My nephew was bitten on the foot by a cooperhead last night. It was hiding under his kids’ slide. He killed the snake before going to the ER. He didn’t want it striking one of the kids.
He said it feels like someone hit his foot with a sledge hammer and then set it on fire.
He reported that treatment consisted of administering antibiotics and pain relievers, marking the swollen area, and sending him home with instructions to return when/if swelling progressed past the knee.
I wondered the same thing, Olpea. There is - CroFab, but interesting that it was not administered. There seems to be some variation in protocols for Copperhead bites and the use of anti-venom that I can find out there on the Internet. Here are some links I found:
So, if the ER docs were following this algorithm, then the patient would have had to be exhibiting those qualifying symptoms in order for anti-venom to be indicated. I think that the thinking out there is that Copperhead venom or possibly the amount of venom is not as severe as other pit vipers (like the Mojave rattlesnake or the Southern Pacific rattlesnake, for example). So, there may not be as much anti-venom either given at all or by dosage.
Yes, there is. Not every place gives it right away for at least a few reasons.
Only 20-25% of defensive bites by venomous snakes are envenomated. (His was because the “swelling” continues to increase)
Not every hospital has it in stock. It’s expensive, and usually requires multiple vials.
Sometimes the anti-venom is delivered to the hospital, and sometimes the patient is airlifted to the nearest center that has it in stock.
Muddy, those days of allergic reactions to anti-venom are past. The new CroFab is hypoallergenic, but you’re right on all counts, and also that some old time ER docs have that thought in mind, “Cure might be worse than the bite”. Which is old thinking, and could cost a patient their limb.
I know. That was also a little disconcerting for me as well. The ER should have held him for a few hours, and meanwhile, located some anti-venom in case they needed to either get the anti-venom to them, or the patient to the anti-venom.
Ray, he’s near Myrtle Beach. I know patients from around the state are often brought here to Richland for care. Even though the anti-venom is kept in stock here, sometimes when patients require many vials they have to pull in more from the network.
My own feeling is that sometimes decisions on whether to admit or not is dependent on patient census at the moment. I’m not declaring that a true statement, just a belief.
His mom, my sister, is the one who had Spotted Tick Fever in June.
OMG, that is probably the biggest understatement of the century, lol!!! We just had two more Southern Pacific rattlesnakes in neighbors’ homes these last two weeks. My next door neighbor had yet another one that was taking a drink out of the pool (hubby was about to jump in and it caught his eye across their large natural looking pool), and the neighbors down the street had one curled up in their garage trying to stay cool. August and September tend to be the worst months. We are the most dry, rodents come into the yards looking for water and snakes follow. Dianna did your nephew ask the doc why he was not being given anti-venom? Did he think to ask (sometimes guys just don’t think of those sorts of questions, I know.)
Fall does usually have an increased incidence of snake strikes across the country.
I don’t know if he even asked. I didn’t even know about it until this afternoon when one of my daughters told me. My only info has been what he’s posted on FB. I don’t want to add to what is probably already too many curious callers.
I’m trusting that if it gets bad enough that they will act accordingly. Just wish I knew that he went to a good hospital.
Yes,I hope everything turns out okay.I’d better watch my step,literally,when visiting my sister,in that area next week.Are there any other creepy crawlers there,that can cause harm? Brady
I would disagree, nobody is going to pay them for a hospital admission if patient recovers quickly.
The insurance companies base pay rates on how the average snake bite patient does. So if a patient stays 1 day or 9 days pay rate is exactly the same. Insurance companies base payment on average stay. This method was adopted based on what the government agencies pay out.
When my wife gave birth she stayed 4 days in the hospital and the insurance company paid for the 4 days. These days they will not pay for more than one day on all pregnancies. Payment is based on diagnosis, not what is really needed for each individual patient. The only way hospitals can avoid loses is by sending you home ASAP.
If long term care is needed, patient must be sent to long term acute care facilities (My wife works at such a place). At these institutions rates of payments are based on length of stay but works exactly opposite as hospitals. Such as a kidney failure patient must stay 5 days, if sent home at 3 days, full payment is withheld. So such facilities (again like where my wife works) patient is held captive for 5 days cured or not for facility to realize full payment.
This is what happens when you get government involved in healthcare. The market or competition plays no role in payment.
As far a hospital consensus the county ambulance dispatcher knows status of all hospitals, some may be closed to ambulance runs and patient is rerouted to another hospital. Walk ins are always taken. The hospital hate to close, as it is loss of income so usually will pile patients in the ER hallways till a bed opens. They try to avoid closing and the ER manager will be held accountable for all closings. My wife was an ER manager for 10 years. She constantly fought with upper management over closure status. She would close when she felt they were dangerously full of patients. She would have to justify these actions to upper management who are bean counters.
The system has been broken for a long time. Fixed prices have never worked, and still don’t really work here either.
The hospital probably sent your nephew home because they will not be paid for any hospital stay. If patient comes back, diagnosis will change from snake bite victim to complications of snake bite, where 1 or 2 days of hospital stay will now be paid for by the government or insurance companies.
Well, no, not exactly on either count. I was a Utilization Review and Discharge Planning nurse at one time in my long nursing career. First, a patient is admitted if they meet acute admission criteria, not because of census. They may have to wait a bit in the ER for an open bed, or, even be sent to another hospital (which needs to be in-network for their insurance, if not, they’d be treated in the ER, then transferred to an in-network hospital when stable), but patients who are sick enough to meet in-patient admission criteria would not be turned away because of census. And a patient can stay in the ER to be observed for a number of hours (under 24) without having to be admitted as an in-patient. Thus allowing for a bed to open up. Or, redirected to another hospital with open beds. Drew is right - if a patient is coming in via ambulance, they call ahead, and are told if they have room in both the ER and the hospital, or if the patient needs to be re-directed. Drew’s description of the ER is right on.
Drew’s explanation needs a bit more explanation: An insurance company will pay on a short stay if the patient met in-patient acute admission criteria. Yes, DRG’s pay flat payout amounts, but if a snake-bite admission ends up staying 9 days, instead of 3 days, it is without a doubt that there are additional DRG’s involved that can be billed for. That was my job, after all - does a patient continue to meet in-patient acute criteria. So, there would be more billable DRG’s available based on the patient’s multiple diagnoses (i.e., bite is infected, patient is having other complications that allow the hospital to legally be able to bill for additional DRG’s, etc.)
But, I am with Dianna - I was a little surprised that they allowed her nephew to leave the ER without a little longer observation, and allowed the patient to observe themselves at home. The patient was eventually sent home because no doubt, he did not meet admission criteria - not all snakebites need to be admitted. There is a BIG difference (billing-wise) between being admitted and being observed. That’s really what we’re talking about - that the patient wasn’t allowed to stay in the ER under observation status for a little longer to make sure no complications set in that WOULD make the patient admitable. But then, I am not as experienced with a Copperhead bite as I am with our local rattlesnake bites here in S. California, which are almost exclusively caused by our rather nasty Southern Pacific rattlesnake. Things can get bad quickly with our rattlesnake bites. So, protocols most likely are rather different.
