What are the other Names for this Condition? (Also known as/Synonyms)

• Blue Rattlesnake Bite
• Crotalus Lepidus Klauberi Snake Bite
• Pink Rattlesnake Bite

What is Banded Rock Rattlesnake Bite? (Definition/Background Information)

• The banded rock rattlesnake (Crotalus lepidus klauberi) is a moderately venomous snake that ranges from 1.5 feet to about 2.5 feet or more in length, found in parts of México and some southern states of United States. The rattlesnake is a subspecies of the mottled rock rattlesnake (Crotalus lepidus), a pit viper, belonging to the family Viperidae
• This reptile is found in widely varying habitats ranging from desert lands to rocky mountain sides, from mesquite grasslands to pine forests. The banded rock rattlesnake is mostly diurnal in nature; meaning that it is largely active during the day. It is a quick-moving snake that preys on rodents, lizards, frogs, small mammals, and insects (such as centipedes), by hiding near rocks and stones
• Since the snake is distributed across a wide topography, it comes in a variety of shades including light gray, green, blue, brown, pink, lavender, or even white, and having thin, jagged-edged bands along the length of the snake. The bands may be black, dark brown, or dark gray in color and are usually interspersed by numerous small black/dark spots
• The head of the snake is small and triangular-shaped having a narrowed neck, medium-sized body, and a thick tail with a rattle. Unlike many other rattlesnakes, the banded rock rattlesnake may seldom make hissing sounds and shake/rattle its tail as a warning sign, to announce its presence to any intruder (although, the sound may be audible only at close distance to the snake)
• Banded Rock Rattlesnake Bites involving humans are uncommon; besides, the snake is generally a docile creature that tries to blend itself into the surrounding (rock and mold) to escape easy discovery. It also avoids humans and other larger predators through thermal detection and vibration awareness
• Nevertheless, a bite from a fully-grown banded rock rattlesnake can result in severe envenomation (venom injection), in the absence of adequate treatment. The snake venom is usually a potent mix of hemotoxins that that alters the properties of blood
• The signs and symptoms of Banded Rock Rattlesnake Bite may include mild pain, swelling, blistering, along with nausea and vomiting. The venom can also impair blood coagulation and breakdown the red blood cells, leading to severe systemic symptoms including shock and multiple organ damage
• Early administration of suitable antivenom (or antivenin) is the mainstay of treatment. Apart from this, symptomatic treatment is necessary, which may include the use of pain medication, platelet (blood) transfusion, and peritoneal dialysis. The prognosis of Banded Rock Rattlesnake Bite with prompt and effective therapy is usually good

Who gets Banded Rock Rattlesnake Bite? (Age and Sex Distribution)

• Banded Rock Rattlesnake Bite may occur to any individual exposed to the snake, particularly in its natural habitat
• Individuals of any age and gender are prone to snake bites
• The distribution of the banded rock rattlesnake includes the following geographical regions:
  • United States of America - western parts of Texas, southeast Arizona, and south and central New Mexico
  • Mexico - northwest plateau regions including the states of Jalisco and Durango

What are the Risk Factors for Banded Rock Rattlesnake Bite? (Predisposing Factors)

The risk factors for Banded Rock Rattlesnake Bite include the following factors:

• Camping, hiking, and trekking in the endemic regions
• Mountain climbing in unknown terrain, especially using one’s bare hands
• Living or residing in areas where the snake is found; although, generally, the snake is found away from human habitats
• Walking barefoot or unprotected through dry, rocky terrain; the snake likes to bask in the sun and may be difficult to spot
• Venturing outdoors during the night without adequate protection
• Wildlife enthusiasts and scientific study groups, who explore the region
• Snake catchers and hunters; the rock rattlesnake is reportedly popular with poachers
• Keeping them as pets
• Handling dead or live snakes; intentionally or accidentally picking up the snake
• Drug addicts and alcoholics who come into contact with the snake have a greater risk for being bitten
• Children, elderly adults, and individuals with weak immune system have a higher risk for severe symptoms

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Banded Rock Rattlesnake Bite? (Etiology)

Banded Rock Rattlesnake Bite can take place when one comes into contact with the venomous snake, usually unintentionally or inadvertently.

