WildlifeCampus Game Ranging Course

First Aid for Snake Bite WildlifeCampus

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Module # 11 Component # 4




Basic First Aid for Snake Bite
Envenomation

Objectives

The aim of this component is to provide the student with a concise and
rational approach to the diagnosis, treatment and patient management of
a person who has experienced snake bite envenomation.

Expected Outcomes

To reassure your guests that the chances of
encountering a medically venomous snake when walking
through the bush are negligible.

To account for the occurrence of most snake bites.

To be able to ascertain whether a person has actually
been bitten.

To be able to ascertain whether envenomation has
actually taken place.

To be able to describe the correct procedure for the
management of a snake bite victim.

To be able to list the symptoms of eye envenomation.

To account for the specific species responsible for each
type of envenomation, whether it be Cytotoxic,
Neurotoxic or Haemotoxic.

To be able to describe the symptoms for each type of
envenomation.

To list the peculiarities of a berg adder bite.
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IMPORTANT NOTE



IN ORDER TO QUALIFY FOR COMPLETE FGASA & THETA
ACCREDITATION, A FULLY RECOGNISED AND COMPREHENSIVE
FIRST AID COURSE MUST BE COMPLETED BY THE STUDENT.
CONTACT EITHER THE RED CROSS OR YOUR LOCAL HOSPITAL FOR
DETAILS.


However, in addition to this all Field Guides must be fully competent to
recognise and treat all forms of envenomation (bites or stings received
from animals).

This component will cover the basics of dealing with snake bites.

Insect, arachnid and other arthropod envenomation will be dealt with in
the following component.

Introduction


Bites and stings by venomous animals have the potential to cause
serious local effects and system wide toxic effects. Injuries caused by
venomous animals can be divided into four categories:

Local mechanical injury
Local and systematic effects
Hypersensitivity (allergic reactions)
Infection


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First Aid for Snake Bite WildlifeCampus
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Snake Bite


Snake bite is perhaps the most feared of all injuries that may befall
people when out in the bush. The fact that most people have an
instinctive fear of snakes certainly contributes to this. However, as has
been previously discussed (Module # 4, Component # 3), only 10 % of
South Africas rich diversity of snakes are venomous to the degree of
being potentially dangerous. Recent statistics indicate that only a small
fraction of those bitten are likely to die (1%) and this is mainly due to the
fact that either no, or the incorrect, treatment was administered.


Prevention


In our earlier discussion on snakes, it was already mentioned that all
snakes have a more instinctive fear of us than we do of them. When
snakes are encountered in the field, guides should always make a
concerted effort to avoid them. Snakes do not as a rule view humans
as a prey species. The vast majority of snake bites occur when the
snakes are tormented, handled or put into a position (deliberately or
inadvertently) where they may view biting as their last option of
defence.


As you will recall from Module # 2, Component # 3, all medically
important snakes have been divided up into three groups on the basis of
the effects of their venom. These are

Cytotoxic
Neurotoxic
Haemotoxic


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Procedure when a Bite Occurs


Certain steps must be followed by the field guide if it is thought that a
snake bite has occurred.

1. Decide whether that victim has actually been bitten by a snake.

2. Decide whether envenomation has actually occurred, (remember only
10 % of South African species are venomous).

3. Provide basic life support in cases of severe envenomation. This should
only become necessary if the introduction of anti-venom is delayed, or
if the victim is hypersensitive.

4. Provide general support and symptomatic support (ONLY IF QUALIFIED
TO DO SO).

5. Arrange for immediate removal of the patient to a proper medical
facility for anti-venom administration.

6. DO NOT ATTEMPT TO ADMINISTER ANTI-VENOM YOURSELF
UNLESS YOU HAVE BEEN SPECIFICALLY QUALIFIED TO DO SO !!!

7. However if the victims removal is delayed, and anti-venom (snake bite
kit) is available, administer the anti-venom. Anyone that carries a
snake bite kit should be thoroughly trained in its use.
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1) Has the Person been Bitten?


The victim or another witness may be able to verify that the bite has
taken place.
Look for bite marks. These are usually present, but may occasionally be
difficult to locate. Where present, typically two puncture wounds are
seen 10 20 mm [ in] apart.
The victim might be in shock.
Initiate a cursory search of the immediate area in order to establish the
identity of the snake. This will be helpful in the subsequent treatment of
the victim.
DO NOT UNDERTAKE ANY HEROIC MEASURES IN IDENTIFYING
THE SNAKE. THIS WILL ONLY LEAD TO ANOTHER VICTIM OF
SNAKE BITE.


2) Has envenomation occurred?

General clinical features of envenomation include:
- Fear and anxiety
- Pain and / or numbness, swelling around the bite and local tissue
damage (Specifically in Cytotoxic bites)
- Weakness, nausea, vomiting, sweating and thirst.


3) Basic Life support, general support and evacuation.


The specifics of these procedures lie outside of the scope of this course and
are not included in the practical course. It is absolutely essential
that the basic skills of first aid are acquired. The location of where
you find employment should have basic procedures in place to deal with
emergency evacuation of casualties. MAKE SURE THAT YOU
FAMILIARISE YOURSELF WITH THESE PROCEDURES AS SOON AS
POSSIBLE.

