First Aid

First Aid

1. Keep the person calm, reassuring them that bites can be effectively treated in an emergency room. Restrict movement, and keep the affected area below heart level to reduce the flow of venom.

2. If you have a pump suction device (such as that made by Sawyer), follow the manufacturer's directions.

3. Remove any rings or constricting items because the affected area may swell. Create a loose splint to help restrict movement of the area.

4. If the area of the bite begins to swell and change color, the snake was probably poisonous.

5. Monitor the person's vital signs -- temperature, pulse, rate of breathing, and blood pressure -- if possible. If there are signs of shock (such as paleness), lay the person flat, raise the feet about a foot, and cover the person with a blanket.

6. Get medical help right away.

7. Bring in the dead snake only if this can be done safely. Do not waste time hunting for the snake, and do not risk another bite if it is not easy to kill the snake. Be careful of the head when transporting it -- a snake can actually bite for up to an hour after it's dead (from a reflex).

8.Immobilise the bitten limb with a splint or a sling (any movement or muscular contraction increases absorption of venom into the bloodstream and lynphatics.

9.Avoid any interference with the bite wound as this may introduce infection, increase absorption of venom and increase bleeding.

DO NOT

* DO NOT allow the person to become over-exerted. If necessary, carry the person to safety.
* DO NOT apply a tourniquet.
* DO NOT apply cold compresses to a snake bite.
* DO NOT cut into a snake bite with a knife or razor.
* DO NOT try to suck out the venom by mouth.
* DO NOT give the person stimulants or pain medications unless a doctor tells you to do so.
* DO NOT give the person anything by mouth.
* DO NOT raise the site of the bite above the level of the person's heart.
* DO NOT make local incisions or punctures at the site of the bite or in the bitten limb.
* DO NOT use (black) snake stones.
* DO NOT give electric shock, topical instillation or application of chemicals, herbs and ice packs.

Aims of first aid

attempt to retard systemic absorption of venom

preserve life and prevent complications before the patient can receive medical care (at a dispensary or hospital)

control distressing or dangerous early symptoms of envenoming

arrange the transport of the patient to a place where they can receive medical care (5.2)

ABOVE ALL, DO NO HARM!


The special danger of rapidly developing paralytic envenoming after bites by some elapid snakes: use of pressure-immobilisation

Bites by cobras, king cobras, kraits or sea snakes may lead, on rare occasions, to the rapid development of life-threatening respiratory paralysis. This paralysis might be delayed by slowing down the absorption of venom from the site of the bite. The following technique is currently recommended:

Pressure immobilisation method Ideally, an elasticated, stretchy, crepe bandage, approximately 10 cm wide and at least 4.5 metres long should be used. If that it not available, any long strips of material can be used. The bandage is bound firmly around the entire bitten limb, starting distally around the fingers or toes and moving proximally, to include a rigid splint. The bandage is bound as tightly as for a sprained ankle, but not so tightly that the peripheral pulse (radial, posterior tibial, dorsalis pedis) is occluded or that a finger cannot easily be slipped between its layers.

* Pressure immobilization is recommended for bites by neurotoxic elapid snakes including sea snakes but should not be used for viper and cobra bites because of the danger of increasing the local effects of the necrotic venom.

*Ideally, compression bandages should not be released until the patient is under medical care in hospital, resuscitation facilities are available and antivenom treatment has been started.

*The use of a local compression pad applied over the wound, without pressure bandaging of the entire bitten limb, has produced promising results in Myanmar and deserves further study.

Transport to hospital

The patient must be transported to a place where they can receive medical care (dispensary or hospital) as quickly, but as safely and comfortably as possible. Any movement, but especially movement of the bitten limb, must be reduced to an absolute minimum to avoid increasing the systemic absorption of venom. Any muscular contraction will increase this spread of venom from the site of the bite. A stretcher, bicycle, cart, horse, motor vehicle, train or boat should be used, or the patient should be carried.