1. What to know about snakesSNAKE BITES... If possible, identify the snake or note its characteristics. Do not panic, calm the patient and allow only the minimum required movement. Do not cut and suck the bite wound and no not apply a tourniquet. Apply a bandage firmly along the whole length of the bitten limb, from bottom to top, checking that circulation has not been totally restricted. Immobilize a bitten limb and get the patient to hospital Keep airways open and do not leave patient alone. Treat symptoms as required, e.g. apply mouth-to-mouth or cardio-pulmonary resuscitation. Anti-venom should be administered only under proper medical supervision, if the snake has been correctly identified.This information is provided merely as a guideline and the author does not acceptresponsibility for incorrect/incomplete information.SNAKE BIT SENSEAlthough less than 10% of the estimated 130 to 160 species of snakes in South Africa areextremely venomous, and your chance of being bitten by one is slight, its best to be prepared- especially during the summer months.Poisonous snakes found in Mpumalanga are adders, cobras, mambas, boomslang and vine(also known as twig or bird) snakes. But the chance of coming across these snakes is verysmall since they usually quickly disappear as soon as they sense the slightest movement. Puffadders are the exception however, as these fast striking snakes often lie still and are thereforeeasily trampled on.Take precautions • Never try to catch or kill snakes. • Watch where you walk. • Always use a torch when you walk outdoors at night. • Wear hiking boots, thick socks and long trousers. • Step on top of logs or rocks, not over them. • Stick to footpaths • Dont put your hand into holes in the ground or under objects when picking them up. • Stay away from dead snakes as many fake death. If you see a snake, freeze; make no sudden movements. Then gradually move away very slowly. Most snakes will not
2. waste venom, which takes a lot of energy to produce. If you are too big to eat, they will try to warn you off before striking, unless they are frightened or very annoyed. • If you are bitten, dont panic, very serious injury or death is rare unless the bite is left unattended for several hours or days. However, someone who doesnt receive treatment after a bite from a big, angry mamba or cobra can die within minutes as these snakes can deliver lethal amounts of venom to several people at one sitting! • Get help immediately after a snakebite (unless youre absolutely certain that the snake is not venomous). Phone the hospital en route to give the staff time to prepare the anti-venom. Provide a clear description of the snake its color, markings, length, color of the belly, shape of the head, shape of the tail the reaction of the snake and geographic area.Know the symptoms of a snake bite and the appropriate treatmentTypes of Venomous Snake BitesThe danger from snake bites and the toxicity of venom that a snake injects in to its victimvaries from species to species. The recommended first aid for snake bites will also varyaccording to species and this underlines the importance of being able to place venomoussnakes in to groups according to the properties of their venom. The required treatment for asnake bite is defined according to whether the venom is cytotoxic, haemotoxic or neurotoxicand the wrong treatment will not only be of little or no help but could even be dangerous.CYTOTOXIC: An agent or process that is toxic to cells and suppresses cell function orcauses cell death.The venom from Adders and Vipers is Cytotoxic. Generally two puncture marks at the site ofthe bite. Bite causes instant pain with immediate swelling, bruising and blistering. Symptomscan include nausea and dizziness.Treatment:Immobilise the limb but do not restrict the blood flowHAEMOTOXIC: An agent or process that kills red blood cells and prevents clotting resultingin internal and external bleeding.The venom from Boomslangs and Vine snakes is Haemotoxic. Sometimes puncture woundscan be seen at site of the bite. Bite is generally not very painful but within one hour copiousbleeding is likely to occur from the bite wound and any other wounds cuts or scratches thevictim may have. Symptoms can include a severe headache, nausea and vomiting
3. Treatment:Whilst it is helpful to restrict the blood and lymphatic flow it is important not to causebruising as this could lead to subsequent bleeding under the skin. If Venom is spat in to aperson’s eyes use any liquid available, preferably a neutral one such as water or milk – butanything at all will do - and flush out the eye.NEUROTOXIC: An agent or process that is destructive or deadly to nerves or nervous tissueThe venom from Mambas and Cobras is Neurotoxic. Generally two puncture wounds at thesite of the bite. Bite can feel more like a sting and there is little or no bruising and swelling.Symptoms include feeling confused, dizziness, slurred speech, difficulty swallowing andbreathingTreatment:Immobilise the limb and do restrict blood flow between the bite and the heart. AdministerCPR until Medical help is available.Do’s and Don’ts of Treating a Snake BiteSymptoms usually manifest themselves reasonably soon after a snake bite so observation ofthe victim is extremely important. If no symptoms have occurred within less than half an hourof the bite then indications would be that it was not a venomous snake, it failed to inject anyvenom or the snake was very old and had little or no venom left.DO: • Try to identify the snake; colour, size, shape of head, attacking method are all useful. • Loosen the Victim’s clothing and, if necessary, move them in to the shade • Keep the victim calm and still; movement will increase blood flow and transport the venom to the heart much faster. • Immobilise the limb but do NOT restrict blood flow unless you are certain the bite was from a snake that delivers neu- rotoxic venom.
4. • Clean and dress the wound being careful not to apply pressure and cause bruising. • Be prepared to administer CPR if necessary. • Get the victim to a hospital as soon as possible • Remove jewellery, as swelling tends to progress rapidly. • If the bite is from a cobra or mamba (not an adder such as the puff adder) wrap a crepe or pressure bandage, a handkerchief or shredded cloth, firmly about 20cm above the bite. Never apply bands on either side of a joint such as above and below the knee or elbow. The purpose of the constricting band is to restrict lymph, not blood, flow and should be regularly checked and readjusted as the affected area starts to swell. • Wrapping a crepe or pressure bandage firmly around the area of the bite may help, especially in the case of a mamba or cobra bite. Cover the entire limb (from fingertip to armpit; from toe to groin) but take care that the bandage does not become too tight when the limb starts swelling. Apply hand pressure at the site of the bite until a bandage or strips of fabric can be obtained. • If a snake spits into a persons eyes, wash the eyes with large amounts of water, preferably by holding the persons head under a running tap. If water is not available, use any fluid (even urine) that • is not harmful to the eyes. • Observe the person and record the symptoms and the time they take to appear. • Other than keeping the person comfortable, nothing else is needed. Very occasionally the persons heart may stop if the venom has been injected intravenously. Proceed with heart massage and mouth-to-mouth breathing until a hospital can be reached.DO NOT:While there can be differences of opinion as to what we should do for snake bites theconsensus of opinion as to what not to do is reasonably consistent: • Allow the victim to exercise or stress themselves. • Cut the bite or attempt to suck the venom out. It will only damage tissue and cause the venom to spread through the body more quickly. Give the victim anything to eat or drink especially alcohol. • Apply a tourniquet. It can cause the loss of the limb. • Use potassium permanganate crystals or solution near or on the bite wound. • Use soapy water round the bite wound. • Leave pressure bandages on too long • Leave the victim alone. • Apply ice to the wound. • Soak the affected limb in any solutions • Use anti-venom except in a hospital environment. It may cause adverse or allergic reactions such as anaphylactic shock and delayed hypersensitivity (serum sickness).