INTRODUCTION

Snake- the legless, voiceless, earless creature is probably on a list of phobias of many people. And why it should not be, these reptiles kill approximately 5 million humans in a year! Not to forget they bite thousands more than this number.  A snake bite is a 2-puncture wound due to the bite of a snake.

Now here’s a curious question: Why do snakes bite? Well, the answer is a little complicated than obvious reasons. The obvious reasons being defense, food, threaten, protect eggs, etc. But snakes are known to be mercurial and you never know when they might bite. The exact reasons can be hard to figure out.

Snake venom is actually highly modified saliva which contains zootoxins for digestion of prey and defends against threats. Snakes can bite through fangs while some species can even spit venom! Vipers account for most snake bites to humans.

Snake bite is actually a common phenomenon and it is important to know how to handle it. Identification of snake after the bite is the key to saving the victim. An antidote will be easily available once type of snake has been known.

Types and Symptoms

Envenomation (injecting venom) is a voluntary phenomenon, which means that a venomous snake may or may not inject venom while biting.

A bite without venom is called a dry bite. Dry bite may not be fatal but can cause severe damage like lacerations and infections which if not treated properly may result in amputation.

 

General Symptoms of Envenomation through bite:

However, the significant thing is that there is vast variation between symptoms of snakebites from different snakes. Here are the common types of snakebites owing to types of snakes:
 

  1. Black Mamba: A highly venomous, large snake, the black mamba is indigenous to the African continent. Its bite is called as ‘kiss of death’; with its highly toxic venom; a human has a 100% chance of dying within 7-10 hours. It is naturally the most dangerous and feared snake in Africa as well as quite a common one. Its bite numbers have now decreased in number owing to awareness in people to avoid confrontation with it.
    • Extreme pain
    • Burning sensation (described by survivors as many needles piercing)
    • Anaphylactic shocks(during treatment)
    • Paralysis
    • Neurotoxicity
    • Spontaneous Bleeding (blood does not coagulate)
       
  2. Cobras: Known for their ability to form a hood by flattening their neck rib, cobras are very much revered in their indigenous place India and Southeast Asia. They are unique in many aspects which include their ability to literally stand up by raising one-third of their bodies. Their strong inclusion in mythology (considering them as a messenger of god) nonetheless lessens the fact that they contain a larger amount of venom (as compared to others) and can hiss, bite and spit venom.  They have the super power of smelling due to Jacobsen’s organs. A special mention goes for King Cobra which is unique than any other snake on the planet, owing to the facts that it is the longest venomous snake in the world, is super intelligent and builds a nest for eggs.
    • Severe pain
    • Vertigo
    • Coma
    • Paralysis
    • Respiratory failure
    • Kidney failure
       
  3. Water Moccasins: Native to the United States, this is a venomous semiaquatic snake and is quite a strong swimmer. Due to white colored, cottony stuff lining their mouth, they’re also called as Cottonmouth. Having special heat-sensing pits, these pit vipers accurately target the prey which is the source of the heat. The only physical feature which separates these from their nonvenomous water snake counterparts is the cat-like, vertical pupil in place of a round one. They are aggressive but the fatality rate for humans is very less because they generally do not bite. However, their untreated bite can be seriously fatal.
    • Temporary and/or permanent tissue & muscle damage
    • Extreme pain
    • Internal Bleeding
    • Coagulopathy
    • Spontaneous bleeding from mouth and nose
    • Weakness, lethargy
       
  4. Coral Snakes: Theses beautiful, vibrantly colored snakes are actually deadly and highly venomous. Despite being slender and small (18-20 inches in size), they have the second most deadly venom after Black Mamba. Divided into 2 groups, based on habitat i.e., Asia and Americas, corals come in wide variety of colors and mostly have eye-catching patterns and bands. Their venom contains powerful neurotoxins and thus can affect the brain the most. Although, they are not aggressive and are hard to spot, but if found it is the curiosity of people that leads to a significant number of snake bites.
    • Slurring Speech
    • Difficulty in moving and seeing
    • Convulsions
    • Change in skin color
    • NO immediate pain and late set in of symptoms
    • Rapid Paralysis
       
