There's a concern that North Carolina will see increased numbers of bites this year due to COVID-19 social isolation. More people will be off from work and school -- and spending time around the home or in the outdoors will likely lead to more bites.
Benjamin German, MD, discusses how people can avoid snake bites, what they should do if bitten, and what treatments are given once someone reaches the emergency department.
Selected Podcast
Ssssssnakes: Do’s, Don’ts and Uh Oh’s
Featured Speaker:
Benjamin German, MD
Dr. Benjamin German is a emergency medicine physician (also known as the Venom Doc). He’s a snake enthusiast who believes that families need to be educated about the facts so they can reduce their fears and take safety precautions while enjoying the beautiful outdoors in North Carolina. Transcription:
Ssssssnakes: Do’s, Don’ts and Uh Oh’s
Bill Klaproth (Host): With more people off work and school and spending more time at home or in the outdoors due to COVID-19 and social isolation, that may lead to an increased number of snake bites in the triangle. So let’s talk about avoiding snake bites and what to do if you do get bit with Dr. Benjamin German, an emergency medicine physician at WakeMed Health and Hospitals. This is WakeMed Voices, a podcast from WakeMed Health and Hospitals. I'm Bill Klaproth. Dr. German, thank you so much for your time. So North Carolina sees more snake bites per capita than any others state. Why is that?
Benjamin German, MD (Guest): Well, you know, in North Carolina we have a lot of venomous snakes and we have a lot of people. What produces bites is that human snake interaction. North Carolina has always had a lot of snakes here. The copperheads are the predominate venomous snake in the state, but we do have other venomous snakes as well. Just by virtue of North Carolina being a nice place to live, we’ve seen a large increase in human population here over the years. People are moving into areas where snakes have always been. Just going about their daily activities whether it’s work or recreation they come into contact with the snakes. That’s how the bites occur. So it’s kind of the perfect setup for snake bite.
Host: This is a great discussion. As we stay in, nature comes out. So this is a good podcast to remind people about the dangers of snakes. So you mentioned the copperhead snake. What are some of the other venomous snakes found in North Carolina and specifically here in Wake County?
Dr. German: So here in Wake County copperheads are the primary venomous snake. So in our major urban areas, that’s the most likely snake that you're going to encounter from a venomous snake standpoint. In the extreme eastern part of the county there are cottonmouth snakes, and they are a relative to the copperhead. Their bites can be a little bit more severe than a typical copperhead bite. If you get out of Wake County into other parts of the state, we have three different species of rattlesnake. There's the eastern diamondback rattlesnake, the timber rattlesnake, and the pygmy rattlesnake but we don’t usually see bites from those snakes right here in the immediate triangle area.
Host: Right. So how can people avoid snakebites?
Dr. German: The best way to avoid snakebite is just being aware of your surroundings. So you want to be careful around wood piles, leaf piles. Anywhere a snake might want to come out and bask. As the weather warms up more consistently, the snakes start to become more active at night. So particularly in later May and through the summer most of our bites occur right at dusk or after dark when people are walking around the house or walking on trails or picking things up outside the house when it’s after dark. A flashlight is your best friend when you go out around your house or out around the town after dark. Just really watching carefully where you put your hands and feet is going to prevent many bites.
Host: So watch out for those times that you described. Bring a flashlight. That could be your best friend. Certainly watch your hands and feet. So what should someone do if they are bitten by a snake?
Dr. German: So the first thing to do is try to avoid being bitten a second time, which actually does happen, where people get bitten by a snake and then they think they have to capture it or kill it. Sometimes they’ll sustain additional bites during that process. So the first thing is just to get away from the snake. It’s not critical that you identify the snake or that you certainly bring the snake to the ER. We don’t recommend that people do that. We can generally tell what type of snake bit you based on the clinical picture, what the symptoms are. Again, here in the triangle copperheads are far in a way the most predominate offenders. So we’re usually dealing with a copperhead bite if there are signs of envenomation.
Now sometimes people get bitten by non-venomous snakes. We have lots of different species of non-venomous snakes here as well. From a non-venomous snake bite, there's typically minimal pain, no swelling, no other signs of envenomation. So we’re also usually able to tell if someone was not envenomated based upon the clinical picture. Now if it’s possible to get a cellphone photo of the snake in a safe way, that can be very helpful. Because if we can determine its non-venomous then really the treatment for those bites in wound care, maybe a tetanus shot if you're not up to date on that, and then you can go home.
Host: So if you do get bit, is it a general rule of thumb that you automatically go to the emergency department?
Dr. German: So if a person is certain that it’s a non-venomous snakebite, they don’t necessarily have to come to the emergency department. If someone is unsure or certainly if there’s any pain, any swelling, any signs of local injury it is very important to come to the emergency department. Venomous snakebites can worsen in a short period of time. We do have treatments for envenomation. There is anti-venom available. The earlier we administer it generally the better the outcome.
