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             Allay anxiety and fright

Deaths have been reported from shock due to fright even when the bites were by non-poisonous snakes. Hence, it is vital to reassure patients.

• Not all snakes are poisonous.
• Not all poisonous snakes are fully charged with venom.
• Even those that are fully charged do not always inject a lethal dose.

Reassurance helps reduce anxiety related high. blood pressure, palpitations, tremors, sweating and rapid breathing.

Check if the bite is due to a poisonous or a non-poisonous snake. because people who are bitten can't always positively identify a snake, they should seek prompt care for any bite, though they may think the snake is nonpoisonous. Even a bite from a so-called "harmless" snake can cause an infection or allergic reaction in some individuals.

In cases where the snake is killed and brought to the clinic, examination of the snake helps differentiate whether it is poisonous or non-poisonous. In the absence of the snake, the bite mark should be examined using a magnifying lens.

      Features of poisonous & non-poisonous snakes                                                                            

• If possible, try and keep bitten extremity at body level, when the person is lying. Raising it can cause venom to travel into the body. Holding it down, can increase swelling.
• Go to nearest hospital or medical facility as soon as possible
• If possible try to identify the snake and if possible kill and take the snake along to the hospital.

A patient bitten by a cobra or krait if not dead in 2 hours will probably recover rapidly. A patient bitten by a viper is in danger for a much longer time.

Under Medical Supervision

Administration of anti-venom -

Polyvalent anti-snake venom contains antibodies against cobra, common krait and viper.
5 vials are given if signs are mild -primarily local manifestations.
10 vials if signs are moderate -bleeding from gums, ptosis.
15 vials if signs are severe -vascular collapse, progressive paralysis.

1/3 of the dose should be given subcutaneously (near bite but not in fingers or toes).
1/3 intramuscularly.
1/3 intravenously.

The intravenous dose can be repeated every 6 hours till the symptoms disappear. For sea-snake bites, special antivenoms are available.

More on Anti-Snake Venom and Its Administration

Manage toxic signs/symptoms

Anti-venom acts only against circulating toxin, not toxin fixed to tissue. Therefore, specific measures have to be taken.
In case of neuro toxic signs and symptoms, atropine (0.6 mg) subcutaneously should be followed by 5 injections of neostigmine (0.5 mg) intravenously (repeated 2 hourly depending on response) to reverse muscle paralysis.
In case of vasculotoxic signs and symptoms, fibrinogen along with heparin may be given, but with extreme caution and constant monitoring, as heparin can intensify bleeding.

Take supportive measures

These include blood or plasma transfusion to combat shock,
mechanical respiration to combat respiratory distress,
antibiotics to prevent secondary infection. Neuromuscular paralysis is the most dreadful complication of snake bite. It may occur within 15 minutes  but may be delayed for several hours. 
To tackle hypersensitivity reactions to antivenom-steroids, adrenaline and antihistamines may be given.

For more info on Management of Snake bite see this page

http://w3.whosea.org/bct/snake/5f.htm

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