Bite by Stiletto Snake Atractaspis bibronii
• 77% developed progressive painful swelling •
6% progressive weakness
•
<1% bleeding
Prevention The greatest cause of snake bite is people trying to kill the snake. When a snake is fighting for its life and it bites, it delivers far more venom than in a chance encounter. Common sense is the gold standard in preventing snakebites: Wear boots that covers the ankle and loose hanging long pants. Most of the snakebites are on the feet, ankle and lower leg. • Don’t step over an obstacle if you cannot see what is on the other side. • Don’t put your hand into a hole when you can’t see what is inside. • Don’t handle snakes if you are not a professional snake handler. • Don’t confront a dangerous snake •
Do not try to kill it
If you encounter a snake back of as fast as possible keeping your eye on the snake. However if you are
so close that you are within striking distance and the snake is already engaged to strike stand dead still until the snake withdraws. Snakes only strike at movement Prevent nocturnal bites by using a light, wearing footwear and sleeping in a snake proof dwelling (zip up tents).
Be careful of handling “ dead “ snakes as some elapids, notably the Rinkhals, may feign death. Medical management The majority of patients can not correctly identify the snake even with the help of pictures. Because of this Dr Blaylock divided the snakebite victims into the following 3 groups according to the clinical picture at presentation. •
Painful Progressive Swelling
•
Progressive Weakness
•
Bleeding
The treatment of these patients with antivenom simplifies the treatment of snakebites drastically. Antivenom is given in each of these groups according to set criteria based on signs and symptoms. Patients also receive supportive treatment according to the organ systems affected e.g. ventilation support for patients with respiratory failure and platelets and blood clotting components for patients with active bleeding
General principles to consider: • Remain calm and think before you act • Remember: very few people die from snake bite • Keep the patient calm and reassured. • Immobilize the patient as far as possible and don’t waste time in delaying his transport to the nearest medical facility. • Do not give the patient anything to drink or eat - especially not alcohol. • Incision, suction, cryotherapy (freezing of bite site), electrotherapy, topical or ingested medication is of no value. • Do not waste time by searching for and trying to kill the snake • Pressure immobilization bandaging is not recommended as it may aggravate or precipitate tissue necrosis (death/destruction) or compartment syndrome as the majority of snakebites presents with progressive swelling. • An arterial tourniquet is of value in known non spitting cobra and mamba bites and should be reserved for cases with positive identification of one of the above group of snakes. Tourniquet application can cause severe underlying tissue damage if applied wrongly .It is best to leave it to people with the necessary training on tourniquet application. The tourniquet must be released every 30 min and not be kept on for longer than 2 hours. • Patients who cannot swallow their saliva must be placed in the recovery position and closely observed for respiratory failure. The saliva
First Aid Getting the patient to medical help is the major priority. AFRICAN EXPEDITION MAGAZINE July 2008
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