Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

What You Need To Know About Snakebites

Eastern coral snake Eastern coral snake, photo courtesy of Norman Benton, CC-BY-SA 3.0

The Wilderness Medical Society held its annual meeting at Snowmass last summer July 23-28, 2010. There were numerous terrific educational sessions. In a series of posts, I am going to highlight some of what we learned from the presenters.

Jonathan Allen gave a presentation on venomous snakebite management. Here are some facts to remember:

Snakebite Statistics

Approximately 15 percent of the 3,000 snake species worldwide are dangerous to humans. There are annually 400,000 to 2,000,000 envenomations from snakebite worldwide, with 20,000 to 100,000 deaths. In the U.S., there is at least one species of venomous snake in every state except Alaska, Maine, and Hawaii. There are approximately 20 venomous species, including pit vipers and coral snakes, and an estimated 6,000 to 7,000 venomous snakebites each year, including six to 10 deaths. Perhaps only 20 percent of bites are reported.

Deaths from snakebites typically Read more »

This post, What You Need To Know About Snakebites, was originally published on by Paul Auerbach, M.D..

Snake Bites: Should You Suck The Venom Out Or Not?

Last spring there was a news story about a man who said he saved his dog’s life by sucking venom from a rattlesnake bite out of the animal’s nose. After he performed this lifesaving feat and took his dog to a veterinarian, he reportedly began feeling ill himself.

It is further reported that he went to a hospital and received four vials of antivenom. The dog reportedly had its head swell up to three times its normal size and it also was administered antivenom. The man and his dog recovered. Read more »

This post, Snake Bites: Should You Suck The Venom Out Or Not?, was originally published on by Paul Auerbach, M.D..

At Last: An Antidote For Scorpion Stings

In the May 14, 2009 issue of the New England Journal of Medicine, in an article entitled “Antivenom for Critically Ill Children with Neurotoxicity from Scorpion Stings,” Dr. Leslie Boyer and colleagues report the results of a study in which the efficacy of scorpion-specific F(ab)’2 antivenom was compared to placebo in the treatment of 15 children ages 6 months to 18 years who were admitted to a pediatric intensive care unit with clinically significant signs of scorpion envenomation (N Engl J Med 2009;360:2090-8). The primary clinical end point was the resolution of the clinical syndrome within 4 hours after administration of the study drug. Secondary end points included the total dose of concomitant midazolam (Versed) – a sedative – and quantitative plasma (bloodstream) venom levels, before and after treatment.

The results showed that the clinical syndrome resolved more rapidly among recipients of the antivenom than among recipients of placebo, with a resolution of symptoms in all 8 antivenom recipients versus one of 7 placebo recipients within 4 hours after treatment. More midazolam was given to the placebo recipients (by necessity to treat symptoms) than in the antivenom recipients. Plasma venom concentrations were undetectable in all 8 antivenom recipients, but in only one placebo recipient one hour after treatment, which indicates that the antivenom neutralized circulating antivenom.

The conclusions are very helpful for clinicians treating scorpion envenomation syndromes with neurotoxic manifestations in critically ill children. They are that intravenous administration of scorpion-specific F(ab)’2 antivenom resolved the clinical syndrome within 4 hours, reduced the need for concomitant sedation with midazolam, and reduced the levels of circulating unbound venom.

This is very important new information. It is estimated that in North America, predominately in Mexico, more than 250,000 people per year are stung by scorpions. The major culprits are of the genus Centruroides. The antivenom used in this study was scorpion-specific F(ab)’2 antivenom (Anascorp, Centruroides [scorpion] immune F(ab)2 intravenous [equine], Instituto Bioclon).

The authors note that there has never been an approved, marketed antivenom therapy for scorpion envenomation in the United States. The only previously available scorpion antivenom in the U.S. was a goat-derived whole IgG (immunoglobulin G) preparation that has not been produced since 1999. Based on the current study, it now appears that there is a relatively safe product for treatment of critically ill children. Its use for critically ill adults and for children and adults with non-critical scorpion envenomation syndromes remains to be studied with the degree of rigor necessary to suggest its regulatory approval for use in the U.S.

image courtesy of Phoenix

This post, At Last: An Antidote For Scorpion Stings, was originally published on by Paul Auerbach, M.D..

Snakebite: Global Public Health Menace

Snakebite continues to be a significant public health issue worldwide. In the current issue of Wilderness and Environmental Medicine (2009;20:43-56), Ian Simpson and Robert Norris have published an article entitled, “The Global Snakebite Crisis – A Public Health Issue Misunderstood, Not Neglected.” In this very well thought out concept paper, the authors introduce a marketing model to examine global snakebite and to identify if the current approach to treatment (specifically, with antivenom) is relevant and effective. They use a model to examine if the correct products are available, whether sufficient information exists concerning estimated market size, whether the assumptions frequently made about the costs of the product are correct and fully understood, if the product is promoted properly, and whether the method by which the product reaches the end user is optimum.

By their reasoning, the authors present the case that perhaps the current approach to antivenom issues is not adequate, and compounded by a lack of implementation of key solutions, such as training doctors in developing countries with relevant protocols.

Multiple flaws in snake antivenom (ASV) production and distribution are revealed, including selection of venoms against which to create ASVs, unscrupulous behavior by certain manufacturers, assumptions about the epidemiology of snakebites, definition of envenomation syndromes, estimations of mortality, sustainability of the current economic model, and others. The authors do not merely sit back and take shots at what they perceive to be flaws. They offer a practical model for how it might be possible to achieve solutions for most of these issues.

This paper has already stimulated a great deal of discussion, and will undoubtedly be viewed by some readers as provocative. The topic of snake bite, and therefore ASV production, distribution, and use, is on the agenda of the World Health Organization. Anyone interested in venomous snakebite and the medical-economic-social-political issues related to antivenom and other medical interventions for envenomation, would be interested in reading this paper carefully, and considering how best to determine if there is a need to validate the contentions and suggestions.

image courtesy of

This post, Snakebite: Global Public Health Menace, was originally published on by Paul Auerbach, M.D..

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »