First Aid in Snakebite

1	Courtesy:Snakebite Research Unit Little Flower Hospital,Angamali  Reassure the victim
	Calm the victim down. Un-necessary panic will only raise the pulse rate and blood pressure and moves the venom into the system faster. Tell the victim that 70% of snakebites are from non-poisonous species. Of the remaining 30%, only half will actually involve injecting venom. The chances are they are OK!
2	Immobilise the bitten limb without compression.
	If the bite is on a hand or arm place it in a sling bandage or use a piece of cloth to support the arm. In the case of a leg bite, use a splint to support both legs and bandage them together. Do not tie the bandages tightly, we are only trying to immobilise not apply any pressure.
3	Get the patient to Hospital as fast as safely possible.
	Don’t waste time washing the wound, seeking traditional remedies or applying any drugs or chemicals to the victim. Science has shown that traditional remedies do not work and simply waste valuable time. Snakestones do not absorb venom and many herbal remedies make the situation worse. Keep the patient as immobile as possible.
4	Tell the Doctor any of the following signs appearing on the way to the hospital.
	The Doctor will want to know if any of the following signs or symptoms are noticeable on the journey to the hospital: Difficulty breathing. If the patient stops breathing, give artificial respiration. In Cobra and Krait bites this will save the victims life. Drooping eyelids Bleeding from the gums or any unusual bruising appearing. Increases in any swelling. Carry a pen and mark the limit of the swelling every 10 minutes or so Drowsiness Difficulty speaking Bleeding from the wound that does not seem to stop   Do it R.I.G.H.T.
	Common Mistakes
	There will be many who wonder where the tourniquet or compression bandage has gone, surely we must tie a ligature to stop the venom spreading. Others will be wondering why we don’t cut the wound to let some of the venom out. It is important in India that we address these two common actions to see if they benefit or potentially cause harm to the victim.
	Tourniquets and Ties
	Tourniquets or compression bandages have the following drawbacks: 1. The majority of the Indian venomous snakes have venom that contains toxins that do serious local damage at the bite site. This is true of all vipers and the Cobras. This toxin breaks down tissue and destroys it. Confining this toxin in a smaller area, by use of compression techniques creates a greater risk of serious local damage. 2. Compression bandages are based on research that was carried out in Australia in the 1970’s. This research appeared to show that venom could be slowed down by the use of a compression bandage with an integral splint. The version that gets used in India, without the splint, is a local hybrid. The problem with the research was it was done on animals, not humans. Also it is not used currently in the majority of snakebite cases in Australia. The author also concluded that immobilisation with the splint alone or compression bandaging alone would be ineffective.  3. When the tourniquet is removed there is the problem of the venom rapidly entering the system and causing respiratory failure in the case of neurotoxic bites. Unless the doctor is aware of this syndrome and, more importantly equipped to deal with it, death can occur. 4. In the case of Viper bites, tourniquets are also a risk. The Viper’s venom contains pro-coagulant enzymes which cause the blood to clot. In the small space below the tourniquet the venom has a greater chance of causing a clot. When the tourniquet is released the clot will rapidly enter the body and can cause embolism and death. 5. Lastly, there has been a great deal of research showing that tourniquets DO NOT stop venom from entering the body. One study demonstrated that 33% of victims tested, experienced systemic symptoms whilst the tourniquet was still in place!
	Cutting the Wound
	Cutting the wound to let blood and some venom flow out is also a common practice that is wrong. Cutting and bleeding does not release venom from the wound, by the time the cut is made the venom is already mixed.The more critical problem is that, apart from the risk of infection, bites by Vipers cause the blood to be incoagulable i.e. it will not clot. Cutting the victim makes it more likely that the person will bleed to death!