bleeding from recent wounds (including fang marks, venepunctures etc) and from old partly-healed wounds
spontaneous systemic bleeding - from gums, epistaxis, bleeding into the tears, haemoptysis, haematemesis, rectal bleeding or melaena, haematuria, vaginal bleeding, bleeding into the skin (petechiae, purpura, ecchymoses) and mucosae (eg conjunctivae), intracranial haemorrhage..
General symtoms (3)
Neurological (Elapidae, Russell’s viper): Drowsiness, paraesthesiae, abnormalities of taste and smell, “heavy” eyelids, ptosis, external ophthalmoplegia, paralysis of facial muscles and other muscles innervated by the cranial nerves, aphonia, difficulty in swallowing secretions, respiratory and generalised flaccid paralysis
Pressure immobilisation is recommended for bites by neurotoxic elapid snakes, including sea snakes but should not be used for viper bites because of the danger of increasing the local effects of the necrotic venom.
Few ml of fresh venous blood placed in a NEW, CLEAN, DRY, GLASS test tube
Left undisturbed for 20mn
Gently tilted to 45° and examined
If it has remained liquid: consumption coagulopathy ASV required
Clotted: ASV not necessary (at this stage)
Criteria for giving ASV
ASV’s only role is to bneutralize unbound free flowing venom
Neurotoxic envinemation requiring longer term mechnaical ventilation
Surgical cases requiring debridement of necrotic tissue
Viperine envenimation: give ASV then 6 hours before the next dose provides time to transport the patient
Neurotoxic: need for mechanical ventilatory support ? Inability to perform neck lift suggests imminent respiratory failure
Transportation of the patient: NPA + bag mask ventilation
Education ! Know your local snakes, know the sort of places where they like to live and hide, know at what times of year, at what times of day/night or in what kinds of weather they are most likely to be active.
Try to wear proper shoes or boots and long trousers, especially when walking in the dark or in undergrowth.
Use a light (torch, flashlight or lamp) when walking at night.
Avoid snakes as far as possible, including snakes performing for snake charmers. Never handle, threaten or attack a snake and never intentionally trap or corner a snake in an enclosed space.
If at all possible, try to avoid sleeping on the ground.
Keep young children away from areas known to be snake-infested.
Avoid or take great care handling dead snakes, or snakes that appear to be dead.
Avoid having rubble, rubbish, termite mounds or domestic animals close to human dwellings, as all of these attract snakes.
Frequently check houses for snakes and, if possible, avoid types of house construction that will provide snakes with hiding places (eg thatched rooves with open eaves, mud and straw walls with large cracks and cavities, large unsealed spaces beneath floorboards).
To prevent sea snake bites, fishermen should avoid touching sea snakes caught in nets and on lines. The head and tail are not easily distinguishable. There is a risk of bites to bathers and those washing clothes in muddy water of estuaries, river mouths and some coastlines.