Georgia Venomous Snakes & Environmental Emergency Care

Venomous Snakes of Georgia

• Total venomous species in Georgia: 6

  • 5 pit vipers (family Viperidae-subfamily Crotalinae)

  • Rattlesnakes (3)

    • Eastern Diamondback

    • Timber (a.k.a. Canebrake)

    • Pygmy

  • Copperhead

  • Cottonmouth (Water-moccasin)

  • 1 elapid

  • Eastern Coral Snake

• Mnemonic for banded red/yellow/black snakes

  • “Red on black, friend of Jack” ➔ non-venomous Scarlet King Snake

  • “Red on yellow, kill a fellow” ➔ venomous Coral Snake

  • Must see all three colours; partial patterns can mislead

• Identification cues (pit vipers)

  • Triangular head, facial “pit” between eye & nostril (infra-orbital heat sensor)

  • Vertical slit pupil

  • Thick body, short tail, single row of sub-caudal scales beyond vent

  • Swimming: entire body often floats on surface

  • Strike distance ≈ $\frac13$–$\frac12$ of body length (e.g. 6-ft snake → 2–3 ft reach)

• Non-venomous identifiers

  • Smooth, rounded head, round pupils

  • When swimming, only head above water

  • Examples: Rat Snake, King Snake, Corn Snake, Black Racer, Rainbow Snake, Worm Snake, Mud Snake

  • Scarlet King Snake mimics Coral colours (see mnemonic)

• Legal/ethical note

  • Illegal to kill any non-venomous snake in Georgia (state wildlife statute)

Snake-bite Epidemiology & Numbers

• U.S. annual average

  • $\approx 55\,000$ snake bites

  • $\approx 45$ fatalities (≈ $0.1\%$ case-fatality)

• Georgia

  • $\approx 6$ deaths per year (parallels 6 venomous species)

• Comparative fatality figures (U.S.)

  • Bees/wasps $\approx 51$ deaths/yr

  • Dogs $\approx 30$ deaths/yr

  • Spiders $\approx 67$ deaths/yr

  • MVC (motor-vehicle collision) deaths $\approx 32\,000$ (2011 data)

  • Heart disease $\approx 600\,000$ deaths/yr

Snake-bite Pathophysiology & Presentation

• 25 % of pit-viper bites are “dry” (no venom injected)

• Venom effects: local swelling, pain, bruising, coagulopathy, potential anaphylaxis (major actual cause of most deaths)

• Systemic signs: tachycardia, hypotension, paresthesia, metallic taste, nausea/vomiting

• Track swelling by marking margins and time with Sharpie every 15–30 min

Pre-hospital Management of Snake Bites

• Scene safety; prevent second bite

• Do NOT: apply tourniquet, cut/suction wound, apply ice, bring snake to hospital (dead heads still bite)

• Initial care

  • Remove rings/jewellery ⇒ anticipate massive swelling

  • Immobilise bitten limb in neutral position (splint); keep at/above heart level depending on protocols

  • Minimise patient movement; keep patient supine & calm (reduces venom spread)

  • Support ABCs, O₂ as needed

  • Pain control: fentanyl/morphine

  • Mark swelling progression as above

• Anaphylaxis

  • If airway compromise / distributive shock: standard $0.3\,\text{mg}$ IM epinephrine $1:1000$ despite theoretical venom dispersion risk (confirmed by Georgia Poison Ctr.)

• Transport

  • Fast transport to trauma/antivenom center; call ahead

  • Polyvalent Crotalid Fab antivenin covers all pit vipers; Coral antivenom is different (usually not in GA because coral bites rare)

• Hospital availability

  • Trauma centers (e.g., Cartersville, Kennestone) stock antivenom; small EDs may not—confirm via base station

  • Typical adult course ≈ 4–12 vials; cost \$\$ > $10,000–20,000

Prevention Pearls

• Wear boots, avoid tall grass, use lights at night, never handle “dead” snakes

• Education: campers, gardeners, church “snake-handling” groups (historic fatal cluster in Bartow Co.)

