Life saving first aid tips for snake bites

POLOKWANE – Review spoke to snake catcher, Chris Burger, about what to do when you have an uninvited and scaly visitor at your camp site.

“Since people do not really know what snakes are venomous or not, all snake should be treated as if they are dangerous. The best plan to ensure snakes do not visit your campsite is to keep the area clean. Snakes eat rats and mice who are attracted to rubbish and food lying around the campsite. If you keep the campsite clean, there will likely not be any rats which will attract snakes.”

Other reasons why snakes might show visit your campsite is that you may be camping close to a river where there are frogs. Some snakes eat frogs or even birds which attract snakes.

Although it is not likely that slithering visitors will be aggressive and bite, it is still helpful to know what to do if they do happen to bite.

First aid for a snakebite:

• Withdraw from the snake to prevent another bite, and if possible try and identify the snake before it flees.
• Keep calm if you are the victim or else calm the victim. You need to help the victim and it is no good for them if you start to panic. The victim needs to be calmed and reminded that few people die as a result of a snakebite. This is a fact and must be stressed. Get the victim to sit or lie down and remove rings and other restrictive clothing or jewelry.
• Neurotoxic cobras: The venom is absorbed by the lymphatic system, so the less movement until proper first aid is in place, the better it would be as movement aids the flow of lymph fluid in the lymphatic system which spreads the venom. First aid could be an arterial tourniquet or pressure immobilisation.

See details below.

Pressure immobilisation: Apply a broad bandage and wrap from the distal to the proximal limb to occlude the lymphatic system and trap the venom bolus in the area of injection. It should be wrapped as tight as for a sprained ankle, and the limb should be immobilised. Note that both these conditions need to be met in order for this method to be effective. This is effective treatment for neurotoxic snake bites. It is not indicated for cytotoxic bites as it may aggravate this type of syndrome.

It does not work in the case of mamba bites as mamba venom is transported away from the bite site through the circulation.

• Mambas: The venom is absorbed by the capillary bed into the circulation, so restrict movement until first aid is in place. This is in complete contrast with what your natural reflexes will be – wanting to get help or away from the accident scene as soon as possible. First aid at this point is an arterial tourniquet only. See details below.

Tourniquet: Apply a broad bandage or ligature (50 mm) around the upper arm for a bite on the hand or forearm, and upper leg for a bite on the foot or lower leg. The tourniquet should be tight enough to prevent inflow and outflow of any blood. Make a note of the time you applied the tourniquet. Do not keep it in place for more than one and a half hours as permanent damage to the limb may be caused. Also note tourniquets are painful as all the blood and nerve vessels are compressed. Never use a tourniquet if you have identified the snake as an adder or spitting cobra.

• Cytotoxic bites – Adders: Movement in cytotoxic bites will aid in the spread of the venom from the injection site and thus minimise tissue damage, without increasing your risk of dying. Cytotoxic bites to the hands or fingers (puff adder, spitting cobra, stiletto snake or horned adder) can cause severe tissue destruction and it is recommended the bitten arm be elevated and that the hand and fingers be actively flexed and extended for about five minutes. This has the effect of spreading the venom away from the bite site causing the venom concentration to be diluted and reducing the amount of tissue damage to the delicate hand structures, without increasing the mortality rate. The reason why this measure would not affect mortality is because peak envenomation occurs many hours (12 to 24 hours) after the bite by which time the patient would already be hospitalised. This method can also be used for other bites with mixed syndrome of Painful progressive swelling and Progressive weakness like rinkhals, berg adder, garter snake and shield-nosed snake. Mortality would be increased if this measure was used with non-spitting cobras, as the venom is transported lymphatically. Contra-indicate for mamba bites.
• Transport the victim to a hospital as soon as possible, do not wait or waste time.
• If you are a first aid helper, monitor vital signs and prepared to assist a victim of snakebite with progressive weakness by placing the victim in a coma position, oral suction to remove saliva or vomit, artificial respiration if breathing fails and cardiopulmonary resuscitation (CPR) if the heart fails.

First aid for spitting snake:

• Step away from the snake and turn your head to receive any additional spray on the cheek.
• Keep your hands away from your eyes. Do not rub your eyes. This is the most difficult, as you want to instinctively rub your eyes because of the pain.
• Wash the eyes out with water as soon as possible. Also wash around the eyes as venom might have landed on the face and can be transferred into the eyes. If you have a water bottle with you, take the top off, place one eye on the mouth of the bottle and throw your head back, while holding the bottle to your eye. Open the eye and let the water wash through the eye. Repeat for the other eye. Keep on washing the eyes for up to 20 minutes. You can use any bland solution that will not harm the eye like beer, cold drink, milk or urine. There is no truth in the statement that milk is the best treatment. One ampule of adrenaline per 100 ml saline infusion can be used to wash eyes out and are very effective.
• You can use anesthetic eye drops to ease the pain in the eyes. This may be used before washing the eye as it eases the pain and makes it easier to irrigate the eyes.
• Fluorescein staining and slit lamp examination of the eyes must be done by an eye doctor.
• If there are no corneal erosions, use antibiotic ointment in the eye to prevent bacterial infection.
• Protect the eyes from bright light by wearing sunglasses for a few days or staying indoors.
• If corneal erosions are present, use antibiotic eye drops, mydriatic, eye pad and daily slit lamp examination until condition is resolved.

Venom in the eyes is not life threatening and no antivenom is needed.

maretha@nmgroup.co.za