Snake Bite

Clinical Description

Venom diffuses mainly via the lymphatics, not via Blood vessels, tourniquets are thus of little use

FIRST AID TREATMENT

• Clean the wound with Cetrimide + Chlorhexidine solution 15% 1.5% diluted 1 in 20 with water

Alternatively

• Clean with Hydrogen Peroxide Solution 3%
• Apply film constant pressure to the site of the bite
• Apply a crepe bandage firmly to the entire limb
• Immobilize the patient for 12 hours observation
• Give reassurance

Note: Not all patients with snakebite should be given Anti-venom Administration of Snake Anti- venom

• Ensure that the Anti-Venom Solution is clear
• Give 0.5 ml of Adrenaline 1/1000 subcutaneously if needed
• Give 100 ml of the Polyvalent Antivenom as an iv infusion, diluted in 300 ml of Normal

Saline

Children

• Dilute in 0.4 ml/kg of Saline
• Give the infusion slowly for the first 15 minutes (most reactions within this period

Occur Thereafter increase the rate gradually until the whole infusion is completed within 1 hour

If there is a history of allergy:

• The patient may still need to be given anti-venom because of systemic poisoning, but take particular care

If a reaction occurs:

• Hydrocortisone may need to be administered in addition to Adrenaline
• Give an antihistamine: Give Promethazine 25 mg 24 hourly
• If there is no clinical improvement by the end of the infusion:
• Repeat the same dose as above

Note: Reserve Polyvalent Snake Anti – venom (anti-snakebite serum) for patients with one or more of these signs and symptoms:

• Hypotension
• Vomiting
• Neurotoxicity
• Haemotoxicity

SUPPORTIVE THERAPY

Give reassurance - most snake bites are not dangerous

• Treat shock if any (see Section 5.1.1)

Children > 6 months:

• manage in accordance to ABCCCD approach
• give adequate analgesia
• give maintainance IV fluids
• Give Tetanus Toxoid Vaccination (Section 12.3) If patient is developing signs of tetanus:
• Give Tetanus Antitoxin (ATS) 1,500 IU s/c or IM
• Only give antibiotics if evidence of necrosis, no indication for prophylactic antibiotics
• Eventually excise sloughs and graft skin early
• If evidence of compartment syndrome refer to the surgical team for fasciotomy