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Things You Should Never, Ever Do If You’re Bitten By A Venomous Snake

Snakebite Overview

Snakes are remarkable animals, successful on land, in the sea, in forests, in grasslands, in lakes, and in deserts. Despite their sinister reputation, snakes are almost always more scared of you than you are of them. Few snakes, with the occasional exception of king cobras (Ophiophagus hannah) or black mambas (Dendroaspis polylepis), act aggressively toward a human without provocation.

Snakes have no limbs, yet all are meat eaters. They catch prey that includes insects, birds, small mammals, and other reptiles, sometimes other snakes. Only about 400 of 3,000 snake species worldwide inject venom (a poison). Many snakes catch their prey by constriction. In constriction, a snake suffocates its prey by tightening its hold around the chest, preventing breathing or causing direct cardiac arrest. Snakes do not kill by crushing prey. Some snakes grab prey with their teeth and then swallow it whole.

Snakes are cold-blooded. Thus, they are unable to increase their body temperature and stay active when it is cold outside. They are most active at 25-32°C (77-90°F).

  • How snakes bite: Snakes that inject venom use modified salivary glands. Venom is a modified form of saliva and probably evolved to aid in chemical digestion. Varying degrees of toxicity also make it useful in killing prey. During envenomation (the bite that injects venom or poison), the venom passes from the venom gland through a duct into the snake’s fangs, and finally into its prey. Snake venom is a combination of numerous substances with varying effects. In simple terms, these proteins can be divided into 4 categories:
  • Whom snakes bite: It has been estimated that up to 1.8 million snakebites occur worldwide each year, causing between 20,000 and 94,000 deaths. Snakebites are more common in tropical regions and in areas that are primarily agricultural. In these areas, large numbers of people coexist with numerous snakes. About 5 deaths occur per year from snakebites in the United States. People provoke bites by handling or even attacking snakes in a significant number of cases in the U.S. Of the estimated 45,000 snakebites per year in the U.S. about 8,000 are by venomous snakes.
  • Which snakes bite: Two major families of snakes account for most venomous snakes dangerous to humans.
    • The elapid family includes the cobras; the mambas; the kraits (Bungarus) of Asia; the coral snakes (Micrurus) of the Americas; and the Australian elapids, which include the coastal taipan (Oxyuranus scutellatus), tiger snakes (Notechis), king brown snake (Pseudechis australis), and death adders (Acanthophis). Highly venomous sea snakes are closely related to the Australian elapids.
    • The viper family includes the rattlesnakes (Crotalus) (Western diamondback rattlesnake and timber rattlesnake); moccasins (Agkistrodon); and lance-headed vipers (Bothrops) of the Americas; the saw-scaled vipers (Echis) of Asia and Africa; the Russell’s viper (Daboia russellii) of Asia; and the puff adder (Bitis arietans) and Gaboon viper (Bitis gabonica) of Africa.
    • Most species of the most widely distributed and diverse snake family, the Colubrids, lack venom that is dangerous to humans. Some species, however, including the boomslang (Dispholidus typus), twig snakes (Thelotornis), the Japanese garter snake (Rhabdophis tigrinus), and brown tree snake (Boiga irregularis), can be dangerous. Other members of this family, including American garter snakes, kingsnakes, rat snakes, and racers, are harmless to humans.

Snakebite Symptoms

Bites by venomous snakes result in a wide range of effects, from simple puncture wounds to life-threatening illness and death. The findings following a venomous snakebite can be misleading. A victim can have no initial significant symptoms, and then suddenly develop breathing difficulty and go into shock.

Signs and symptoms of snake poisoning can be broken into a few major categories:

  • Local effects: Bites by vipers and some cobras (Naja and other genera) are painful and tender. They can be severely swollen and can bleed and blister. Some cobra venoms can also kill the tissue around the site of the bite.
  • Bleeding: Bites by vipers and some Australian elapids can cause bleeding of internal organs such as the brain or bowels. A victim may bleed from the bite site or bleed spontaneously from the mouth or old wounds. Unchecked bleeding can cause shock or even death.
  • Nervous system effects: Venom from elapids and sea snakes can affect the nervous system directly. Cobra (Naja and other genera) and mamba (Dendroaspis) venom can act particularly quickly by stopping the breathing muscles, resulting in death without treatment. Initially, victims may have vision problems, speaking and breathing trouble, and numbness.
  • Muscle death: Venom from Russell’s vipers (Daboia russellii), sea snakes, and some Australian elapids can directly cause muscle death in multiple areas of the body. The debris from dead muscle cells can clog the kidneys, which try to filter out the proteins. This can lead to kidney failure.
  • Eyes: Spitting cobras and ringhals (cobralike snakes from Africa) can actually eject their venom quite accurately into the eyes of their victims, resulting in direct eye pain and damage.

