What do you do if a venomous rattlesnake bites you? Should you try shocking yourself with a car battery?
A rattlesnake owner and frequent venomous snake-bite victim convinced his neighbor to shock him with his pickup truck to treat his most recent snake bite. Doctors describe his subsequent hospital stay. Lu and Tirth discuss this shocking case report on S01E01 of the Recreational Science podcast (timecode 17:13):
Tirth: This study I’m about to present is electrifying. It will shock you to your core.
Lu: Okay, let’s hear it.
Tirth: This is a case report that was published in 1991. The title is “Failure of electric shock treatment for rattlesnake envenomation.” This is published in the Anals, excuse me, Annals of Emergency Medicine in June 1991.
Lu: Interesting. Good journal.
Tirth: Oh, great journal. Excellent journal.
Lu: Both of them actually, the Annals and the Anals of Internal Medicine.
Tirth: Yes. Prime bedtime reading. There’s two authors on here, Richard Dart and Richard Gustafson, so it’s a tale of two Richards.
Lu: Great. Two Dicks, you could say.
Tirth: Yeah, Dick tales if you will.
Lu: Now, are they treating rattlesnakes with ECT [electroconvulsive therapy] or are they treating victims of snake bites?
Tirth: That’s an excellent question. They’re actually treating a patient. Well, rather it was a patient who self-treated himself…
Lu: Oh.
Tirth: …and the sequelae thereof.
Lu: Okay, I like this.
Tirth: This is the introduction: “the application of high voltage, low current electric shock treatment has been reported as an effective treatment for rattlesnake and other envenomations. This concept was proposed in a letter describing dramatic improvement of pain and swelling in victims of snakebite in a remote region of Ecuador. Because of this, widespread adoption of this concept and in the sale of portable self-operated electric shock devices commenced in the United States in the 80s and 90s,” I suppose.
Lu: Okay. Now, who’s buying these portable ECT devices?
Tirth: We don’t know, the records are sketchy. “We report a case demonstrating the potential danger and ineffectiveness of this process, even when applied immediately. The Arizona Poison and Drug Information Center was consulted concerning a 28-year-old man who had been handling his pet great basin rattlesnake when he was bitten near the right upper lip.”
Lu: Now give us a sense, what how big is the snake?
Tirth: The Great Basin Rattlesnake can grow up to 26 to 48 inches.
Lu: Okay.
Tirth: And then it goes on to say, and this is what’s interesting to me, “the patient had a history of 14 prior bites…”
Lu: Mmm.
Tirth: “And had previously developed anaphylactic shock secondary to antivenin administration.” This guy is a repeat offender, and I don’t mean the snake, okay? The guy who owns the snake.
Lu: Yes. Well, you know, it happens when you make out with your snake every night.
Tirth: As one does, I suppose.
Lu: You get bit on the lip 14 times.
Tirth: I suppose he missed that lesson in school. Here are the events that led him to go to the hospital: “the patient noted burning and swelling of the face within minutes of the bite. Based on his understanding of an article in an outdoorsman magazine, the patient and his neighbor had previously established a plan to use electric shock treatment if either was envenomated.” Which brings me to the next question. What is the neighbor doing with this guy’s snake?
Lu: Now, is he one of the Dicks who’s an author of this paper?
Tirth: It’s actually unclear. That’s a very good question. Maybe they’re self-reporting. Anyway, here we go: “the patient was placed supine next to a car.” So this is immediately after he got bit. I guess the neighbor was around. “A spark plug wire was attached to his upper lip by wire with a small clip at each end. The engine was started and repeatedly revved to 3,000 RPM for approximately 5 minutes.”
Lu: For some reason, I really thought he had like an actual ECT machine. No, he just had some jumper cables.
Tirth: Jumper cables. He put it on his lip and it turned the car on. And “the patient lost consciousness with the first electrical charge.” Like, no shit.
Lu: Also, where are the two clamps? One’s on his face?
Tirth: One of them was attached to his upper lip.
Lu: Oh God.
