About Snake Bite :
Snakebite is basically an injury caused by the bite of the snake. While any snake bite can be dangerous and some snakes are very poisonous, a snake bite can result in serious tissue damage at the site of the bite. If the right anti-venom is administered quickly and on time to the patient, it can save the person’s life. This article deals with how snake bite is treated and what the complications are.
How is Snake Bite Treated?
As snakebite is an emergency, it is essential to know how snakebite is treated.
There are mainly two types of treatment for snakebite:
Emergency Treatment at the Site: It is important to get or provide emergency treatment as soon as a snake has bitten. Immediately call on 911, the emergency number
Additionally, the following things need to be done:
- Note down the time of the bite
- Stay calm and still and do not walk
- Remove clothes which are constricting and any jewelry to make the person feel comfortable
- If you cannot go to the hospital, apply first aid by lying down with the site of bite below the level of the heart. Wash the area with soap and water and then cover the area with the clean and dry dressing.
- Try to remember the shape and the color of the snake which helps to identify the snake and start on with immediate treatment.
- Don’t try to catch or hunt for the snake, or to wait for the symptoms to appear.
- Don’t drink alcohol or beverages, or avoid trying to suck the venom out as it may be very dangerous.
Studies have shown that applying pressure bandages can reduce systemic toxicity but can increase the risk of local ischemia, which can result in destroy the local tissues.1 As the use of local bandages depends on the circumstances and the nature of the venom, hence is best decided by an expert to avoid complications.
Stabilization and Supportive Care:
Snakebite is known to be an occupation hazard for farmers and outdoor workers, the rate of morality being high across the globe.2 Hence, apart from first aid, proper treatment for snake bite is necessary to save life and prevent complications.
The second phase of the way in which snakebite is treated includes giving stabilization and supportive care to the patient by the administration of antivenin depending on the snake species and a tetanus booster vaccine. Certain patients may also require the need for hospitalization in case of emergency. In case of non-venomous snake bite, secondary care would be provided by treating the local wound site by removing the teeth of the snake if left inside the skin. Some wounds may also require additional treatments including antibiotics.
What are the Complications of Snakebite?
Snakebite complications can range from mild to severe. It is necessary to know what the complications of snakebite are. Complications mainly include pain and swelling at the site of snakebite, vision damage occurs when the venom spreads into the eyes. Compartment syndrome can occur causing localized swelling which can destroy or damage nerves and blood vessels leading to necrosis, infections, loss of limb, gangrene, internal bleeding, sepsis, cardiac damage, and respiratory compromise and can cause even death if venom spreads in the blood. Coagulopathy is a major and frequent complication caused by the pit viper snakebite.
Some complications also include skin loss, cardiovascular complications, hematologic complications, and also pulmonary collapse. Neurotoxicity along with myokymia of the respiratory muscles can cause respiratory failure and also mechanical ventilation. True compartment syndrome is found to be a very rare complication of the snake bite. Death may also occur but in rare conditions. Tissue death around the area of the bite, severe allergic reactions, kidney failure is also noted in some cases.
Coral snakes can cause a prolonged neuromuscular blockade. Antivenin associated complications are many which may include immediate action with anaphylaxis type-I and delayed serum sickness type-III, and also hypersensitivity reactions. Anaphylaxis is mainly an event mediated by immunoglobulin E (IgE), which involves mast cell degranulation causing laryngospasm, vasodilatation and very leaky capillaries. Serum sickness may occur 1-2 weeks later after administering antivenin. Antigen immunoglobulin G (IgG) complicates the precipitation in skin, joints, and kidneys which is responsible for Arthralgias, Urticaria, and Glomerulonephritis. Supportive care usually consists of Anti-histamines and steroids. Lower incidence of acute hypersensitivity reactions with CroFab is noted.
The devastating effects of venom such as bleeding, kidney failure, diathesis tissue necrosis, and also neurotoxicity are also some related complications of snakebite. Some patients also experience migraine-like symptoms such as headache and vertigo and also photosensitivity to sunlight. Disorders which are related to musculoskeletal structures are pain, muscle weakness, swelling, contractures, deformities, and amputations. Acute kidney injuries, skin blisters, visual impairment, psychological distress, hemiplegia, right-side facial nerve palsy, paresthesis over the site of snakebite, body shivering, chronic non-healing ulcers are some other complications which are noted in some other patients. Some other complications also include non-specific somatic symptoms like abdominal colic, wheezing, chest tightness, body aches, receding gums, and excessive hair loss.
There are some more complications which are associated with hemotoxic snakebite that can occur from the area of snakebite, mucosal membrane, to the serous cavities, and organs mainly include life-threatening conditions like acute kidney failure, (ADRS) acute respiratory distress syndrome and acute lung injury (ALI), capillary leak syndrome (CLS), and disseminated intravascular coagulation (DIC).The mortality rate is usually high with complications like ADRS and CLS. Hemotoxic snake bites are the major cause of mortality and morbidity in India and these species includes Russell’s viper and various pit viper species.
The nervous system is mainly affected by the venom of the Elapids and sea snakes. Muscle death can occur in multiple areas of the body from the venom of Russell’s viper, sea snakes and some of the Australian Elapids. Sudden death can occur even before reaching the hospital due to the stopping of breathing mainly from the venom of Cobras and Mambas.
When compared to hemotoxic snake bites, Elapidae bites are mostly related to multi-organ involvement. Many of the long-term complications, which are mainly related to the hemotoxic snakebites include amputations and limb deformities, osteomyelitis, hypopituitarism, squamous cell carcinoma at the sites of non-healing ulcers, sequelae of an acute coronary syndrome-like dysfunction of the left ventricle and strokes like limb weakness or cognitive impairment.
In some cases, snakebite, the local vascular complications of the area of snakebite are mainly treated by the use of streptokinase and this form of therapy was widely used in most of the thrombo-embolic conditions.
Thus, now that you are aware of snakebite, how it is treated and its complications, you can take appropriate steps, if needed.