Heat-Transfer & Thermoregulation Basics

• Controlled by hypothalamus

• Mechanisms of heat movement

  • Radiation – infrared transfer (camp-fire)

  • Conduction – direct contact (metal poker in flame)

  • Convection – fluid/gas movement (boiling water, circulating blood)

  • Evaporation – phase change of sweat → major physiologic cooling

• Vascular response

  • Heat ⇒ vasodilation ⇒ skin flushing & BP drop

  • Cold ⇒ vasoconstriction ⇒ pale skin & shivering

Heat Illness Spectrum

Heat Cramps

• Early, salt-depletion muscle spasms (abdomen/back/arms)

• Normal or slightly elevated core Tº

• Tx:

  • Oral rehydration with electrolytes (sports drinks, ORS, lightly salted water)

  • IV fluids only if N/V prevents PO intake

Heat Syncope

• Dilated vessels + orthostatic drop (e.g., concert standing, gardening squat → sudden stand)

• Brief LOC, rapid recovery

• Tx: supine position, oral fluids with salt, cooling environment

Heat Exhaustion

• Prolonged fluid & Na⁺ loss

• S/S: heavy sweating, weakness, headache, dizziness, nausea, tachycardia, tachypnea

• Core Tº < $104^{\circ}\text{F}$ (≈ $40^{\circ}\text{C}$)

• Risk of carpopedal spasm (hyperventilation ↓Ca²⁺)

• Tx: move to shade/AC, cool mist/fans, oral or IV isotonic fluids + Na⁺, no plain water chugging (hyponatremia)

Heat Stroke (true emergency)

• Core Tº ≥ $104^{\circ}\text{F}$ plus altered mental status (irritability, confusion, seizures, coma)

• May sweat or be anhidrotic; pupils often pinpoint; possible rhabdomyolysis

• Complications: pulmonary edema, DIC, renal failure

• Pre-hospital priorities

  • Remove from environment; strip clothing

  • Active cooling: ice packs axilla/groin/neck, cold-water immersion, ice-soaked sheet

  • Goal: stop active cooling at approx. $102^{\circ}\text{F}$ core (rectal) to avoid overshoot hypothermia (field rectals rare—balance clinical judgment/time)

  • Cool IV fluids judiciously; continuous lung-sound & EtCO₂ monitoring (pulmonary edema risk)

  • Consider sedation (midazolam) & airway control if combative/LOC/seizures; benzodiazepines also blunt shivering

Cold-Related Injuries

Frostbite

• Superficial: white, waxy, firm skin over soft tissue ("like frozen halibut")

• Deep: mottled blue-black, hard tissue, hemorrhagic blisters

• Pain, numbness, tingling; massive edema during thaw

• Field care

  • Remove from cold/wind; do not rub/massage

  • Protect & elevate limb

  • Cover with dry, sterile, preferably warmed dressing

  • Re-warm only if no chance of refreezing (water bath $100–104^{\circ}\text{F}$ for 15–30 min in hospital ideal)

  • Analgesia (fentanyl, ketorolac) for re-warming pain

Trench Foot (Immersion Foot)

• >24 h exposure to cold, wet (above freezing) conditions in boots

• Path: vasoconstriction → ischemia → edema → necrosis

• S/S: pale, numb, then hyperemic painful swelling; may mimic frostbite but without ice crystal formation

• Tx: preventive foot hygiene, dry socks; field care identical to frostbite minus water bath

Chilblains (Pernio)

• Repeated exposure to damp & cool (1–15 °C /33–59 °F) temps

• Itchy, burning, reddish-purple papules on fingers, toes, ears, nose

• Usually self-limited; treat with gentle warming, topical steroids if ordered

Hypothermia Basics (preview)

• Defined as core Tº < $95^{\circ}\text{F}$ (≈ $35^{\circ}\text{C}$)

• Cold pathophysiology mirror-opposite of heat illnesses (vasoconstriction, shivering, slowed metabolism)

• Management principles teased for next lecture

Practical / Ethical / Real-World Connections

• Outdoor workers, athletes, military, hikers = high-risk cohorts: educators should emphasize prevention

• Legal ramifications of killing protected wildlife & dangerous implication of transporting snake body parts

• Community myths (tourniquets, “suck & cut,” bringing dead snake) contrast with evidence-based care

• Cost barrier of antivenom ⇒ insurance/EMS resource planning

• Ethical dilemma: balancing epi for anaphylaxis vs. theoretical venom spread—current consensus favors treat the anaphylaxis

• Climate change → longer heat seasons & altered snake habitats = increasing call volumes for both problems

Quick-Reference Values

• Core temp thresholds

  • Heat stroke ≥ $104^{\circ}\text{F}$

  • Active cooling stop ≈ $102^{\circ}\text{F}$

  • Hypothermia ≤ $95^{\circ}\text{F}$

• Electrolyte normal Na⁺ range 135–145\,\text{mEq·L}^{-1}

• Epinephrine anaphylaxis adult dose $0.3\,\text{mg}$ IM $1:1000$

• Strike distance formula: $d_{strike}=0.33\text{–}0.5\times\text{(body length)}$