I hunted with Andrew at Gache Gache in Zimbabwe several years ago and we had a very successful hunt. This is the link to the hunt report I filed here:

http://forums.accuratereloadin...051023091#2051023091

Details are sketchy, but apparently he was slowly riding his motorcycle on a game ranch while viewing some wildebeests when he felt a sharp pain in his lower leg, looked down and saw a Black Mamba attached to it. He was in the hospital within 1.5 hours and received the anti-venom. He passed out and woke up one week later a very lucky man. He expects to return home shortly.

Somebody up there likes him.

I have added the comments of two Medical Doctors to this thread. One who treated Andrew and the other who made some useful comments.


Black Mamba Bite

1. 06-01-2017, 17:08 #1
Willie Barnard
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Black mamba bite
Mamba bite lephalale area:
Was phoned at 08h30 with news of mamba bite victim on his way to hospital. Would be transported with four seater helicopter (game catcher's) and ETA 09h05. Bitten at 08h00.

Eventually arrived 09h25, patient had difficulty to breathe, but conscious.

Was riding motorbike on game farm and watching blue wildebeest, when he felt something strike his right leg. Looked back, and saw a 2 m mamba in the road.

Two fang marks in middle of lower leg lateral side. Fang marks 15 mm apart, had been "dragged" over skin, due to speed of bike.

Patient given oxygen mask, breathing spontaneous and kept oxygen sats at 97%.
Cortisone and promethazine given intravenously. One amp of polivalent antivenom given IV. Patient observed for ten minutes for possible allergic reaction. No allergy. 5 Amps prepared in side-drip and started IV.

After 10 minutes itching and red skin rash. Adrenalin (diluted) given and antivenom stopped. Rash went away. Antivenom started again - rash came back. Antivenom stopped - adrenalin given again. Rash went away but more slowly than first time. Antivenom not restarted.

Patient admitted to high-care ward. Stable for now.

Lessons learned:
- observe patient for at least 30 minutes after first dose of antivenom, for allergic reactions.
-This patient, if again bitten by a snake, should probably not get antivenom again.
Consider Neostigmin (Anaesthetic muscle relaxant reversal) in case of neurotoxic bites.

Sorry no pics, I have forgotten how to upload them!

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Re: Black mamba bite
Was riding his bike with his attention on a herd of Blue wildebeest. Was bitten in motion, and only saw the snake afterwards.

Probably only a small amount of venom injected because of the bike "ripping him away".
Enough though to cause some neurologic symptoms.
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1. Originally Posted by FantomBadger
Out of curiosity, would a mamba's fangs penetrate a jean?
Many years ago I treated a young man who was bitten by a mamba through the then army issue browns. Not only did the fangs penetrate the brown trouserleg (mid thigh anterior), it administered a huge dosage of mamba venom, this guy nearly died. I think a jean is about the same thickness.
1. Originally Posted by Plaashaas
Nice oom doc.

1. What was the treatment prior to arrival at hosp?
2. Could they not have driven to hospital in less than 1:25?
The correct treatment would be:
Get him to hospital as fast as possible.
Support breathing with ambubag/ mouth to mouth resuscitation, if and when the need arises.

The former was done, the latter wasn't necessary. I am not sure whether they were ready with equipment and knowledge to do that.

2. I am usually quite critical of the notion that a helicopter is always the best way of medical evacuation, very often it is slower than road transport.
However, in this case, it probably was the best and fastest way of transport. About 25 minutes of the time was used by the victim to get back to the farmhouse, and start making calls. I am not sure about what vehicles (and drivers) were available on the farm. The farm is about 1h30 fast driving from the hospital.

1. Re: Black mamba bite
Thanks for all the well wishes. Ddeswardt is right about the antivenom.
LukeS is right about the respiratory support and fast evacuation.
Tourniquet ONLY when the victim is alone, needs to evacuate himself, and has been bitten on a limb by neurotoxic snake.
(Black and green mamba, snouted cobra and cape cobra.)
Then tourniquet should be rubber and tight enough to cut of arterial blood flow. If victim can reach phone signal, and summon help within 30 minutes, dont use the tourniquet.

