Depends upon the amount of venom injected, site of bite (worse if on face or trunk), age (worse in children and the aged), physical activity after bite (in direct proportion) and the time lag between bite and the administration of anti-venom. Neurologic paralysis may progress despite anti-venom administration. Muscle strength may not return to normal for 4-6 weeks after recovery Effective anti-venom treatment should half the progression of local edema, and should reverse coagulopathy within 6 hours of administration.
Treatment
First Aid
A reassurance is often the most important part of treatment to the panicked patient.
Tie a tourniquet above the site of bite on the limn, using a handkerchief or long piece of cloth, not too tight –Just to occlude venous & lymphatic return.
Immobilize the limb with splint, because movements = more absorption.
if snake was poisonous, make a cruciate incision through the bite marks, and allow the blood to flow
Signs of Poisoning. Two Puncture marks, ¾-1 cm apart, should make you suspicious of poisonous snake bite. There are 2 types of Snake Poisons – Paralytic type and Hemolytic type. Paralytic type: Stage I: Ptosis. Stage II: Difficulty in Swallowing Stage III: Respiratory difficulty & paralysis. Hemolytic type: Local swelling around the bite, develops rapidly. Blood collectred in test tube does not clot. If no signs of poison
Tab CALMPOSE 1 stat (Diazepam = 4D-3 = to relieve anxiety)
Tab Disprin 1 stat (Analgesic = 3A-1)
Inj. T.T. ½ cc IM stat.
Reassure the patient.
Observe for 6 hrs. Watch for the 4 signs of snake poison – local swelling, ptosis, dysphagia and respiratory difficulty.
If signs of Poison are seen, A)Paralytic type: Act immediately if ptosis or dysphagia is seen. If you do not have A.S.V. take the patient quickly to a Hospital where A.S.V. is available. Remember that Respiratory paralysis is imminent.
inj. Decardan 2cc I.V. stat (steroid= 9A-2,3,5)
Inj. Avil 1 amp I.V. stat (Antihistaminic = 5B-1)
Inj. A.S.V. 1 to 4 vials, slow I.V. x after test does. Then 1 vial, every 15 or 30 mins. Till the signs start reversing (ASV- Polyvalent = 14-16i). A.S.V. vial contains powder. Dissolve in 10 ml. Distilled water. Inject ½ c I.V. as test dose. Wait for 2 mins. And watch for Urticaria. Then inject the full dose of A.S.V.
Endotracheal intubation and artificial respiraton with Ambu Bag – if respiratory paralysis.
-Give A.S.V. 1 vial every ½ hr. till respiration starts. A total of 10 to 15 vials may be required if respiratory paralysis has occurred. B)Hemolytic type: If there is local swelling around the area of the bite, First collect 1 cc blood in a test tube and see if it clots. If it doesn’t-
Inj. Decardron 2cc I.V. stat (9A-2)
Inj. Avil 1 amp I.V. stat (5B-I)
Inj. A.S.V 2-6 vials slow I.V. x A.T.D. x depending on the severity of local swelling.
-Repeat clotting time every 4-6 hrs.-Repeat Inj. A.S.V. 1 vial if local selling continues to increase.
Inj. A.S.S 1-2 ml locally around the site.
Elevate the leg, apply Thrombophobe ointment, and Give Magsulph compresses. Or If edema is minimal, apply Elastocrepe and remove the bandage – watch the skin - reapply every 6 hrs.
If edema becomes severe, skin becomes bluish black or if circulation to toes is impaired, then immediate faciotomy incisions must be taken to save the limb. In late cases, watch for Hematuria, urine output and bleeding from other sites. If Urine output reduces,
Reassurance, avoiding giving stimulants, IV fluids only for the first 24 hours, as many patients have nausea, and diarrhea due to increased GI smooth muscle contraction.
Inadequate Response
In the patients given inadequate amounts of antivenom, or delayed absorption of venom from a depot at the site of bite.
Prevention
Protective clothing in snake infested areas. Carrying a flash light when walking at night.
