A Copperhead Snake Strikes During a Patient's Outdoor Televisit

Gregory A. Hood, MD

Disclosures

September 23, 2020

I was looking forward to a televisit with a patient I'd been treating for 16 years. He lives in a beautiful, mountainous area of rural Kentucky and wanted to hold the virtual visit from his backyard.

My patient had had one leg amputated above the knee. His wife was setting up his chair for the visit. Suddenly she began screaming and looked down: A copperhead snake that had been sunning itself in their garden had wrapped itself around her leg, struck, and sank its fangs into her ankle.

The wife was frantic, but she kicked the snake off and it slithered into the rocks. Copperheads are pit vipers whose fangs can inject hemotoxic venom. My patient followed the snake and verified that it was the venomous copperhead. While copperhead bites aren't typically fatal to adult humans (although children and the elderly may have more severe reactions), they usually are to dogs, cats, and other pets. In most years, copperheads bite more people than does any other US species of snake, according to the North Carolina State University Cooperative Extension Service.

My office staff members had been on the phone with the wife and jumped into action. My nurse told her how to look for the fang entry marks, clean the wound, and wrap the bite in bandages — don't put a tourniquet on it — and then get to the emergency medical center immediately. That's what she did.

My patient's wife was shaken but, fortunately, other than local tissue damage and severe pain, she was okay. She does have ongoing burning pain in the leg, however, which often can last up to 4 weeks. We have rescheduled my patient's telemedicine visit, with plans that next time they will broadcast from inside their den.

And that brings me to some important points about conducting telemedicine visits.

We have had little time to set new norms for such interactions. Over the past 6 months, several points have been made clear to me:

If your patients are setting up for a virtual visit outdoors, please suggest that they check their surroundings thoroughly — not only for venomous snakes, but perhaps also for other irritations such as bees, airplanes that fly over on a regular schedule, or other factors that could make it harder to hear or communicate during the visit.

Everyone should be mindful of what is in the background of the video display, to avoid potentially provocative situations. There have been reports of police being sent to the homes of children who've had BB guns and the like visible during virtual school. Make sure that your background is professional and appropriate. For instance, you may not realize the impact it could have if a patient sees your political books or similar materials. Even a wine collection can send the wrong message to patients with certain cultural backgrounds or personal or family histories of alcoholism.

When setting up outdoor virtual visits, do not presume that there is no one else within hearing or viewing range — and you may want to remind the patient of that too, lest personal details not meant for others' ears be unintentionally divulged.

Some virtual visits have had dogs interrupt and take up time and attention. Physicians and patients should do their best to have the pets squared away.

Perhaps no interaction in society has been codified more than that of physician and patient. And while some rules remain, new practices during the pandemic underscore that we have reached the point where we need to develop new guidelines — and make sure we pay attention to them.

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