For most of us, a snake bite of any type would send us directly into a panic. However, when Ray was bitten while working in his lawn, he was hesitant to go to the doctor. He didn’t want to overreact. He wasn’t even sure he’d been bitten because of the heavy gloves he wore outside.

“Initially I knew it wasn’t good, the numbness and tingling. I told my wife that I thought I got bit by a snake but I never saw it because I was trimming the shrubs,” Ray said. “I actually called the Emergency Department at Cook Children’s and talked to one of the physicians I work with, and he advised that I go into my local ER to get some labs.”

While Ray was on the phone with the doctor, his wife went to the front yard where he was bit, found the snake and killed it. Later, poison control confirmed the snake hiding in their shrubs was, in fact, a venomous copperhead.

Ray went to Texas Health Resources for testing and bloodwork, and eventually started Crofab (an anti-venom) in the following hours. He spent the next four days in the hospital, receiving additional doses of antivenom while waiting to regain use of his left hand.

Providers aren’t immune to the fear of the unknown that patients often experience. It was in that same unease that he began to sympathize with his own patients.

“Going from a caregiver and being placed into the role of a patient is something I’m going to take away from this,” Ray said. ”I was really anxious in the waiting room because of the swelling, I even knew the science behind it all, but it was still a source of anxiety for me so for children to be a patient, it’s even harder on them.”

Now fully recovered, Ray’s experience has given him a deeper level of empathy for his patients and has made him a better provider for children with anxiety.

“Seeing the compassion of the other physicians and the nurses is something that is going to make me a better provider going forward,” Ray said. “This experience is going to make me more compassionate. I think whenever a provider is forced into the role of a patient it can create more empathy for their future patients.”

Related Topic:

• After the Bite: When and Why Antivenom is Used at Cook Children's
• 1 Year Old Bitten By Rattlesnake Recovering At Cook Children's
• Patients Bitten By Snakes
• What Are The 4 Venomous Snakes Found in Texas?

Last year, 35 children were treated for snake bites at Cook Children's, up from 21 bites in 2017 and 20 in 2016. Earlier in the week, a 19-month-old girl became the first child to be treated for a venomous snake bite at the medical center. She was admitted to the ICU and given three vials of anti-venom over the course of two days, according to Fox4News. The child is now recovering at home.

When children are taken to Cook Children’s Emergency Department, a careful snake bite protocol begins that can result in antivenom given to the patient.

"We have advance practice providers with years of experience and expertise in caring for snakebite victims as part of the Trauma Team," said Melinda Weaver, Trauma Program Manager at Cook Children's. 

The Trauma Team uses an evidenced based clinical guideline along with a scoring system, lab results and other indicators to decide if the antivenom is needed or not. If it's determined the antivenom is needed, the Cook Children's Pharmacy team is notified.

Cook Children’s Pharmacy carries one of the largest stocks of Crofab®, a snakebite antivenom treatment, in the area for rattlesnake, copperhead and water moccasin (cottonmouth) bites at all times.

Once the patient is brought to Cook Children’s, he or she is watched carefully for signs and symptoms to a venomous bite.

The initial evaluation of the patient includes the “A-B-Cs” (airway, breathing, circulation) and vital signs. The wound is then examined for swelling, discoloration and bleeding. Signs that the antivenom is needed include:

• Respiratory distress
• Nausea
• Vomiting
• Abdominal pain
• Bleeding from nose, skin or gums
• Tingling or prickling sensations
• Abnormally low blood pressure
• Faster than normal heart rate.

Ean Miller, a manager in the Pharmacy Clinic and a pediatric clinical specialist in the Emergency Department at Cook Children’s, said the signs that Crofab will be needed usually occurs within the first couple of hours.

“Once we know it’s a snake bite, we are immediately drawing the labs,” Miller said. “We will then assess the bite wound. One of the things that we watch for is if the redness and swelling around the bite starts to expand rapidly. If it’s not a venomous snake, usually there will be a little bit of redness and swelling but it doesn’t spread."

The initial care is administered by the Emergency Department and then the Trauma team at Cook Children’s takes over for treatment. An order is given if it’s determined the child needs the antivenom. The mixing takes 15 to 20 minutes by the pharmacist to get the antivenom ready.

The most important factors to giving CroFab are evidence of coagulopathy (blood clotting factors out of normal range) and evidence of respiratory distress, low blood pressure and fast heart rate.

If the patient responds to the initial dose and no allergic reaction occurs then an additional two vials will be given every six hours for three more doses.

Miller said 90 percent of patients start to improve after that first four to six vials of Crofab. Most of remaining 10 percent show improvement after an additional four to six for an almost 100-percent rate.

On rare occasions, a patient will develop an allergic reaction to the antivenom. If that happens, the patient cannot receive any more antivenom and treatment consists of symptomatic and supportive care.

Antivenom is not effective for the other venomous snakes in this country. Coral snakes, which also are in Texas, and other exotic species make up the remaining 1 percent of venomous snake bites in this country. Crofab® antivenom is not used to treat these bites. Patients are admitted to the hospital for 24-hour observation and supportive care.

