snake bite


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A bite from a snake which may be nonpoisonous or poisonous—which may cause envenomation and, if severe, be fatal
Epidemiology 7,000–8,000 people are bitten by poisonous snakes/year in the US; about 5 die

snake bite

A puncture wound made by the fangs of a snake. All snakes should be considered poisonous, although only a few secrete enough venom to inoculate poison deeply into the tissues.

Patient care

When snake bite, esp. from a venomous snake, is confirmed or strongly suggested, the patient's airway, breathing, and circulation should be assessed, and he should be transported immediately to a medical facility equipped and staffed to handle snake bites. In the hospital, the patient is attached to a cardiac monitor, an automatic noninvasive blood pressure monitoring machine, and a pulse oximeter. If necessary, oxygen administered at 4 L/min via nasal cannula, and an intravenous infusion of Ringer's lactate or normal saline should be started. Pulses below the wound and capillary refill time in the wounded limb are assessed and compared to the unaffected limb. The circumference of the affected limb should be measured at the bite and at equal distances above and below it, to monitor the spread of edema and inflammation. Lung sounds are auscultated for clarity, and the patient is asked about medical history, allergies, and history of previous snakebite. Snakebite symptoms can range from mild swelling, pain, and erythema to hypotension, shock, and a disseminated intravascular coagulation-like syndrome. In all cases the affected limb should be placed in a neutral, resting position.

If the patient has actually received venom from the snake bite (only about 50% of patients have), the appropriate antivenin should be administered intravenously, appropriately diluted. If the required antivenin is prepared from horse serum, the patient should be tested for sensitivity before administering the antivenin. The antivenin should be infused slowly, over about an hour in most cases, and the patient monitored for adverse reactions for at least another hour. Resuscitation equipment for treating anaphylaxis should be readily available throughout the infusion. Children require a higher dosage of antivenin than do adults. A blood sample should be drawn from the patient for complete blood count, coagulation profile, BUN, creatinine, creatine kinase, and blood type and cross-match. A urine specimen should be obtained to test for myoglobinuria.

The wound should be cleaned with cool soap and water. Analgesics and other prescribed treatments (antibiotics, methylprednisolone, antihistamines) should be administered, as well as tetanus prophylaxis if indicated.

Snake antivenin information is available from the nearest Poison Control Center. The patient should be observed for potential complications such as compartment syndrome, coagulopathy, rhabdomyolysis, renal failure, and wound infection. Prior to discharge, the signs and symptoms of delayed adverse reactions to antivenin should be explained to the patient, and he or she should be advised to immediately report fever, malaise, joint pain, rash, or unusual body bruising.

First Aid

The patient should be transported immediately to a medical facility equipped and staffed to handle snake bites. In the hospital, an intravenous infusion of Ringer's lactate or normal saline should be started.

A polyvalent antivenin serum for bites by pit vipers is prepared by Wyeth Lab. Inc. Antivenin for coral snake bite is also available from Wyeth. The use of antibodies to treat pit viper bites is being used experimentally.

CAUTION!

Alcoholic stimulants must not be taken, and nothing should be done to increase circulation. One should not cauterize with strong acids or depend on home remedies. Tetanus prophylaxis is essential.
See also: bite
References in periodicals archive ?
Snake bites are recognised by the WHO as a neglected tropical disease and are responsible for up to 125 000 deaths around the world each year.
Four cases of venomous snake bites were recorded have at Paphos general hospital in the last few days, according to the facility's manager.
8220;This is an exciting time for us, and we're thrilled to partner with Eagle Distributing and Bay Area Distributing to make Snake Bite available to new consumers in Northern California.
In SMS Hospital alone the numbers of snake bite cases in June, July and August were 22, 45 and 53, respectively.
Dr Ruben Arias del Rio of The Veterinary Hospital who conducted the post-mortem confirmed the marks found on the dog's right hind leg appeared consistent with a snake bite.
He said snake bites do not always lead to the injection of venom into the wound.
An 11-year-old male patient was presented to our Pediatric Emergency Outpatient Clinic because of snake bite which occured 2 hours ago.
Consequently, snake bites are more common on the lower and upper extremities.
one was immobilised only after arriving at hospital and one after walking to get help following the snake bite.
Jo Harvey, matron for emergency care services, said: "It's the first snake bite I have looked after in 20 years of nursing.