When to Seek Medical Care

Any snakebite victim should go to a hospital emergency department unless the snake is positively identified by an expert as nonvenomous. Remember, misidentification of the snake species could be a fatal error.

Bites by nonvenomous species require good wound care. Victims should receive a tetanus booster if they have not had one within the last 5 years.

Exams and Tests

Diagnosis of snakebite is made based on the history of the event. Identification or description of the snake would be helpful, because not all snakes are venomous, and because different kinds of antivenom exist for different species of snakes. In Australia, the doctor may use a kit to determine the specific type of snake. The doctor also looks for evidence of fang marks or local trauma in the area of the bite. Pain and swelling accompany many snakebites.

  • The doctor treats breathing problems, shock, and/or immediately life-threatening injuries even before a full workup is complete.
  • The wound needs to be examined and cleaned.
  • The doctor will likely send blood and urine samples to the laboratory to look for evidence of bleeding, problems in the blood clotting system, kidney problems, or muscle death. These problems may not be initially apparent, but can have dire consequences if missed.
  • The victim is monitored to look for worsening symptoms at the wound site, or worsening systemic symptoms in the breathing or cardiovascular systems.
  • A rare complication in very swollen limbs is compartment syndrome. Limbs are divided into compartments of muscles, blood vessels, and nerves. Severe swelling can cut off the blood circulation to a compartment. When the circulation is cut off, the victim usually has severe pain and numbness. Later, the limb may get white and cold. If not treated in time, the limb may need to be amputated.

Snakebite Treatment — Self-Care at Home

Medical Treatment

The doctor treats life-threatening conditions first. A victim with difficulty breathing may need a tube placed in his or her throat and a ventilator machine used to help with breathing. People who are in shock require intravenous fluids and possibly other medicines to maintain blood flow to vital organs.

  • The doctor gives antivenom to victims with significant symptoms if appropriate and available. This therapy can be lifesaving or limb-saving. Antivenom can occasionally also cause allergic reactions, however, or even anaphylactic shock, a life-threatening type of shock requiring immediate medical treatment with epinephrine and other medications.
  • Antivenom can also cause serum sickness within 5-10 days of therapy. Serum sickness causes fevers, joint aches, itchingswollen lymph nodes, and fatigue, but it is not life threatening.
  • Even victims without significant symptoms need to be monitored for several hours, and some people need to be admitted to the hospital for overnight observation.
  • The doctor cleans the wound and looks for broken fangs or dirt. A tetanus shot is required if the victim has not had one within 5 years. Some wounds may require antibiotics to help prevent infection.
  • Rarely, the doctor may need to consult a surgeon if there is evidence of compartment syndrome. If treatment with limb elevation and medicines fails, the surgeon may need to cut through the skin into the affected compartment, a procedure called a fasciotomy. This procedure can relieve the increased limb swelling and pressure, potentially saving the arm or leg.

Next Steps — Follow-up

A snakebite victim who has been released from the hospital should return to medical care immediately if he or she develops any worsening symptoms, especially trouble breathing, change in mental status, evidence of bleeding, worsening pain, or worsening swelling.

Someone who has received antivenom treatment for snakebite should return to medical care if any signs of serum sickness develop (fever, muscle or joint aches or swelling, hives). This complication usually occurs within 5-10 days after administration of antivenom.

A snakebite victim (particularly a rattlesnake bite) should, for the first few weeks, warn his or her physician of this fact before any routine or emergency surgery. Some snake venoms can cause difficulty in blood-clotting for a week or more after the bite.

Prevention

The snake is almost always more scared of you than you are of the snake. Giving the snake the opportunity to escape prevents most bites.

