Snake Bites

In the UK approximately 100 people are envenomated by a snake each year.

So what do you need to do if your patient has received a venomous bite from a snake? (not the classic UK cocktail).

  • Don’t Cut & Suck!
  • Treat what you see 
  • Call Toxbase

Symptoms/signs

  • 70% patients have LOCAL symptoms only:
    • Pain – immediate sharp pain (can take unto 30min to develop)
    • Tingling/Paraesthesia – can develop later
    • Swelling/Inflammation – local and regional lymph nodes
      • This may be mistaken for cellulitis initially
      • Over 24hrs, may develop bruising, erythema alone lymphatics, whole limb swelling (possibly whole body)
  • 30% patient have SYSTEMIC symptoms:
    • Severe Anaphylactoid reaction – often within 5min of bite (but may be delayed by hours)
      • Angioedema, bronchospasm, tachycardia, lsweating/fever, light headed, D+V, abdo pain
      • Can fluctuate over 48hr
    • Generalised Oedema – can be fatal, affecting, airway, lungs, brain etc..
    • Hypotension – can be life threatening, will normally develop within 2hrs
    • Bleeding – Unusual but can be fatal (may present with bleeding gums, wounds, lungs, GIT)
    • Acute Kidney Injury – especially children
    • Rhabdomyolysis
    • Decending paralysis – can start with ptosis and progressing to respiratory muscle paralysis
  • Deaths – in the UK its not likely 14 deaths since 1876, and last death 1975

Non-Venoumous Snake bites

  • Often present with local sharp pain, and swelling
  • Look for tooth fragment
  • Remember Snakes have significant material load (so antibiotic and tetanus cover)

Treatment – See Toxbase.org

Anti-venom use will be directed by the NPIS(toxbase) consultant – 0344 892 0111

They will need some information to aid their decision making (call early):

  • Snake species – Ideally latin name (english names can cover several species) – Can send a photo to NPIS if you have one
  • History/Exam – time, site, local and systemic signs/symps, lymph node involvement
  • Investigations – FBC, Blood Film, Coat Screen, D-Dimer, U&E, CK, Urine dip, ECG

General Treatment

  • DON’T CUT & SUCK!!!
  • ABC’s
  • Analgesia
  • Treat Anaphylaxis – Treat early
  • Ventilation – intubate early if developing depending paralysis
  • Beware Surgeons! – you can be misled into a diagnosis of compartment syndrome. Beware, on measuring pressures are often normal, and fasciotomy prior to correction of coagulation may be fatal.
  • Tetanus IgG
  • Antibiotic cover
  • Look for tooth fragments
  • Admit –  for at least 24hr

 

Snake identification

 

Useful Links

 

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