Not Something You See Every Day

A lady called to make an appointment for a hospital follow-up. Sure; what had she been in the hospital for?

She had been bitten by a snake.

A copperhead had apparently been lounging on her driveway at night as she walked her dogs. It was pitch black, which was why she hadn't seen it (although notice how incredibly well they blend in with their surroundings:)
In fact, she was grateful that it was she who was bitten and not one of her dogs, for whom the bite would surely have been fatal.

The pain was severe and almost immediate. At the hospital, she told me the ER doc said to her, "I have no idea how to treat you." He got on the phone to Poison Control and they basically talked the medical staff through her care for the entire three days she was in the hospital. (Nothing wrong with that, by the way.)

So as a semi-public service to others (like me) unfamiliar with the treatment of venomous snakebite, the basics of copperhead bite management can be found here.

It turns out that the risks of antivenin (anaphylaxis and serum sickness) are significant enough to render it useful only in "severe" envenomations, ie, edema and erythema reaching the trunk, or systemic symptoms or laboratory abnormalities (consumptive coagulopathy, etc.)

I saw her five days post-bite. Her entire lower leg was green and swollen, but not nearly as swollen as it had been, she told me. She was worried about the green. I explained hemolysis, so she was quick to pick up on the idea of "soft tissue bruising." There was still a fair amount of pain, especially when she let the leg hang down after it had been elevated. She described a "whoosh" of pain, as if the blood rushing to her leg were fire. It did not sound fun.

In addition to continuing elevation of the leg and offering pain medicine, I'd recommend adding outdoor illumination to the driveway. The moral of the story, as always, is "watch where you step." (edit: She told me she's getting a pair of knee-high snake boots just as soon as the swelling goes down enough to try them on. They're hideous, but she doesn't care. And she's not going anywhere near the driveway where she was bitten without them.)