Snakebite first aid: what you should do immediately in a snakebite before reaching the emergency room and what you should not, in Indian setting too.
India is the land of snake charmers. India also holds various species of venomous snakes and poisonous snakebites are common. In such a situation, emergency care is critical, but immediate care is primary. Snakebites cause a lot of terror and panic both to the victim and the bystanders. At the site of attack, any previous information we have had on snakebite first aid will be serving as the guide to our immediate intervention. In any setting in general, where the emergency medical team is not available or is delayed, there are some do's and don’ts in first aid that we can follow to delay the further spread of the venom in the body, and avoid complications.
The first aid recommended is based around the mnemonic:
“Do it R.I.G.H.T.”
R. = Reassure the patient. 70% of all snakebites are from non- venomous species and only 50% of bites by venomous species actually envenomate the patient.
I = Immobilize. Use bandages or cloth to hold the splints. Do not apply pressure or tie tightly as it blocks the blood supply.
G. H. = Get to Hospital Immediately.
T= Tell the doctor of any systemic symptoms such as ptosis (drooping of upper eyelids), blurred vision, disorientation, vomiting, bleeding from nose or eyes ,difficulty in breathing and speaking, that manifest on the way to hospital.
CAPTURING THE SNAKE
If the snake is killed, take it carefully to the doctor. A dead snake can bite reflexly for up to an hour and inject the venom. No time should be wasted to kill or capture the snake. It wastes time and lead to other victims.
DONT'S IN THE FIRST AID
1. Washing of the wound is often done to remove the venom on the surface. This should not be done as it further spreads the venom into the body through lymphatic circulation.
2. Tourniquets in form of cloth, belt, string, or rope should not be used to tie on or around the wound as they blocks the blood flow, thus resulting in gangrene and necrosis and even loss of the limb. This usually happens because they are not properly tied.
3. Cutting and sucking is to be avoided as it doesn’t remove any significant amount of venom, especially after 3 minutes of the bite. It can lead to bleeding and infection, and inhibit natural oozing of the venom from the wound. It can also lead to spread of venom on the oral mucous membrane.
4. Electric shock therapy does not denature the venom as shown by current research.
5. Cryotherapy involves application of ice to the site of bite. Studies show that it has no effect and further increase the necrotic effect of the venom.
DO's OF THE FIRST AID
1. Protect the victim and the others from further bites.
2. Make the victim to lie on the ground. Keep the victim calm.
3. Remove constrictive clothing, jewelry or footwear because the area can get edematous or swollen and block the blood supply.
4. Immobilize the limb and keep the area below the heart level to delay blood returning to heart and other parts of the body.
5. Do not give the victim anything to eat or drink. Alcohol should be avoided as it causes vasodilatation and increase venom absorption.
6. Pressure Immobilization Method (PIM) was developed by Sutherland in 1974. It involves applying enough pressure to prevent lymphatic drainage and immobilizing limb to limit muscle activity thus reducing venom absorption. Howarth found that the pressure of application was different in the upper and lower limbs- upper being 40-70 mm Hg and lower being 55-70 mm Hg. Splint the limb, and put a spiral bandage up, starting 2-4 inches above the bite (between the heart and the bite). Spiral the bandage down, over the wound and down the limb. If possible use a crepe bandage tight enough for an ankle sprain. Walking more than 10 minutes will make the PIM ineffective. Do not remove the PIM until reaching the hospital.
With timely hospital admission and intervention, all snakebites can be treated with polyvalent anti snake venom or ASV. Polyvalent means that it can be given in bites from different types of poisonous snakes. The only exception is hump-nosed pit viper, which has no antivenom.