ENVENOMATIONS - Medicine for Mountaineering and Other Wilderness Activities - page 501

keep the individual quiet and allay anxiety but must not be given to a stuporous or uncon-
scious person. Pain should be controlled with moderate analgesics. Strong analgesics may
have harmful effects and should not be administered. Alcohol, which increases absorption
of the venom and physical activity by the person, must be avoided.
Mostsnakebitefatalitiesresultfromshock,regardlessofthespeciesofsnakeorwhether
the venom is primarily hemolytic or neurotoxic. This complication should be anticipated
and treated.
Every person with a venomous snakebite is different and the treatment for each must
be individualized. Children and elderly persons tolerate venomous snakebites poorly and
require more vigorous treatment. Children can require huge quantities of antivenom. Bites
occurring in the spring, when the snake has just emerged from hibernation and its venom
is more concentrated, are more severe than bites occurring at other times of the year. Bites
about the head or trunk are more dangerous than bites on the extremities and require more
aggressive treatment.
Avoiding Venomous Snakes
Venomous snakes and their bites are best avoided, not treated. Several simple measures
would prevent almost half of all envenomations:
◆ Venomous snakes should not be teased or handled, even after they are dead. Reflex
strikes with envenomation can occur for several hours after death.
◆ Unprotected hands should not be inserted under logs or stones or into cracks or
crevices that have not first been visually inspected.
◆ After dark special care must be taken to avoid snakes. Walking barefoot or collecting
firewood after dark are two activities that contribute to venomous snakebites.
◆ Snakes rarely strike higher than the ankle. Loosely fitting long pants and hiking boots
that cover the ankles prevent many bites.
SPIDER, SCORPION, ANT, AND OTHER BITES AND STINGS
Allergic Reactions to Insect Stings
Between 50 and 150 deaths result annually from allergic reactions to Hymenoptera
stings (bees, wasps, hornets, and fire ants) in the United States, which is more than the
deaths from rabies, large animal attacks, venomous snakes, spiders, and scorpions com-
bined. Approximately 1 of every 200 people in the United States has experienced a severe
reactiontosuchstings.Fatalreactionscanbepreventedorsuccessfully treatedinindividu-
als known to have such allergies, but many deaths still occur in persons whose allergic
status has not been recognized. The problem of allergies and the severe, lethal allergic re-
actions known as anaphylactic shock are discussed in Chapter 23: Allergies .