Education

Bites and stings inject drama into Houston Venom Conference

Baylor College of Medicine and Texas Children’s Hospital host meeting to debunk myths about envenomation


By Alexandra Becker | May 1, 2019

Did you know that snakes can still bite and kill after they are decapitated?

That’s a frightening image but also potentially lifesaving information about envenomation—one of many facts that Spencer Greene, M.D., is spending his career setting straight. One of his biggest platforms? The Houston Venom Conference—an annual, daylong event in its seventh year.

Hosted by Baylor College of Medicine and Texas Children’s Hospital, the sold-out 2019 conference on April 30 focused on topics ranging from the proper management of different types of envenomation that could occur in Southeast Texas, including spider bites, snakebites, scorpion stings and jellyfish stings as well as exposures to asps and assassin beetles. Open to clinicians, first responders and the public, the Houston Venom Conference is led by Greene, who serves as director of medical toxicology consultation services for Baylor.

“Last year, we had 160 attendees, and this year we have more than 310—the auditorium is at capacity,” Greene said.

The Houston Venom Conference aims to educate health care providers about the basics of envenomation management and when expert consultation may be necessary. Greene also hopes that potential envenomation victims attending the conference will learn how to best handle exposures before reaching a hospital.

Spencer Greene, M.D., director of medical toxicology consultation services for Baylor College of Medicine.

Speakers of this year’s event included world-renowned envenomation specialist Sean Bush, M.D.; private-sector reptile enthusiast Ray Morgan, creator of The Venom Interviews documentary; Jordan Benjamin, a paramedic who has spent more than a decade treating snakebites in Africa; Nicklaus Brandehoff, M.D., chair of the American Academy of Clinical Toxicology Envenomations Section and experts from the Houston Zoo. The lectures ranged in topics from snakebites in India and Sub-Saharan Africa to the history of electrical therapy in envenomation management and the hazards of home aquaria. Experts also offered practical instruction for anyone exposed to or charged with treating envenomation.

The conference was first held in 2013 after Greene moved to Houston and observed numerous instances of mismanagement of snakebites and spider bites. Even worse, interventions which had been proven ineffective for decades such as unnecessary surgery and inappropriate antibiotic use were still in practice.

“Very few doctors actually know anything about it—it’s not something that’s commonly taught in medical school,” said Greene, who worked as a paramedic prior to entering medical school. Already interested in toxicology, he became fascinated with native snakes, spiders and scorpions during his deployment in Iraq. “Some of the things that were being done here—and are unfortunately still done sometimes in Texas—have been shown to be useless at best and dangerous at worst. We were doing things that could result in increased morbidity and potentially, mortality … and I just realized, there is a major need for this because so many people were getting substandard care.”

Greene’s hope is that attendees of the conference will share what they learn with colleagues and friends so that myths and misconceptions surrounding envenomation in Southeast Texas will begin to be replaced by facts and knowledge.

The worst things to do

“Aggressive surgical intervention, we now know, is one of the worst things you can do for snakebites,” Greene said. “Surgery doesn’t help in any way. All it does is take a bite and make it worse.”

Why? Because snake venom, he explained, is often described as a “soup of antigens”—full of dozens of components that each attack a victim differently and can cause extensive tissue damage.

“Time is tissue,” Benjamin noted during his presentation, emphasizing that the quicker a patient can get treatment, the better the outcome.

Antivenom, Greene said, is the best treatment for snakebites.

In Southeast Texas, clinicians should use CroFab, the only FDA-approved antivenom for North American pit vipers, which include copperheads, rattlesnakes and cottonmouths. (A different antivenom exists for coral snake bites.)

Antibiotics are also unnecessary, unless there is an infection, which is exceptionally rare, Greene said. Other potentially harmful practices? The use of venom extraction devices, sucking out venom, tourniquets, pressure immobilization, electrical shock therapy, applying ice or heat and positioning the affected extremity below the heart.

“One of the most important things we do when someone arrives at the hospital with a typical snake bite is to elevate,” Greene said. “A lot of places keep the extremity flat or, even worse, below heart level, thinking it will decrease systemic absorption. That may or may not be true, but what it does do is result in more damage to the affected extremity.”

Debunking myths

The myths surrounding envenomation endure. Baby snakes are not more poisonous than adults. Snakes in Southeast Texas are not typically aggressive and generally only attack when they feel threatened.

While snakebites are the most common envenomation Greene sees, he also treats individuals exposed to other venomous creatures, including spiders. He said that it is extremely rare for patients to have a brown recluse bite, which causes tissue damage.