Much more important to equip yourselves with BVM Resussitator (ambu bag) and know how to use it.

Much has happened here - update in next post
On Friday night at 18h00 and again at 23h30 I saw him and everything seemed okay.
Was complaining a bit about swollen throat at last visit.
Gave some cortisone again. Was looking forward to discharging him the next day.

Saturday morning 04h00: CRISIS
Oxygen saturation dropped, had to resuscitate, intubated, ventilated. Lots of secretions sucked from lungs.
Adrenalin given again, blood gas analysis showed low pH. Soda-bic given.
Transfer to ICU arranged, managed to get some really competent ambulance staff for transfer.
(Helicopter cannot fly because of all the rain in Pretoria)

Reached ICU at 13h30. He is okay there, on ventilator, but I think he will survive.

What happened? I thought it was the allergic reaction. The ICU specialist thinks it was still the effect of the mamba venom causing paralysis.
I gave it a rethink, and am thinking along the lines of Acute respiratory distress syndrome (ARDS). This can be caused by the antivenom, or by the combination of stressors.

Lesson: "There are no routine mamba bites."

1. Hi all. This is an interesting case. Some updates which are useful for the practitioners who see these patients.

We now don't think of "cyto/neuro/haemotoxic" venoms, but rather of the 3 syndromes of progressive weakness, progressive painful swelling or bleeding. This syndromic approach allows the practitioner to treat the symptoms rather than get involved in the identification of the snake. We often get a poor dead snake bought into the casualty, who the family swears bit the patient, but is often an innocent bystander that they caught and killed immediately after the bite occurred. The exception to this is the experienced snake collector or handler who knows his/her snakes. (I once managed a boomslang bite that someone was keeping in a terrarium!)

I don't teach giving a pre-dose with antivenom. This has a poor predictive value of the development of an allergic reaction. We give S/C adrenaline (250ug) and no anti-histamines. Steroids seem to make no major difference as they will take a few hours to work. The whole dose of the antivenom must be given, it is not a weight based dose (even for children). For progressive weakness - 80ml is the dose. For progressive painful swelling 50ml is the dose and for the gaboon adder 200ml is given. Combined PW and PPS 50ml. Monovalent dose for boomslang is 10-20ml. Polyvalent is ineffective in berg adder, night adder and burrowing asp envenomations.

The description of the delayed respiratory compromise may point to a serum sickness (which is a type of delayed immune reaction) to the antivenom. Treatment is largely supportive.

I hope this helps. The two articles I send my registrars to read are behind these links for your reading pleasure!

MULLER, G J et al. Snake bite in southern Africa: diagnosis and management. Continuing Medical Education, [S.l.], v. 30, n. 10, p. 362-381, sep. 2012. ISSN 2078-5143. Available at: <http://www.cmej.org.za/index.php/cme...view/2546/2581>.

http://www.safpj.co.za/index.p...article/view/310/310

regards

lithium
2. Re: Black mamba bite
Originally Posted by SamVimes
Thanks, interesting read. One question if I may - why only 50ml for combined PW and PPS? 80ml makes more sense to me, unless you're confident that the weakening is purely due to swelling.


Sent from my iPad using Tapatalk
The risk of the higher dose versus the benefit of the anitvenom needs to be weighed up here. Combined venoms will need lower doses - the PW part of the combined PW & PPS is the more problematic portion of the envenomation, whereas the swelling rarely leads to compartment syndrome (which is the normal indication for antivenom in a patient with PPS). The higher the dose of the antivenom, the more likely the allergic reaction.

Hope this helps.

lithium
1.
Where the OP disappeared to will be explained in another thread.
Thanks for some valuable contributions especially from Lithium and DdeSwardt.

The patient was successfully transferred to an ICU in a Pretoria hospital.

I had the privilege to see him in ICU on Tuesday (10 Jan), and he was doing well.
(Was in Pretoria by coincidence.)

