as possible in the ED before CT scan. A surgeon needs a map to operate. They don’t go in up to their elbows in blood and “clamp a bleeder.” The long bone (extremity) X-rays can wait in an emergency unless a hip is fractured.
    Off to surgery.
    The surgeon will deal with whatever happened in the crush. If the spleen is ruptured, it might be removed. If the liver is lacerated, it will be repaired. If there’s a hole in the intestine, it’ll be fixed. He’ll need a tetanus shot. If he has his spleen out, he’ll also need a pneumovax (pneumonia shot) as he’ll be more susceptible without a spleen.
    The time in ICU depends on stability. At least overnight.
    The time upstairs after ICU depends on progress.
    Patients vary widely in their responses to trauma and surgery. Young healthy adults do better than ill elderly or sick infants. You can tailor this interval to fit your story. He can’t go from critical to stable without intervention. He can’t fake critical unless he can control his blood pressure and heart rate.
    The best ways to keep him in the hospital are: continued severe pain; can’t keep anything down orally; can’t ambulate; can’t pee.
    Hope this helps!

    1. Thank you so much! I kept looking in the wrong place for an answer. This helps a lot, and it's way more than I hoped for! So glad you've put up this blog!