From my lungs to his…

…Breathing life into an Eastern diamondback rattlesnake

Crotalus adamanteus

Big Chief, male Eastern diamondback rattlesnake and king of the forest. Photo by Alex Bentley

Handling venomous snakes under anesthesia is never straightforward.  At any moment, an anesthetized snake–particularly during induction of anesthesia or during awakening from anesthesia–can experience enough arousal to snag you with his fangs.

It is my third Eastern diamondback rattlesnake this year, a vigorous 6.5 pounds male sporting a 9 inch circumference and at 66 inches total length, much longer than I am tall.  An impressive individual and a member of the largest species of venomous snake in North America, he is nonetheless fairly easy to handle.    His radio transmitter, thermal recording device and identifying pit tag are already sutured up tight inside his lower abdomen.  Biologist and field coordinator Mike Martin places the sleeping serpent back into his box and three biologists, a veterinary technician and I all walk around muttering, allowing the tension of having handled him before and during surgery to diffuse.

prepping the diamondback

Tension is evident in the faces of biologist Mike Martin and Kathi S. Craft, LVT.  These procedures always carry some risk to the handlers.

After a few minutes, we wander back to the snake’s box and observe him.  He is not waking up, not even a little bit.  This is not unusual; they can wake quickly or slowly.  But we all stare at him with his crazy pattern of diamonds long enough to decide he either isn’t breathing or at least isn’t breathing enough to be conducive to his well-being.

The three biologists rightly become nervous.  They’ve actually seen, assisted in or done many more of these procedures than I, a mere mortal veterinarian, have.  But it is my O.R., a sacred place where I command the bridge and seldom perform my job with an audience.  It is usually just me and one or two technicians.  But their concerns are buzzing in my ears like a swarm of bees.  And I am the one who has to make the call as to what must happen next.

applying glue to incision

The procedure is done, I have removed the drape, cleaned the patient of blood and I am applying a cyanoacrylate tissue adhesive to the incision.  Photo by Charles Smith

I go on autopilot, a place where I am directed by years and years of training and my emotions are checked at the door.  Come, go along with me.

Me:  Do you want me to entubate him?

Them:  It might be a good idea to give him a breath or two

Me:  OK, get him up on the table, head on this end.

Them:  Do you have a red rubber catheter? (a tube used to pass into the glottis of snakes)

Me:  I have a trach tube that will fit him.

Me, to my LVT:  Kathi, I need a tongue depressor.

Kathi, instantly at my side, is bearing a handful of tongue blades:  Right here, doctor.

rattlesnake mouth

Opening the mouth, it’s a tricky thing, whether you are doing it to tube feed the individual, as team leader Ab Abercrombie and I are doing with this one, or whether you are entubating it to assist breathing, as I did with “Chief” and Mike Martin.

Mike silently and carefully considers what he is about to do and then holds the snake’s head up off the table for me.  Then it is happening.  Holding it flat with my right hand, I insert the tongue depressor laterally between the patient’s mandible and maxilla and I turn the blade 90 degrees to open the mouth.  The fangs unhinge and drop down and I hear biologist-intern Alex in the background remarking on how big they might be.

I am not looking at the deadly fangs at all.  My focus is on the glottis–the tracheal opening–in the floor of the mouth just behind the front teeth.  Automatically, I use my left hand to insert the tip of the endotracheal tube and advance it slightly.  It is a snug fit, and I don’t need to put it far.  During this procedure, both of my hands are within two inches of the fangs.

Then it happens.  I lean forward, put my lips on the adapter end of the trach tube and generate a breath from my lungs into his, my face mere inches from his truly impressive fangs.  But I am not looking at the mouth or the fangs or the glottis.  I am looking beyond to watch my own breath expand his glorious body.

At the apex of the breath, I pause.  Air is neither leaving my lungs to go into his, nor is it leaving his lung to come back into mine.  For a second or two, we are one.

I release my lips and take the trach tube out of his glottis and observe a fractional spasm.

Then, perhaps a bit too bitchily, I say:  I think this is unnecessary.  He is getting body tone back.

I might add that I slept like a baby that night.

endotracheal tube

A 3 mm endotracheal tube is designed for cats, kittens and tiny dogs. It fit our patient perfectly, though the majority of snakes need much smaller and more specialized tube.  In a pinch, a red rubber catheter may be used in place of a designated tracheal tube.

 The patient began breathing well on his own right after my gift of breath.  He was rattling and tongue flicking in short order.  Because snakes have only one elongated lung and lack a diaphragm, sometimes they need a little help to jump start their respiration after a surgical procedure.

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