He was ventilated, and eventually weaned from the ventilator.
He was extubated today, and is still in ICU.

We are hoping for a full recovery and discharge some time next week.

This was my closest call by a snake bite case yet, and I must admit, I am a bit shaken by it!

1. Re: Black mamba bite
On Wednesday, a patient is shown into my room, and he looks so familiar. I just can't remember who he is, but I know that I know him.
"I am ............ the guy bitten by the mamba!" he said.

What a nice surprise, he was discharged from hospital, and is back on the farm.
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1.
I'm also from Ellisras and follow our local snake catcher on Facebook. This morning he was on 71 for the month so far.

This is one of the black mambas that he caught recently, according to him about 2.4m.

Wow! Agree he has an angel.

That is far more scary than any elephant, lion or Buffalo, IMO. YIKES!

That's crazy. Just finished rereading Capsticks biography of Wally Johnson and his run ins with gaboon vipers.

That's when Lucky really means Lucky

An incredible story.
While hunting in South Africa myself, the PH and a tracker had a very large black mamba rear up in front of us way to close for comfort. 7 yds. maybe. The tracker was carrying a stick and instantly threw it at the mamba. Mamba headed for his hole which lucky for us was in the opposite direction. PH estimated this snake at 15'. It was huge.
While I was there the PH's father had their house dog killed by a black mamba. The4y lived about 20 miles away. WE were just on the southern edge of Krueger National Park. Apparently black mambas are quite common in that area.

quote:

Originally posted by DLS:
That is far more scary than any elephant, lion or Buffalo, IMO. YIKES!

I've been in real close to elephants in the jess, but a black mamba is the scariest thing I've seen in Africa.

Snake bites PH. PH lives. Snake dies. Film at 11:00.

I had a run in with a black momba when I was hunting just south of Krueger National Park, South Africa, in 1988. It's a scary critter. it rose up at least 7 feet in the air only about 7 yds. from myself, PH, & tracker. The tracker, in the lead had a stick in his hand which he threw at the snake. Then the snake dropped down and went in his hole. Which luckily for us was about 10 yds. behind him. The PH said if his hole would have been behind us he would have bitten all three of us on his way to his hole. PH said there was no anti-venom available locally and we were too far from the nearest well equipped hospital, none of us would have survived. He was incredibly fast, just a blur.

How do you know that the snake died?
Sorry for the double post. I thought that the previous post had been lost.

This thread is my worst nightmare...I shouldn't of opened it.

Are there a lot of mambas in the luangwa valley?

I HATE snakes...

I hate snakes!!!

Can't help but comment but forgive me for my 2c worth. I grew up just south of the Kruger Park, snake and especially mamba heaven. We would regularly catch them and sell them to snake parks but if could not we shot them. The hospital had one of the largest series of snake bites reported but unfortunately many mamba victims never made it to get anti venom. I and my brother had a number of close calls but our guardian angels protected us. I had shed skin in my room of 11'8". I tried to catch it but never could. They smelt like curry so if you smell that while hunting beware. Usually a territorial one. We noticed that rats when bitten did not react much and it turns out the venom has a very powerful pain killer. A fellow I know whom we sent snakes to gotten bitten and was on a ventilator for 5 days and the Docs wanted to turn it off but his wife pleaded with them and he next day he moved his big toe and recovered. He told me it was like going to paradise! He coould see it cold be addictive! the largest I saw was 14 ' and had a third of it's body off the ground as it crossed a dirt road in front of us. A similar sized one rushed out the bush in front of a bush fire we were watching , not far from us. They have a terribly evil smile that looks like they want to kill you just for pleasure. I could tell more stories about them but needless to say we were always wary around bushes and long grass or when we heard birds giving warning calls. (this is very near the now biggest rhino breeding farm, if you saw the show with Ivan Carter).

quote:

It's a scary critter. it rose up at least 7 feet in the air

That would put it at well over 20ft stretched out and by SCI recording standards be the new N.1

I've come across a shitload in my time and the biggest ever measured just under 13ft. I don't normally kill snakes but this very irate lady Mamba was in the camp store and had to be dispatched.

