Snake

Dos and Don’ts during Snake Bite

November 7, 2023

425

Dos and Don’ts during Snake Bite

A bite from a venomous snake can be deadly, and should always be treated as a medical emergency. Even a bite from a harmless snake can be serious, leading to an allergic reaction or an infection. Hence, Snake-bite is an environmental, occupational and climatic hazard in rural and urban areas. Snakes have adapted to a wide range of habitats and prey species. It is therefore a medical problem that has important implications for the nutrition and economy of the countries where it occurs commonly. It is recommended that snake-bite should be formally recognized as an important occupational disease in the South East Asian region. Most of the fatalities are due to the victim not reaching the hospital in time where definite treatment can be administered. In addition people are also not well informed about the occupational risks and simple measures which can prevent the bite. Thus, people need to be educated about the practices to be done and not done during a snake bite.

Identifying a snake bite

two puncture wounds swelling and redness around the wounds pain at the bite site difficulty in breathing vomiting and nausea, blurred vision .sweating and salivating

The bitten area, and immobilization may increase the severity of the damage in this area, but also reduce the total area affected; whether this trade-off is desirable remains a point of controversy. Since the types of snakes vary from region to region, first aid methods also vary. However, most first aid guidelines agree on the following:

Protect the person and others from further bites. While identifying the species is desirable in certain regions, risking further bites or delaying proper medical treatment by attempting to capture or kill the snake is not recommended. 2. Keep the person calm. Acute stress reaction increases blood flow, and endangers the person. 3. Call for help to arrange for transport to the nearest hospital emergency numbness in the face and limbs

FIRST AID

Snakebite first aid recommendations vary, in part because different snakes have different types of venom. Some have little local effect, but life-threatening systemic effects, in which case containing the venom in the region of the bite by pressure immobilization is desirable. Other venoms instigate localized tissue damage around rooms where antivenom for snakes common to the area will often be available. 4. Make sure to keep the bitten limb in a functional position and below the person’s heart level so as to minimize blood returning to the heart and other organs of the body. 5. Remove any items or clothing which may constrict the bitten limb if it swells (rings, bracelets, watches, footwear, etc.) 6. Keep the person as still as possible. India developed a national snake-bite protocol in 2007 which includes advice to: Reassure the victim who may be very anxious Immobilize the whole of the patient’s body by laying him/her down in a comfortable and safe position and, especially, immobilize the bitten limb with a splint or sling. Any movement or muscular contraction increases absorption of venom into the blood stream and lymphatics [level of evidence E]. If the necessary equipment and skills are available, consider pressureimmobilization or pressure pad unless an elapid bite can be excluded (See Annex 4). In Myanmar, the pressure pad method has proved effective in victims of Russell’s viper bite (Tun Pe et al., 1995) [level of evidence O]. Avoid any interference with the bite wound (incisions, rubbing,vigorous cleaning, massage, application of herbs or chemicals) as this may introduce infection, increase absorption of the venom and increase local bleeding (Bhat, 1974) [level of evidence O]. Release of tight bands, bandages and ligatures: Ideally, these should not be released until the patient is under medical care in hospital, resuscitation facilities are available and antivenom treatment has been started (Watt et al., 1988).

