Snake Bites

Snake bites are a potentially life-threatening medical emergency caused by the injection of venom into the body by a venomous snake. The clinical presentation and severity of symptoms depend on the species of snake and the amount of venom injected. Prompt recognition and appropriate management are essential for the successful treatment of snake bites.

Case

A 35-year-old male presented to the emergency department with complaints of severe pain, swelling, and discoloration at the site of a snake bite on his right foot. The patient reported that he was walking in a forest when he accidentally stepped on a snake. He was unable to identify the snake species but reported that it was brown in color and approximately 4 feet in length.

Pathophysiology:

Venomous snakes inject venom through their fangs, which are specialized teeth located in the front of their upper jaw. Venom is a complex mixture of enzymes, toxins, and other bioactive molecules that can cause a variety of effects on the human body. The specific effects depend on the composition of the venom and the amount injected.

Signs and Symptoms

The signs and symptoms of a snake bite can vary widely depending on the snake species and the amount of venom injected. Common symptoms include:

• Severe pain at the site of the bite
• Swelling and discoloration of the affected area
• Nausea and vomiting
• Headache
• Dizziness and weakness
• Blurred vision
• Difficulty breathing
• Paralysis
• Cardiac arrest

Investigations:

The diagnosis of a snake bite is primarily based on the patient’s history and physical examination. Identification of the snake species can be helpful in determining the appropriate treatment. Laboratory tests, such as complete blood count, coagulation profile, and serum electrolyte levels, may also be ordered to monitor for complications.

Treatment:

The treatment of snake bites involves a multi-pronged approach, including:

• Immobilization: The affected limb should be immobilized and kept at the level of the heart to slow the spread of venom.
• Anti-venom therapy: Anti-venom is the specific treatment for venomous snake bites. It is made from antibodies that neutralize the venom and prevent it from causing further damage. The appropriate anti-venom should be used based on the snake species involved.
• Pain management: Pain relief can be achieved with non-steroidal anti-inflammatory drugs (NSAIDs), opioids, or local anesthetics.
• Supportive care: Patients may require additional supportive care, including intravenous fluids, oxygen therapy, and respiratory support.
  Tetanus prophylaxis: Tetanus immunization status should be assessed, and tetanus toxoid should be administered if necessary.

Dos and Don’ts:

In the event of a snake bite, it is essential to follow the following dos and don’ts:

• DO stay calm and immobilize the affected limb.
• DO seek medical attention immediately.
• DO provide the medical team with information on the snake species if possible.
• DO NOT attempt to suck out the venom or use a tourniquet.
• DO NOT apply ice or cold compresses to the affected area.
• DO NOT cut the wound or attempt to remove the venom.

References:

Warrell, D. A. (2010). Guidelines for the management of snake-bites. World Health Organization. https://www.who.int/bloodproducts/animal_sera/African%20region%20guideline.pdf

Kasturiratne, A., Wickremasinghe, A. R., de Silva, N., & Gunawardena, N. K. (2008). Pathophysiology of snakebite-induced acute kidney injury. Kidney International, 74(7), 948-952.