It is generally timid (like most reptiles) but unhesitating to strike if you put yourself between it and its home so if you get the feeling of being "chased" that is the most likely reason.

quote:

Originally posted by Heym 450/400:
This thread is my worst nightmare...I shouldn't of opened it.

Are there a lot of mambas in the luangwa valley?

I HATE snakes...

+1

I leave non poisonous snakes alone but the only good poisonous snake is a dead one....

. . . unsuccessfully trying to learn to love snakes.

quote:

Originally posted by Heym 450/400:
This thread is my worst nightmare...I shouldn't of opened it.

Are there a lot of mambas in the luangwa valley?

I HATE snakes...

Tens of thousands of them.

One under every bush.

Fulvio:

They can "look" like they are looking you right in the eye when they stand up, even if they aren't quite that tall. Done the "chased" thing once in a vehicle and I suppose you are right about being between the snake and its hole. The snake stood up in the middle of the track, the driver threw it in reverse, snake appeared to charge the vehicle, but then as we retreated, rapidly, it broke off and disappeared into the grass, likely down its hole.

Mambas are the one thing that truly frighten me -- and I'm not ashamed to admit it. Very lucky PH

quote:

Originally posted by lavaca:
Fulvio:

They can "look" like they are looking you right in the eye when they stand up, even if they aren't quite that tall. Done the "chased" thing once in a vehicle and I suppose you are right about being between the snake and its hole. The snake stood up in the middle of the track, the driver threw it in reverse, snake appeared to charge the vehicle, but then as we retreated, rapidly, it broke off and disappeared into the grass, likely down its hole.

Mambas are the one thing that truly frighten me -- and I'm not ashamed to admit it. Very lucky PH

They are of course territorial and your encounter was probably due to encroachment of its space - it was probably out hunting when you crossed paths.

I have had one rear up about 1 foot higher than my cruiser bonnet but 7 ft - even if I am knee-high to a grasshopper, seems a bit much.

During my first hunt in the Zambezi Valley, we approached a pan that was frequented by various game. After walking for several hours, we were a little tired so we decided to take a break near the pan and take photos of any game that approached the pan. I located a nearby termite mound and proceeded to sit down. In the meantime, my PH started searching for and gathering broken branches. I watched amusingly as he gathered broken branches and then began to stick them into the holes near my position. I inquired regarding his very unusual behavior. My PH sat next to me and said "I don't want to get bitten in the arse by a black mamba". During subsequent safaris, I NEVER approached any termite mounds!

1988 must have been a bad year for mambas around Krueger National Park. Just before I arrived one had taken up residence in the thatch roof of a house on a nearby ranch. They had to burn the house down to get rid of it.
I didn't have a ruler to measure the mamba that I spoke of but I'm 5"9" and for sure it rose up higher than my head. The PH said it was the biggest one that he had ever seen. The 7 feet estimate came from the PH, and he'd been hunting the area for many years and living there for many more, if you weren't there then you have no basis for an argument, for sure it was the biggest, meanest looking snake that I ever saw
We avoided that area for the rest of the hunt.

Black mambas are perhaps the most fearsome because of their length which is directly related to the amount of venom it possesses and the neurotoxic nature of the venom.

To call them "aggressive" would be to fall into the bunny huggers' folly of anthropomorphism, but they are territorial, which few snakes are.

Anyone interested in African snakes should check out Johan Marais' African Snakebite Institute on the Web.

PH Paul Stones was bitten in Pongola , South Africa back in the 1990's and survived. Another harrowing story!