• The snake is found in a wide range of terrain, but usually away from developed areas. Most rattlesnakes bite only if threatened or in self defense, when they are provoked to a point of retaliation. Before it strikes, the snake displays sufficient warning and aggression signs, to be left alone
• The venom of banded rock rattlesnakes depends are mostly hemotoxic affecting the hematological (blood) system, resulting in bleeding and internal hemorrhages

What are the Signs and Symptoms of Banded Rock Rattlesnake Bite?

The signs and symptoms of Banded Rock Rattlesnake Bite can vary from one individual to another. The signs and symptoms depend on the age (whether child or adult), weight, and overall health status of the individual (whether having an underlying condition or illness). Also, the signs and symptoms vary according to the potency and amount of venom injected.

In many cases, the signs and symptoms of Banded Rock Rattlesnake Bites are mild and not life-threatening. In some, the signs and symptoms may develop within a period of few hours and may include:

• Burning pain at the bite site; presence of noticeable fang marks, which may be single or double set of marks
• In a majority of cases, snake bites occur on the feet and ankles followed by the hands
• Skin discoloration; the skin color may change to blue and black
• Blistering of skin
• Swelling at the bite site
• Bleeding from the wound; the oozing blood is thin
• Sensation of metallic taste in the mouth; salivation
• Twitching of eye and mouth
• Paresthesia or tingling sensation and numbness
• Chills and sweating
• Anxiety
• Breathing difficulties
• Nausea and vomiting
• Abdominal pain
• Blurred vision and droopy eyelids
• In some cases, death of tissue (or necrosis) around the affected region or limb, observed within a few days
• Low blood pressure
• Tachycardia, or heart rate that is above normal
• Feeling faint or dizzy
• Weakness and malaise

Some of the systemic signs and symptoms with severe envenomation may rarely include:

• Bleeding disorder due to: (usually mild to moderate)
  • Decreased blood platelets or thrombocytopenia
  • Destruction of red blood cells or hemolysis
• Internal hemorrhaging including:
  • Blood in urine
  • Bleeding from recent wounds
  • Mucosal bleeding - from nose, ears, eye, gastrointestinal tract, etc.
  • Anemia due to spontaneous bleeding
• Acute kidney injury or kidney failure
• Neurological symptoms

Note:

• In some cases, the fang marks may not be pronounced or even visible. Sometimes only small scratch marks or lacerations may be observed. Thus, any contact with a rattlesnake merits immediate medical attention
• Severe anxiety may also result in some misleading symptoms of snakebites, such as sweating, fatigue, and shock, even when no bite has taken place (the individual may be imagining), or when it is a dry bite. Nevertheless, even in suspect cases, the presence of any such symptoms requires the attention of a qualified medical professional
• Also, if the individual has been treated using alternative/native medicines, it may present additional confusing symptoms. Thus, it is important to always consult a qualified healthcare provider promptly

How is Banded Rock Rattlesnake Bite Diagnosed?

Banded Rock Rattlesnake Bite may be diagnosed using the following tests and exams:

• Complete physical examination with comprehensive evaluation of medical history; a physical examination of the affected site by the physician may be normally sufficient to diagnose a snake bite
• The individual may be asked to provide an account (history) of the events that occurred (what took place and how), if possible
• Assessment of the signs and symptoms exhibited by the individual may be carefully observed
• Blood tests that may include: (many of these tests are repeated over the course of treatment)
  • Complete blood count (CBC) with differential and platelet count
  • White blood cell count
  • Hematocrit blood test: Hematocrit is the proportion of blood that is made up of red blood cells
  • Prothrombin time (PT) and partial thromboplastin time (PTT) tests
  • Fibrinogen blood test
  • Lactate dehydrogenase (LDH) test
  • Serum electrolytes including blood urea nitrogen (BUN) and creatinine levels
  • Arterial blood gas
• Urine test or urinalysis to test for free protein, myoglobin, and hemoglobin levels
• Continuous urine output monitoring is helpful to determine damage to the kidneys, if any
• Electrocardiogram or ECG, to check for arrhythmias (or irregular heartbeat) and hyperkalemia (increased blood potassium)
• Kidney function test
• Liver function test
• Nerve conduction studies and neurological evaluation