The latest happened over Memorial Day weekend to an Arlington, Texas teenager. Conner Norman was camping with his family at Lloyd Park on Joe Pool Lake when a copperhead bit the back of his heel. His father, Kip Norman, says his son was walking back to the campsite after taking his sister for a ride on a jet ski when it happened.

"He came into the camper and said 'Dad, I just got bit by a copperhead," Norman said. "I was in disbelief at first, until I turned around and saw his face."

Norman and the family rushed to the emergency room at a local adult hospital. Staff there decided to transfer the teen to Cook Children's Medical Center in Fort Worth. Though his foot and leg swelled nearly twice the normal size, the snake didn't inject enough venom to warrant anti-venom treatment. Conner was closely monitored and released the next day, which also happened to be his birthday.

"He turned 15 at midnight in the ED at Cook Children's. I guess the snake was trying to give him a birthday kiss," Norman joked.

Thankfully, the family can laugh about it now because Conner is going to be just fine.

WFAA-TV reported that a Granbury toddler was bitten by a copperhead snake while on a playground at daycare. The child's father told the TV station that the little girl's finger turned black and became swollen.

At Cook Children's, between 17 and 25 children have been admitted due to snake bites each year since 2013.

"We’ve already seen several snake bites this year," said Sharon Evans Trauma/Injury Prevention outreach coordinator at Cook Children’s. “The numbers we’ve seen are not above normal, but it’s always a good idea to warn children about snakes.”

Evans says it’s not just live snakes that pose a threat either.

“We’ve seen bites that occurred after a snake was killed. Often the parents or kids want to get a closer look of the ‘dead’ snake and the head still had the reflex to bite.”

With the recent rain in North Texas, snakes may be seeking dry areas and may be spotted in places you wouldn't normally see them. Parents shouldn't be alarmed, but this is a good reminder to talk to your kids about snake safety.

Here are nine tips to start the conversation with your child:

1. Don't touch a snake
2. Don't try to kill a snake
3. Ignore the snake if you see it
4. Wear closed-toe shoes in wooded areas
5. Don't put fingers under rocks or crawl under houses or other structures
6. Don't canoe or boat under limbs on rivers, streams or lakes
7. Avoid edges of lakes, streams and rivers where vegetation is high
8. Instruct your children to notify you if they see a snake 
9. If bitten by a snake, seek medical help immediately. DO NOT open the wound or try to suck out the venom. 

Four species of venomous snakes found in Texas: rattlesnakes, cottonmouths, copperheads, and coral snakes.

Rattlesnakes are most populous in dry areas with prevalent rocks and canyons. When threatened, rattlesnakes will curl into a defensive position and rapidly shake their rattles. Rattlesnakes can be recognized by the “rattle” apparatus at the end of the tail. This species of snake has scales in a distinct diamond pattern, as well as a large head and fangs. Depending on the location, rattlesnakes can vary in color from brick red, buff pink, straw-yellow, beige, brownish and light gray:

Cottonmouth snakes (seen on the right), also known as water moccasins, are found where prey is plentiful. These snakes require large basking sites and will travel far from water to hibernate. Cottonmouths spend the majority of their time coiled at the edge of bodies of water or draped over nearby vegetation:

Copperhead snakes are common in wooded areas from the hardwood bottomlands in east Texas, to woody patches in the Trans Pecos of west Texas. Additionally, copperheads can be found in open areas within short proximity of woods. During the summer, copperheads are most active at night:

Coral snakes are extremely common across the state, from the pine forests in the East to the oak juniper canyons on the Pecos River. These snakes thrive in urban, suburban, and other habitats with plentiful rock crevices or plant cover:

Mark Shelton, M.D., an Infectious Disease doctor at Cook Children’s and an Eagle Scout with the Boy Scouts of America, says it’s important to teach respect for snakes.

If you ignore a snake, more than likely, the snake will avoid you,” Dr. Shelton said. “But kids being kids, that’s sometimes easier said than done. Talk to your children about staying away from the snake. Don’t try to pick it up or kill it. Teach your child not to touch it or walk near it. Children should stand still when they spot a snake, then turn around slowly and walk away. Usually, the snake will crawl away into the bushes.”

Don’t be alarmed by the prevalence of these creepy crawlies within our great state, they love the sun and warmth just like us! Here are 10 tips to stay safe from snakes this summer:

1. Be especially careful of snakes after the rain. They will be seeking dry area and may be on a sidewalk or walking path they normally wouldn’t cross.
2. Don’t canoe or boat under limbs on rivers, streams and lakes.
3. Ignore the snake and they will ignore you.
4. Don’t touch or pick up a snake.
5. Don’t try to kill a snake.
6. Wear closed-toe shoes when in wooded areas.
7. Don’t put fingers under rocks and don’t crawl under houses or other structures.
8. Avoid the edges of lakes, streams, and rivers where vegetation is high.
9. Instruct your children to notify you if they see any species of snakes or other threatening animals.
10. If bitten by a snake, seek medical help immediately. Don’t open the wound or suck out the venom. Seek medical help.