As for jellyfish stings? Don’t pee on them. The best treatment, Greene said, is to submerge the affected extremity in water as hot as the unaffected extremity can tolerate to neutralize the pain.

Becky Futch, who worked for years at the Houston Zoo as their “jellyfish keeper,” said during her presentation that it’s also important not to touch the affected area because the tiny nematocysts will continue to fire and “sting” their victim if any pressure is applied. Instead, she said to use a knife or credit card edge to scrape them off and, if possible, administer an oral antihistamine.

Here’s the good news: “People almost never die from snake bites,” Greene said. “There are about 5 to 10 deaths a year in the entire country. It’s not something you should expect. What you should expect—what you need to worry about and what you need to treat or prevent—is permanent disability.”




Social Posts

profile_image

BCMHouston

@bcmhouston

Happy Friday! Thank you to @KSFOrthopaedic for sending us this joke! If you have a favorite joke, send it to us and we might use it in a future post. #jokes #ThanksgivingJokes #funny https://t.co/jQsZxN7G1V

30 mins ago
profile_image

MD Anderson Cancer Center

@MDAndersonNews

Our Dr. Cheng-En Hsieh explains why radiation-induced liver disease is an important factor to consider during #livercancer treatment: https://t.co/M18QvNAneT @cure_magazine #endcancer

1 hour ago
profile_image

BCMHouston

@bcmhouston

RT @bcm_ocd: So excited to have Dr. Jeff Wood present the results of our NIH funded study examining personalized CBT vs. standard care CBT…

1 hour ago
profile_image

BCMHouston

@bcmhouston

RT @BCMHoustonJobs: We're hiring! Read about our latest job opening here: Instructor - Nurse Practitioner - https://t.co/ZKY1iNNTuY #Health…

1 hour ago
profile_image

Veterans Affairs

@DeptVetAffairs

Today’s #VeteranOfTheDay is Army Veteran Louis D. Brinner, who served as a rifleman in Europe during WWII and turns 100 Nov. 22: https://t.co/g8CQSNuLTI

1 hour ago
profile_image

Texas Children's

@TexasChildrens

At @TexasChildrens, we know all about helping children and their families through stressful times like surgeries. Take a look at these helpful tools to use as you prepare for your child's surgery: https://t.co/4wyHxbjcxe https://t.co/xBp95faWly

2 hours ago
profile_image

Rice University

@RiceUniversity

Even though this lightweight material is full of holes, it's nearly as hard as diamond and stops bullets better than solid materials: https://t.co/N1QBG6C6yz https://t.co/XKyesrwt6c

2 hours ago
profile_image

MD Anderson Cancer Center

@MDAndersonNews

@ShirleyHelenTx We're sending good vibes your way, Shirley. Please let us know if your husband needs anything while he's here.

2 hours ago
profile_image

TexasHeartInstitute

@Texas_Heart

A "silent heart attack" is caused by ischemia, a temporary blood shortage. Sometimes the shortage causes the pain of angina pectoris. But in other cases, there is no pain. These cases are called silent ischemia, or "silent heart attacks." https://t.co/UKu4mglkKJ

3 hours ago
profile_image

MD Anderson Cancer Center

@MDAndersonNews

After seeing photos of herself from a family celebration, Adriana Mercado was shocked at how unhealthy she looked. Now, thanks to a walking routine, she’s lost 70 pounds and improved her overall health: https://t.co/dx7z4STihG @FocusedonHealth #endcancer https://t.co/NVmGyo6r8W

3 hours ago
profile_image

University of Houston

@UHouston

Coogs, we love you ❄️SNOW❄️ much! Happy #CougarRedFriday https://t.co/d43lBGfJBX

3 hours ago
profile_image

Rice University

@RiceUniversity

@debadrita_j Thank you!

3 hours ago
profile_image

Veterans Affairs

@DeptVetAffairs

VA, Prostate Cancer Foundation seek solutions for aggressive prostate cancer https://t.co/uGXX5vPImo via #VAntagePoint

3 hours ago
profile_image

Rice University

@RiceUniversity

@debadrita_j This is beautiful! Can we share this on Instagram and credit you?

4 hours ago
profile_image

UTHealth

@UTHealth

RT @UTH_CVSurgery: Congratulations to Dr. Anthony Estrera @estrera_md, honored and appointed the Hazim J. Safi, MD, Distinguished Chair in…

5 hours ago