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Banded Rock Rattlesnake Bite?

The complications of Banded Rock Rattlesnake Bite may include:

• Multiple bites, causing injection of a large quantity of venom
• Hyperkalemic cardiotoxicity due to muscle breakdown
• Blood clotting defects resulting in severe internal bleeding
• Deep tissue and muscle damage of the affected leg or hand, which can result in superimposed infections and gangrene formation
• Rarely, increased pressure causing compartment syndrome, which is an urgent medical condition
• The snake toxin can damage the muscle resulting in muscle breakdown known as rhabdomyolysis. Extensive muscle breakdown can lead to a variety of complications including kidney failure
• Flaccid paralysis that is mild to severe
• Severe shock
• Seizures and coma
• Multiple organ failure

Presence of misleading symptoms due to fear and anxiety, which may be also aggravated by those around the individual, such as one’s family members, can sometimes result in inappropriate or over-treatment.

Antivenom reactions:

• Some individuals may develop an allergic reaction, such as anaphylaxis, to the antivenom that may be serious. This may develop within 10 minutes or even after 6 hours, typically starting with itchiness over the scalp and other skin areas
• Life-threatening anaphylactic reactions that require immediate medical treatment may include:
  • Low blood pressure or hypotension
  • Bronchospasm causing narrowing of the airways (bronchi) resulting in breathing difficulties
  • Angioedema: Swelling of skin tissue layers at various locations including the throat, causing speaking and breathing difficulties
• Serum sickness may develop as a complication of antivenom therapy causing fever, nausea, itchy skin, muscle and joint pain, etc. It may develop after 4 days or even 2 weeks (average 7 days) following the administration of antivenom serum

How is Banded Rock Rattlesnake Bite Treated?

All snake bites should be considered as medical emergencies and evaluated by trained medical professionals, as soon as possible; the first 6-8 hours are particularly vital for preventing life-threatening symptoms. Failure to obtain early assessment and management from the highest level of care (available within the community) may potentially result in severe complications and death.

The following measures may be considered in the treatment of Banded Rock Rattlesnake Bite, based on the medical evaluation of a trained healthcare professional:

• Administration of intravenous fluids to keep the patient well-hydrated; pain medication
• Administration of anti-snake venom (ASV) to neutralize the venom through slow intravenous injection or infusion method, especially when neurological symptoms, such as altered mental status, and cardiac abnormalities are noted. The type of venom administered is called polyvalent crotalid antivenom
• Address any signs or early allergic reaction
• Periodic blood and urine tests are undertaken for 12-24 hours or more
• Tetanus vaccination is usually required, if it is not up to date
• The patient is generally admitted and placed in an ICU setting and monitored for at least a day following the abatement of symptoms; the patient has to be rested and kept warm
• If necessary, blood and plasma transfusions for severe cases
• Intubation and respiratory support
• Medications to control blood pressure
• Peritoneal dialysis for acute kidney failure
• Pressure management (using appropriate pressure devices) of affected limb for compartment syndrome
• Rehabilitation of the affected limb through physical therapy

Note:

• For envenomation involving rattlesnake bites, the use of prophylactic antibiotic therapy is medically not advised
• The dose of antivenom does not vary for a child, adult, or even for a pregnant woman, since the snake typically injects the same quantity of venom into an individual
• Consultation with a medical toxicologist is recommended for all cases requiring the administration of anti-snake venom

How can Banded Rock Rattlesnake Bite be Prevented?