Tirth: And I guess the other is at the car. Right on the side of the bite, I assume.
Lu: And I’m assuming there wasn’t a clamp that was grounded.
Tirth: It doesn’t say.
Lu: We can assume this is not a grounded jump start.
Tirth: I am pretty sure about 80 years ago the Geneva Conventions banned this sort of thing, but here we are in Tucson, Arizona. I think they probably didn’t get news that this kind of stuff is outlawed. Anyway, not shockingly, they called an ambulance. The ambulance arrived 15 minutes later. The patient was unconscious and incontinent of stool.
Lu: Okay.
Tirth: Initial vital signs: his blood pressure was 100, his heart rate was 100, and respirations were 20. Then he continued to deteriorate. He was intubated an hour and 40 minutes in; his blood pressure was 62 now. Severe facial edema and ecchymosis, just reddening of the face, were noted. The actual journal article has a has a picture of this unfortunate gentleman. It shows the massive swelling and all this other stuff. Essentially, he was in a very bad shape. He was in critical condition.
Lu: Because of the snake bite or because of the electric shock?
Tirth: I’m gonna say both. And it’s actually not clear to me which one is worse. I think it’s the electric shock that’s causing most of this.
Lu: Very possible.
Tirth: This guy basically shocked himself.
Lu: Mhm. Multiple times it sounds like.
Tirth: Oh multiple times. He said they revved the car engine repeatedly to 3,000 RPM.
Lu: Oh.
Tirth: So, they gave him 27 vials of anti-venin in an 8-hour period. Eventually, the lab abnormalities resolved. He still had some facial edema. He needed plastic surgery for his lip.
Lu: Again, from the snake bite or the clamp?
Tirth: Uh, it’s unclear.
Lu: Uh-huh. So, question I have is, this is not an experiment. It’s like a case report.
Tirth: Yes, it’s a case study.
Lu: Like an observation of a single case, right? N of one, sample size of one.
Tirh: Yes. With some very light lit review.
Lu: If they were to do an experiment, it would be make a guy make out with a snake, get bit, and then either assign them to a no electric shock therapy group or an electric shock therapy group, right?
Tirth: Yes.
Lu: So they didn’t do that, but they still thought it was important to publish this… for what reason?
Tirth: It’s unclear. If I had to speculate, it’s because this guy is unique. He was bitten 14 times before and he still did this.
Lu: Basically, it’s to kink shame this guy. That’s the reason why they published this. This is of no use to anybody in medicine.
Tirth: Well, I will note that this was 1991. Times were different. Kink shaming probably didn’t exist as a concept.
Lu: That’s true. Yeah.
Tirth: But I agree. Maybe the author should issue an addendum or a clarification or a letter to the editor.
Lu: Mmm. Very very interesting. Now, what can our listeners take away from this?
Tirth: I would say a few things: number one is, if you have a pet rattlesnake, I think it’s completely fine to make out with it. We’re not here to judge you and your preferences and your proclivities, okay? We’re really accepting of all comers. So, please do that. Just keep in mind that if the snake’s going to bite you, as snake is want to do, just go to the hospital. Don’t jump start yourself with a pickup truck and attach some jumper cables to your lips. Or I’ll say this, if you are into that stuff too, which is again, totally fine, no judging, okay?
Lu: Yeah, you know, if a guy is into making out with rattlesnakes, he’s probably also into having clamps put on his lips.
Tirth: Absolutely. But just keep them separate.
Lu: Keep them separate.
Tirth: Just keep them separate. Moderation is key. And then the other thing I’ll say is, if you’re an emergency room treating physician, just don’t kink shame people.
Lu: Very important.
Tirth: Let them live, let them be. I understand the urge to inform the public. In their defense, maybe they’d seen a bunch of these types of cases and they were like, “Okay, this guy seems to have the most educational value,” I suppose.
Article citation
Dart et al., 1991. Failure of electric shock treatment for rattlesnake envenomation. Annals of Emergency Medicine. https://www.annemergmed.com/article/S0196-0644(05)82389-3/abstract
Leave a Reply