We were tracking eland in Zim a few years back when we came across a large mamba only a few yards in front. Mark Vallaro said he would soon smell us and probably head away from us. Luckily he did and we continued. I believe it was the next day when we came back to camp and found a dead 9 to 10' mamba in the garden. The cook was preparing dinner and heard something. When he turned the mamba was raised up and looking at him. The cook scrambled to the back and locked himself in another room screaming blooding murder. The staff came running and eventually killed it. Our hunting party was huddled around the dead snake. I decided to get a closer inspection and bent down grabbed it's head and tried to pop open his mouth with my thumb to get a look at his fangs. The camera man calmly said "I wouldn't do that if I were you. All it takes is a prick and you're in big trouble. I thought to myself " you know, I'm a dumb shit".

quote:

Originally posted by John Weaver:
We were tracking eland in Zim a few years back when we came across a large mamba only a few yards in front. Mark Vallaro said he would soon smell us and probably head away from us. Luckily he did and we continued. I believe it was the next day when we came back to camp and found a dead 9 to 10' mamba in the garden. The cook was preparing dinner and heard something. When he turned the mamba was raised up and looking at him. The cook scrambled to the back and locked himself in another room screaming blooding murder. The staff came running and eventually killed it. Our hunting party was huddled around the dead snake. I decided to get a closer inspection and bent down grabbed it's head and tried to pop open his mouth with my thumb to get a look at his fangs. The camera man calmly said "I wouldn't do that if I were you. All it takes is a prick and you're in big trouble. I thought to myself " you know, I'm a dumb shit".

John, you owe me a new computer monitor. It's covered in Mtn. Dew right now...

Yeah, I'd say the African bush is not someplace to have a 'hold my beer and watch this' moment.

I don't care for venomous snakes at all. I have encountered more than my share of rattlesnakes. In Africa, especially Namibia on one hunt we spotted a number of puff adders. Fortunately, and I don't want to jinx myself, I have not encountered a venomous snake in Tanzania. Although every where I have hunted in Tanzania they certainly exist. On a hunt years ago in RSA, the PH pointed out a long shiny snake crossing ahead of us and said it was a mamba. I calmly stated him that is why I like being last in this line.

For those of you who think you are safe in a car, they can rear up at a window and even worse take a ride. I was named after a surgeon who told a story of riding over a mamba, got home, and suddenly from under the hood came out a mamba..he and his wife sprinted out og h carport and sprinted in doors. I always took the story with a pinch of salt. One day in the Kruger I tried to ride over a young one of 6' or so. I did not see a dead snake on the road in my rear view mirror. A mile or so further on we stopped for some lions on the road. Out slithered the snake from under he hood .. He d taken a free ride, some how safely avoiding everything and then got away. The lions looked at it but were it appeared
happy it left the scene.

Mike, you look like a fearless snake handler in that pic

quote:

Originally posted by AilsaWheels:

quote:

Originally posted by Heym 450/400:
This thread is my worst nightmare...I shouldn't of opened it.

Are there a lot of mambas in the luangwa valley?

I HATE snakes...

Tens of thousands of them.

One under every bush.

Heym, Heym, Heym.....and we thought you were the epitome of the fearless, midwestern cowboy....and here you diplay a childish fear of serpents...look at Mike Jines pic and grow a pair...

I'll give Mr. Jines credit....I would have been about 50 more feet behind that cobra and probably up on the cruiser with the safety off.

I'm not a fan of spiders either...which would make Australia hell on earth for a wimp like me. I will stand my ground with the largest and fiercest of beasts...but run like hell from those slithering bastards.

quote:

Originally posted by Heym 450/400:
I'll give Mr. Jines credit....I would have been about 50 more feet behind that cobra and probably up on the cruiser with the safety off.

I'm not a fan of spiders either...which would make Australia hell on earth for a wimp like me. I will stand my ground with the largest and fiercest of beasts...but run like hell from those slithering bastards.

What happens when you are from wisconsin

Dont go fishing in the amazon - the camp had massive spiders - the size of ones hands all over the place.

Mike

My wife is a hand surgeon. I have listened to her give the grizzly detail of operating on someone bitten by a moccasin. That is horrendous. A mamba must be far worse. I can't even imagine the pain the pain he must have been in.

quote:

Originally posted by Beretta682E:

quote:

Originally posted by Heym 450/400:
I'll give Mr. Jines credit....I would have been about 50 more feet behind that cobra and probably up on the cruiser with the safety off.