Host: Once again just to be clear, no need to bring the snake to the emergency department. Is that right?
Dr. German: Absolutely. Every year we do see people that try to capture the snake or kill the snake and bring it in to the emergency department thinking it will be helpful. The interesting thing is is that even a snake that has been killed can still be dangerous. So we’ve seen over the years a few people get bitten by what they thought was a dead snake. They cut the head off and the head is actually able to bite for up to an hour or two after it’s removed from the body. So I’ve definitely seen that where people cut the head off and then 30 minutes later pick it up and then they get bitten. So the less someone interacts with the snake the better.
Host: Most people would probably agree with you on that. I know you mentioned treatment a little bit before, but can you talk more about the treatment for snakebites once someone reaches the emergency department?
Dr. German: Sure. We’ll take a typical copperhead bite for example. If someone is envenomated, which means the snake actually injected venom into their body, usually the first thing they feel is pretty severe pain. They know something is wrong. So when they arrive to the emergency department, our primary focus initially is determining were they envenomated? If they were, treating the pain because that can be very severe as the venom starts to destroy tissue. Typically we place an IV, we check some bloodwork because snake venom can effect blood clotting and other parameters on your lab work. So we check that and we’re trying to determine if a person needs or meets criteria for anti-venom. Typically if someone shows signs of envenomation and there's signs that the syndrome is getting worse—in other words, worsening pain, worsening swelling—we’ll have a discussion about whether or not to administer anti-venom to neutralize the snake venom.
Host: If you could wrap it up for us Dr. German, what else should we know about snakes and snake bites?
Dr. German: You know I think in light of the current COVID-19 pandemic, people just need to be extra careful because people are out of work, they're out of school. They're doing more outdoor activities, which is great, but it does raise the potential for more human snake interactions. So we’ve already seen a trend early on this year of increasing numbers of bites. I just want people to be aware of that. The other thing I want to mention too is some people are really afraid of going to the emergency department these days because of the pandemic, but this is a condition where we don’t want them to stay at home and try and tough it out. We’ve also seen that trend where people—because of fear or not wanting to come to the emergency department—they're staying at home with serious conditions. We’ve seen it with heart attacks and strokes and other medical emergencies. So I want people to know the emergency department is safe. The potential for contracting the virus from coming to the emergency department is extremely low. So I don’t want that to be a deterrent for seeking medical care for a true emergency.
Host: That’s a really good message. The emergency department is open and ready for you. So hopefully you want, but if you do get bit by a snake make sure you head right to the emergency department at WakeMed. Dr. German, this has really been informative. Thank you so much for your time.
Dr. German: Thank you very much.
Host: That’s Dr. Benjamin German. For more information please visit wakemed.org. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. I'm Bill Klaproth with WakeMed voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Thanks for listening.
Ssssssnakes: Do’s, Don’ts and Uh Oh’s
Bill Klaproth (Host): With more people off work and school and spending more time at home or in the outdoors due to COVID-19 and social isolation, that may lead to an increased number of snake bites in the triangle. So let’s talk about avoiding snake bites and what to do if you do get bit with Dr. Benjamin German, an emergency medicine physician at WakeMed Health and Hospitals. This is WakeMed Voices, a podcast from WakeMed Health and Hospitals. I'm Bill Klaproth. Dr. German, thank you so much for your time. So North Carolina sees more snake bites per capita than any others state. Why is that?
Benjamin German, MD (Guest): Well, you know, in North Carolina we have a lot of venomous snakes and we have a lot of people. What produces bites is that human snake interaction. North Carolina has always had a lot of snakes here. The copperheads are the predominate venomous snake in the state, but we do have other venomous snakes as well. Just by virtue of North Carolina being a nice place to live, we’ve seen a large increase in human population here over the years. People are moving into areas where snakes have always been. Just going about their daily activities whether it’s work or recreation they come into contact with the snakes. That’s how the bites occur. So it’s kind of the perfect setup for snake bite.
Host: This is a great discussion. As we stay in, nature comes out. So this is a good podcast to remind people about the dangers of snakes. So you mentioned the copperhead snake. What are some of the other venomous snakes found in North Carolina and specifically here in Wake County?
Dr. German: So here in Wake County copperheads are the primary venomous snake. So in our major urban areas, that’s the most likely snake that you're going to encounter from a venomous snake standpoint. In the extreme eastern part of the county there are cottonmouth snakes, and they are a relative to the copperhead. Their bites can be a little bit more severe than a typical copperhead bite. If you get out of Wake County into other parts of the state, we have three different species of rattlesnake. There's the eastern diamondback rattlesnake, the timber rattlesnake, and the pygmy rattlesnake but we don’t usually see bites from those snakes right here in the immediate triangle area.
Host: Right. So how can people avoid snakebites?
