Dendroaspis viridis bite - West African Green Mamba

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.

Dendroaspis viridis bite - West African Green Mamba

Postby Sico » Sun Jun 26, 2011 10:24 pm

This morning at 09h42 I was unlucky enough to be bitten by a juvenile Dendroaspis viridis on site here in Liberia.
One of the guys came and called me about a snake he had just seen move under one of the accommodation units. I went to have a look, and climbing under the unit I saw part of a snake coiled on top of one of the concrete footings, in a narrow space under the base of the container. It was a greeny blue colour (from what I could see in the shade), and had black-edged scales. I assumed (2nd mistake) that it was only a Bush snake of sorts as they are pretty common around these parts. I hooked the snake out with my hand, and scuttled back out from under the container, and as I was standing up the snake turned its head slowly towards my arm and bit me. It only got one fang in and was attached to my arm for roughly 10 seconds. Immediately I knew this was no bush snake! The immediate area around the bite got goosebumps as the erector pilli muscles in my hairs were affected by the venom, in a circle around 40mm in diameter. I walked back to my room, still holding the snake, who was still lazily trying to bite me (which I avoided) and popped it into a pillow case. By this stage the area where the bite was starting to get a bit tender.
I called the other two Advanced life support paramedics in the camp to meet me at the clinic (thankfully we don't work alone here anymore) and told them I had been bitten by a snake, of which species I was unsure, but it felt like there was some type of envenomation that occurred. Checking up in "Dangerous Snakes of Africa" by Spawls and Branch, I realised that I had been tagged by a D. viridis
By 09h52 all the muscles in my neck going down into my chest had started to ache a lot (the kind of ache you get in your muscles the day after really strenuous exercise, like completing an Iron Man marathon :) ), it hurt when I tried to swallow (like a bad case of tonsilitis), I had a metallic taste in my mouth, and my saliva was starting to thicken. I could only turn my head with great difficulty. The bite site had started to throb quite a bit, and my skin felt like I had recently received bad sunburn and this all within ten minutes of a single bite from a small mamba!
I had actually been through the treatment of snakebite with the other paramedics earlier last week so I guess now was the time to put the training to the test. I have to admit, knowing more or less what to expect, I was quite apprehensive and not a little bit concerned. I told them what they could expect, should I fall unconscious and how to manage the teatment of whatever symptoms I exhibited, had them put up an IV line (Normal Saline 0.9%), and prepare for antivenom treatment. We do keep 20 amps of SAIMR polyvalent and 10 amps of Echis carinatus antivenom in all our clinics here.
Once the line was up and I had a baseline set of vital signs (Blood Pressure 141/94mmHg, Pulse 105/min regular and strong, respiratory rate 12/min regular and deep) I asked them to pre-dose me with hydrocortisone (steroid) and promethazine (antihistamine) as I am an asthmatic and I was worried that the antivenom might precipitate some kind of respiratory problems on top of what I expected from the venom.
By this stage I was having a lot more pain coming from the muscles between my ribs, they felt like lead, and I asked the other two guys to prepare to intubate me and put me on a mechanical ventilator if it got to that point. I could not turn my head very much, it felt like all my neck muscles were taught steel cables, the glands under my tongue were swollen to the point that you could almost not see the front of my neck, and I was completely unable to swallow as my throat felt too small, and my saliva was very thick and gooey. I had to suction myself as the secretions built up. All the muscles in my arms and legs (thighs and calves) were extremely tender, and I was unable to lift my own leg up although I could move it from side to side with difficulty. I was able to use my arms slightly more, although they too felt very heavy. An interesting thing I experienced was that my skin all over my body was very sore, especially on my scalp and face, if it was touched I wanted to just climb through the roof!
We decided to go with 5 amps of antivenom initially, which was mixed up in 200ml of Normal Saline 0.9% with 10ml of 50% Dextrose added in. This was set up in a fast infusion to run in over 50 min. I have to admit that I felt no relief from the symptoms during the time it took to run in this load of antivenom, in fact the same symptoms just got worse. I did however develop a slight reaction to the antivenom, causing me to have a petechial rash develop over my face and chest, my right eyelid swelled a bit, my eyes went bloodshot and I developed asthma-like symptoms. My colleagues put me onto a nebuliser with Ipratropium 0.5mg and Fenotrol 1.25mg over 5 minutes, which helped a lot with relieving the difficulty breathing. My blood pressure had increased to 165/105mmHg, pulse was 127/min, strong and regular, respiratory rate was 20/min, shallow and regular. Honestly I felt awful, and I had the feeling that if this went on much longer I wouldn’t be able to carry on fighting it. Everything was an absolute mission, breathing, trying not to choke on my own saliva, trying to remain calm and assisting my colleagues, who were extremely professional and competent in dealing with something that had almost no idea about. Hats off to them.
With almost no relief from the symptoms after 5 amps of antivenom, I suggested we try another three amps in the remainder of what was left of the 1st drip, and at my estimate by the time I had finished the 7th amp, I was starting to feel noticeably better. I let the last amp run in, and removed the drip. My vital signs remained pretty stable and had by this time pretty much normalised. Now, 10 hours after the bite, my right arm is still rather stiff and tender, I have a slight headache, my sublingual glands are still slightly inflamed but no longer tender, and I feel generally a little achey but 1000% better than I did 30 minutes after that snake zapped me.
I will post some pics tomorrow, and will put up some pics of the snakes under the Goe Fantro thread.
This has been a bit of an eye opener to me, I think it stresses yet again, not to become blasé about handling snakes, even if you think they may not be dangerous. Make your ID 100% before you decide on how you are going to handle them, and react quickly if the poop hits the fan. I think this may have had a way more unpleasant outcome if I had been alone up here (without other MEDICALLY trained people), and I do not like to think how I would have been without antivenom therapy. I was astonished at how fast the symptoms took hold and became serious (within 10 minutes I was feeling the systemic symptoms), and this from a snake roughly 50cm long that only got me with one fang… I do not like to imagine the result of a large Mamba bite.
As a result of this my trip up here might be cut short, as the company wants me back in SA for kidney function tests post antivenom therapy so I may be back in SA in a day or two for that to be all sorted out and get my clean bill of health.
Pics to follow :)
Mark
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Re: Dendroaspis viridis bite - Wesst African Green Mamba

