Visual Dx

It was a surprisingly quiet early May morning in a Midwest emergency department. I was partway through a coffee and enjoying the pace of the morning when the dreaded squad phone rang. We all got a quick chuckle as the nurse noted a local squad bringing in a 16-year-old male with a turtle bite; most of us thought a small pet turtle had snapped at him. Two minutes later, the squad called back and asked that med command approve Morphine for the patient. As it turned out, what was missed with the first call was that it was about a 25-30 pound snapping turtle, and the turtle was still on the patient’s face. The emergency department staff then became very busy as everyone tried to prepare for what we might see roll through the ambulance bay doors.

The staff and I had gathered several potentially useful instruments in preparation for the patient’s arrival including umbrella handles, tool box with pliers, a large cardboard box, orthopedic room cast spreaders and other potentially useful devices.

The doors opened and in rolled a-16-year old male holding a large local snapping turtle against his chest as the turtle clenched down with its jaws on the right side of the patient’s face. The turtle’s front claws were against, but not yet scratching, the patient’s anterior neck. Fortunate for the patient and the staff, the patient was surprisingly cooperative and unshaken by his situation. Staring at this scene amidst a slew of nurses and staff, the question was posed to me, “What do we do now?”


How would you handle this case? Send your solution to This email address is being protected from spambots. You need JavaScript enabled to view it. .
We’ll print the best responses along with the case resolution next month.



# Uh..."A DEAD TURTLE DOESN'T BITE!"gregmd 2011-02-02 22:49
Sever the turtles neck and I guarantee that you will be able to release it from the face! Then, irrigate the wounds and IF cosmetically needed, repair them, update tetanus and cover for reptile related diseases with Doxycycline or Cipro and discharge the patient!

IF you don't want to kill the turtle I would recommend calling a 24hr veternarian hospital to ask how to best sedate the beast and go forward with their recommendations !
I sincerely doubt that you are going to get the reptile to relinquish its grip without sedation! I thought about local lidocaine to make the area "taste bad" but I DOUBT that that would work.

So...1) Kill it and unpry the jaws or 2)Call a 24hr Vet and ask for recommendations on how to sedate the animal!!!
# Paralyze Jeff W 2011-02-05 09:30
I would try to get as much as I could between the turtle and the patient to protect from further injury. At that point, with an adequate amount of padding, I'd consider injecting a massive dose of an IM paralytic into the turtle.
# Cast Spreaders to the rescueWilliam Sullivan, DO 2011-02-06 17:56
Neat case.
This would require some MacGuyvering, but I think that the corner of some cast spreaders would fit between the turtle's jaws. Either that or slip one end of a Kelly clamp between the jaws and bend backward.
Perhaps using a syringe to squirt something nasty tasting into the turtle's mouth?
# Bolt cuttersSarahG 2011-02-07 11:43
Bolt cutters should remove the turtle's head from the rest of its body. Maybe Dr. G's loppers would work.
# TAM 2011-02-08 02:05
Put something between the claws and the patient, and squirt alcohol in its mouth to make it let go. Oh yes, and make sure someone has a good grip on the thing! By the way, they have long necks.
I was going to say "cut its head off", but I suppose that could cause a lot of scratching.
As far as the patient, I have no idea, I was just looking at the veterinary aspect of it.
# DecapitationDanimal 2011-02-08 04:40
I remember reading about decapitation as the best method of euthanization for iguanas -- I'm pretty sure that it'd work for snapping turtles as well. Then as the first poster suggested -- irrigate, tetanus and cover for zoonotic bugs, and finish with a nice snapping turtle stew.
# T. Hunt 2011-02-08 13:41
Try to convince the turtle that he's just not that into her?
# Reptile.. cool it down. Kimm 2011-02-08 15:37
I would apply ice packs to the turtle... cool it down, then it should relax and let go. No need to harm it.
# Snapping Turtle forumRSDS 2011-02-08 23:45
My first thought was to cover the turtle's nostrils, but then I remembered that they can stay submerged under water for very long periods of time.

People on this pet snapping turtle forum might have some ideas of how to get the turtle to release the patients face.
# Snapping TurtlesIatros 2011-02-09 12:19
Well known in southern lore is the fact that snapping turtles don't let go till it thunders!

