Show
Knowing whether a snake bite is dangerous or not can be difficult. This article explains what to do — including providing the proper first aid treatment — if you are bitten by a snake. It’s also important to be aware that bites from snakes can cause a severe allergic reaction (anaphylaxis) in some people. Learn more about first aid treatment for severe allergic reactions in the ‘anaphylaxis’ section below. How do I provide first aid for snake bites?You should always provide emergency care if you or someone else is bitten by a snake — including cardiopulmonary resuscitation (CPR), if required. Keep calm, and follow these steps:
If you can’t use a pressure immobilisation bandage because the bite is on the trunk or stomach, apply constant, firm pressure. Do not apply a tourniquet, cut the wound or attempt to suck the venom (poison) out. St John Ambulance Australia has a quick guide to the first aid management of snake bites. The Australian Red Cross also has a handy infographic on how to treat them. Pressure immobilisation bandageA pressure immobilisation bandage is recommended for anyone bitten by a venomous snake. You should firmly bandage the area of the body involved — such as an arm or leg — and keep the person calm and still until medical help arrives. Follow these steps to apply a pressure immobilisation bandage:
St John Ambulance Australia's first aid fact sheet includes information on pressure immobilisation bandages. Anaphylactic shockSome people occasionally have a severe allergic reaction to being bitten by a snake. Their whole body can react to the bite within minutes, which can lead to anaphylactic shock (anaphylaxis). Anaphylactic shock is very serious and can be fatal. Symptoms of anaphylactic shock include:
If someone is experiencing anaphylaxis, call triple zero (000) for an ambulance. If the person has a ‘personal action plan’ to manage a known severe allergy, they may need help to follow their plan. This could include administering adrenaline via an autoinjector (such as an Epipen) if one is available. The Australasian Society of Clinical Immunology and Allergy recommends that for a severe allergic reaction, adrenaline is the only treatment. For further information, visit the Choosing Wisely Australia website. For more information on anaphylaxis, including setting up a personal action plan, go to www.allergy.org.au. Cardiopulmonary resuscitation (CPR)In some cases, the person bitten by the snake may need cardiopulmonary resuscitation. See healthdirect’s page on how to perform CPR for more information. St John Ambulance Australia has a printable poster on first aid resuscitation procedures. What different types of snake bite are there?Dry bitesA dry bite is when the snake strikes but no venom is released. Dry bites are painful and may cause swelling and redness around the area of the snake bite. Once medically assessed, there is usually no need for further treatment, such as with antivenoms. Many snake bites in Australia do not result in venom entering your body (known as envenomation) and so they can be managed without antivenom. Because you can’t always tell if a bite is a dry bite, always assume you have been injected with venom and manage the bite as a medical emergency — call triple zero (000) for an ambulance. Venomous bitesVenomous bites are when the snake bites and releases venom into a wound. Snake venom contains poisons that are designed to stun, numb or kill other animals. Symptoms of a venomous bite include:
In Australia, there are about 2 deaths each year from venomous snake bites. CHECK YOUR SYMPTOMS — Use our bites and stings Symptom Checker and find out if you need to seek medical help. How can I make sure the snake is identified?Venomous snakes can be identified based on any venom deposited on clothing or the skin. Do not wash the area of the bite, try to suck venom out of it, or discard clothing. Do not try to catch or kill the snake to identify it since medical services do not rely on visual identification of the species of snake. Is antivenom available for all types of snake bite?Antivenom is available for all bites by venomous Australian snakes. Around 100 Australian snakes are venomous, but only 12 are likely to inflict a wound that could kill you. Australia has about 140 species of land snake, and around 32 species of sea snake. Most snake bites happen when people try to kill or capture them. Don’t panic if you come across a snake. Back away to a safe distance and let it move away. Snakes often want to escape when disturbed.