Postby Zophos » Sun Jun 26, 2011 10:37 pm

Hi

Glad you're still with us. Thanks for the update. Speedy recovery...

;)
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Re: Dendroaspis viridis bite - Wesst African Green Mamba

Postby s'mee » Sun Jun 26, 2011 10:43 pm

Glad to hear you made it through OK.

The one good thing about Dendroaspis envenomations is that they usually respond very well to early antivenin therapy but it is still scary just how fast the venom manifests.

I would be interested to know if you attempted any immediate first aid measures - ie a pressure bandage or tourniquet, as you didn't make any mention of it.

Very good, objective description of a typical mamba bite, and hopefully an eye-opener for some people out there....
If ignorance is bliss, there must be a lot of happy people out there...
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Re: Dendroaspis viridis bite - Wesst African Green Mamba

Postby Jen » Sun Jun 26, 2011 10:43 pm

Thanks for sharing your very interesting story. Thank goodness the outcome was good. Sometimes I actually think it is more frightening when you are medically trained and know full well what the possibilities are - i know I am an AWFUL patient! Well done to you on keeping calm, as well as to your colleagues.
I think the lesson in this thread is also a very important one - it must be so easy to become complacent when you are handling & removing snakes on a very frequent basis.
I hope you make a quick recovery
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Re: Dendroaspis viridis bite - Wesst African Green Mamba

Postby Bob H » Sun Jun 26, 2011 11:32 pm

Glad you are OK. Thanks for sharing, you did a great write up of what happened. Hopefully it will keep someone else from taking a bite and if not they can take your description to the Dr. with them.
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Re: Dendroaspis viridis bite - Wesst African Green Mamba

Postby Sly » Sun Jun 26, 2011 11:52 pm

Hey Mark, thank goodness all went well considering, looks like someone needs to do a refresher course on Snake I.D.'s...haha, please keep us posted, glad you ok, regards, speak to you soon.
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Re: Dendroaspis viridis bite - Wesst African Green Mamba

Postby SABOAMAN » Mon Jun 27, 2011 6:15 am

Hope you make a full recovery. Lesson learned for ALL of us
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Re: Dendroaspis viridis bite - Wesst African Green Mamba

Postby Loslappie » Mon Jun 27, 2011 7:29 am

Glad it all ended well.
If it hasnt yet, it will!
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Re: Dendroaspis viridis bite - Wesst African Green Mamba

Postby Kevin Lancaster » Mon Jun 27, 2011 9:43 am

Thank you for sharing what must have been a rather hair-raising experience. Hope you have a complete recovery. Your tale reminds me of a quote by the Dalai Lama that goes something like "When you lose, don't lose the lesson"

Peace
Kevin
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Re: Dendroaspis viridis bite - Wesst African Green Mamba

Postby fuscusV2 » Mon Jun 27, 2011 9:50 am

Horrid experience, you must have felt a little off when you realised that a hot had just tagged you. I guess there weren't too many things it could have been with smooth scales, bright green etc. Dendroaspis is no joke. Anything shorter than 500mm is never easy to handle, particularly a climber. I often try catching a philothamnus with bare hands when I get the opportunity just to see how easy / difficult it is to handle the bugger without getting tagged... keeps you on your toes.
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Re: Dendroaspis viridis bite - Wesst African Green Mamba

Postby bubblesharp » Mon Jun 27, 2011 10:02 am

Damn, really glad that you are ok!