  • Do not attempt to handle, capture, or tease venomous snakes or snakes of unknown identity.
  • Snakebites are often associated with alcohol use. Alcohol intake can weaken your inhibitions, making it more likely that you might attempt to pick up a snake. Alcohol also decreases your coordination, increasing the probability of a mishap.
  • If you are outdoors, you can help prevent significant bites by wearing boots while hiking. Long pants can reduce the severity of a bite. When in snake country, be cautious where you place your hands and feet (for example, when gathering firewood or collecting berries), and never walk barefoot after dark.
  • If your occupation or hobby exposes you to dangerous snakes on a regular basis, preplanning before a potential bite may save your life. Since not every physician is familiar with snakebites and not every hospital has or knows how to obtain antivenom, providing information regarding the type of snake, type of venom, and the procurement and use of antivenom can help the medical staff treat you.

Outlook

Although the vast majority of victims bitten by venomous snakes in the United States do very well, predicting the prognosis in any individual case can be difficult. Despite the fact that there may be as many as 8,000 bites by venomous snakes, there are fewer than 10 deaths, and most of these fatal cases do not seek care for one reason or another. It is rare for someone to die before they are able to reach medical care in the United States. The majority of snakes are not poisonous if they bite. If you are bitten by a nonvenomous snake, you will recover. The possible complications of a nonvenomous bite include a retained tooth in the puncture wounds or a wound infection (including tetanus). Snakes do not carry or transmit rabies.

Not all bites by venomous snakes result in venom poisoning. In more than 20% of bites by rattlesnakes and moccasins, for example, no venom is injected. These so-called dry bites are even more common with bites by some of the elapids. Dry bites have the same complications as nonvenomous snakebites.

A victim who is very young, old, or has other diseases may not tolerate the same amount of venom as well as a healthy adult. The availability of emergency medical care and, most important, antivenom can affect how well the victim does.

Serious venom effects can be delayed for hours. A victim who initially appears well could still become quite sick. All victims possibly bitten by a venomous snake should seek medical care without delay.

Multimedia

Media file 1: Snakebite. King cobra (Ophiophagus hannah), a dangerous Asian elapid and longest of the venomous snakes at around 4 m (13 ft). Photograph by Joe McDonald.

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Media file 2: Snakebite. Black mamba (Dendraspis polylepis), an extremely fast, large, and dangerous African elapid. Photograph by Joe McDonald.

Snakebite Photo

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Media file 3: Snakebite. Coral snake (Micrurus fulvius), a shy American elapid that accounts for only about 1% of venomous snakebites in the United States. Recognize it by this catch phrase: “Red on yellow, kill a fellow.” Photograph by Joe McDonald.

Snakebite Photo

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Media file 4: Snakebite. Milk snake (Lampropeltis triangulum), a harmless mimic of the coral snake. “Red on black, venom lack,” although this old saying becomes unreliable south of the United States. Photograph by Joe McDonald.

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Media file 5: Snakebite. Western diamondback rattlesnake (Crotalus atrox), an American pit viper, with rattle vibrating. This is one of the most dangerous snakes of North America. Photograph by Joe McDonald.

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Media file 6: Snakebite. Timber rattlesnake (Crotalus horridus), American pit viper, caught yawning after a big meal. Photograph by Joe McDonald.

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Media file 7: Snakebite. Cottonmouth or water moccasin (Agkistrodon piscivorous), American pit viper usually found in or near water. Photograph by Joe McDonald.

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Media file 8: Snakebite. Northern copperhead (Agkistrodon contortrix), an American pit viper. Bites by this species tend to be less severe than rattlesnake or water moccasin bites but still require urgent medical attention. Photograph by Joe McDonald.

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Media file 9: Spitting cobra bite. Many elapid bites result in little local swelling, but the spitting cobras are known for the amount of swelling and tissue damage they can cause. Photograph by Clyde Peeling.

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Media file 10: Western diamondback rattlesnake (Crotalus atrox) bite. Rattlesnake bites can cause severe swelling, pain, and permanent tissue damage. Photograph by Clyde Peeling.

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Media file 11: Copperhead (Agkistrodon contortrix) bite. These bites usually result in local pain and swelling but usually have less tissue loss than rattlesnake bites. Photograph by Tom Diaz.
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Media file 12: Timber rattlesnake (Crotalus horridus) bite. Pit viper bites can cause a leakage of blood cells out of the blood vessels, even on parts of the body away from the bite site. Note the significant bruising of the upper forearm and arm. Photograph by Clyde Peeling.

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Source :

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