Dr. German: The best way to avoid snakebite is just being aware of your surroundings. So you want to be careful around wood piles, leaf piles. Anywhere a snake might want to come out and bask. As the weather warms up more consistently, the snakes start to become more active at night. So particularly in later May and through the summer most of our bites occur right at dusk or after dark when people are walking around the house or walking on trails or picking things up outside the house when it’s after dark. A flashlight is your best friend when you go out around your house or out around the town after dark. Just really watching carefully where you put your hands and feet is going to prevent many bites.
Host: So watch out for those times that you described. Bring a flashlight. That could be your best friend. Certainly watch your hands and feet. So what should someone do if they are bitten by a snake?
Dr. German: So the first thing to do is try to avoid being bitten a second time, which actually does happen, where people get bitten by a snake and then they think they have to capture it or kill it. Sometimes they’ll sustain additional bites during that process. So the first thing is just to get away from the snake. It’s not critical that you identify the snake or that you certainly bring the snake to the ER. We don’t recommend that people do that. We can generally tell what type of snake bit you based on the clinical picture, what the symptoms are. Again, here in the triangle copperheads are far in a way the most predominate offenders. So we’re usually dealing with a copperhead bite if there are signs of envenomation.
Now sometimes people get bitten by non-venomous snakes. We have lots of different species of non-venomous snakes here as well. From a non-venomous snake bite, there's typically minimal pain, no swelling, no other signs of envenomation. So we’re also usually able to tell if someone was not envenomated based upon the clinical picture. Now if it’s possible to get a cellphone photo of the snake in a safe way, that can be very helpful. Because if we can determine its non-venomous then really the treatment for those bites in wound care, maybe a tetanus shot if you're not up to date on that, and then you can go home.
Host: So if you do get bit, is it a general rule of thumb that you automatically go to the emergency department?
Dr. German: So if a person is certain that it’s a non-venomous snakebite, they don’t necessarily have to come to the emergency department. If someone is unsure or certainly if there’s any pain, any swelling, any signs of local injury it is very important to come to the emergency department. Venomous snakebites can worsen in a short period of time. We do have treatments for envenomation. There is anti-venom available. The earlier we administer it generally the better the outcome.
Host: Once again just to be clear, no need to bring the snake to the emergency department. Is that right?
Dr. German: Absolutely. Every year we do see people that try to capture the snake or kill the snake and bring it in to the emergency department thinking it will be helpful. The interesting thing is is that even a snake that has been killed can still be dangerous. So we’ve seen over the years a few people get bitten by what they thought was a dead snake. They cut the head off and the head is actually able to bite for up to an hour or two after it’s removed from the body. So I’ve definitely seen that where people cut the head off and then 30 minutes later pick it up and then they get bitten. So the less someone interacts with the snake the better.
Host: Most people would probably agree with you on that. I know you mentioned treatment a little bit before, but can you talk more about the treatment for snakebites once someone reaches the emergency department?
Dr. German: Sure. We’ll take a typical copperhead bite for example. If someone is envenomated, which means the snake actually injected venom into their body, usually the first thing they feel is pretty severe pain. They know something is wrong. So when they arrive to the emergency department, our primary focus initially is determining were they envenomated? If they were, treating the pain because that can be very severe as the venom starts to destroy tissue. Typically we place an IV, we check some bloodwork because snake venom can effect blood clotting and other parameters on your lab work. So we check that and we’re trying to determine if a person needs or meets criteria for anti-venom. Typically if someone shows signs of envenomation and there's signs that the syndrome is getting worse—in other words, worsening pain, worsening swelling—we’ll have a discussion about whether or not to administer anti-venom to neutralize the snake venom.
Host: If you could wrap it up for us Dr. German, what else should we know about snakes and snake bites?
Dr. German: You know I think in light of the current COVID-19 pandemic, people just need to be extra careful because people are out of work, they're out of school. They're doing more outdoor activities, which is great, but it does raise the potential for more human snake interactions. So we’ve already seen a trend early on this year of increasing numbers of bites. I just want people to be aware of that. The other thing I want to mention too is some people are really afraid of going to the emergency department these days because of the pandemic, but this is a condition where we don’t want them to stay at home and try and tough it out. We’ve also seen that trend where people—because of fear or not wanting to come to the emergency department—they're staying at home with serious conditions. We’ve seen it with heart attacks and strokes and other medical emergencies. So I want people to know the emergency department is safe. The potential for contracting the virus from coming to the emergency department is extremely low. So I don’t want that to be a deterrent for seeking medical care for a true emergency.
Host: That’s a really good message. The emergency department is open and ready for you. So hopefully you want, but if you do get bit by a snake make sure you head right to the emergency department at WakeMed. Dr. German, this has really been informative. Thank you so much for your time.
Dr. German: Thank you very much.
Host: That’s Dr. Benjamin German. For more information please visit wakemed.org. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. I'm Bill Klaproth with WakeMed voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Thanks for listening.