Description
Access to early, equipped medical care for snake bites is crucial. Suspected snakebite victims need prompt transportation to a health facility and should avoid traditional treatments. Improving outcomes requires quick IV access, hydration assessment, vital sign monitoring, and timely antivenom administration. Early antivenom use can save lives, reduce suffering, and speed up recovery, but many patients lack timely access to antivenom. This delay can lead to prolonged illness, slow recovery, and increased disability risks. Additional support like breathing assistance or clotting issue management may be necessary depending on the type of snake venom.
Summary Listen
- First aid for snake bites should prioritize avoiding harm. Common practices like applying ice, squeezing out blood, or using venom extractors are not recommended. Tight tourniquets are particularly dangerous and should be avoided. If a tie is necessary, it should be loose enough to allow a finger to pass through.
- Immediate actions include calming the patient, removing ornaments, and splinting the affected limb. The pressure immobilization technique, using elastic bandages, is not recommended for untrained individuals, according to Indian guidelines. Glycerol trinitrate ointment lacks sufficient human data to support its use.
- When handling snakes, avoid bringing them to the hospital. Taking a picture of the snake for identification is preferable. Identifying the snake species is not crucial for treatment, but it can aid in confidence. Major snakes in India include the common cobra, common crate, Russell's viper, and saw-scaled viper.
- Initial assessment of a snake bite patient involves primary assessment (ABCDE). GCS is not a valid tool for assessing consciousness after neurotoxic envenomation. Identifying fang marks is not reliable for determining venomous or non-venomous bites. Symptoms to watch include local bleeding, blistering, swelling, and tender lymph nodes.
- Treatment for snake bites is ASV (antivenom). The antivenom production process involves extracting venom from snakes and injecting it into animals, usually horses, to produce antibodies. Antivenom should not be administered prophylactically but only when there are signs of envenomation. Dosage varies depending on the snake species.
- ASV administration can cause reactions, including anaphylaxis. Prophylactic adrenaline can be considered, but it is not universally recommended. Other treatments include cleaning the bite site, surgical decompression for compartment syndrome, and avoiding NSAIDs. Atropine-neostigmine injections are sometimes used for neurotoxic bites.
- FFP can be considered for coagulopathy, particularly with humped-nosed pit vipers. Patients should be observed for at least 24 hours and longer if ASV is administered. Before discharge, patients should be informed about the possibility of serum sickness.
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About the Speakers
Dr. Nirmal Peter Abraham
Emergency Physician, IQRAA International Hospital & Research Centre, Kozikode
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