Snake Bite and its Management

There are thousands of different species of snakes in the world. But very few of them are poisonous. More than 50,000 people die each year due to poisonous snake bite. This may be only the tip, because many go without reporting. Venomous snakes are divided into the following categories Viperidae (old world vipers, asian pit vipers etc), Elapidae (cobras, coral snakes and Australian venomous snakes), Hydrophiidae (all sea snakes), Atractaspididae (burrowing asps), and Colubridae.

It is very difficult to differentiate venomous from non venomous snakes. Fang marks are of no diagnostic value. Symptoms of snake bite include fear of impending death, nervousness, local swelling, redness of the site, sharp pain. More than 20% (75% of sea snakes) of the bite are ‘dry type’ which means either no venom or insufficient venom to cause serous problem or death.

First Aid Measures:

If the bite of the snake is in limb it should be immobilized and firm pressure bandaging of the bite area and few inches above the bite site should be tied. These measures significantly delay the spread of the venom. Patients are generally apprehensive and nervous and they should be reassured and sedated if necessary.

Treatment of snake bite:

  • The site of the bite should be cleansed properly and left strictly alone. Nothing should be done with the bite site, otherwise chances of infection increases. Tetanus prophylaxis should be done with tetanus toxoid. If there is necrosis of skin, it should be sloughed off and skin grafting if required.
  • If required sedatives can be administered. General measures like intravenous fluids should be given.
  • Anti venoms should be given only if there is clear evidence of systemic poisoning. But some authorities prefer to give anti venom within four hours if diagnosis of snake bite is confirmed, to avoid necrosis. Anti venom is available for some common snakes only depending on the country, within country also different regions have different types of snakes so also anti venom. If snake is not common in an area anti venom for that particular snake may not be available. If it is available than it should be made sure that it is clear and has no opacities.

Depending on the severity 20 to 100 ml is diluted in two units of normal saline and given by slow infusion. Adrenalin (1:1,000 solutions) should be kept ready in case anaphylactic shock (dangerous allergic reaction) develops. Giving anti venom at the earliest is very important because once the venom is lodged it is very difficult to dislodge the venom from the site.

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