I'm not a fan of spiders either...which would make Australia hell on earth for a wimp like me. I will stand my ground with the largest and fiercest of beasts...but run like hell from those slithering bastards.

What happens when you are from wisconsin

Dont go fishing in the amazon - the camp had massive spiders - the size of ones hands all over the place.

Mike

Please delete this before Joyce see's it.

quote:

Originally posted by larryshores:
My wife is a hand surgeon. I have listened to her give the grizzly detail of operating on someone bitten by a moccasin. That is horrendous. A mamba must be far worse. I can't even imagine the pain the pain he must have been in.

Larry, one has Hemotoxic venom, the other Neurotoxic. The swelling from the Hemotoxic bite could easily cause compartment syndrome and great tissue distraction. With the Neurotoxic bite the swelling is a non-issue without very prompt treatment because you are dead.

Cheers
Jim

quote:

Originally posted by jdollar:
I leave non poisonous snakes alone but the only good poisonous snake is a dead one....

Said by the man who lived with numerous rattlesnakes.

Namibia,2007,our first morning in the bush and we were hunting gems buck. We saw lots of decent gems buck, but nothing we wanted to take. Dirk,the PH says let's move and hunt another area. Namibia in June is chilly in the morning, but when the sun comes up the temperature begins to rise and it becomes quite nice. We were driving down a two track to another area when all of a sudden there was a whap on the door of the old Land Rover. Dirk yells out the famous 4 letter word and I start looking around. Dirk was driving and my wife Carol was riding shotgun with the tracker and me in the high seats. I am looking around and all I see is some grass moving. Dirk then tells me a black mamba was sunning itself on the two track and we had run over its tail. Mambas being mambas it struck the door of the Rover about six inches below Dirk's arm. It had struck the door hard enough to make a small dent in the door. Needless to say I kept an eye out for snakes but the only other one seen was a baby rock Python about 8ft. long. Those are the only snakes I have seen in 3 safaris. Jerry Hoover

quote:

Originally posted by Frostbit:

quote:

Originally posted by Beretta682E:

quote:

Originally posted by Heym 450/400:
I'll give Mr. Jines credit....I would have been about 50 more feet behind that cobra and probably up on the cruiser with the safety off.

I'm not a fan of spiders either...which would make Australia hell on earth for a wimp like me. I will stand my ground with the largest and fiercest of beasts...but run like hell from those slithering bastards.

What happens when you are from wisconsin

Dont go fishing in the amazon - the camp had massive spiders - the size of ones hands all over the place.

Mike

Please delete this before Joyce see's it.

I was brushing my teeth in camp when these little spider legs stick out of the corner of the sink - there was a gap in carpentry. The gap was 1.5-2 the size of a bottle cap. Out of the gap comes these little spider feet that become big spider feet. Then a little head that becomes a big head. Finally the body that was little relative to the head but the size of the opening. As the body squeezed thru it expanded to 3 times its size. Suddenly the spider was the side of my palm.

Me being a cool player kept brushing. Spiders snakes crocs don't scare me - elephants do

Mike

Snakes including mambas are beautiful creatures and part of Africa. I'm scared to death of mambas, but love seeing them. Seems strange,I know.

Last february I walked towards the hut I was to occupy for 2 weeks...when my host and I were to enter he remarked "Wouldnt you know...3 days ago I came here to check that the staff had done it right here...I grabbed the door and heared a loud hisss inside...a mamba lay in one of the corners...had to fetch a stick and clobber him.."..

Well I replied, THANKS for letting me know..

Perhaps a rifle drilling is a good idea...2 side by side large bore cartridges for DG and a 12 gauge shotgun barrel under to expedite mambas..

Although living in South Africa since 35 years I have never seen a black mamba. Other snakes plenty, i e cobras, puff adder, pythons and others. As a forester and hunter, some years ago at home not far away from Kruger National Park, I was in the bush on a daily basis but still, there were only invisible mambas. They were watching me, that's for sure.