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Snake Bite
 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 non-venomous 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:
- Get away from the
snake to 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 (non-venomous). 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.
- Remove constricting
items on the victim, such as rings or other jewelry, which could cut off blood
flow if the bite area swells.
- 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 check periodically to ensure that it is not cutting off
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.
- Applying mechanical
suction (such as with a Sawyer Extractor) is highly unlikely to remove any
significant amount of venom, and may increase tissue damage. This is in
contrast to past recommendations by many experts.
- 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
anti-venom (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.
Medical Treatment
The doctor treats life-threatening
conditions first. A victim with difficulty breathing may need a tube placed in
his or her throat and a ventilator machine used to help with breathing. People
who are in shock require intravenous fluids and possibly other medicines to
maintain blood flow to vital organs.
- The doctor gives
anti-venom to victims with significant symptoms. This therapy can be life
saving or limb saving. Anti-venom can occasionally also cause allergic
reactions, however, or even anaphylactic shock , a life-threatening type of
shock requiring immediate medical treatment with epinephrine and other
medications.
- Antivenom can also
cause serum sickness within 5-10 days of therapy. Serum sickness causes
fevers, joint aches, itching, swollen lymph nodes, and fatigue, but it is not
life threatening.
- Even victims without
significant symptoms need to be monitored for several hours, and some people
need to be admitted to the hospital for overnight observation.
- The doctor cleans the
wound and looks for broken fangs or dirt. A tetanus shot is required if the
victim has not had one within 5 years. Some wounds may require antibiotics to
prevent infection.
- Rarely, the doctor
may need to consult a surgeon if there is evidence of compartment syndrome.
If treatment with limb elevation and medicines fails, the surgeon may need to
cut through the skin into the affected compartment, a procedure called a
fasciotomy. This procedure can relieve the increased limb swelling and
pressure, potentially saving the arm or leg.
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