The following section is a presentation of the first aid measures
required for the management of snake bite. It is stressed that this is not a
suitable substitute for formal training. It is the absolute responsibility of
the student to attain a formal first-aid qualification.
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Management of a snake bite victim

Follow the steps commonly known as:
S. Safety
A. Airway
B. Breathing
C. Circulation

Make sure that there is no danger to yourself before attempting to
assist the victim.
Make sure that there are no obstacles to breathing for the victim. Eg. A
blocked airway.
Ensure that the victim is able to breathe easily.
Perform CPR (Cardio-pulmonary resuscitation) if necessary.
Expose the area of the bite by cutting away overlying clothing.
Wipe away any excess venom from the skin, using plenty of water.
Cover the wound with a sterile dressing.
Keep the victim calm and discourage movement.
Remove rings or other items that may restrict circulation in the
proximity of the wound.
DO NOT squeeze or cut into the wound.
DO NOT apply any local remedies.
DO NOT attempt any electric shock treatment, as it is of no value.
Suction of the wound may only be attempted if one is in possession of
the correct apparatus Eg. Aspivenin. DO NOT ATTEMPT TO SUCK
OUT THE VENOM WITH YOUR MOUTH.
If a Neurotoxic or Haemotoxic bite is suspected, apply a crepe
bandage as tightly as possible, as for a sprain, over the site of the
bite and extend the bandage to cover the whole limb, with the
exception of the digits. The bandage causes the collapse of local
lymphatic drainage reducing the absorption of venom into the blood
stream. It should not be so tight that it causes swelling or pain.
DO NOT apply a crepe bandage in the case of a Cytotoxic snake bite.
An arterial tourniquet may ONLY be applied for Neurotoxic and
Haemotoxic envenomation, IF medical assistance is several hours
away. Release and reapply the tourniquet every half hour.
Immobilise the affected area (arm or leg) with a splint or sling.
DO NOT let the victim drink if there is any difficulty in swallowing.
With cytotoxic snake bite, maintaining body fluid is important in
reducing the risk of shock.
Monitor breathing and other vital signs continuously.
ARRANGE FOR IMMEDIATE REMOVAL OF THE VICTIM TO
HOSPITAL.


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Eye Envenomation


The Rinkhals and spitting cobras are able to spray or spit their venom
up to a distance of three meters [10 ft]. They are not specifically very
accurate, rather generating a fine aerosol spray in the general direction
of their aggressor. Only one droplet is sufficient to cause all of the
symptoms listed below.

Symptoms of eye envenomation

Immediate and severe burning pain
Swelling
Impaired vision
Disorientation
Itching



Treatment


Rinse the eyes immediately with copious amount of water.
Other types of bland liquid like milk, fruit juice or soft drinks may also
be used. DO NOT use alcohol in any form. Urine may be used in the
absence of anything else.
Continue to rinse for 15 to 20 minutes.
DO NOT rub the eyes.
If available, apply local anaesthetic eye drops.
Cover with an eye pad
ARRANGE IMMEDIATE REMOVAL OF THE VICTIM TO HOSPITAL.

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Cytotoxic Snake Bite


Snakes that are responsible for this type of envenomation include:

Major Bites
Puff adders
Gaboon adders
Spitting cobras
Rinkhals (some sources report their bite to be neurotoxic)

Minor Bites
Horned adders
Night adders
Berg adders


Symptoms of a Cytotoxic bite


An immediate, local and intense pain at the site of the bite.
Marked swelling that gradually becomes pronounced.
Subcutaneous tissue necrosis (the tissue around the bites dies and
changes colour).
Swelling may involve the entire limb.
Substantial fluid loss may lead to circulatory failure.
An irregular heart beat has been reported in Gaboon adder bites.
Where the bite is considered minor, the effects may be similar, but
reduced.


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Neurotoxic Snake Bites


Snakes responsible for this type of envenomation include:

Black mamba
Green mamba
Cape cobra
Forest cobra
Egyptian cobra
Berg adder (discussed separately)


Symptoms of a Neurotoxic bite


Pain at the site of the bite.
Varying degree of minor local swelling
The affected area may have a blue discolouration.
Bite victims may present with a combination of drowsiness, vomiting,
hyper-salivation, sweating and trembling.
After 30 to 120 minutes, victims may also begin to exhibit blurred or
double vision, dilated pupils, slurred speech and difficulty in
swallowing.
Within 1 3 hours, victims will begin to experience progressive
respiratory muscle paralysis which ultimately leads to respiratory
failure the most serious effect of Neurotoxic envenomation.
The stiletto snake, or burrowing asp species, is also a common cause of
neurotoxic envenomation but not with life threatening symptoms. These
bites are commonly characterised by a single fang penetration.

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Berg adder bite


The envenomatory effects of a bite from this species are very distinctive
in that its venom is both Cytotoxic and Neurotoxic. Symptoms of berg
adder bites include:

Loss of eye movement
Loss of sense of taste and smell
Selective paralysis of some cranial nerves
Difficulty in swallowing.
Respiratory failure.

Envenomation by berg adder bite is not generally considered life
threatening. However, if introduced in sufficient quantities it might become
so. In addition the loss of taste and smell may persist for up to 12
months and more.




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Haemotoxic Bites


Snakes responsible for this type of envenomation include:

Boomslang
Vine snake


Symptoms of a Haemotoxic bite


The effects of a Haemotoxic bite revolve around the fact that the venom
depletes the necessary blood compound (fibrinogen) that enables blood
clotting. The venom is also responsible for breaking down internal blood
vessels.

Minimal swelling at the bite site.
Oozing of uncoagulated blood from the bite site.
Victims may also experience lethargy, headache, confusion,
sweating, nausea and vomiting.
After 12 36 hours victims may begin to present with bleeding from
some or all orifices.
The condition (if untreated) may then rapidly deteriorate into multiple
organ failure.

In almost all cases anti-venom is required to treat cases of boomslang
envenomation. It may therefore be necessary to transport the anti-venom
to the victim. If this is the case contact the South African Vaccine
Producers immediately on:

011 386 6000 [office hours] or 011 386 6078 [after hours]