My Green Mamba (Dendroaspis anguticeps) bite

This section will help you get first aid treatment protocols incase of an envenomation. This includes indigenous and exotic reptiles. Please do not use this forum for photo sharing, etc.

My Green Mamba (Dendroaspis anguticeps) bite

Postby EDDY » Tue Apr 09, 2013 10:53 pm

On Easter Sunday (31/03/2013) my worst nightmare became true. I was not having a very good day to start off with, the whole day I had a weird gut feeling. Easter Sunday is our busiest day of the year and it was almost time for the snake demonstration (14h20). I went to the Reptile Park to fetch the Green Mamba, which I have used many times for demonstrations! The bucket was ready and I had the snake on the hook and tailed. I put it in the bucket and with the lid in my left hand to close the bucket. As I closed it the snake came out and my left index finger was on the wrong spot at the wrong time and it bit me. First thought was maybe it was a dry bite, I saw the blood and felt a stingy feeling at the bite site, and then I knew! I immediately put the snake back and made sure the cage is locked. I phoned our HR manager and told him we need to go to the hospital and I was bitten. I quickly went to the first aid kit, got a bandage and wrapped it tightly around my forearm (it was too small to do my full arm) and was taken to hospital. Amazingly enough I was so calm while doing all this; I think it’s because I know how important staying calm in this situation is. We also informed Krugersdorp Netcare Private Hospital that we are on our way.

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(30 minutes after bite)

The first symptoms I experienced were swelling around the bite but not allot of pain, a hectic cold sweat, shaking lips and nausea. When I got to the trauma unit they were ready for me. I made sure HR knew that if I blacked out that he would contact Arno Naude for any big decisions the doctor might need to make. My dad was also on his way and already contacted Arno. They put me on a drip, gave me an anti-histamine shot, put me on oxygen and monitored my breathing and heart rate and my saturation levels very closely. They also gave me an adrenaline shot.

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(1-2 hours after the bite and cleaned)

Dr. Erasmus in the trauma unit told me that he will only use anti-venom as a last resort; I also heard some of the nurses telling each other that you treat the symptoms of a snake bite. The symptoms that followed were the worst: bite swelling more, still a cold sweat, lips still shaking, still nauseas, my whole body started to feel stiff and sore. I started to struggle to breathe and swallow. There was also needles and pins on all my fingers and toes. It was the worst feeling ever and now I started to worry.
After stabilising me and making sure that the saturation levels are sufficient and no further neurotoxic effects are prominent, I was then moved to ICU, where Dr. Vermooten (Intern specialist) took over. He told me that the hospital does have Polyvalent Anti-Venom in stock and there was some more on the way from Millpark Hospital. He asked me I must inform immediately if I start to lose any vision. The symptoms more or less stayed the same. The only one that was really getting bad was that my whole body was in pain! My skin, bones and organs everywhere was in pain. I also started to develop a slimy cough and my eyes were watering allot. My arm was elevated and I could slowly see the swelling moving down my arm, but the colour was normal. I was monitored right through the night. I stayed on oxygen, a drip and my blood pressure was taken every 30 minutes. An X-ray was taken of my chest for the doctor to see how much fluid is in my lungs. They also tested my blood a few times and a ventilator was also standing ready.
The next morning I was feeling allot better, but the swelling was up unto my elbow. The doctor moved me to a normal ward. I stayed on oxygen, a drip and received some painkillers. By the end of the day the swelling was up to my armpit.

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(hand comparison day 2)

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(Swelling on my arm day 2)

By the third day the swelling did not go any further and a surgeon came to check for compact syndrome, but didn’t see any. I also received physiotherapy on the arm for the next 4 days. Where they did an ultrasound on the arm and also massaged it. I also received another 2 sets of x-rays while standing to check for fluid on my lungs. They also did a sleep study on me to check that there isn’t any disturbance with my nerves while sleeping. My blood was also tested every second day and every day I was injected with blood thinning medicine. On day 5 the doctor removed the oxygen as well as the drip and I was sent home on the 7th day after the bite. It’s been exactly 10 days after the bite and my hand and arm is still sensitive. My breathing is also not 100% and I get out of breath very quickly. But I feel better every day.

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(Day 7 till present)

This was really the scariest thing I have ever experienced in my life and never want to have it over again. Even though my overweight body and slow metabolism helped to let the venom move through my body allot slower, it will make the recovery quite longer. So I’m really going to lose some weight. Luckily I stopped smoking 2 months or so back, otherwise it might also have been worse on my lungs. I am very lucky that I got off so lightly from this and didn’t even need anti-venom. I can also be very lucky that it is a WCA , otherwise I am not sure my medical aid would have covered everything.
When it gets to venomous snake handling to me, the number one rule is always safety. But after this event I have come to another number one rule and that is: “NEVER MAKE AN EXCEPTION!” I handle venomous snakes on a daily basis and it is my job. I never take chances and have never free handled any venomous.

