The hospital I used to work in is situated near a rice field and the area has been known to have several sightings of snakes. One day, a distress call was made at the ER seconds after a one-year old child was brought in. The child was bitten by a snake just outside their house which is fronting the hospital. When I saw him, he was already unconscious without spontaneous breathing, but I could still hear faint heart sounds. He had two snake bite marks on his right leg, without swelling and bleeding. I noticed the tourniquet was applied 3 inches above the bite. I began to question why the child looked so terribly ill. Parents admitted that 3 hours had already passed from the time he was bitten before they rushed him to the hospital, because they first brought the child to a traditional healer. I intubated the child, gave respiratory support and emergency medicines, but I needed to transport him to a tertiary hospital where antivenom was available. The last thing I’ve heard, the child did not make it. It was too late.
Snakebites, although rare, should not be underestimated. A victim’s age does not affect the severity of snakebites, but size does. This is the reason why infants and children are more vulnerable to envenomation. However, not all snakes are poisonous. Non-poisonous snakes have narrow heads, smooth tapered bodies, no facial pits, rounded pupils, and double row of teeth. Pit vipers have arrow-head or triangular head, with facial pits between the eyes and nostril, vertical or elliptical pupils, and movable fangs. Lastly, cobras have the characteristic hoods, which spread when they are threatened.
It is very important to differentiate between the bite of a pit viper with that of a cobra because their treatments differ (Cobra antivenom is useless against venom of other poisonous snakes). In viper bites, the swelling is marked and extensive which may involve the whole extremity, associated with bleeding symptoms that can lead to shock. In contrast, cobra bites are characterized with burning pain in the bitten area that frequently radiates up the limb. Swelling is less intense than that of viper bites. There is dusky discoloration around the bite marks that extends and darkens. Victims of cobra bites usually present with rapidly progressive paralysis of muscles and cessation of breathing.
Although antivenom is the ultimate treatment for poisonous snake bites which is available only in hospitals, personal knowledge of how to deal with snake bites at the time and place of incident is just as important.
Here are some guiding principles in the initial management of snake bites.
#1. No incision should be made on the bite site. Manipulation of the bite site can introduce infection and delay healing, or may damage nerves and tendons.
#2. Do not apply an arterial tourniquet. If transport to a hospital with antivenom will take more than 30 minutes, apply an absorption delaying compression bandage (such as cloth/towels torn into strips or panty hose) around the limb and ON the bitten area. It should be as tight as one would bind a sprained ankle.
#3. If the bite is on the trunk, neck, and head, apply a firm pressure OVER the bitten area. Do not restrict chest movements.
#4 If venom enters the eyes (from a spitting cobra), patient’s head should be immersed in water and the patient should be told to blink. In doing so, venom will be quickly diluted with no further ill effects in most cases.
#5 During transit, the bitten limb should be moved as little as possible to minimize the spread of venom. Hence, the involved limb should be immobilized using splints.
#6 If possible, bring transport to the patient rather than vice versa to lessen movement of the body which could enhance spread of the venom.
#7 Bite wounds may be insignificant. Patients, most especially children who claim that they have been bitten, even in the absence of fang marks, should be believed.
Snakebites are rare, but its rarity must not make anyone complacent about it. For every patient who has been bitten, it is a matter of life and death. And doing the proper initial treatment at home could tip the balance toward a life-saving end and hopefully spare the life of the victim.