Having caught several of these fishing, I agree with the tenacity and toughness of these critters, who can survive just about anything. Decapitation would be the fastest way to relief the patient, but requires large instruments. Cutting its throat and allowing it to exsanguinate into a basin would work, eventually. Those who think they can open those jaws with a Kelly should think again!
# ER Murse 2011-02-09 21:00
This link says ketamine and medetomidine work on turtles. It looks like medetomidine is just a vet medicine product, but I bet you could get some ketamine into the turtle.
# Arzt4Empfaenger 2011-02-14 11:23
As far as I know the usual “secret” is to stay calm and offer the turtle an escape into water (i.e. partially submerging it in the filled bathtub), since aggressive behavior will usually just lead to stronger clamping. And boy, are they strong. Of course, if it doesn’t let go, I'd pry open the jaw with something other than a finger (small stick, toothbrush handle etc.), if possible. Vets do that to administer medications when the turtle can’t just eat a med-spiked fish or such. Vets probably have a whole better "juice" to sedate it, though it's handy to know alternatives when you're far from any hospital or vet hospital.
# Arzt4Empfaenger 2011-02-14 11:25
Btw., the prying might only work on red-cheeked water turtles and smaller specimens, not the snapping turtle, which is a whole lot stronger (thus the name). I would never get close to one of those, they're so fast, too! I missed that part for some reason. (My own experiences were with a red-cheeked one and my sister ;->).
# Scare it?Patrick 2011-02-14 12:29
so it goes AAAAAHHHHHHHHHH HHHHHHHHHHHHHHH , and when it opens it's mouth to scream, extricate the patient from the jaws of terrapin terror. A picture of Michael Moore should do the trick.
# pete hoy 2011-02-15 10:07
do a shellectomy without propofol or squirt some of the broth from the hospitals brussel sprouts in his throat
# They dont teach turtle physiology in medical schoolBlacksails 2011-02-16 17:28
But as cold blooded animals, they cant keep their metabolism running in the cold. Give the patient a blanket and stick him in a walk in freezer.
# Dr N 2011-02-17 19:02
All you have ti do is block the turtle's nares and it will let go.
# 4 Options to Keep it SimpleMatt Kurlan 2011-02-19 12:07
1: put a rag saturated w/ ether (from the lab) by the turtle's nose to render it unconscious.
2: position the patient such that the turtle is upsidedown & can't breathe, so it lets go & tries to right itself.
3: call Batman for some turtle spray (from his utility belt)
4: tell the pt. his HMO denied the visit
# Tammy 2011-02-24 08:39
Haven't you ever seen a dead turtle? Just as chickens literally run around with their heads cut off, turtles open and shut the mouth for quite a while after the head is detached from the rest of the body. So -- decapitate the darned thing and wait for the weird reflexes to set in and it should come loose on its own.
# After you decapitate the beastTammy 2011-02-24 08:41
By the way, snappers, like so many other weird things, really DO taste "just like chicken." So, I like the idea of making a stew after everything's done. Perhaps, like chicken noodle soup, turtle stew (which tastes just like chicken) will make a person get well quicker, too!
# DOiris ford 2011-02-24 20:07
I have been told pressure on the eyes will cause a reflex mouth opening in croc/alligator types. That would be the first thing I would try with the turtle(maybe using the stick end of a big gyne swab to keep my fingers away!).
# Emergency PhysicianJustin 2011-03-01 04:12
I would definitely plan to euthanize the turtle. Once the turtle comes off (if still alive) he poses a risk to all other staff. In my personal experience, snapping turtles are unpredictably nasty animals, the pitbulls of the pond, so to speak. I would not plan on going to battle with a snapping turtle that is not paralyzed or euthanized, particularly a 25 pound one. The jaws of a small snapping turtle can easily amputate a human finger.

I would find a vein or do an IM injection of paralytic. Decapitating the turtle may cause more cosmetic trauma to the patient's face during the process, AND decapitation does not necessarily mean that the jaws will release post-mortem. You may just be left with clamped jaws and no way to introduce a paralytic.
# Other anesthetic choices.KateA 2011-03-15 16:14
Vets no longer use medetomidine, but we use dexmedetimidine , which is approved for use in post op ICU patients, so most hospitals should have this. Using this, along with ketamine (is that still commonly used in peds?), sedation is pretty quick. Here is a reference for its use in humans:

>>>In 1999, dexmedetomidine , a novel selective and specific alpha2-agonist, was granted marketing authorisation in the USA for postoperative sedation of intensive care patients (2, 3).
# When Turtles AttackNancy Anderson RN ED 2012-02-28 09:56
Having raised turtles for over 30 years, I have only had ONE snapper, and it was a hatchling. It went back to its bog a year later when it figured out what it was and I didn't want my other turtles eaten! I fouond it interesting in the actual article that the patient's eyes were "blacked out" by a black bar, but so were the turtle's!! Turtle HIPPA? Anyway, from my experience with Herp Vets, herpetologists and
the like, I think the paralytic/sedat ive was a good move. I might have phoned a vet to see what they would have suggested that would be on hand in the hospital. Did the turtle survive or die?
# The Boy Genius Got Exactly What He Deserved!Turtle 2012-08-13 17:25
Hey Idiots, Who's The Retard Here? Why Kill The Turtle? What A Bunch Of Morons You Mostly Are! Quite Especially Tammy. A Snapping Turtle Just Doesn't Magically Appear At Your Face. Decapitate The Kid And Send The Turtle Back To The Water To Live Its Very Long Life. Given Half A Chance Away From The Likes Of You People This Turtle Will Far Outlive All Of Us. If You're 16 And Stupid Enough To Put A Snapper In Range Of Your Face You Get What You Deserve. So If This Kid Were Taunting A Dog Or Cat Would Your Suggest Dacapitating Them Too? And Yes, It Is The Same Thing.
# Punish the kid for his stupidity!!!Barb 2012-08-14 15:02
It's not the turtles fault he had to defend himself. Give the kid a local, cut his lip and remove the terrified turtle from his face. Call the plastic surgeon, take skin from the kids butt and fix his face. Why so many of you want to kill the victim in the story is beyond me. Animals hurt us when we do stupid things, killing them shouldn't be your first choice.

You could also put something tasty in front of his face with a large strong item behind it to push him and the food away from the boys face.
# So easyNobody 2012-08-15 15:35
The majority of reptiles will let go of anything if you put alcohol in their mouths. Works on anything from a giant burmese python to stubborn anole.

Then fine the kid for molesting a turtle.
# Cheeky ResolutionHLogic 2012-08-15 17:11
In elaboration of response by Arzt4Empfaenger , February 14, 2011…

Fill a basin of sufficient size as to contain the turtle with water of a depth sufficient to submerge the turtle. Put the turtle in the basin of water – the turtle’s head will need to be submerged. Once in the water the turtle will release its hold.

If the picture is of the actual patient, that turtle did not weigh nearly 25 llbs. 5 – 8 possibly…

Decapitation, occluding nares, ether or other gaseous anesthetic, cooling would serve no purpose.

I wouldn't worry about the teen. Chances are pretty good he will be removed from the gene pool before he reproduces.
# DVM/PASteve 2012-08-15 17:36
There is no reason to sever the turtle's head.

Doing so could expose the patient to additional pathogens via blood. Nor is the bite pressure of a Common (Eastern) Snapping turtle so immense that it cannot be physically removed. (This is NOT an Alligator Snapping turtle). You could sedate the turtle but it may take a while for it to be sedated, as reptiles typically respond more slowly to anesthetics. While pugnacious, the damage from Common (Eastern) Snapping turtle bites to humans is seldom severe. This is contrary to popular belief as illustrated above...

Restrain the turtle by having one person hold each forelimb, and one person holding the turtle from the rear of the shell (carapace). Try to keep the turtle level as possible as to not put any more torsion on the patients wound (tearing). The jaws can then be pried open. After the turtle is removed, the assistants holding the forelimbs immediately let go, leaving the person holding the turtle by the carapace. The neck is not long enough to allow the person holding it to be bitten like this. Holding the turtle by the tail is inappropriate and can damage the animal. A belt or similar cut resistant material can be placed in it's mouth (gag) and tied around the rear of the turtles top shell above the tail. This will restrain it positively and provide an easy way to swab for microbial (bacterial) culture.

The wound should be flushed and Doxycycline should serve well as a prophylactic. Cipro is probably not needed and typically over prescribed and can lead to other issues such as C. difficile overgrowth.

Interesting case.
# jonny 2013-08-09 08:36
Spare the turtle and cut off the kid's lip. Nobody is going to want to kiss him after this anyway.
# justin proper 2013-10-14 12:28
pour some liquor in it's mouth it should open right up

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