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MEDICAL INFORMATION

MEDICAL INFORMATION:  http://www.aafp.org/afp/20020401/1367.html

Snakebite First Aid

In recent years, first aid measures for snakebites have been radically revised to exclude methods that were found to worsen a patient's condition, such as tight (arterial) tourniquets, aggressive wound incisions, and ice. Initial treatment measures should include avoiding excessive activity, immobilizing the bitten extremity, and quickly transporting the victim to the nearest hospital.

A wide, flat constriction band may be applied proximal to the bite to block only superficial venous and lymphatic flow (typically, with about 20 mm Hg pressure) and should be left in place until antivenin therapy, if indicated, is begun. One or two fingers should easily slide beneath this band, since any impairment of arterial blood flow could increase tissue death. Upper extremities should be splinted as close to a gravity-neutral position as possible, preferably at heart level.

No study has shown any benefit in survival or outcome from incision and suction.11-13 However, a venom extractor can be beneficial if applied within five minutes of the bite and left in place for 30 minutes. Although electric shock (often with a stun gun) has been a popular treatment for snakebite in developing countries, it should be avoided as it is a potentially hazardous intervention that has never been shown to be effective.

An attempt should be made to identify the type of snake from a safe distance; however, no attempt should be made to capture or kill the snake. Even if the snake is dead, it should not be picked up with the hands because envenomation by reflex biting after death of the snake has been reported.

Equine-derived antivenin to snake venom is not recommended for the formularies of standard emergency medical services because of the potential for life-threatening allergic reactions from the antivenin and the length of time required for reconstitution (up to 60 minutes). As safer products, such as Crotalidae Polyvalent Immune Fab (Ovine; CroFab), become more commonplace, antivenin administration in the field may become more feasible, especially in remote areas.

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