Snake Bite

>Introduction

Any snakebite victim should go to a hospital emergency department unless the snake is positively identified as nonvenomous. Remember, misidentification of the snake species could be a fatal error.

Bites by nonvenomous species require good wound care. Victims should receive a  tetanus   booster if they have not had one within the last 5 years.

Self-Care at Home

Common sense will guide your efforts if you are bitten by a snake or are witness to someone else being bitten. Even a bite from a nonvenomous snake requires excellent wound care. The victim needs a tetanus booster if he or she has not had one within 5 years. Wash the wound with large amounts of soap and water. Inspect the wound for broken teeth or dirt.

Take the following measures:

• Prevent a second bite or a second victim. Snakes can continue to bite and inject venom with successive bites until they run out of venom.
• Identify or be able to describe the snake, but only if it can be done without significant risk for a second bite or a second victim.
• Safely and rapidly transport the victim to an emergency medical facility unless the snake has positively been identified as harmless (nonvenomous). Remember, misidentification could be fatal. A bite without initial symptoms can still be dangerous or even fatal.
• Provide emergency medical care within the limits of your training.
  • Provide emergency medical care within the limits of your training.
  • If you are in a remote area in which transport to an emergency medical facility will be prolonged, you should apply a splint to the affected limb. If you do apply a splint, remember to make sure the wound does not swell enough to make your splint a tourniquet, cutting off the blood flow. Check to make sure toes and fingers are still pink and warm, that the limb is not going numb, and that pain is not getting worse.
  • If you have been bitten by a dangerous elapid and have no major local wound effects, you may apply a pressure immobilizer. This technique is mainly used for Australian elapids or sea snakes. Wrap a bandage at the bite site and up the extremity with a pressure at which you would wrap a sprained ankle. Then immobilize the extremity with a splint, with the same precautions concerning limiting blood flow. This technique may help prevent life-threatening systemic effects of venom, but may also worsen local damage at the wound site if significant symptoms are present there.
  • While applying mechanical suction (such as with a Sawyer Extractor) has been recommended by many authorities in the past, it is highly unlikely that it will remove any significant amount of venom, and it is possible that suction could actually increase local tissue damage.
• The two guiding principles for care often conflict during evacuation from remote areas.
  • First, the victim should get to an emergency care facility as quickly as possible because antivenom (medicine to counteract the poisonous effects of the snake's venom) could be life-saving.
  • Second, the affected limb should be used as little as possible to delay absorption of the venom.
• A number of old first aid techniques have fallen out of favor. Medical research supports the following warnings:
  • Do NOT cut and suck. Cutting into the bite site can damage underlying organs, increase the risk of infection, and does not result in venom removal.
  • Do NOT use ice. Ice does not deactivate the venom and can cause frostbite.
  • Do NOT use electric shocks. The shocks are not effective and could cause burns or electrical problems to the heart.
  • Do NOT use alcohol. Alcohol may deaden the pain, but it also makes the local blood vessels bigger, which can increase venom absorption.
  • Do NOT use tourniquets or constriction bands. These have not been proven effective, may cause increased tissue damage, and could cost the victim a limb.

Follow-up

A snakebite victim who has been released from the hospital should return to medical care immediately if he or she develops any worsening symptoms, especially trouble breathing, change in mental status, evidence of bleeding, worsening pain, or worsening swelling.

Someone who has received antivenom treatment for snakebite should return to medical care if any signs of serum sickness develop (fever  , muscle or joint aches   or swelling, hives). This complication usually occurs within 5-10 days after administration of antivenom.

A snakebite victim (particularly a rattlesnake bite) should, for the first few weeks, warn his or her physician of this fact before any routine or emergency surgery. Some snake venoms can cause difficulty in blood clotting for a week or more after the bite.

Prevention

The snake is almost always more scared of you than you are of the snake. Giving the snake the opportunity to escape prevents most bites.

• Do not attempt to handle, capture, or tease venomous snakes or snakes of unknown identity.
• Snakebites are often associated with alcohol use. Alcohol intake can weaken your inhibitions, making it more likely that you might attempt to pick up a snake. Alcohol also decreases your coordination, increasing the probability of a mishap.
• If you are outdoors, you can help prevent significant bites by wearing boots while hiking. Long pants can reduce the severity of a bite. When in snake country, be cautious where you place your hands and feet (for example, when gathering firewood or collecting berries), and never walk barefooted after dark.
• If your occupation or hobby exposes you to dangerous snakes on a regular basis, preplanning before a potential bite may save your life. Since not every physician is familiar with snakebites and not every hospital has or knows how to obtain antivenom, providing information regarding the type of snake, type of venom, and the procurement and use of antivenom can help the medical staff treat you.