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Posted on 06-23-2016

June Case of the Month:
The Serpent and the Golden

“Uh guys, do we have any Antivenin?” The receptionist looked concerned and pensive as she rounded the corner into the treatment area.  We’re used to emergencies at the end of the day, but a snake bite in mid-March made everyone take notice.

The owner had done the smart thing: they called to confirm that we had the antivenin as they rushed over. Some clinics don’t keep antivenin due to cost and supply concern, but we were happy to report that there were two vials of the life-saving medication in our refrigerator.

The receptionist told the owner that we could help, and our staff braced for the proverbial impact.

Image of a RattlesnakeRattlesnake bites vary a lot from case to case.  Southern California has 5 varieties of rattlesnakes and between them they carry 2 different venom types.  Hemotoxic venom (more common) causes blood cell and tissue damage, while the Neurotoxic type affects the nervous system.  In both cases, massive swelling and tissue death (“necrosis”) around the bite site are serious concerns.  Severe and systemic reactions can potentially lead to breathing difficulties or even cardiac failure. Variables also include the size and age of the snake, the size, age and medical condition of the animal, and the location of the bite itself.

We prepared for the worst and readied I.V. fluids, medications to treat for shock & pain, and even our portable oxygen tank.  All staff we could spare were “on deck” and ready to handle what came through the door.

What entered our waiting room a few minutes later was a large, beautiful Golden Retriever who looked surprisingly chipper despite his ordeal. His owners could not mask their distress as well, but they remained ready to help their friend in any way they could.  When they walked in, one might have never guessed that the dog had just tangled with a large, upset rattlesnake, but we knew that his status could change quickly.

As our first concern was making sure our new patient was stable and not painful, we gathered up the friendly Golden with little preamble and took him in the back to start emergency treatment.  The staff quickly took the dog’s vitals, then placed an IV catheter so they could begin fluids and medications to prevent shock, tissue damage and pain.  Blood was also drawn to confirm that vital organs, electrolytes, blood cells and clotting factors were all at healthy levels.  Dr. Helfrich, who was there to receive the case, did an exam and began writing up medication dosages to help keep his patient stable.

While the doctor and a crew of technicians buzzed around starting treatments on the Golden, we went out to discuss a treatment plan with the owner.  While we always initiate life saving treatments first, we also needed to prep the owner for the intense course of treatments used for rattlesnake bites. Ultimately, along with the IV fluids, hospitalization, bloodwork, medications and antivenin, the dog would need to be hospitalized overnight, requiring transfer to a 24 hour facility.  The owners understood and agreed – anything to save their sweet friend.

Large Rattlesnake bite on a Golden Retriever.  Treated with Antivenin.By the time the IV catheter was placed, fluids and medications started, the poor dog’s head had swelled significantly.  We shave the area on top of his head where the dog was bitten and found an impressive set of wounds.  Two flaming-red bite marks sat 3-inches apart on top of the dog’s head.  The wide spread told the story of the snake – he had been massive.

The size of the snake, while scary to the owner, may have been to the dog’s benefit.  Small, young snakes are inexperienced with their venom and tend to empty their venom sacs with every bite.  Larger, older snakes don’t use all their venom with every bite and even less-so with bites meant to defend the snake, rather than to kill prey.  Ultimately though, it’s hard to determine how much poison the patient took on; we just have to treat fast, watch the swelling and vital signs, and hope.

After the shock medications were administered, we began antivenin therapy.  Antivenin must be given carefully while watching the patient for reaction.  The big Golden took it like a champ and remained his sweet, smiling (if somewhat swollen) self the whole time.  While part of the staff assisted with the antivenin, another technician ran the labwork.

During the course of treatment, we watched the dog’s vital signs carefully for changes, and measured his head and muzzle regularly for excessive swelling that could hinder breathing and cause tissue damage.  In this case, the swelling was also a good sign of the body’s reaction to the poison and an indication of how well our treatments were working. 

The labwork came back relatively normal.  Organ systems, red and white blood cells, electrolytes and clotting factors all looked great, so all that was left to do was watch the dog like a hawk and wait.

Ultimately, the time came for our friend to be transferred to the overnight facility.  When he left he looked surprisingly good.  The swelling had stopped its progression and he walked out with a doggy grin on his face (and an impressive set of fang marks on his head).

The emergency facility continued our course of treatments, giving IV fluids, controlling pain, monitoring bloodwork and watching their patient closely for swelling and changes to vital signs.  After a very successful night of hospitalization, he was discharged in the morning with only a course of antibiotics, pain medication and a few days of rest left in his treatment plan.  The report from the overnight facility said that he had done very well during his stay.

We called the client the next day to check on our patient.  She was happy to report that he was doing great.  The swelling and gone down almost to normal and he was expected to make a full recovery.

Rattlesnake bites are a scary part of living in San Diego.  While snakes are in no way out to get us, startled or pestered snakes are can do a lot of damage in an effort to defend themselves.

There are, however, things that owners can do to keep their pets safe from rattlesnakes:

  • Keep your dogs on leash:  unleashed dogs are rarely under full control and a leash will allow you to pull your pet out of danger if you see a snake.
  • Stay on wide trails: A great number of rattlesnake bites occur not because the dog is investigating the snake, but because they step or jump on the snake while running off trail.  Dogs also like to stick their noses in rock crevices or holes which are favorite hiding spaces for snakes.  Snakes rarely like to remain on open, unprotected trails.
  • Watch out for trail overgrowth:  Stay on wide trails and try to walk towards the middle.  Snakes may like to warm themselves on a trail, but prefer to remain hidden. They can often be found in foliage overgrowing the sides of the trail.
  • Keep an ear out for the telltale “rattle”: Snakes don’t want to be bothered, they will rattle as a warning if they know you’re coming.
  • If you see a snake – walk away or wait:  Rattlesnakes don’t WANT to bite us, if you see one, give them time to go away or walk a different direction.

Remember: It’s always an emergency.  Regardless of the type, age or size or rattlesnake, or whether or not your dog has had the “rattlesnake vaccine,” a snakebite is always an emergency.  Because of the variable nature of snakebite reactions, immediate care can be essential for survival.

For more information on snake bites, please read this article:

http://allpetsanimal.com/topics/seasonal---summer/april-featured-article--rattlesnakes.html

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