Early access to medical care in a health facility that has personnel trained and capable of diagnosing snakebite envenoming is essential. This means, a health centre which is equipped with the basic resources needed to provide immediate emergency treatment needs, including the administration of antivenom and other adjunct therapy. People who suspect they have been bitten by a venomous snake should be transported to a health facility without delay. First aid should be applied (see Box 1). Traditional medicines and other treatments such as wound incision or excision, suction, or application of “black stones” should be avoided. Many people die every year on the way to a health facility as a result of being transported lying flat on their backs and having their upper airway obstructed by vomit, or paralysis of muscles in the tongue. Keep them on their left side with mouth turned down so that the risk of this is reduced. Health facilities should treat all snakebite cases as emergencies and give priority to assessing these patients and instituting treatment without delay. Improving the clinical outcomes for the victims of snake bite needs much more than just access to safe antivenoms. Intravenous access should be achieved early, hydration state determined and corrected if needed, and vital signs must be closely monitored. The early administration of an adequate dose of effective antivenom to patients with signs of envenoming is crucial. If no antivenom is available, referral to a centre which has supplies should be planned and undertaken quickly. If this is not possible then symptomatic treatment including support of airway patency and breathing, maintenance of circulation and control of bleeding, and the treatment of local wounds should be prioritized as appropriate. Administered early, antivenoms are not just life-saving, but can also spare patients some of the suffering caused by necrotic and other toxins in snake venom, leading to faster recovery, less time in hospital and a more rapid transition back to a productive life in their communities. But the reality for many patients is that early access to antivenom is simply not possible for a multitude of reasons (see Box 2). As a consequence, these patients do not receive the full potential benefit of antivenom, and some of the effects of the snake venom may not be neutralized effectively, leading to prolonged illness, slower recovery and greater risk of disability. For those affected by toxins that cause paralysis, sustained airway and breathing assistance using either manual resuscitators or mechanical ventilators may be necessary. Patients bitten by snakes with venom that affects normal blood clotting may have a higher risk of internal bleeding into the brain and other organs, and those affected by dermonecrotic toxins will experience more severe local tissue damage.
If you suspect a snake bite:
Some of the key contributors to delayed antivenom treatment include:
Antivenoms remain the only specific treatment that can potentially prevent or reverse most of the effects of snakebite envenoming when administered early in an adequate therapeutic dose. They are included in WHO’s Model List of Essential Medicines. Early access to safe, affordable and effective antivenoms is critical for minimizing morbidity and mortality, and improving this access is a major component of an emerging WHO strategy to control snakebite envenoming. Additional therapy to treat envenomingIn addition to antivenom, additional medical measures, including administration of other drugs, artificial respiration, kidney dialysis, wound care, reconstructive surgery and prosthesis as well as comprehensive rehabilitation services, are needed to effectively treat snakebite patients. A class of drugs known as anticholinesterases can be beneficial in restoring neuromuscular function after the bites of some species of neurotoxic venomous snakes. Several drugs are also being explored for their potential to act as anti-necrotic agents, reducing the local tissue damage that can lead to severe disability and even amputation, after some snake bites.
At present there is only one commercial diagnostic test available that makes it possible to confirm the type of snake venom present in the body of an envenomed patient. This test uses antibodies to recognize specific types of venom produced by different species of snakes. Other diagnostic tests that use similar approaches are being used experimentally, but there is a need in some regions and countries for commercial tests that can be used to better inform the proper selection of antivenoms to treat patients. There are however simple tests and diagnostic tools (algorithms or checklists) that can be used to confirm the presence of important clinical signs of snakebite envenoming which indicate the need for early antivenom treatment and, in some cases, can help differentiate the most likely genus or species of snake responsible for the bite. Spontaneous haemorrhage due to envenoming by some snake species is an important clinical indication for antivenom. Diagnosis is aided by a test known as the 20 Minute Whole Blood Clotting Test (20WBCT). A clean, dry glass bottle or vial into which 1-2 millilitres of venous blood is added, is allowed to stand at room temperature for 20 minutes, and is then inverted and the presence or absence of a complete clot is recorded. Where a blood is present, the test result is negative, whereas if no clot forms and the blood remains liquid, the test result is positive, indicating presence of a coagulopathy and the need for antivenom treatment. Where this test is used it is essential that it be appropriately standardized using uniform glassware, sample volume and temperature, and validated for accuracy using serial donor samples prior to routine use. Diagnostic tools also have considerable potential to better inform the surveillance of snakebite envenoming by enabling retrospective identification in pathology samples of venom immunotypes from various species of snakes. This can improve the reporting of snakebite envenoming and assist in determining optimal antivenom needs for regions.
Snakebites are well-known medical emergencies in many parts of the world, especially in rural areas. Agricultural workers and children are the most affected....
Snakebite is a neglected public health problem. Rural populations are frequent victims as they go about their daily food production and animal rearing... |