My rules are:
• SAFETY FIRST AND NEVER MAKE AN EXCEPTION.
• MAKE SURE YOU HAVE THE RIGHT TOOLS AND CONTAINERS.
• WHEN DANGEROUS VENOMOUS ANIMALS ARE HANDLED, MAKE SURE THERE IS ANOTHER HANDLER WITH YOU, THAT IS ALSO EQUIPPED WITH TOOLS.
• WHEN WORKING WITH DANGEROUS VENOMOUS ANIMALS, MAKE SURE THAT PEOPLE ARE AT A SAFE DISTANCE.
• NEVER HANDLE ANY VENOMOUS ANIMALS IF YOU ARE UNDER THE INFLUENCE OF ALCOHOL OR ANY STRONG MEDICINE.
• NEVER HANDLE VENOMOUS WHEN YOU ARE IN A HURRY
• IF YOU ARE HANDLING VENOMOUS WITH PEOPLE AROUND, MAKE SURE YOU IGNORE THEIR TALKING AND CONCENTRATE ON THE SNAKE.
• RATHER LEAVE THE VENOMOUS SNAKES FOR THE NEXT DAY IF YOU DO HAVE A BAD GUT FEEL OR HAVING A BAD DAY.

So where did I go wrong then? Well I was making an exception on 3 of my rules. By being in a hurry, no other handler present and handling while not feeling good. I hope every venomous handler can learn from my mistake.

I would like to say thank you to GOD, my family, friends and RLNR colleagues for their support, help and prayers. Special thanks to Krugersdorp Private Hospital, thank you for helping me. Thank you to the trauma unit, the ICU and the nurses of the Constantia Ward. Thanks to Dr. Erasmus, Dr. Vermooten, Ronel Venter and to Arno Naude for helping.

Praise God for raining me up on resurrection day.

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Re: My Green Mamba (Dendroaspis anguticeps) bite

Postby SABOAMAN » Wed Apr 10, 2013 7:03 am

EDDY glad you made it through without anti venom. I wish you a speedy recovery. Thank you for sharing your experience on the forum hopefully some will learn from this.
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Re: My Green Mamba (Dendroaspis anguticeps) bite

Postby Blake » Wed Apr 10, 2013 7:10 am

That's pretty hectic man. You truly have been blessed to still be here today and by the grace of God you pulled through. Wish you all the best for your recovery.
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Re: My Green Mamba (Dendroaspis anguticeps) bite

Postby Kakibos » Wed Apr 10, 2013 7:31 am

Hi Eddy, glad that you made it through the worst and hope you make a speedy recovery.
Just for interest sake, why did the Doctors give you anti-histamine and adrenaline shots? Was it a precaution for when and if they were going to administer anti venom to prevent an allergic reaction?
Was the anti-histamine for the swelling?
Just thought it could be interesting to hear what the experts had to say.

All the best with your recovery!
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Re: My Green Mamba (Dendroaspis anguticeps) bite

Postby Sico » Wed Apr 10, 2013 8:06 am

Thanks for documenting that so well. It makes a very interesting comparison to the bite I got from D. viridis.
I also experienced the intense pain all over my body, especially in my large muscle groups. Good to see that the staff handled it well, it looks like all the education being done in the field of treating envenomations is starting to pay off. Please keep us updated as to anything else you may experience.
The shortness of breath and tiredness should resolve within about 14-20 days of the bite, until then take it easy. Oh, did you have any ECG abnormalities that you know of, and keep checking your blood pressure to see that it isn't going up, I will be interested to see if you end up with any residual hypertension as a result of this.
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Re: My Green Mamba (Dendroaspis anguticeps) bite

Postby froot » Wed Apr 10, 2013 8:30 am

What a good post! Eddy glad you're ok. Looks like you got top class treatment. If it's ok with you I'd be interested in what the hospital bill is, just as a guideline figure of what one can expect to pay for this sort of treatment. Thanks for sharing.
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Re: My Green Mamba (Dendroaspis anguticeps) bite

Postby Smeegle » Wed Apr 10, 2013 8:42 am

Great post, thanks for sharing! Definitely a wake-up call for many of us.