DO NOT

Do not use a tourniquet. Do not cut into the snake bite. Do not use a cold compress on the bite. Do not give the victim any medications unless directed by a doctor. Do not raise the area of the bite above the victim’s heart. Do not attempt to suck the venom out by mouth (CDC, 2012). Do not use a pump suction device. While these devices were formerly recommended for pumping out snake venom, it is now believed that they are more likely to do harm than good. Do not give the person anything to eat or drink. This is especially important with consumable alcohol, a known vasodilator which will speed up the absorption of venom. Do not attempt to kill the snake as far as possible – as this may be dangerous. However, if the snake has already been killed, it should be taken to the dispensary or hospital with the patient in case it can be identified. However, do not handle the snake with your bare hands as even a severed head can bite! Washing the bite with soap and water is recommended by many organizations. Australian recommendations for snake bite treatment recommend against cleaning the wound. Traces of venom left on the skin/bandages from the strike can be used in combination with a snake bite identification kit to identify the species of snake. This speeds determination of which antivenom to administer in the emergency room. India developed a national snake-bite protocol in 2007 which includes advice to: Reassure the victim who may be very anxious Immobilize the whole of the patient’s body by laying him/her down in a comfortable and safe position and, especially, immobilize the bitten limb with a splint or sling. Any movement or muscular contraction increases absorption of venom into the blood stream and lymphatics [level of evidence E]. If the necessary equipment and skills are available, consider pressureimmobilization or pressure pad unless an elapid bite can be excluded. In Myanmar, the pressure pad method has proved effective in victims of Russell’s viper bite (Tun Pe et al., 1995) Avoid any interference with the bite wound (incisions, rubbing,vigorous cleaning, massage, application of herbs or chemicals) as this may introduce infection, increase absorption of the venom and increase local bleeding Release of tight bands, bandages and ligatures: Ideally, these should not be released until the patient is under medical care in hospital, resuscitation facilities are available and antivenom treatment has been started.

ANTIVENOM

Until the advent of antivenom, bites from some species of snake were almost universally fatal. Despite huge advances in emergency therapy, antivenom is often still the only effective treatment for envenomation. Antivenom is made by injecting a small amount of venom into an animal (usually a horse or sheep) to initiate an immune system response. The resulting antibodies are then harvested from the animal’s blood. Antivenom is injected into the person intravenously, and works by binding to and neutralizing venom enzymes. It cannot undo damage already caused by venom, so antivenom treatment should be sought as soon as possible. Modern antivenoms are usually polyvalent, making them effective against the venom of numerous snake species. Pharmaceutical companies which produce antivenom target their products against the species native to a particular area. Although some people may develop serious adverse reactions to antivenom, such as anaphylaxis, in emergency situations this is usually treatable and hence the benefit outweighs the potential consequences of not using antivenom. Giving adrenaline (epinephrine) to prevent adverse effect to antivenom before they occur might be reasonable where they occur commonly. Antihistamines do not appear to provide any benefit in preventing adverse reactions.

Precautions to Avoid Snake Bites

Protective gear: Wearing rubber boots and gloves while out in snake habitats could prove useful
Flashlight: Rechargeable torches could help you see better during night time
Avoid dark corners: Snakes seek out shady or dark places where they can rest and cool down
Know your snake prone area: Find out more about your local snake species and about the habitats they prefer
Do not disturb a snake: Snakes do not bother anyone if left alone
Do not imitate TV shows: Handling snakes takes immense practice and skill, which is not always portrayed on television

Basic Steps to be taken in case of a bite

Go to the nearest hospital as all government hospitals possess anti-venom (for all the Big 4 venomous snake species found in India)
Apply a bandage on the bite site covering the bite and the area around it

The bandage should not be tight
Avoid unnecessary and sharp movements
Place a splint while bandaging, to avoid joint movements
Walking or running is not advisable
In case of a bite on the hand, bandage the arm and put in a sling from the shoulder

What not to do after a snake bite

Panicking during such times would make matters worse
Do not make any cut, scratch or incision, leave the bite alone
Do not suck the wound, it is a myth and medically not advisable
Do not apply an ice pack to the bitten area
Do not use a tight bandage or tourniquet
Alcohol, herbal medicine or aspirin are not medically-proven antidotes

Things to remember

A snake bites when they feel threatened: Leave the snake alone and maintain safe distance until professional rescuers reach the location
Many of the bites are by accident: Snakes do not intend to attack, chances of a bite are accidental and/or if provoked
No snake bites in revenge and follows you: Snakes do not have the memory to recognise or remember anyone
People are duped into believing tantrics/local medics who recommend magic to heal snake bites etc, this is not true

Respite lies with Anti-venoms. Although India has 60 types of snakes, we only have one type of anti-venom i.e. the polyvalent snake anti-venom. However, a study recently revealed that more research needs to be done on snake anti-venoms. Additionally, it is always in best interest if you stay informed about snake avoidance behaviours.

Dos and Don’ts during Snake Bite