Banded Rock Rattlesnake Bite may be avoided by:

• Learning to recognize rattlesnakes using the following tips:
  • The specific coloration and shapes/patterns on the body
  • The snake stays perfectly still and tries to blend more into the surrounding, until approached very closely or disturbed
  • Rattlesnakes provide clear warning signs by slightly expanding their body and raising their head and body when approached
  • The unmistakable back and forth shaking of tail producing a rattle sound
  • Before striking, the snake continuously coils in a serpentine manner
• If you spot a rattlesnake, step back slowly and keep a safe distance of at least 10 feet or more (between yourself and the snake)
• Be on the lookout for snakes and other animals while trekking or hiking; also, if you are with a pet, do not allow the pet to wander away
• Always allow snakes crossing your path the right of way
• Always stay on established paths and clearings, while walking in the woods, grasslands, or through thick undergrowths
• Being alert, if you are in snake-infested regions, particularly containing dangerous species of snakes
• Avoid picking up firewood sticks, stones, or rocks without checking the area for any concealed creatures
• Always check before sitting on dead tree logs, stumps, or a pile of rocks; use a stick to stir or probe around the area
• Do not reach out to move or hold bushes or tree branches without properly examining them for any camouflaged creatures such as snakes
• Watch where you place your hands while climbing a ledge, trees, rocky slopes, or mountains
• Wildlife explorers, amateur adventurers, and others are requested to carry first aid kit, especially when traveling through areas containing highly venomous snake species
• Avoiding being outdoors at night in forested areas; be careful while camping outdoors
• Avoid tall grassy areas or thick bushes; if you plan to explore the area, use heavy boots and thick pants
• Avoid playing with or teasing snakes such as by touching their tails
• Do not pick up dead snakes - they may be poisonous and still bite through a reflex action
• Do not reach into dark nooks/corners/recesses with your bare hands/foot
• Teach and educate children about the dangers and importance of snakes

What is the Prognosis of Banded Rock Rattlesnake Bite? (Outcomes/Resolutions)

• The prognosis of Banded Rock Rattlesnake Bite is dependent on the size of the snake, site of bite, overall health of the individual, and promptness of medical response. In many cases, the prognosis is good with immediate treatment and administration of antivenom
• Without treatment or access to proper healthcare, deaths from severe complications, such as respiratory distress, severe paralysis, and organ failure may occur

Additional and Relevant Useful Information for Banded Rock Rattlesnake Bite:

• It has to be noted that snakes of the same species may vary in their physical and biological characteristics, including in their habitat and prey, from one geographical region to another. Due to this, it is always recommended to consult your local (zoological) expert to understand or evaluate the nature of the snake, including whether it is venomous or non-venomous
• In some cases, the snake bite may be a ‘dry bite’, meaning that even though there is a bite mark, no venom injection occurs. However, even for dry bites, the patient must be placed under observation and monitored closely for a period ranging anywhere from 12-24 hours, prior to discharge
• Depending on the geographical region, either monovalent antivenom or polyvalent antivenom may be administered for systemic envenomation. Monovalent antivenom neutralizes venom of a single snake species only, whereas polyvalent antivenom can neutralize the venom of several snake species.
• The snake venom is a highly complex mix of several proteins, enzymes, amino acids, peptide chains, fats, and even certain metals. The bite causing venom injection into the body may be categorized as:
  • Intramuscular injection: Long-fanged snakes have a potential for injecting venom directly into the muscles (this is highly infrequent though)
  • Intraperitoneal injection: When the snake bite involves the stomach or abdomen region
  • Intravenous injection: In very rare cases, the snake fangs may inject venom directly into a blood vessel, releasing venom directly into blood (posing an even greater danger than normal snake bites)
  • Subcutaneous injection: A majority of snake bites involve the subcutaneous skin layers (venom is injected just below the skin surface)