Snake Bites and Treatment in the San Luis Valley

June, 2019.  Alamosa, Colorado. Submitted by Eric Ball M.D., Medical Director of Emergency Medicine, San Luis Valley Health Regional Medical Center.

As temperatures heat up, the San Luis Valley finally begins to breathe and welcomes travelers from all corners of the country. With spring comes melting snow and high water; it is at these times we are reminded that several species of poisonous snakes inhabit the southwest United States. In the San Luis Valley, we are home to 3 species of poisonous rattlesnakes as well as poisonous coral snakes in our neighboring New Mexico and Arizona. During high water times, snakes migrate from their common hiding spots in drainages and low brush areas to yards, trails, and campsites. These snakes are frequently encountered on brush filled trails and wood piles. Please use caution during these times and watch where you walk and reach.

Snakes serve a valuable purpose in our environment as they help with pest control and keep down transmissible diseases like Hanta Virus in our community. Rattlesnakes by their nature are not aggressive and will only strike out of self-protection. They will usually give a warning and will move out of the way well before an encounter. In the fast-paced era of constant distractions and headphones, it is easy to miss the warning signs the snakes give. Please be aware to watch where you step and listen for the telltale warnings of these creatures. Avoid heavy brush and rock ledges where these snakes tend to live and await prey. Look carefully and make noise before reaching for firewood or clearing brush around campsites.

What to do if you encounter a snake: Stop immediately and slowly back away. Snakes sense heat and vibration; rapid movement could trigger a strike. Leave snakes where they are and give them plenty of space when passing by. They can strike well over half of their body length so please keep your distance. Do not try to move snakes off of trails or try to relocate them. Most bites happen when people try to move the snake or get closer to them.

Rattlesnake Identification: There are three species common in Colorado, the Prairie Rattlesnake, the Massasauga Rattlesnake, and the Midget Faded Rattlesnake. Rattlesnakes have triangular shaped heads due to venom glands at the back of their jaws. They also have slit-shaped eyes and heat sensing pits above their nostrils. Not all rattlesnakes have rattles. Baby and juvenile snakes may not have noticeable features. There are several species of snakes in Colorado that can look very similar to rattlesnakes. Most notably, the Bull Snake has similar patterns and will even coil and strike like a rattlesnake. Unlike rattlesnakes, the nonpoisonous Bull Snake has round eyes, no rattle, and has an elliptical shaped head.

(L to R) Prairie Rattlesnake, Massasauga Rattlesnake and Midget Faded Rattlesnake

Bull snake

Coral Snake identification: There are two species of coral snake in the southwestern United States called the Texas Coral snake and the Sonoran Coral snake. While not living specifically in the San Luis Valley, these snakes do live in our neighboring New Mexico and Arizona. North American Coral snakes have red, yellow, and black banding. They are extremely poisonous and have many snakes that mimic them. In North America only, the color pattern can help identify the poisonous coral snake from the non-poisonous Milk and King snake. A simple saying can easily help identify: Red on Yellow Kill a Fellow, Red on Black Venom-Lack. So, if you see a bright banded snake with red bands touching yellow bands please keep clear as it is a highly venomous Coral snake.

(L to R) Texas Coral snake, Sonoran Coral snake, Non-poisonous milk snake

What to do if you are bitten by a snake in the San Luis Valley: Immediately move to a safe location and protect the wound; gently cleanse the wound and elevate the area. Bite wounds to hands and legs are the most common. Seek medical care immediately at your closest Emergency Department. All Emergency Departments in the San Luis Valley carry antivenom for rattlesnake bites called CroFab and are trained in caring for poisonous snake bites.

DO NOT place a tourniquet, cut open the wound to drain venom, or use a suction devise on the wound as these actions will likely cause more harm than help. Snakebite kits frequently purchased in sporting goods store are NOT recommended by medical experts. DO NOT try to capture the snake to help identify it. It is important that you are evaluated quickly in your closest Emergency Department.

When you arrive in the Emergency Department let the triage nurse and team know you were potentially bitten by a rattlesnake. The team will evaluate you and determine your need for antivenom and proceed with proper treatment. Not all rattlesnake bites are poisonous and in fact, 25% of bites from adult rattlesnakes are dry bites where no venom is injected[1]. You will be closely observed in the ER and your wounds will be cleansed and your tetanus immunization will be updated. Rattlesnake venom is hemotoxic, which means it frequently causes local tissue damage, blood clotting problems, and in very rare circumstances can be fatal. Depending on your symptoms and the likely type of snake, antivenom may or may not be necessary. Your treatment team will discuss plans for treatment and the possible need for antivenom. In rare cases of severe envenomation, patients may become extremely ill and will need to be transported out of the San Luis Valley by medical evacuation. If you believe you have been bitten by a Coral Snake, you will be closely observed and likely transferred immediately out of the area. Coral Snake venom is neurotoxic and causes tingling, numbness, muscle weakness, and eventually respiratory collapse. These bites are very rare and account for less than 1% of the poisonous snake bites in the United States[2]. There are no Emergency Departments in Colorado that currently stock Coral Snake antivenom. You will be transferred to a facility capable of caring for these rare envenomations.

We hope you have a fun and an exciting time exploring all our great valley has to offer. Please be aware of your surroundings and walk carefully near trails, waters, and brush. If you are bitten by a rattlesnake please seek medical attention at your closest Emergency Department or call 911. Poison Control is available by calling (800) 222-1222. Be safe and have an amazing time outdoors.