Glad you are on the mend:)
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Re: My Green Mamba (Dendroaspis anguticeps) bite

Postby Mitton » Wed Apr 10, 2013 9:05 am

Very well documented Eddy, thanks for sharing.
Hope you feel better soon and glad it did not turn out worse.
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Re: My Green Mamba (Dendroaspis anguticeps) bite

Postby Rodis » Wed Apr 10, 2013 9:15 am

Hi Eddy.

Glad it turned out well Eddie!

Well done Eddy for staying calm. I have always worried about this aspect myself. I think if I was ever bitten I would go into a dead panic even knowing what we all know.
Thank you for documenting the symptoms for the rest of the community.

I am hoping that Arno or one of the experts may answer this for my own knowledge and the rest of us who find venom fascinating.
Arno is the swelling common (PPS) with Dendroaspis envenomations? I realise that in this case the swelling may not have been as severe as in the case of a Bitis envenomation or Naja mossambica but I have never realised it presents itself like it did in Eddie's case.

Sico did you experience this symptom with your viridis envenomation?

Also as already asked, is the antihistamine standard practice and does it help?

I ask this only, and I do stand to be corrected, but when I completed my snake bite course with Mike Perry a number of years ago, I seem to remember him explaining to a medic that this was not advisable because if antivenom was needed it would work against it and block some of the neutralising effects of the antivenom, basically that is was a contraindication.

I am not 100% sure if my memory serves me correctly, this is why I ask?

Thank you.

And once again Eddie, thank you for posting your account. I would have "kaked" myself!
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Re: My Green Mamba (Dendroaspis anguticeps) bite

Postby rico » Wed Apr 10, 2013 9:55 am

Hi Eddy ,

Great post. Very informative. Have a speedy recovery.
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Re: My Green Mamba (Dendroaspis anguticeps) bite

Postby Scar69 » Wed Apr 10, 2013 10:03 am

Wow... You where lucky bud,
I guess keeping calm is the most important thing after a snake bite,
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Re: My Green Mamba (Dendroaspis anguticeps) bite

Postby EDDY » Wed Apr 10, 2013 11:41 am

Thanks for all the replies!

Just for interest sake, why did the Doctors give you anti-histamine and adrenaline shots? Was it a precaution for when and if they were going to administer anti venom to prevent an allergic reaction?
Was the anti-histamine for the swelling?


The adrenaline I'm sure was for a precaution for anti-venom and anti-histamine I think is a standard procedure. Because I read that they also gave it to Johan Marais for his puffadder bite, he said that there is no evidence that it does any good.

Oh, did you have any ECG abnormalities that you know of, and keep checking your blood pressure to see that it isn't going up, I will be interested to see if you end up with any residual hypertension as a result of this.


There was no abnormalities that I know of and I'm checking my blood pressure often. So far it seems normal.

If it's ok with you I'd be interested in what the hospital bill is, just as a guideline figure of what one can expect to pay for this sort of treatment.


I have no idea, but will try to find out. Like I said it is a workman's compensation claim.

Regards
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Re: My Green Mamba (Dendroaspis anguticeps) bite

Postby Sico » Wed Apr 10, 2013 11:54 am

Rodis I did not develop any significant swelling from the viridis bite, only minor (3cm diameter) around the fang mark.
The adrenaline was likely given as a precursor to antivenom (if it had been required) to limit the significance of anaphylaxis to the antivenom (recommended dosage 0.25mg IM adrenaline prior to antivenom therapy). Antihistamines pre-antivenom are shown to have little to no effect in limiting allergic reactions, but should be given along with corticosteriods if an allergic reaction develops, as part of the anaphylaxis protocol.
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Re: My Green Mamba (Dendroaspis anguticeps) bite

Postby Bushviper » Wed Apr 10, 2013 2:44 pm

Eddy you are really lucky. Your first doctor was one of my students and it seems like he listened in class.

At your age if you can avoid antivenom that is the first priority. Personally if you had not been a herper I would have zapped you with 10 vials. Your recovery would have been quicker with less side effects however the risk of anaphylaxis is always present. That would be a problem for any future envenomations.

The swelling is not that unusual. This seems to be determined by the locality of the snake involved. Some areas seem to have more swelling properties in their venom than others. The physio was great and I am a huge supporter of that.

The blood thinners tickle the hell out of me. Why would they give you that?

Take it easy and let us know how everything goes.
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Re: My Green Mamba (Dendroaspis anguticeps) bite

Postby atropos » Wed Apr 10, 2013 3:47 pm

A fascinating account, so happy that everything turned out ok.

Well done for documenting this so well, I'm sure that we can all learn a lot from this.

Also comforting to know that there are legends like bv available for advice and expert knowledge.
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