Then Comes the Debridement

This is the second update to “…And Then Stuff Happens,” documenting the snake bite Clint sustained Saturday afternoon. In the four days that have followed, he has been treated with Cro-Fab antivenom, given medicine to counteract an episode of serious low blood pressure and possible allergic reaction (to venom, antivenom, or both), and the hospital has carefully monitored some coagulopathies (problems with blood factors related to clotting). And yesterday there was what Clint described as the worst part of the whole experience, the debridement of apparently dead and necrotic tissue.

His fingertip had become progressively more discolored and swollen, although the overall swelling of his hand and arm had subsided. The plan yesterday was for a plastic surgeon to have a look at Clint’s finger. Once he had a look at it, the surgeon decided to remove tissue that he determined was “dead.” This would seem to be tricky business, since the region of a pit viper bite may have quite a bit of ecchymosis, or discoloration from pooling of blood under the skin or blood leaking from vessels. I would not pretend to know whether a dark, swollen, purple-black fingertip was necrotic (“dead”) or very discolored from ecchymosis. Initially the surgeon cut into the fingertip, producing quite a bit of pain, and so the area was deadened. Clint described the doctor taking scissors and pushing down into the finger and then spreading the scissors, and I’m not sure any amount of pain medicine would make that tolerable. In any case, Clint reported that as the medicine’s effects faded, the pain was the worst he had ever experienced. The surgeon removed the skin from the fingertip and advised that the area should be amputated.

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The debrided fingertip (ventral aspect)

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Debrided fingertip, dorsal aspect

We talked about this, made some calls, and Clint and Amber felt they did not have enough information to make an informed decision about this. The excruciating pain Clint felt from the debridement would make the average person wonder if there is not live, viable tissue there, and that the fingertip might be spared and might granulate in new tissue and recover. It certainly might not be like the original fingertip, but a damaged finger could be better than an amputated one. Clint’s and Amber’s decision was to ask for more information (including what the risks and benefits might be of attempting to save the finger) and ask for a second opinion.

As it turns out, Clint reports that the trauma physician who has been managing his care looked at it today and suggested that the finger might be spared and allowed a chance to heal. There is a consultation tomorrow with the plastic surgeon – we’ll see what is recommended and what Clint decides.

I am sharing this information about Clint’s experience at Clint’s request, to offer a detailed and first-hand account of what a venomous snake bite might be like. Our intention is certainly not to increase anyone’s fear of snake bite. For most people, even hikers and naturalists, these bites are unlikely to occur. They tend to be “wrong place at the wrong time” accidents, stepping or putting one’s hand in a place where the snake is present but not seen. For those of us who seek out these snakes to observe or photograph, or who move them or relocate them when needed, the risks are a little higher. Even then, the risk seems acceptably low, provided that we have the right training and experience.

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