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 ?
Poisonous snake bite is a common cause of morbidity and mortality among rural populations in our country.
Study on the clinico-epidemiological profile and the outcome of snake bite victims in a tertiary care centre in Southern India.
In this context, the objective of our study was to determine the sociodemographic profile and the management of snake bite cases admitted to the Kempegowda Institute of Medical Sciences (KIMS) Hospital and research center, Bengaluru.
Snake bite envenomation is quite uncommon in Australia, and resultant AKI is even rarer.
Most of the cases of snake bite (82%) occurred between the months of April and September.
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.
After a snake bite when patients come to hospital, the standard operating procedure is admission and evaluation for blood coagulation using 20-minute whole blood clotting (20MWBC) technique along with checking for neurotoxic symptoms.
Case of snake bite in German shepherd dog in field condition was successfully treated using anti snake venom sera.
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.
The paralysis of these muscles following snake bite is a very rare complication and the internal rectus muscle has been reported to be the most commonly affected muscle (5,6).