  5. Rattlesnakes:  One of the largest venomous snakes, they account for most snake bites. They are very easily identifiable due to rings (rattles) at the end of their tail. This acts as a warning system by vibrating and producing a distinct sound when threatening or threatened. Due to this, they are considered the newest and most evolved snakes on the planet. Except a few species being more neurotoxic, their venom contains hemotoxins, which means its target group is the circulatory system. Fatalities are rare as it can be treated easily with antivenin but due to negligence, the human death rate has increased.
    • Pain, tingling and burning at the bite site.
    • Discoloration and Bruising
    • Necrosis
    • Coagulopathy
    • Weakness and Vertigo
    • Internal Bleeding
    • Difficult breathing
    • Edema
       

TREATMENTS

Since it is very complicated to infer if it is a dry bite or Envenomation, every snake bite should be considered as a life-threatening medical emergency.

Identification of snake is a very crucial factor in proceeding with treatment. Once the snake has been known, its specific antivenin can be given and the patient can quickly recover with a certainty. This is not the case where the biting snake is not familiar and a general antidote has to be given.

The WHO recognizes snakebite as a neglected disease. It is important that victim is given proper medical treatment and is not left depend on outmoded practices.

 

First Aid

First steps after snake bite vary according to the snake. A common contradiction is seen regarding washing of wound with soap. While some countries advise it, Australian Guidelines suggest against it. Therefore, here are some general guidelines which are required:

  1. Identify the snake: Remember its color, length, any distinctive habit, etc.
  2. The person should remain calm so as to not trigger the acute stress reaction. Otherwise, this will result in increased blood flow and hence spread of venom.
  3. Comfort the victim: It is a major guideline to convince the victim that he/she will not die. It helps in preventing the person from going into shock.
  4. Loosen tight clothing and remove constricting jewellery like rings, watches, wristbands, etc.
  5. Keeping the affected part below heart level, so that blood may not return to the heart and affect other organs.
  6. The person should not move and stay still.
  7. Call for help immediately.
     

What NOT to do?

  1. Do not use Tourniquets- It cuts all blood flow to affected limb and may result in unnecessary amputation.
  2. Do not incise the wound- It results in further injury and risks the person to severe infection.
  3. Do not try to suck venom either by mouth or through the pump- It will result in necrosis and a severe risk of infection.
  4. Do not give cold compress or immerse in warm water
  5. Do not use Electroshock therapy- It is useless and adds to the risk of death.
  6. Do not eat or drink anything
     

AT THE HOSPITAL

  1. Upon arrival, the patient is examined for airway, consciousness, and circulatory status.
  2. Urgent resuscitation is given to those in shock.
  3. Normal saline or Ringer’s Lactate is given to all patients suspected of Envenomation.
  4.  A precise history is taken of the patient and the incident.
  5. Then depending upon history, a person is administered with the antivenin of that particular snake.
  6. A tetanus shot is mostly given depending on the last date of tetanus booster, which should be given to every person every 10 years.
  7.  A person is kept under observation for 24 hours.
  8.  Full recovery may take more than 3 weeks with episodes of pain and swelling which can be treated by regular pain killers like paracetamol and proper limb exercise.
     

WHAT IS ANTIVENOM?

Anti-Venom or Anti venin is a biological product used for neutralizing snake venom in the affected part. Since they cannot undo any damage from snake bite which is already done, it is important that they may be administered as soon as possible. The process of forming antivenin involves milking of the snake and introducing the venom into a subject animal which kicks the immune response, producing antibodies which are then harvested and used for Envenomation treatment.
 

CONCLUSION

Snake bite is a serious life threatening disease which requires quick treatment. Despite this, the majority can survive if they follow guidelines and are aware of proper first aid treatment. It is our duty to know about the snakes prevalent in one’s area since it is important for supplying antivenin. So be aware and stay protected!