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 ?
Most of the species of snakes in the Philippines are harmless but the country is also home to some of the deadliest snakes in the world that is why poisonous snake bites still represent an important, albeit largely unpublicized, health hazard in the country, especially in the rural areas.
In the developing countries, it has been noticed that about 80% of the snake bite patients first consult traditional practitioners before approaching the hospital and the delay in transportation leads to mortality.
Some Coast counties, especially Kilifi and Taita Taveta, are among those with high incidents of snake bites.
The vice-president of the hospital Wen Daiwei said 99 per cent of snake bite patients who were treated with traditional medicine at her hospital were effectively cured.
'The only first aid you can give to a snake bite patient is paracetamol and then you rush to the hospital.
A snake bite accident in sheep by Bothrops Jaracara.
Hypertensive encephalopathy following snake bite in a child: A diagnostic dilemma.
A total of 206 patients admitted with a diagnosis of poisonous snake bite were studied with investigations relevant to the clinical presentation of each case and retrospective analysis of the cases were done.
The modal site of snake bite was foot and ankle in 42.30%.
But as soon as the vet saw Oscar he knew it was a snake bite and immediately ordered a blood test.
With a lack of affordable healthcare, the people most in danger of experiencing a poisonous snake bite often have limited access to the expensive procedures - potentially up to $100,000 -necessary to save their lives in the aftermath of a bite.
The blunt-nosed viper is the most dangerous and a snake bite requires immediate medical attention.