I think posts like these should be printed for any one with hots, or handling hots, or anyone that may handle/come across hots can read on a regular basis. Not as much to scare but to prepare. I am very much the same as you in the sense that if I am aware of what too expect next etc I am better at dealing with it. You also remind me of my cousin, also a paramedic but a lecturer now. I think if he was in your shoes he would also tell everyone how to treat him. It really sucks when the person with all the knowledge is the one in the situation. At least you were able to keep your cool and convey the knowledge and of any possible complications that may follow and the treatment there of.
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Re: Dendroaspis viridis bite - Wesst African Green Mamba

Postby Bushviper » Mon Jun 27, 2011 12:04 pm

Wow. I am really glad you are around to post this. The mistake is excusable and all of us are guilty of assuming identities at times.

The symptoms are rather quick for such a small snake bite and the fact that it was not that aggressive makes you wonder how bad it could have been if the snake was stressed.

Personally I would have started with 10 ampoules and I would have let them run a bit faster (possibly 50minutes for 100 ml) but I suppose the possible allergic reaction was in the back of your mind.

Many symptoms are missing such as vomiting, dizziness, slurred speech, drooping eyelids, paresis of most muscles etc. Is this just because you did want to write an essay?

I think that must have been one of the scariest things that can happen to anyone. Especially if you know the countdown of the symptoms. Really glad you pulled this one off unscathed.

I would not worry about the kidney function. The chances for serious damage is very slight. Let us know if anything else happens especially serum sickness.
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Re: Dendroaspis viridis bite - Wesst African Green Mamba

Postby Sico » Mon Jun 27, 2011 1:06 pm

Thanks for the wishes guys. After a somewhat restless night trying to get comfortable I do feel much better than yesterday. My arm is still sore where the bite occurred as you can see in the attached pic there is some redness around the area and it is very tender to the touch. All my other muscle aches have resolved although there is still al lingering headache. I’m due to fly back to SA tonight for the run of tests that everyone thinks I need… since I’m not paying for it I’m not going to argue too much.
In answer to all your questions –
@S’mee – no I did not attempt any first aid measures. The time from the bite to the onset of symptoms was literally so fast and by the time I got to the clinic I had already decided to go the whole hog and start the antivenom, I felt that at that point putting on a bandage etc would be like farting against the wind. If the venom had taken longer to act, or the symptoms had been slower in onset then I might have done so. That said, with my previous cytotoxic bites many, many years ago I also did not attempt any first aid measures.
@ Jen – I think my colleagues were grateful for the assistance, although I know for a fact that at one point they just wanted me to shut the hell up and let them get on with it. I think part of it was also trying to keep myself busy, perhaps a little in control rather than just being “helpless” in a situation that was already near to putting me in that position.
@ FuscusV2 – I attempted this morning to get DNA samples off the two of these snakes before I released them. The first one I tried taking out the bag, just kept biting and biting on my glove, and not wanting to risk a second tag I just released them without getting any. They were just way too aggressive and I could not control them.
@ BV – I was astonished at how fast the symptoms became severe, I think a bite from even a small one would be disastrous on a child or unhealthy aged person or someone’s pet dog for instance. As far as the admin and dosage of the antivenom was concerned, I just sort of went by rule of thumb based on the package insert and what Spawls and Branch recommend in their book. This was the first time I have dealt with a neuro bite (from a snake), and also the first time I have worked with antivenom, and yes, my pre-existing asthma was somewhat of a concern. I did not experience any drowsiness, or drooping of the eyelids, no nausea or vomiting, my speech wasn’t affected other than the annoyingly thick and sticky saliva making it a little difficult, and I only had significant weakness in my legs. I was unable to lift them off the bed, and I was unable to sit up forward without any assistance, being totally weak. I think flaccid paralysis of my muscles would have set in shortly if the antivenom hadn’t kicked in at that point.
Mark
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Re: Dendroaspis viridis bite - Wesst African Green Mamba

Postby WW » Mon Jun 27, 2011 10:14 pm

Wow, that's a scary story! Thanks for posting this in so much detail. Together with Tony's lucky escape after his Cape cobra bite (again, largely thanks to competent medical help being just minutes away), this should be compulsory reading for the many herpers who appear to be labouring under delusions of immortality.

Have a fast and complete recovery, and stay safe!
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Re: Dendroaspis viridis bite - Wesst African Green Mamba

Postby Johan Marais » Tue Jun 28, 2011 12:06 am

Wishing you a speedy recovery.
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